hoag
City of Huntington Beach
Medical Well ness Blood Cancer & Ultrasound Screening
City of Huntington Beach
Attn: Cody Hernandez - Buyer
2000 Main Street
Huntington Beach, CA
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A. Cover Letter & Vendor Application Form
Hoag Corporate Health
500 Superior Ave, Suite 200
Newport Beach, CA 92663
949.999.9300
City of Huntington Beach
RFQ - Medical Wellness Blood Cancer & Ultrasound Screening 2000 Main Street
Huntington Beach, CA
April 26th, 2024
To Whom It May Concern:
Hoag Corporate Health is excited at the opportunity to bid and ultimately participate in the Blood Cancer and Ultrasound screening program. In the following proposal, Hoag Corporate Health will illustrate just how uniquely qualified our First Responder Program staff are to accomplish every aspect of the Scope of Services outlined in the RFQ, as well as our willingness to work hand in hand with the City of Huntington Beach to offer enhanced service components unique to Hoag.
At present the Hoag Corporate Health First Responder program conducts roughly 2,500 specialty assessments annually, conducting 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, Anaheim Police Department, Huntington Beach Fire and the City of Anaheim, just to name a few. In the case of 3 of these agencies, we have provided not simply similar programs, but in the case of the Orange County Fire Authority, Anaheim Fire & Rescue and HBFD, identical blood cancer and ultrasound screenings. Presently, Hoag Corporate Health is the preeminent clinical partner for the Firefighter Wellness division at Grail, the makers of the Galleri Multi-Cancer Blood test. Having conducted both large scale Galleri screening events, as well as implementing the testing protocol directly into the annual Firefighter Wellness exam program for the Orange County Fire Authority, Hoag Corporate Health is regularly asked to consult and advise agencies contemplating the implementation of a blood cancer screening program.
Hoag Corporate Health is extremely familiar with screening ultrasound programs as this technology is employed in the Hoag Executive Physical of which we conduct over 700 exams annually. In addition, the Hoag First Responder Program recently conducted the first large scale ultrasound screening event for Anaheim Fire & Rescue where ~80 firefighters over a 3-day period at their North-Net training facility. In this instance firefighters who chose to receive an ultrasound instead of a full-body CT scan, were able to have their ultrasound study performed prior to their annual Firefighter Wellness Exam, and results were reviewed in person during their in-office examination. Any abnormal findings were communicated by a physician immediately following receipt of the radiology report and the Hoag First Responder team worked with the firefighterto aid in scheduling and coordination of an follow-up testing.
These two examples illustrate the experience and expertise Hoag Corporate Health will bring to the City of Huntington Beach Blood and Ultrasound Screening program. Below we will outline some preliminary approaches to how we foresee implementing and supporting this program - as with any of our First Responder programs, we understand scheduling and logistics may limit some of the proposed options and welcome the ability to adjust in order to accommodate HB personnel.
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Multi-Cancer Blood Screening
As we assess the options for conducting the Galleri multi-cancer blood test, there are a couple logistical options that could be implemented:
Option 1 - Large Scale Screening Event
Hoag Corporate Health has experience conducting this type of event, where specific dates/times are designated for on- duty and/or off-duty personnel are able to receive their blood draw at a City of Huntington Beach location. Hoag Corporate Health would work hand-in-hand with Galleri in order to coordinate the labeling and processing of specimens and all results would be provided to Hoag Corporate Health within 5-7 days of the event. Upon receipt of the test result Hoag Corporate Health would implement the following results communication:
Negative Result - Results are communicated to firefighter by secure email. Firefighter receives copy of Galleri Results, along with medical explanation of results from our Chief Medical Officer, Dr. James Lindberg.
Furthermore, firefighters are able to coordinate a follow-up call with a Hoag Corporate Health provider should they have any additional questions or need clarification on any items.
Positive Results - Results are communicated directly to the firefighter by phone, from a Hoag Corporate Health physician. The physician will have been briefed by the Medical Director at Galleri in order to obtain a thorough explanation of results and findings. The Hoag Corporate Health provider will explain next steps.
Hoag's First Responder Care Team will then make appropriate referrals/recommendation to specific doctors if desired by the patient. Our providers are available to communicate results to the firefighters Primary Care Physician given Galleri tests are very new and the technology may not be familiar to a traditional PCP.
Hoag Corporate Health implemented this model for the Orange County Fire Authority in November of 2023 and conducted "'215 Galleri Multi-Cancer Blood Screenings over two separate 4-hour events.
Option 2 - Blood Cancer Screening Added to Annual Firefiehter Wellness Exam Given Option 1 may not be feasible, the other screening option would be to incorporate the Galleri blood draw into the current annual Firefighter Wellness Exam program that Hoag Corporate Health conducts for HBFD. In this model, firefighters would schedule their annual wellness exam as they already do, upon arrival at the Hoag First Responder Program facility, their blood would be drawn for the Galleri Multi-Cancer test. Upon receipt of the results - typically 5-7 days - Hoag Corporate Health would enact the above outlined Negative/Positive result protocol.
Hoag Corporate Health implemented this model for the Orange County Fire Authority in July of 2023 and to date has conducted ~800 Galleri Multi-Cancer Blood Screenings via in-office blood draw on the day of their annual firefighter wellness exam.
Ultrasound Screening Program
Large Scale Screening Event
Hoag Corporate Health has experience conducting large scale ultrasound screening events, where designated days/times are offered to on-duty and/or off-duty personnel to receive a multi-system cardiovascular and cancer screening ultrasound study. Hoag Corporate Health offers a unique approach to large scale ultrasound screening due to our ability to offer physician review and consultation from our faculty of First Responder M.D.'s both via telehealth/phone or in-person during a participants annual Firefighter Wellness Exam. Furthermore, Hoag Corporate Health will utilize an algorithm to "risk stratify" findings and any necessary follow-up while also offering the capability of coordinating specialty referrals and care coordination, should there be a significant finding. In this operational delivery model, Hoag will work directly with the City of Huntington Beach or a designated "coordinator" from a specific hoag
agency to determine both the schedule dates as well as individual participant and/or crew schedule. Each screening takes approximately ~45-60mins to complete. At the conclusion of each screening event, ultrasound imagery is transmitted securely for review and reading by the imaging radiologist. The radiologist will complete their radiology report which will in-turn be sent to the physicians at Hoag Corporate Health for review. Upon receipt and review of the radiology report Hoag Corporate Health would implement the following results communication:
Negative Result - Reports with notes will be sent to patients via secure email, or in the event the patient has a scheduled Annual Wellness Exam scheduled within 2-3 weeks of the ultrasound, these results will be reviewed during their exam by the physician. Patients will receive a copy of their radiology report along with a medical explanation of results from our Chief Medical Officer, Dr. James Lindberg. Furthermore, firefighters are able to coordinate a follow-up call with a Hoag Corporate Health provider should they have any additional questions or need clarification on any items.
Positive Results - Results are communicated directly to the patient from a Hoag Corporate Health physician.
The physician will have been briefed by the radiologist who read the ultrasound study in order to obtain a thorough explanation of results and findings. The Hoag Corporate Health provider will explain next steps.
Hoag's First Responder Care Team will then make appropriate referrals/recommendation to specific doctors if desired by the patient.
Hoag Corporate Health implemented this model with Anaheim Fire & Rescue in August of 2023 and conducted ~SO Multi-System Screening Ultrasounds over 4 separate 6-hour screening events - see page 10 below for event flyer.
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
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REQUEST FOR PROPOSAL
VENDOR APPLIC ATION FORM
TYPE OF APPLICANT:NEWr": CURRENT VENDOR
Legal Contractual Name of Corporatiou: Hoa9 Clinic
Contact Person for Agreement: Justin Davis
Coiporate Mailing Address: 50° Superior Ave, Suite 200
City, State and Zip Code: Newport Beach. CA 92663
E-Mail Address: [email protected]
Phone:949.566.8419Fax:
Contact Person for Proposals:Justin Davis
Title:vice presktent ~ Business DevelopmentE-MaU Address: [email protected] Business Telephone:949.566.8419Business Fax:
Year Business was Established:
Is your business: (check one)
^ NON PROFIT CORPORATION
b your business: (check one)
FOR PROFFT CORPORATION
E CORPORATION
^ INDIVIDUAL
H PARTNERSHIP
:H LmiTEDLIABILirr PARTNERSHIP
[^ SOLE PROPRIETORSHIP
" UNINCORPORATED ASSOCIATION
1 of 2
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Names & Titles of Corporate Board Members
(Also list Names & Titles ofpeKoas with written authorization/resolution to sign contracts) Names Title Phone
Andrew Guarni
Gayathri Jith
James Lindberg
Justin Davis
CFO
SVP
Chief Medical Officer
VP
Federal Tax Identification Number:
949.566.8419
City ofHuntiugton Beach Business License Number;
(If none, you must obtain a Huntingtou Beach Business License upon award ofcontiacf.) City ofHunrington Beach Business License Expiratiou Date:
2 of 2
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B. References
1. Orange County Fire Authority & OC Professional Firefighters Association Brian Abney - Director of OCPFA
July 2023 - Present
[email protected] 805.331.8404
Hoag Corporate Health conducts the entirety of the Orange County Fire Authority's Wellness and Fitness (WeFit) Program and has done so since January of 2018, conducting ~1,000 First Responder physical exams annually in addition to conducting educational/instruction-based station visits to all 78 firehouses. In 2023 the OC Professional Firefighters Association (Local 3631) requested to add the Galleri Multi-Cancer Blood Test to the WeFit program. Hoag Corporate Health worked with the OCPFA to establish a first of its kind blood cancer screening cadence allowing for augmented testing parameters based on age and risk level. To kick off the program Hoag conducted 2 large scale screening events which were held at OCPFA Head Quarters where ~225 fire fighters were screened. In addition, Hoag began incorporating the Galleri Multi-Cancer blood test into the annual WeFit exam protocol, allowing OCFA fire fighters to get the test drawn at the same time they are onsite for their physical examination. As such, Hoag Corporate Health as administered ~800 Galleri cancer screenings to OCFA personnel in ~9-monhts. Hoag Corporate Health also implemented a comprehensive education and post-screening protocol designed to fully support and assist with care navigation for any positive tests as well as allow for individual post result follow-up for any fire fighter who wants additional information regarding negative test results as well. Lastly, Hoag supported the OCPFA and OCFA by aiding in the development of the protocols, messaging and concerns related to the implementation of the program - meeting with Administration leadership and stakeholders to understand both the science and clinical specifics of the Galleri test as well as the internal and external messaging.
2. City of Anaheim Fire & Rescue
Robert Stuart - Battalion Chief
Aug 2023 - Present
[email protected] 714.772.1917
Hoag Corporate Health has conducted annual exams and fitness screenings for ~200 eligible Anaheim Fire & Rescue suppression and HazMat personnel and have done so since November of 2018. In addition to the annual clinical exam program, AF&R has had a full-body CT screening program in place for many years. Since we began engaging with department, Hoag has voiced our concerns about this program and the significant radiation exposure associated to a full-body CT. As such we worked with the department to identify alternative solutions to this screening modality, which we suggested could be the implementation of an Ultrasound screening program. In late 2023 Hoag Corporate Health along with our preferred ultrasound partner, conducted 3 full-day ultrasound screening events, conducted inside of AF&R's "NorthNet" training facility. 72 ultrasound screenings were conducted over the 3-day event. It was extremely well received and Hoag plans to continue supporting this alternative screening protocol as we hopefully transition away from full-body CT.
3. Huntington Beach Fire Department
Jeff Lopez - Division Chief
Dec 2023 / January 2024
jlopez@surfaty-hb,org 714.374.5376
Hoag Executive Health has conducted the Medical Wellness Exam program for HBFD since 2019, recently transitioning to a year-round exam delivery schedule. In 2023 HBFD contacted Hoag Corporate Health and requested to have ~10 Galleri Multi-Cancer screenings conducted on pre-designated firefighter personnel. We implemented 2 delivery models, with roughly half of the participants "adding" the multi-cancer blood test onto their scheduled annual medical wellness exam - getting drawn in office, and the other half coming to our office specifically to have the blood draw for the test and not incorporating the draw into their annual medical and wellness exam. hoag.
References - Supporting Information
Hoag / OCFA Multi-Cancer Blood Test Media Coverage
1. Behind the Badge Feature
Department Wide Roll.Oul
Galleri Cancer Screening
• Galleri Cancer Screening
- Department Wide Offering : July 2023
- Every member of the OCPFA hlealthcare trust has an
opportunity to take part in the Galleri Cancer Screening this year
- Test performed during WEFIT Exam. Simple Blood Draw
- Results are typically received within 7-10 days.
• Cancer Screening Event
- Held at Local 3631 Headquarters on November 15 and
16,2023
- Gave the opportunity to firefighters who already came to WEFIT, prior to July 1, to get the Galleii Tesl.
- Screened 215 Firefighters during 2-dc)y event
^ Behind the Badge
BdiindI tht.? Bcylfie' ArticlR
Hoay,f>[Ai)tio!(jc.niciuig(f»t Oianyo County fitffiylUPts hoag.
https://behindthebadfie.com/hoaR-Rrail-hold-cancer-screeninR-for-oranRe-countv-firefighters/
2. Spectrum 1 News - SoCal Market & New York Market
Department V/ide Roll-Out
Galleri Cancer Screening
• Galleri Cancer Screening
- Screened a total of 650 Fireflghters in 6 months (Roughly 'A of Dtpartment
- 2 Positive Results
- 0.3% Positlvity Rate
Results Communication
- Negative Result - Results are communicated to firefighter by secure email. Firefighter receives copy of Galleri
Results, along with medical explanation of results from Dr.
Lindberg.
- Positive Results - Results are communicated directly to the firefighter by phone, from the physician. The physician has been briefed by the Medical Director at Galleri for thorough explanation of results and findings. Doctor will explain next steps. Hoag Care Team will then make
appropriate referrals/recommendation to specific doctors if desired by the patient. Our doctors are available to communicate results to Primary Care Physicians as well.
OCFA gets blood t<>tl th.il scfeens l0f 50 csnr<
(» .
Spectrum News Story
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https://nvl.com/nvc/all-borouRhs/health/2024/01/23/ocfa-gets-blood-test-that-screens-for-50-cancers hoag
3. Anaheim Fire & Rescue Ultrasound Screening Flyer
•* over hatf of afl adults m the Untted States wil suffer from a heart attack, oancer or stroke in their lifetime. 8936 of these incidents can be prevented or successfidly TreatE(|g((h ettfy detecbofL for Cardiovascular Disease and Cancer Prevention
10-SCREENING c?wr,^^^,i,^r^ :,ch
iccaraioaram
ULTRASOUND PACKAGE ultrosound to^etect early siqns
AS PART OF AF&R
#2 Carotki llirrasound
EMPLOYEE HEALTH S^eens fu, fatty ^oque in the,:,
ASSESSMENT WITH HOAG stroKe
#3 Aortic Aneuiysm Screeninq
Detects eanv siqn& ot ;3n aoruc
Valued A; Over $4000 in Hosprtais uinosouna
is or neon aisea&e
#2 Carotki llirrasound
leens fu; fatty pluque in the c'jrotid artefy to detec
#3 Aortic Aneuiysm Screeninq
Detects early siqns ot ;3n aoruc aneufysm usinc]
•ij.-ii^ •/o'.i. a; >^ ;>;n
WHEN:
AUGUST 21. 22 & 25
WHERE:
NORTH NFT,
CONFERENCE ROOM
Abdominol Cancer 5-in I Screening
#4 Liver - #5 Kidneys - #6 Pancreas*
-»? Gallbladdei - US Spleen
leens for eary •5'qns c'f cancer usinq uttrasour
#9 Thyroid Ultrosound
reens for early •?iqns ijt cancer using ultrasoui
#10 Colon Cancer Screening
A safe and eMective at-home test that yields
irmieijiate lesuli;
;mpnmeniarv wim screening poctcige
Pelvic Ulliasound Scieening for Women
~>etwts ubnoimulitie'. iri the uteius ovuries and
tornetnuiT
4Some areos of the pancreas canTrot be seen usinq Liltra£our»ci hoag
C. Pricing
Multi-Cancer Blood Screening
Galleri Multi-Cancer Blood Screening
Ultrasound Screening
Cardiovascular and Cancer Screenings
Optional Pelvic Screening (Women)
Cost
$750/ea.
$490/ea.
$110/ea.
Screening Service Detail
Galleri Multi-Cancer Blood Screening
1. Includes cost of test, blood draw, result delivery and consultation with a physician to review results
2. Includes consultation, direction and insight for HBFD leadership regarding the clinical rationale, implications and messaging related to the rollout of the multi-cancer blood screening program.
3. Includes care coordination and support for any firefighter who receives a positive test a. Physician Consultation with firefighter
b. Physician Outreach and consultation with firefighters primary care doctor c. Support with identifying specialist and scheduling preliminary appointments inside or outside of Hoag network.
Cardiovascular Ultrasound Screening
1. Echocardiogram - Evaluates cardio functions using digital ultrasound with color flow imaging
2. Carotid Ultrasound - Screens the main arteries of the neck to detect blockages to blood flow and identify narrowing of vessels, tumors and other abnormalities
3. Aortic Aneurysm - Screens the abdominal aorta in search of precursors or signs of abdominal aortic aneurysms Cancer Ultrasound Screening
1. Liver Screening - screens liver for masses and cysts
2. Kidneys Screening - screens the kidneys for masses and cysts
3. Pancreas Screening - Screens the pancreas for masses and cysts (Note: some areas of the pancreas are not visible through ultrasound)
4. Gallbtadder Screening - Screens the kidneys for masses and cysts
5. Spleen Screening - Screens the spleen for masses and cysts
6. Thyroid Screening - Screens the thyroid for masses and cysts
7. Colon Cancer Screening Kit - FDA Approved EZ Detect Occult Blood Test kit to detect pre-symptomatic hidden intestinal tract diseases including colorectal cancer
Optional "add-on" Ultrasound Screening
1. Pelvic Screening (For Women) - Screens for masses, cysts, fibroids and other abnormalities in the uterus, ovaries, and endometrium
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D. Federal Grant Forms
GENERAL PRINCIPLES CERTIFICATION FOR FEDERAL-AID CONTRACTS CONSULTANT shall comply with generally accepted accounting principles and good business practices. CONSULTANT shall, at its own expense, furnish all cost items associated with the proposed services except as specified to be furnished by City. CONSULTANT shall retain financial records, supporting documents, statistical records, and all other records pertinent to the proposed sen'ices for a period of a minimum of three (3) years from the expiration of the term of the Master Agreement.
CONSULTANT shall take reasonable measures to safeguard protected personally identifiable information and other information designated as sensitive or is considered sensitive consistent with laws regarding privacy and responsibility over confidentiality.
CONSULTANT shall also certify that none of the proposed equipment or services are produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities); or produced by an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country in accordance with 2 CFR 200.21 6.
In order to ensure objective contractor performance and eliminate unfair competitive advantage, CONSULTANT must certify that they did not assist rn the development of draft specifications, requirements, statements of work, or invitations for bids or requests for proposals for the project.
Business Name: Hoag Clinic D.B.A. Hoag Executive Health 4/27/2024 Justin Davis - Vice President Business Development Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
hoag.
NON-DISCRIMINATION CERTIFICATION FOR FEDERAL-AID CONTRACTS CONSULTANT shall comply with the provisions of Title VII of the Civil Rights Act of 1964 in that it will not discriminate against any individual with respect to his or her compensation, terms, conditrons, or privileges of employment nor shall CONSULTANT discriminate in any way that would deprive or intend to deprive any individual of employment opportunities or otherwise adversely affect his or her status as an employee because of such individual's race, color, religion, sex, national origin, age, handicap, disability, medical condition, sexual orientation, gender identity, or marital status. These actions shall include, but not be limited to, the following: employment, upgrading, demotion or transfer recruitment or recniitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship.
CONSULTANT shall ensure that sen-ices and facilities are provided without regard to ethnic group identification, race, color, national origin, creed, religion, age, sex, physical or mental disability, political affiliation, or marital status in accordance with applicable laws, including, but not limited to, Title VI of the Civit Rights Act of 1964 (42 U.S.C. 200-d); Section 162 (a) of the Federal-Aid Highway Act of 1973 (23 U.S.C. 324); Section 504 of the Rehabilitation Act of 1973; the Civil Rights Restoration Act of 1987 (P.L. 100-209); Executive Order 12898 (February 11,(994); Executive Order 13166 (August 1G, 2000); Title VII of the Civil Rights Act of 1964 (42 U.S.C 2000-d); the Age Discrimination Act of 1975 (42 U.S.C. 6101); Article 9.5, Chapter I, Part 1 , Division 2, Title 2 (Section H 135, etseq)ofthe California Government Code; Title 9, Chapter 4, Subchapter 6 (Section 10800, et seq) of the CCR and California Department of Social Sen/ices Manual of Policies and Procedures (CDSSMPP) Division 21.
CONSULTANT shall ensure Ihat proposed activities be accomplished in an equitable and impartial manner so that no person shall be excluded because of race, color, gender, or national origin from participation in, or be denied the benefits, or any program or activity for which federal financial assistance is received (31 CFR Part 22).
Business Name: Hoag Clinic D.B.A. Hoag Executive Health 4/27/2024 _ Justin Davis - Vice President Business Development Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
hoag
MBE and WBE CERTIFICATION FOR FEDERAL-AID CONTRACTS
It is the policy of the City to encourage the participation of disadvantaged, minority and women- owned business enterprises in the City's procurement process.
CONSULTANT agrees to use its best efforts to carry out this policy when sourcing the use of outside consultants, advisors and contractors to the fullest extent practicable, consistent with the efficient performance of a contract. CONSULTANT may rely on written representations by consultants. advisors and contractors regarding their status. CONSULTANT shall report to the City the names of all consultants, advisors and contractors hired for the proposed services and information on whether or not they are a disadvantaged, minority or women-owned business enterprise, as defined in Section 8 of the Small Business Act (15 U.S.C. Sec. 637).
CONSULTANT shall, in accordance with 2 CFR 200.321, take affirmative steps to include minority business, women's business enterprises, and labor surplus area firms when sourcing the use of outside consultants, advisors, and contractors for a contract by:
(a) Placing qualified small and minority businesses and women's business enterprises on solicitation fists;
(b) Assuring that small and minority businesses and women's business enterprises are solicited whenever they are potential sources;
(c) Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small and minority businesses and women's business enterprises;
(d) Establishing delivery schedules, where the requirements permit, which encourage participation by small and minority businesses and women's business enterprises; and (e) Using the ser/ices and assistance, as appropriate, of such organizations as the Small Business Administration and the Minority Business Development Agency of the Department of Commerce.
Business Name: Hoag Clinic D.B.A. Hoag Executive Health 4/27/2024 _ Justin Davis - Vice President Business Development Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
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DOMESTIC PREFERENCE CERTIFICATION FOR FEDERAL-AID CONTRACTS It is the policy of the City to encourage a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). The requirements of this section must be included in all subawards including all contracts and purchase orders.
CONSULTANT agrees to use its best efforts to comply with 2 CFR 200.322 to the fullest extent possible consistent with the efficient performance of a contract.
RECOVERED MATERIALS CERTIFICATION FOR FEDERAL-AID CONTRACTS CONSULTANT shall comply with 2 CFR 200.322 and procure only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded S 10,000. CONSULTANT certifies that the percentage of recovered materials to be used in the performance of this Agreement will be at least the amount required by applicable specifications or other contractual requirements. For contracts over $100,000 in total value, CONSULTANT shall estimate the percentage of total material utilized for the performance of the project that is recovered materials and shall provide such estimate to City upon request.
Business Name: Hoag Clinic D.B.A. Hoag Executive Health 4/27/2024 _ Justin Davis - Vice President Business Development Date: _ By:
Name and Title of Authohzed Representative
Signature of Authorized Representative
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CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT CERTIFICATION FOR
FEDERAL-AID CONTRACTS
CONSULTANT agrees to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act, as amended, 42 U.S.C. §§ 740l-7G71q. CONSULTANT agrees to report each violation to the USDA and the appropriate EPA Regional Office.
CONSULTANT agrees to comply with alt applicable standards, orders or regulations issued pursuant to the Federal Water Pollution Control Act as amended (33 U.S.C. §§ 1251-1387). CONSULTANT agrees to report each violation to the USDA and the appropriate EPA Regional Office.
Business Name: Hoag Clinic D.B.A, Hoag Executive Health 4/27/2024 Justin Davis - Vice President Business Development Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
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Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 13 CFR Part 145. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211).
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON FOLLOWING PAGE) "I. The prospective primary participant certifies to the best of its knowledge and belief that it and its principals:
(a) Are not presently debarred, suspended, proposed for disbarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this application been convicted of or had a civil judgement rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction: violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (I )(b) of this certification; and
(d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default.
2. Where the prospective primary participant is unable to certify to any of the statements in this certificatron, such prospective primary participant shall attach an explanation to this certtfication.
Indicate to whom it applies, initiating agency, and dates of action.
Business Name: Hoag Clinic D.B.A, Hoag Executive Health 4/27/2024 _ Justin Davis - Vice President Business Development Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
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INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's detemnination whether to enter Into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant teams that Its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.
5. The terms "covered transactkm," "debaned," "suspended." 'ineligible." "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded." as used in this clause, have the meanings set out In the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is submitted for assistance in obtaining a copy of those regulations (13 CFR Part 145).
6. The prospective primary participant agrees by submitting this proposal that, should the proposed covered transactton be entered into, it shall not knowingly enter into any lower tier covered transactfon with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction.
7. The prospective primafy participant further agrees by submitting this proposal that it will include the clause tiUed "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitatkins for lower tier covered transactions.
8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency t?y which it determines the ineligibility of its principals. Each participant may, but Is not required to, check the Nonprocurement List.
9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a pmdent person in the ordinary course of business dealings.
10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarrecl, ineligible, or voluntarily excluded from participation in this transaction, in addiGon to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. hoag
NON-LOBBYING CERTIFICATION FOR FEDERAL-AID CONTRACTS
The prospective participant certifies, by signing and submitting this document, to the best of his or her knowledge and belief, that:
(1) No Federal appropnated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, toan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its instructions.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S- Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10.000 and not more than S100,000 for each such failure.
The prospective participant atso agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed S 100,000 and that alf such subrecipients shall certify and disclose accordingly.
Business Name: Hoag Clinic D.B.A. Hoag Executive Health 4/27/2024 _ Justin Davis - Vice President Business Development Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
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REQUEST FOR PROPOSAL
FOR
MEDICAL / WELLNESS BLOOD CANCER AND ULTRASOUND SCREENING FIRE Department
CITY OF HUNTINGTON BEACH
Released on March 19, 2024
Compliant with Federal and State Grant Requirements Pursuant to Title 2 of the Code of Federal Regulations (CFR) Part 200
General Liability Third Party Claims Administration
REQUEST FOR PROPOSAL (RFP)
1. BACKGROUND & OBJECTIVE
The City ofHuntington Beach (City) is a local municipality located along the coast of Southern California within the County of Orange, 35 miles south of Los Angeles and 90 miles north of San Diego. It is bordered by the Pacific Ocean on the west, and is known for its 8.5 miles of beautiful beach. The City services a population of approximately 200,000 residents and draws over 11 million visitors to the City each year. The City ofHuntington Beach is a full-service City and provides Police, Fire and Marine Safety services to the citizens.
The intent of this RFP is to solicit quotes from qualified vendors (hereafter referred to as "Vendor") for medical/wellness cancer detection bloodwork and ultrasound screening for the City ofHuntington Beach (hereafter referred to as the "City") The Huntington Beach Fire Department (hereafter referred to as the "Department") is seeking bloodwork panels to include a cancer detection bloodwork screen. Additionally, the Department is also seeking bids to provide ultrasound screening for the current employees.
The Department may consider options to consolidate one or both of these services to a single vendor, while also considering the most cost-effective options for each independently. Vendors should quote elements separately as well as combined, if available. The ideal vendor, medical facility, or facilities would be located within Orange County, California limits.
The City reserves the right to cancel, amend, modify and/or redistribute services needed for one or all items listed in this RFP, if determined to be in the best interest of the City, for any reason. This RFP may be partially or fully grant funded and Vendor agree to follow all grant, Federal, State, and City policies, guidelines, and regulations if selected as an awarded vendor for this RFP. The City will hold final decisions on the acceptance or denial of a claim and on any settlement authority.
2. SCHEDULE OF EVENTS
This request for proposal will be governed by the following schedule:
Release of RFP March 1 9,2024
Deadline for Written Questions April 2, 2024 by 4 p.m.
Responses to Questions Posted on Web April 11, 2024
Request for Proposal Due April 26, 2024 by 4 p.m.
Tentative Award May 2024
3. SCOPE OF WORK
The vendor is to provide the City with the following services:
A. Program Administration:
Vendor shall provide:
A. BIoodwork panels to include a cancer detection bloodwork screen for Department employees. This blood panel should include but is not limited to detection screening for multiple cancers such as: Adrenal Cortical Carcinoma, Ampulla ofVater, Anus, Appendix Carcinoma, Bile Ducts, Intrahepatic Bladder, Urinary Bone, Breast, Cervix, Colon and Rectum, Esophagus and Esophagogastric Junction, Gallbladder, Gastrointestinal Stromal Tumor, Gestational Trophoblastic Neoplasms, Kidney, Larynx, Leukemia, Liver, Lung, Lymphoma (Hodgkin and Non Hodgkin), Melanoma of the Skin, Merkel Cell Carcinoma, Mesothelioma, Malignant Pleural, Nasal Cavity and Paranasal Sinuses, Nasopharynx, Neuroendocrine Tumors of the Appendix, Neuroendocrine Tumors of the Colon and Rectum, Neuroendocrine Tumors of the Pancreas, Oral Cavity, Oropharynx (HPV-Mediated, pl6+), Oropharynx (p 16-) and Hypopharynx, Ovary, Fallopian Tube and Primary Peritoneum, Pancreas, exocrine, Penis, Plasma Cell Myeloma and Plasma Cell Disorders, Prostate, Soft Tissue Sarcoma of the Abdomen and Thoracic Visceral Organs, Soft Tissue Sarcoma of the Head and Neck, Soft Tissue Sarcoma of the Retroperitoneum, Soft Tissue Sarcoma of the Trunk and Extremities, Soft Tissue Sarcoma Unusual Histologies and Sites, Stomach, Testis Uterus, Carcinoma and Carcinosarcoma, Ureter, Renal Pelvis, Utems, Sarcoma, Vagina and Vulva. A telehealth consultation with a physician should be provided for all POSITIVE results.
B. Ultrasound screening for the Department employees. The ultrasound screen should include but is not limited to: Cardiovascular / Stroke, Carotid, Aortic Aneurysm.
The ultrasound should also include liver, kidney, pancreas, gallbladder, spleen, thyroid, colon and pelvic screen for women. A telehealth consultation with a physician should be provided for all POSITIVE results.
C. The Department may consider options to consolidate both of these services, while also considering the most cost-effective options for each independently. Vendors should quote elements separately as well as combined, if available.
B. Optional
A. The ideal vendor would be located within Orange County, California limits.
4. SPECIFICATIONS AND SERVICE PERFORMANCE STANDARDS
A. All federal, state, and local authorizations needed, such as certifications and licenses required, for listed bloodwork panels, listed ultrasound screenings, and other listed scope of work items.
B. An example can be found on the GRAIL website: GRAIL'S clinical laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and accredited by the College of American Pathologists (CAP). The Galleri test was developed, and its performance characteristics were determined by GRAIL. The Galleri test has not been cleared or approved by the Food and Dmg Administration. GRAIL'S clinical laboratory is regulated under CLIA to perform high-complexity testing. The Galleri test is intended for clinical purposes.
C. Turnaround time between bloodwork panels and ultrasound screenings should be ten (10) days or less. Ideally, we can complete both tests for each staff in one visit, but separate test schedules is acceptable.
D. Vendor should have the ability to schedule and test 128 staff members within a six (6) week period. This proposal is for one cycle of testing and covers 128 staff members.
E. Vendor should be able to do a mobile blood draw located at Central Net Training Center in Huntington Beach. The vendor shall commit to four (4) mobile blood draw events and should have the ability to draw blood for up to 60 people at each event. The vendor should have a location within Orange County where staff members can go to obtain blood draws if they are unable to attend one of the four mobile blood draw events.
F. Vendor should be able to do a mobile ultrasound located at Central Net Training Center in Huntington Beach. The vendor shall commit to four mobile ultrasound events and should have the ability to conduct ultrasound for up to 60 people at each event. The vendor should have a location within Orange County where staff members can go to obtain ultrasounds if they are unable to attend one of the four (4) mobile ultrasound events.
5. EVALUATION CRITERIA
The City's consultant evaluation and selection process is based upon Qualifications Based Selection (QBS) for professional services. The City ofHuntington Beach may use some or all of the following criteria in its evaluation and comparison of proposals submitted. The criteria listed are not necessarily an all-inclusive list. The order in which they appear is not intended to indicate their relative importance:
A. Compliance with RFP requirements
B. Understanding of Project
C. Methods and approach described to accomplish the Scope of Work of this RFP.
D. Recent experience in conducting work of similar scope, complexity, and magnitude for other public agencies.
E. Educational background, work experience, most importantly public sector work experience, and directly related consulting experiences.
F. Price
G. References from local clients with particular emphasis on local government.
The City may also contact and evaluate the bidder's and subcontractor's references; contact any bidder to clarify any response; contact any current users of a bidder's services; solicit information from any available source concerning any aspect of a proposal; and seek and review any other information deemed pertinent to the evaluation process. The evaluation committee shall not be obligated to accept the lowest priced proposal, but shall make an award in the best interests of the City.
After written proposals have been reviewed, discussions with prospective firms may or may not be required. If scheduled, the oral interview will be a question/answer format for the purpose of clarifying the intent of any portions of the proposal. The individual from your firm that will be directly responsible for carrying out the contract, if awarded, should be present at the oral interview.
A Notification of Intent to Award may be sent to the vendor selected. Award is contingent upon the successful negotiation of final contract terms. Negotiations shall be confidential and not subject to disclosure to competing vendors unless an agreement is reached. If contract negotiations cannot be concluded successfully, the City may negotiate a contract with the next highest scoring vendor or withdraw the RFP.
6. PROPOSAL FORMAT GUIDELINE
Interested vendors are to provide the City ofHuntington Beach with a thorough proposal based on the Scope of Work using the following guidelines:
A. Vendor Application Form and Cover Letter
Complete Appendix A, "Request for Proposal-Vendor Application Form" and attach this form to the cover letter. A cover letter, not to exceed three (3) pages in length, should summarize key elements of the proposal. An individual authorized to bind the consultant must sign the letter. The letter must stipulate that the proposal price will be valid for a period of at least 180 days. Also, the cover letter should indicate the address and telephone number of the contractor's office located nearest to Huntington Beach, California, and the office from which services will be provided, if they differ.
B. References
Provide at least three references that have received similar services from your company. It is preferrable in the references are for either other governmental agencies or are local companies. The City reserves the right to contact any of the organization o individuals listed. Complete Reference form in Appendix A or provide references in your own formatting containing all the required information.
C. Fee Proposal
Indicate which services your able to provide as well as the cost for those services. Indicate the testing price for each individual to include cancer screen bloodwork and ultrasound.
D. Federal Grant Forms
Complete the various required certifications for Federal-Aid Contracts (Appendix D) The City will only award a contract or purchase order to a responsible bidder possessing the ability to perform successfully under the terms and conditions of this procurement and which will be most advantageous to the City.
7. PROCESS FOR SUBMITTING PROPOSALS
All proposals must be submitted in PDF file format.
• Content of Proposal
The proposal must be submitted using the format as indicated in the proposal format guidelines.
• Preparation of Proposal
Each proposal shall be prepared simply and economically, avoiding the use of elaborate promotional material beyond those sufficient to provide a complete, accurate and reliable presentation.
• Number of Proposals
Submit one (1) PDF file format copy of your proposal in sufficient detail to allow for thorough evaluation and comparative analysis.
• Submission of Proposals
Complete written proposals must be submitted electronically in PDF file format via the Planetbids.com website no later than 4:00 p.m. (P.S. T) on April 26, 2024. Proposals will not be accepted after this deadline. Faxed or e-mailed proposals will not be accepted. • Inquiries
Questions about this RFP must be directed via Planetbids through the Q.&A tab no later than April 2, 2024 @ 4pm
Cody Hemandez, Buyer
Cody. hemandez(S),surfcity-hb. org
From the date that this RFP is issued until a firm is selected and the selection is announced, firms are not allowed to communicate for any reason with any City employee other than the contracting officer listed above regarding this RFP, except during the pre-proposal conference. Refer to the Schedule of Events of this RFP or the City webpage to determine if a pre-proposal conference has been scheduled. The City reserves the right to reject any proposal for violation of this provision. No questions other than written will be accepted, and no response other than written will be binding upon the City. • Conditions for Proposal Acceptance
This RFP does not commit the City to award a contract or to pay any costs incurred for any services. The City, at its sole discretion, reserves the right to accept or reject any or all proposals received as a result of this RFP, to negotiate with any qualified source, or to cancel this RFP in part or in its entirety. All proposals will become the property of the City ofHuntington Beach, USA. If any proprietary information is contained in the proposal, it should be clearly identified.
8. STANDARD TERMS AND CONDITIONS
• Amendments
The City reserves the right to amend this RFP prior to the proposal due date. All amendments and additional information will be posted via planetbids. Bidders should check this web page daily for new information.
• Cost for Preparing Proposal
The cost for developing the proposal is the sole responsibility of the bidder. All proposals submitted become the property of the City.
• Contract Discussions
Prior to award, the apparent successful firm may be required to enter into discussions with the City to resolve any contractual differences. These discussions are to be finalized and all exceptions resolved within one (1) week from notification. If no resolution is reached, the proposal may be rejected and discussions will be initiated with the second highest scoring firm. See Appendix B for a sample agreement. • Confidentiality Requirements
The staff members assigned to this project may be required to sign a departmental non- disclosure statement. Proposals are subject to the Freedom of Information Act. The City cannot protect proprietary data submitted in proposals. • Financial Information
The City is concerned about bidder's financial capability to perform, therefore, may ask you to provide sufficient data to allow for an evaluation of your firm's financial capabilities.
• Payment by Electronic Funds Transfer - EFT:
The City requires that payment be made directly to the vendor's bank account via an Electronic Fund Transfer (EFT) process. Banking information will need to be provided to the City via an Electronic Credit Authorization form. A City Representative will provide the Electronic Credit Authorization form upon intent to award. Vendor will receive an Electronic P.-emittance Advice with the payment details via email. It is solely the responsibility of the vendor to immediately notify the City of any change to their information related to payments.
The City reserves the right to cancel, amend, modify and/or redistribute services needed for one or all items listed in this RFP, if determined to be in the best interest of the City, for any reason.
This RFP may be partially or fully grant funded and Vendor agree to follow all grant, Federal, State, and City policies, guidelines, and regulations if selected as an awarded vendor for this RFP. • Insurance Requirements & Sample Agreement
City Resolution 2008-63 requires that licensees, lessees, and vendors have an approved Certificate of Insurance (not a declaration or policy) on file with the City for the issuance of a permit or contract. Within ten (10) consecutive calendar days of award of contract, successful bidder must furnish the City with the Certificates of Insurance proving coverage as specified in Appendix C. Failure to furnish the City with the required certificates within the time allowed will result in forfeiture of the Proposal Security. The City strongly encourages all bidders to review the Sample Agreement and Insurance Requirements before responding to the Request for Proposal.
Please carefully review the Sample Agreement and Insurance Requirements before responding to the Request for Proposal enclosed herein. The terms of the agreement, including insurance requirements, have been mandated by the City Council and can be modified only if extraordinary circumstances exist. Your response to the Request for Proposal must indicate if you are unwilling or unable to execute the agreement as drafted as well as providing the insurance requirements. The City will consider this in determining responsiveness to the Request for Proposal.
APPENDIX A
REQUEST FOR PROPOSAL
VENDOR APPLICATION FORM
TYPE OF APPLICANT:D NEWCURRENT VENDOR
Legal Contractual Name of Corporation:
Contact Person for Agreement:
Corporate Mailing Address:
City, State and Zip Code:
E-Mail Address:
Phone:
Contact Person for Proposals:
Title:
Business Telephone:
Fax:
E-Mail Address:
Business Fax:
Year Business was Established:
Is your business: (check one)
NON PROFIT CORPORATION d FOR PROFIT CORPORATION
Is your business: (check one)
CORPORATION
INDIVIDUAL
PARTNERSHIP
0 LIMITED LIABILITY PARTNERSHIP
d SOLE PROPRIETORSHIP
UNINCORPORATED ASSOCIATION
1 of 2
Names & Titles of Corporate Board Members
(Also list Names & Titles of persons with written authorization/resolution to sign contracts) Names Title Phone
Federal Tax Identification Number:
City ofHuntington Beach Business License Number:
(If none, you must obtain a Huntington Beach Business License upon award of contract.) City ofHuntington Beach Business License Expiration Date:
2 of 2
References of Work Performed Form
(Like agencies preferred)
Company Name:
1 .Name of Reference:
Address;
Contact Name:
Email;
Dates of Business:
2. Name of Reference:
Address:
Contact Name:
Email:
Dates of Business:
3. Name of Reference:
Address:
Contact Name:
Email:
Dates of Business:
Phone Number:
Phone Number:
Phone Number:
APPENDIX B
SERVICE AGREEMENT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
FOR
THIS AGREEMENT ("Agreement") is made and entered into by and between the City ofHuntington Beach, a municipal corporation of the State of California, hereinafter called "City," and_, a California Limited Liability Company, hereinafter referred to as "Contractor."
Recitals
A. The City desires to retain a Contractor having special skill and knowledge in the field ofjanitorial and porter services.
B. Contractor represents that Contractor is able and willing to provide such services to the City.
C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a comparable company or firm in the field.
Contractor has been selected to perform these services pursuant to Huntington Beach Municipal Code Chapter 3.02.
NOW, THEREFORE, it is agreed by City and Contractor as follows:
1. Scope of Services
Contractor shall provide all services as described in Exhibit "A," which is attached hereto and incorporated into this Agreement by this reference. These services shall sometimes hereinafter be referred to as the "Project." Contractor hereby designates _, who shall represent it and be its sole contact and agent in all consultations with City during the performance of this Agreement.
2. City Staff Assistance
City shall assign a staff coordinator to work directly with Contractor in the performance of this Agreement.
17-6145/170197/11/28/17/DO
3. Compensation
a. City agrees to pay, and Contractor agrees to accept as total payment for its services, the rates and charges identified in Exhibit "B." The total sum to be expended under this Agreement, shall not exceed _ ($_) per year for any one year during the term of this Agreement, with a _ year aggregate total not to exceed amount of_ ($_).
b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures.
Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. c. Contractor shall be paid pursuant to the terms of Exhibit "B."
4. Term
Time is of the essence of this Agreement. The services of Contractor are to commence _, or as soon as practicable after the execution of this Agreement by City (the "Commencement Date") and terminate _, unless terminated earlier in accordance with the provisions of this Agreement. Contract may be extended for 2 additional one-year periods if mutually agreed to in writing by both parties. The time for performance of the tasks identified in Exhibit "A" are generally to be shown in Exhibit "A." This schedule and Term may be amended to benefit the Project if mutually agreed to in writing by City and Contractor.
In the event the Commencement Date precedes the Effective Date, Contractor shall be bound by all terms and conditions as provided herein.
5. Extra Work
In the event City requires additional services not included in Exhibit "A" or changes in the scope of services described in Exhibit "A," Contractor will undertake such work only after receiving written authorization from City. Additional compensation for such extra work shall be allowed only if the prior written approval of City is obtained.
6. Disposition of Plans, Estimates and Other Documents
Contractor agrees that title to all materials prepared hereunder, including, without limitation, all original drawings, designs, reports, both field and office notices, calculations, computer code, language, date or programs, maps, memoranda, letters and other documents, shall belong to City, and Contractor shall tim these materials over to City upon expiration or termination of this Agreement or upon Project completion, whichever shall occur first. These materials may be used by City as it sees fit. 17-6145/170197/11/28/17/DO
7. Hold Harmless
Contractor hereby agrees to protect, defend, indemnify and hold harmless City, its officers, elected or appointed officials, employees, agents, and volunteers from and against any and all claims, damages, losses, expenses, judgments, demands and defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to Contractor's employees and damage to Contractor's property, arising directly or indirectly out of the obligations or operations herein undertaken by Contractor, caused in whole or in part by any negligent act or omission of the Contractor, any subcontractors, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable, including but not limited to concurrent active or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the City. Contractor will conduct all defense at its sole cost and expense and City shall approve selection of Contractor's counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Contractor.
8. Workers Compensation Insurance
Pursuant to California Labor Code Section 1861, Contractor acknowledges awareness of Section 3700 et seq. of this Code, which requires every employer to be insured against liability for workers' compensation; Contractor covenants that it will comply with such provisions prior to commencing performance of the work hereunder.
Contractor shall obtain and furnish to City workers' compensation and employer's liability insurance in an amount of not less than the State statutory limits.
Contractor shall require all subcontractors to provide such workers' compensation and employer's liability insurance for all of the subcontractors' employees. Contractor shall furnish to City a certificate of waiver ofsubrogation under the terms of the workers' compensation and employer's liability insurance and Contractor shall similarly require all subcontractors to waive subrogation.
9. General Liability Insurance
In addition to the workers' compensation and employer's liability insurance and Contractor's covenant to defend, hold harmless and indemnify City, Contractor shall obtain and furnish to City, a policy of general public liability insurance, including motor vehicle coverage covering the Project/Service. This policy shall indemnify Contractor, its officers, employees and agents while acting within the scope of their duties, against any and all claims arising out of or in connection with the Project/Service, and shall provide coverage in not less than the following amount: combined single limit bodily injury and property damage, including products/completed operations liability and blanket contractual liability, of One Million Dollars ($1,000,000) per occurrence. If coverage is provided under a form which includes a designated general aggregate limit, 17-6145/170197/11/28/17/DO
the aggregate limit must be no less than One Million Dollars ($1,000,000) per occurrence. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than One Million Dollars ($1,000,000) for this Project/Service. This policy shall name City, its officers, elected or appointed officials, employees, agents, and volunteers as Additional Insureds, and shall specifically provide that any other insurance coverage which may be applicable to the Project^Service shall be deemed excess coverage and that Contractor's insurance shall be primary.
Under no circumstances shall said above-mentioned insurance contain a self- insured retention, or a "deductible" or any other similar form of limitation on the required coverage.
10. Automobile Liability Insurance
Contractor shall obtain and furnish to City an automotive liability insurance policy covering the work performed by it hereunder. This policy shall provide coverage for Contractor's automotive liability in an amount not less than One Million Dollars ($1,000,000.00) per occurrence and a separate "Additional Insured Endorsement" page listing both the policy number and naming the "City ofHuntington Beach, its officers, elected or appointed officials, employees, agents and volunteers'" as additional insured on the endorsement. The above-mentioned insurance shall not contain a self-insured retention, "deductible" or any similar form of limitation on the required coverage except with the express written consent of City.
11. Certificate of Insurance
Prior to commencing performance of the work hereunder, Contractor shall furnish to City a certificate of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverage as required by this Agreement; the certificate shall:
a. provide the name and policy number of each carrier and policy; b. state that the policy is currently in force; and
c. promise that such policy shall not be suspended, voided or canceled by either party, reduced in coverage or in limits except after thirty (30) days prior written notice; however, ten (10) days' prior written notice in the event of cancellation for nonpayment of premium.
Contractor shall maintain the foregoing insurance coverage in force until the work under this Agreement is fully completed and accepted by City.
This requirement for carrying the foregoing insurance coverage shall not derogate from Contractor's defense, hold harmless and indemnification obligations as set forth in this Agreement. City or its representative shall at all times have the right to demand the original or a copy of the policy of insurance. Contractor shall pay, in a prompt and timely manner, the premiums on the insurance hereinabove required. 17-6145/170197/11/28/17/DO
12. Independent Contractor
Contractor is, and shall be, acting at all times in the performance of this Agreement as an independent contractor herein and not as an employee of City.
Contractor shall secure at its own cost and expense, and be responsible for any and all payment of all taxes, social security, state disability insurance compensation, unemployment compensation and other payroll deductions for Contractor and its officers, agents and employees and all business licenses, if any, in connection with the Project and/or the services to be performed hereunder.
13. Conflict of Interest
Contractor covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement.
14. Termination
This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination, subject to the following conditions:
a. As a condition of such payment, the Director may require Contractor to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Contractor consents the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement.
15. Exclusivity and Amendment
This Agreement represents the complete and exclusive statement between the City and Contractor, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Contractor. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Contractor or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein.
17-6145/170197/11/28/17/DO
16. Assignment
Inasmuch as to this Agreement is intended to secure the specialized services of Contractor, Contractor may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subconbract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City.
17. City Employees and Officials
Contractor shall employ no City official nor any regular City employee in the work performed pursuant to this Agreement. No officer or employee of City shall have any financial interest in this Agreement in violation of the applicable provisions of the California Government Code.
18. Notices
Any notices, certificates, or other communications hereunder shall be given either by personal delivery to Contractor's agent (as designated in Section 1 hereinabove) or to City as the situation shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and depositing the same in the United States Postal Service, to the addresses below. City and Contractor may designate different addresses to which subsequent notices, certificates or other communications will be sent by notifying the other party via personal delivery, a reputable overnight carrier or U.S. certified U.S. certified mail-return receipt requested:
To City: Contractor:
City ofHuntington Beach
Attn: Attn:
2000 Main Street
Huntington Beach, CA 92648
19. Consent
When City's consent/approval is required under this Agreement, its consent/approval for one transaction or event shall not be deemed to be a consent/approval to any subsequent occurrence of the same or any other transactions or event.
20. Modification
No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both parties.
17-6145/170197/11/28/17/DO
21. Section Headings
The titles, captions, section, paragraph and subject headings, and descriptive phrases at the beginning of the various sections in this Agreement are merely descriptive and are included solely for convenience of reference only and are not representative of matters included or excluded from such provisions, and do not interpret, define, limit or describe, or constme the intent of the parties or affect the constmction or interpretation of any provision of this Agreement.
22. Interpretation of this Agreement
The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the parties. If any provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining covenants and provisions of this Agreement. No covenant or provision shall be deemed dependent upon any other unless so expressly provided here. As used in this Agreement, the masculine or neuter gender and singular or plural number shall be deemed to include the other whenever the context so indicates or requires. Nothing contained herein shall be construed so as to require the commission of any act contrary to law, and wherever there is any conflict between any provision contained herein and any present or future stafaite, law, ordinance or regulation contrary to which the parties have no right to contract, then the latter shall prevail, and the provision of this Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements of the law.
23. Duplicate Original
The original of this Agreement and one or more copies hereto have been prepared and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of the date of its execution and delivery, be deemed an original. Each duplicate original shall be deemed an original instmment as against any party who has signed it.
24. Immigration
Contractor shall be responsible for full compliance with the immigration and naturalization laws of the United States and shall, in particular, comply with the provisions of the United States Code regarding employment verification.
25. Legal Services Subcontractine Prohibited
Contractor and City agree that City is not liable for payment of any subcontractor work involving legal services, and that such legal services are expressly outside the scope of services contemplated hereunder. Contractor understands that pursuant to Huntington Beach City Charter Section 309, the City Attorney is the exclusive legal counsel for City; 17-6145/170197/11/28/17/DO
and City shall not be liable for payment of any legal services expenses incurred by Contractor.
26. Confidentiality
Contractor recognizes that in the performance of its duties under this Agreement, it must conduct its activities in a manner designed to protect information of a sensitive nature from improper use or disclosure. Contractor warrants that it will use reasonable efforts consistent with practices customary in the facilities management industry in recruiting, training and supervising employees and in otherwise performing its duties hereunder in order to achieve this result. In the furtherance of this. Contractor agrees, at the request of the City, to require its employees to execute written undertakings to comply with the foregoing confidentiality provision.
27. Discrimination
Contractor shall not discriminate because of race, color, creed, religion, sex, marital stahis, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations.
28. Jurisdiction-Venue
This Agreement and all questions relating to its validity, interpretation, performance, and enforcement shall be government and construed in accordance with the laws of the State of California, This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement.
29. Professional Licenses
Contractor shall, through the temi of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City ofHuntington Beach and all other governmental agencies.
Contractor shall notify the City immediately and in writing of her inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement.
17-6145/170197/11/28/17/DO
30. Attorney's Fees
In the event suit is brought by either party to construe, interpret and/or enforce the terms and/or provisions of this Agreement or to secure the performance hereof, each party shall bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its attorney's fees from the non-prevailing party.
31. Survival
Terms and conditions of this Agreement, which by their sense and context survive the expiration or termination of this Agreement, shall so survive.
32. Governing Law
This Agreement shall be governed and construed in accordance with the laws of the State of California.
33. Signatories
Each undersigned represents and warrants that its signature herembelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
34. Entirety
(a) The parties acknowledge and agree that they are entering into this Agreement freely and voluntarily following extensive arm's length negotiation, and that each has had the opportunity to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and agree that no representations, inducements, promises, agreements or warranties, oral or otherwise, have been made by that party or anyone acting on that party's behalf, which are not embodied in this Agreement, and that that party has not executed this Agreement in reliance on any representation, inducement, promise, agreement warranty, fact or circumstance not expressly set forth in this Agreement.
(b) All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 17-6145/170197/11/28/17/DO
35. Effective Date
W WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. This Agreement shall be effective on the date of its approval by the Mayor. This Agreement shall expire when terminated as provided herein.
CONTRACTOR
->a
California limited liability corporation
CITY OF HUNTINGTON BEACH, a
municipal corporation of the State of
California
By:_
Print name
ITS: (circle one) Chairman/President/
Vice President
AND
Mayor
City Clerk
By:_
Print name
ITS: (circle one) Secretaiy/Chief Financial
Officer/Asst. Secretary-Treasurer
INITIATED AND APPROVED:
Director of
APPROVED AS TO FORM:
City Attorney
REVIEWED AND APPROVED:
City Manager
17-6145/170197/11/28/17/DO10
APPENDIX C
CITY OF HUNTINGTON BEACH INSURANCE REQUIREMENTS
Vendor Type
Minimum Insurance Requirements
Automobile
Liability General Liability
Professional
Liability
Property
Insurance Workers' Comp
Additional
Insured
Endorsements
\Huntington Beach City Council Resolution No. 2008-63 requires submittal of certificates of insurance evidencing the following minimum limits with a California admitted carrier with a current A.M. Best's Rating of no less than A: VII. See Exhibits Al - 4 for sample forms. \Email: [email protected] or [email protected] Phone: 714-374-5378 or 714-536-5210. Fax: 714-536-5212. \Any deductible other than those allowed in this matrix, self-insured retentions or similar forms of coverage limitations or modifications must be approved by the Risk \Manager and City Attorney of the City ofHuntington Beach. NOTE: Waivers and/or modifications are discouraged and will be considered only under extraordinary circumstances.
Contractors: Any persons or entities who
contract with the City and/or provide services to
the City which are readily available and
efficiently procured by competitive bidding.
Permittees: Any persons or entities who make
I application to the City for any use of or
I encroachment upon any public street, waterway,
Ipier, or City property.
Vendors: Any persons or entities who transfers
property or goods to the City which may or may
not involve delivery and/or mstallation.
Minimum of
$1,000,000 per
occurrence for
bodily injury,
personal injury
and property
damages. Allows
up to $1,000
deductible.(5ee
Note 1 below.)
Combined single limit
bodily injury and
property damage.
Minimum of
$1,000,000 per
occurrence. Allows
up to $5,000
deductible.
(Additional Insured
Endorsement is always
required with General
Liability Ins.)
As required by
the State of
California, with
Statutory Limits
and Employer's
Liability
Insurance with
a limit of no
less than
$1,000,000 per
accident for
bodily injury or
disease. (See
Note 2 below.)
Include the
policy number
and Additional
Insured
Endorsement
Requirement
statement
below. (See Note
3 below.)
|Note 1 - Automobile Liability: The City ofHuntmgton Beach, its officers, elected or appointed officials, employees, agents and volunteers must be named as |certificate holder and as additional insured by separate attached endorsement. PermiUees who do not use vehicles or equipment in connection with the permit [shall not be required to provide auto insurance. To be exempt from this requirement, pennittees must execute a declaration such as Exhibit 1 attached. |Note 2 - Workers' Compensation Exemption: If entity has no employees, a signed Declaration ofNon-Employee Status form is required. [Note 3 - Additional Insured Endorsement Requirements: The City, its officers, elected or appointed officials, employees, agents, and volunteers are to be I covered as additional insureds by separate attached endorsement(s) as respects liability arising out of action performed by or on behalf of the contractor, Iproducts and completed operations of the contractor, premises owned, occupied or used by the contractor, or automobiles owned, leased or borrowed by the contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City.
HB Insurance Matrix_revised 4-7-16 (2).xlsx lof4
CITY OF HUNTINGTON BEACH INSURANCE REQUIREMENTS
Vendor Type
Minimum Insurance Requirements
Automobile
Liability General Liability
Professional
Liability
Property
Insurance Workers' Comp
Additional
Insured
Endorsements
Huntington Beach City Council Resolution No. 2008-63 requires submittal of certificates of insurance evidencing the following minimum limits with a California admitted carrier with a current A.M. Best's Rating of no less than A: VII. See Exhibits Al - 4 for sample forms.
Email: [email protected] or [email protected] Phone: 714-374-5378 or 714-536-5210. Fax: 714-536-5212.
Any deductible other than those allowed in this matrix, self-insured retentions or similar forms of coverage limitations or modifications must be approved by the Risk Manager and City Attorney of the City of Huntington Beach. NOTE: Waivers and/or modifications are discouraged and will be considered only under extraordinary circumstances.
Design Professionals: Professional service
contractors who contract with the City and/or
provide architectural and/or engineering services
to the City.
Professional Services: Services that involve
the exercise of professional discretion and
independent judgment based on an advanced or
specialized knowledge, expertise or ta-aining
gained by formal studies or experience or
services which are not readily or efficiently
procured by competitive biddmg pursuant to HB
IMuni Code 3.02. Services includes but are not
I limited to those services provided by appraisers,
architects, attorneys, engineers, instructors,
insurance advisors, physicians and other
specialized consultants.
Minimum of
$1,000,000 per
occurrence and
in the
aggregate.
Allows up to
$10,000
deductible.
IClaims made policies are acceptable if the policy further provides that:
1) The policy retroactive date coincides with or precedes the professional services contractor's start ofwork (including subsequent policies purchased as renewals or replacements).
2) The professional services contractor will make every effort to maintain similar msurance during the required extended period of coverage following project completion, iacludmg the requirement of adding all additional insureds. |3) If insurance is tenninated for any reason, professional services contractor agrees to purchase an extended reporting provision of at least two (2) years to |report claims arising from work performed in connection with this agreement or permit. i4) The reporting of circumstances or incidents that might give rise to future claims.
HB Insurance Mabnx_revised 4-7-16 (2).xlsx 2 of 4
CITY OF HUNTINGTON BEACH INSURANCE REQUIREMENTS
Vendor
Minimum Insurance
Automobile
Liability General Liability
Professional
Liability
Requirements
Property
Insurance Workers' Comp
Huntington Beach City Council Resolution No. 2008-63 requires submittal of certificates of insurance evidencing the following minimum limits with admitted carrier with a current A.M. Best's Rating of no less than A: VII. See Exhibits Al - 4 for sample forms.
Email: [email protected] or [email protected] Phone: 714-374-5378 or 714-536-5210. Fax: 714-536-5212.
Additional
Insured
Endorsements
a California
Any deductible other than those allowed in this matrix, self-insured retentions or similar forms of coverage limitations or modifications must be approved by the Risk Manager and City Attorney of the City ofHunHngton Beach. NOTE: Waivers and/or modifications are discouraged and will be considered only under extraordinary circumstances.
Licensees/Lessees: Any persons or entities
who contract with the City for the use of public
property.
Combined single limit
bodily injury and
property damage.
Minimum of
$1,000,000 per
occurrence. Allows
up to $5,000
deductible.
(Additional Insurance
Endorsement is always
required with General
Liability Ins.)
Full
replacement
cost with no
comsurance
penalty
provision.
As requu-ed by
the State of
California, with
Statutory Limits
and Employer's
Liability
Insurance with
a limit of no
less than
$1,000,000 per
accident for
bodily injury or
disease. (See
Note 1 below.)
Include the
policy number
and Additional
Insured
Endorsement
Requirement
statement
below .(See Note
2.)
Note 1 - Workers' Compensation Exemption: If entity has no employees, a signed Declaration ofNon-Employee Status form is required.
Note 2 - Additional Insured Endorsement Requirements: The City, its officers, elected or appointed officials, employees, agents, and volunteers are to be covered as additional insureds by separate attached endorsements) as respects liability arising out of action performed by or on behalf of the contractor, products and completed operations of the contractor, premises owned, occupied or used by the contractor, or automobiles owned, leased or borrowed by the contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City.
HB Insurance Matrix_revised 4-7-16 (2).xlsx 3of4
CITY OF HUNTINGTON BEACH INSURANCE REQUIREMENTS
Huntington Beach City Council Resolution No. 2008-63 requires submittal of certificates of insurance evidencing the following minimum HmHs with a California admitted carrier with a current A.M. Best's Rating of no less than A:VIL Any deductible other than those allowed in this matrix, self-insured retentions or similar forms of coverage limitations or modifications must be approved by the Risk Manager and City Attorney of the City ofHuntington Beach, NOTE: Waivers and /or modifications are discouraged and will be considered only under extraordinary circumstances, Vendor TypeMinimum Insurance Requirements
Professional Liability
Design Professionals: Professional service contractors who contract with the City and/or provide architectural and/or engineering services to the City.
Minimum of $1,000,000 per occurrence and in
the aggregate. Allows up to $10,000 deductible.
IProfessional Services: Services that involve the exercise of Iprofessional discretion and independent judgment based on an advanced or specialized knowledge, expertise or training gained by formal studies or experience or services which are not readily or efficiently procured by competitive bidding pursuant to HB Muni Code 3.02. Services includes but is not limited to those services provided by appraisers, architects, attorneys, engineers, instructors, insurance advisors, physicians and other specialized consultants, Claims made policies are acceptable if the policy further provides that:
1) The policy retroactive date coincides with or precedes the professional services contractor's start of work (including subsequent policies purchased as renewals or replacements). 2) The professional services contractor will make every effort to maintain similar insurance during the required extended period of coverage following project completion, including the requirement of adding all additional insureds.
3) If insurance is terminated for any reason, professional services contractor agrees to purchase an extended reporting provision of at least two (2) years to report claims arising from work performed in connection with this agreement or permit.
4) The reporting of circumstances or incidents that might give rise to future claims.
HB Insurance Matrix_revised 4-7-16 (2).xlsx4of4
APPENDDC D
GENERAL PRINCIPLES CERTIFICATION FOR FEDERAL-AID CONTRACTS CONSULTANT shall comply with generally accepted accounting principles and good business practices. CONSULTANT shall, at its own expense, furnish all cost items associated with the proposed services except as specified to be furnished by City. CONSULTANT shall retain financial records, supporting documents, statistical records, and all other records pertinent to the proposed services for a period of a minimum of three (3) years from the expiration of the term of the Master Agreement.
CONSULTANT shall take reasonable measures to safeguard protected personally identifiable information and other information designated as sensitive or is considered sensitive consistent with laws regarding privacy and responsibility over confidentiality.
CONSULTANT shall also certify that none of the proposed equipment or services are produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities); or produced by an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country in accordance with 2 CFR 200.216.
In order to ensure objective contractor performance and eliminate unfair competitive advantage, CONSULTANT must certify that they did not assist in the development of draft specifications, requirements, statements of work, or invitations for bids or requests for proposals for the project.
Business Name:
Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
1 of 11
NON-DISCRIMINATION CERTIFICATION FOR FEDERAL-AID CONTRACTS CONSULTANT shall comply with the provisions of Title VII of the Civil Rights Act of 1964 in that it wilt not discriminate against any individual with respect to his or her compensation, terms, conditions, or privileges of employment nor shall CONSULTANT discriminate in any way that would deprive or intend to deprive any individual of employment opportunities or otherwise adversely affect his or her status as an employee because of such individual's race, color, religion, sex, national origin, age, handicap, disability, medical condition, sexual orientation, gender identity, or marital status. These actions shall include, but not be limited to, the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship.
CONSULTANT shall ensure that services and facilities are provided without regard to ethnic group identification, race, color, national origin, creed, religion, age, sex, physical or mental disability, political affiliation, or marital status in accordance with applicable laws, including, but not limited to, Title VI of the Civil Rights Act of 1964 (42 U.S.C. 200-d); Section 162 (a) of the Federal-Aid Highway Act of 1973 (23 U.S.C. 324); Section 504 of the Rehabilitation Act of 1973; the Civil Rights Restoration Act of 1987 (P.L. 100-209); Executive Order 12898 (February 11,1994); Executive Order 13166 (August 16, 2000); Title VII of the Civil Rights Act of 1964 (42 U.S.C 2000-d); the Age Discrimination Act of 1975 (42 U.S.C. 6101); Article 9.5, Chapter 1, Part 1, Division 2, Title 2 (Section 11135, et seq) of the California Government Code; Title 9, Chapter 4, Subchapter 6 (Section 10800, et seq) of the CCR and California Department of Social Services Manual of Policies and Procedures (CDSSMPP) Division 21.
CONSULTANT shall ensure that proposed activities be accomplished in an equitable and impartial manner so that no person shall be excluded because of race, color, gender, or national origin from participation in, or be denied the benefits, or any program or activity for which federal financial assistance is received (31 CFR Part 22).
Business Name:
Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
2 of 11
MBE and WBE CERTIFICATION FOR FEDERAL-AID CONTRACTS
It is the policy of the City to encourage the participation of disadvantaged, minority and women- owned business enterprises in the City's procurement process. • CONSULTANT agrees to use its best efforts to carry out this policy when sourcing the use of outside consultants, advisors and contractors to the fullest extent practicable, consistent with the efficient performance of a contract. CONSULTANT may rely on written representations by consultants, advisors and contractors regarding their status. CONSULTANT shall report to the City the names of all consultants, advisors and contractors hired for the proposed services and information on whether or not they are a disadvantaged, minority or women-owned business enterprise, as defined in Section 8 of the Small Business Act (15 U.S.C. Sec. 637).
CONSULTANT shall, in accordance with 2 CFR 200.321, take affirmative steps to include minority business, women's business enterprises, and labor surplus area firms when sourcing the use of outside consultants, advisors, and contractors for a contract by:
(a) Placing qualified small and minority businesses and women's business enterprises on solicitation lists;
(b) Assuring that small and minority businesses and women's business enterprises are solicited whenever they are potential sources;
(c) Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small and minority businesses and women's business enterprises;
(d) Establishing delivery schedules, where the requirements permit, which encourage participation by small and minority businesses and women's business enterprises; and (e) Using the services and assistance, as appropriate, of such organizations as the Small Business Administration and the Minority Business Development Agency of the Department of Commerce.
Business Name:
Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
3 of 11
DOMESTIC PREFERENCE CERTIFICATION FOR FEDERAL-AID CONTRACTS It is the policy of the City to encourage a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). The requirements of this section must be included in all subawards including all contracts and purchase orders.
CONSULTANT agrees to use its best efforts to comply with 2 CFR 200.322 to the fullest extent possible consistent with the efficient performance of a contract.
RECOVERED MATERIALS CERTIFICATION FOR FEDERAL-AID CONTRACTS CONSULTANT shall comply with 2 CFR 200.322 and procure only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded $10,000. CONSULTANT certifies that the percentage of recovered materials to be used in the performance of this Agreement will be at least the amount required by applicable specifications or other contractual requirements. For contracts over $100,000 in total value, CONSULTANT shall estimate the percentage of total material utilized for the performance of the project that is recovered materials and shall provide such estimate to City upon request.
Business Name:
Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
4 of 11
CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT CERTIFICATION FOR
FEDERAL-AID CONTRACTS
CONSULTANT agrees to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act, as amended, 42 U.S.C. §§ 7401-7671 q. CONSULTANT agrees to report each violation to the USDA and the appropriate EPA Regional Office.
CONSULTANT agrees to comply with all applicable standards, orders or regulations issued pursuant to the Federal Water Pollution Control Act as amended (33 U.S.C. §§ 1251-1387). CONSULTANT agrees to report each violation to the USDA and the appropriate EPA Regional Office.
Business Name:
Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
5 of 11
Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 13 CFR Part 145. The regulations were published as Part VII of the May 26,1988 Federal Register (pages 19160-19211).
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON FOLLOWING PAGE)
1. The prospective primary participant certifies to the best of its knowledge and belief that it and its principals:
(a) Are not presently debarred, suspended, proposed for disbarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this application been convicted of or had a civil judgement rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and
(d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default.
2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective primary participant shall attach an explanation to this certification.
Indicate to whom it applies, initiating agency, and dates of action.
Business Name:
Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
6 of 11
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.
5. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is submitted for assistance in obtaining a copy of those regulations (13 CFR Part 145).
6. The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who Is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction.
7. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the ineligibility of its principals. Each participant may, but Is not required to, check the Nonprocurement List.
9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.
10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 7 of 11
NON-LOBBYING CERTIFICATION FOR FEDERAL-AID CONTRACTS
The prospective participant certifies, by signing and submitting this document, to the best of his or her knowledge and belief, that:
(I) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its instructions.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly.
Business Name:
Date: _ By:
Name and Title of Authorized Representative
Signature of Authorized Representative
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DISCLOSURE OF LOBBYING ACTIVITIES
COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352
1. Type of Federal Action:
a. conb'act
b. grant
c. cooperative agreement
d. loan
e. loan guarantee
f. loan insurance
2. Status
Action:
of Federal 3. Report Type:
a. bid/offer/application
b. initial award
c. post-award
4. Name and Address of Reporting Entity
Q PrimeSubawardee
Tier , if known
a. initial
b. material change
For Material Change Only:
year_ quarter
date of last report
5. If Reporting Entity in No. 4 is Subawardee,
Enter Name and Address of Prime:
6. Congressional District, if known:
Federal Department/Agency:
Congressional District, if known:
7. Federal Program Name/Description:
8. Federal Action Number, if known:9.
CFDA Number, if applicable
Award Amount, if known:
lO.a. Name and Address of Lobby Registrant
(If individual, last name, first name, MI)
lO.b. Individuals Performing Services
(including address if different from No. 10)
(last name, first name, MI)
(attach Continuation Sheet(s) if necessary)
11. Information requested through this form is
authorized by Title 31 U.S.C. Section 1352. This
disclosure of lobbying activities is a material
representation of fact upon which reliance was
placed by the tier above when his transaction was
made or entered into. This disclosure is required
pursuant to 31 U.S.C. 1352. This information will
be available for public inspection. Any person who
fails to file the required disclosure shall be subject
to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
Federal Use Only:
Signature:
Print Name:
Title:
Telephone No.:Date:
Authorized for Local Reproduction
Standard Form - LLL (Rev. 7-97)
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INSTRUCTIONS FOR COMPLETING SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime federal recipient at the initiation or receipt of covered federal action or a material change to previous filing pursuant to title 31 U.S.C. Section 1352.
The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered federal action.
2. Identify the status of the covered federal action.
3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered federal action.
4. Enter the full name, address, city, state, and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier.
Subawards include but are not limited to: subcontracts, subgrants, and contract awards under grants.
5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, state, and zip code of the prime federal recipient. Include Congressional District, if known.
6. Enter the name of the federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard.
7. Enter the federal program name or description for the covered federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.
8. Enter the most appropriate federal identifying number available for the federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant, or loan award number, the application/proposal control number assigned by the federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered federal action where there has been an award or loan commitment by the Federal agency, enter the federal amount of the award/loan commitments for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, state, and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in Item 4 to influence the covered federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a).
Enter Last Name, First Name and Middle Initial (Ml).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid 0MB Control Number. The valid 0MB control number for this information collection is 0MB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect 10 of 11
of this collection of information, including suggestions for reducing this burden, to the OfficeofManagement and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503. 11 of 11