Victorville City Council
October 6, 2026

Attachment A
Amendment Three to the
Professional Services
Provider Agreement
Between the City of
Victorville and Symba Center
for Wellness Center
Wraparound, Shelter
Operator, and ERF-3
Services Project No.

JM23-065-1 ("Consolidated
Project")
1 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 AMENDMENT NUMBER: THREE
TO

CONSULTANT/PROFESSIONAL SERVICES PROVIDER AGREEMENT

BY AND BETWEEN

THE CITY OF VICTORVILLE
AND

SYMBA CENTER
FOR
WELLNESS CENTER WRAPAROUND, SHELTER OPERATOR, AND ERF-3 SERVICES PROJECT NO. JM23-065-1 (CONSOLIDATED PROJECT)
THIS AMENDMENT NUMBER THREE (“Amendment No. 3”) dated September 1, 2026, for reference purposes only, is made by and between the City of Victorville, a California municipal corporation and charter city, hereinafter referred to as the “City”, and SYMBA CENTER, a California non-profit corporation hereinafter referred to as “Consultant”. City and Consultant are sometimes hereinafter referred to individually as a “Party” and collectively as the “Parties”.

RECITALS
WHEREAS, the City has a Consultant/Professional Services Provider Agreement with Consultant dated June 26, 2025, under which Consultant currently provides Wellness Center Wraparound, Shelter Operator, and ERF-3 Services to residents/clients of the City's Wellness Center, those unhoused, and those at risk of homelessness in the City (hereinafter the “Original Agreement”); and
WHEREAS, Supportive, Wraparound, and Wellness Center Services include, but are not limited to, job readiness, financial literacy, rapid rehousing, housing navigation, case management, outreach, recuperative care, and job placement programs; and WHEREAS, by means of Amendment No. 1 dated September 26, 2025, the Parties amended the Original Agreement (said Original Agreement as amended by Amendment No. 1 is hereafter referred to as the “First Amended Agreement”); and WHEREAS, by means of Amendment No. 2 dated July 1, 2026, the Parties amended the First Amended Agreement to provide Consultant with additional ESG Grant funding to expand and enhance rapid rehousing services at the Wellness Center (said First Amended Agreement as amended by Amendment No. 2 is hereinafter referred to as the “Second Amended Agreement”); and
WHEREAS, the City recently received and reviewed program performance and expenditure information related to the ERF-3 Outreach funding available for continued street outreach services; and
WHEREAS, based upon such review, the City has determined that certain ERF-3 Outreach funds allocated to the City’s Code Enforcement Department for homeless engagement activities are being expended at a lower rate than projected and that a portion of such funds ($60,000) may be reallocated to support additional street outreach, engagement, and case management services; and
2 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 WHEREAS, the City has identified an increased need for intensive street outreach, engagement, and case management, and service coordination activities necessary to engage unsheltered individuals and connect them to shelter, treatment, housing, and supportive services; and
WHEREAS, the City desires to maximize the utilization and effectiveness of available ERF-3 funding by reallocating a portion of the available outreach funds to Consultant's street outreach, engagement, and case management activities, thereby increasing direct service capacity and improving outcomes for individuals experiencing homelessness; and WHEREAS, On December 2, 2025, City Council approved acceptance of the 2026 Kaiser Respite grant in the amount of $75,000.00 to fund strengthening the Medical Respite/Recuperative Care (RC) ecosystem in the Inland Region, $60,000.00 of which is being allocated to Consultant as set forth in this Amendment No. 3; and WHEREAS, the City intends to utilize Kaiser Respite Grant funding to enhance the longterm sustainability, operational capacity, and service delivery of the Victorville Wellness Center's Recuperative Care Program and related supportive services; and WHEREAS, on or about June 6, 2026, the City of Victorville applied for and was awarded Homeless Housing, Assistance and Prevention Round 5 Program (HHAP-5) grant funding from the County of San Bernardino in the amount of $273,570.98 to provide rapid rehousing, street outreach, and service coordination for individuals and families experiencing homelessness, of which $52,080.24 is being allocated to Consultant for street outreach engagement and assessment as set forth in this Amendment No. 3; and
WHEREAS, the City recently reviewed operational, financial, and programmatic information related to the Wellness Center, ERF-3 services, outreach activities, recuperative care services, and other homelessness response programs and identified opportunities to strengthen service delivery and program sustainability; and
WHEREAS, City staff have further determined that certain funding sources and budget allocations may be more effectively aligned with current operational demands, service utilization trends, grant objectives, and community needs in order to maintain service continuity, maximize grant performance, and ensure the efficient use of limited public resources; and WHEREAS, the City desires to provide Consultant with additional resources and flexibility to expand and enhance services at the Wellness Center, strengthen street outreach and engagement efforts, increase housing navigation and case management capacity, and further develop recuperative care and other supportive and wraparound services for individuals experiencing homelessness or at risk of homelessness; and WHEREAS, the Parties desire to execute this Amendment No. 3 to the Second Amended Agreement to incorporate these funding adjustments, grant-funded program additions, operational enhancements, and sustainability measures, while reaffirming their shared commitment to reducing homelessness and improving outcomes for unhoused and at-risk residents of the City of Victorville.
3 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 NOW THEREFORE, in consideration of the covenants, conditions, and promises contained herein and for such other good and valuable consideration, receipt of which is hereby acknowledged, the Parties hereby agree to amend the Second Amended Agreement as stated below.

AGREEMENT AMENDMENT

1. Recitals. The Recitals set forth above are true and correct and are made a part of this Amendment by this reference.

2. Amendment of Section 2.b – SCOPE OF SERVICES; TERMS AND CONDITIONS.

Section 2.b is hereby deleted in its entirety and replaced with the following:
b. The Services to be performed under this Agreement are more specifically described in the attached exhibits, which are incorporated herein by this reference. The Parties acknowledge and agree that Consultant’s original response to the RFP for the Wellness Center Project, attached as Exhibit “A-2”, has been modified and superseded by the Operating Budget and Staffing List attached as Exhibit “B-1” and Exhibit “B-2”, related to the ERF-3 Program Grant, and any other modifying provisions contained within this Agreement or any subsequent amendment. (1) In addition to the Exhibits referenced above, the Parties acknowledge and agree that the grant-funded services are further described in the following supplemental exhibits attached hereto and incorporated herein: Exhibit “A-3 (Emergency Solutions Grant (ESG) Rapid Re-Housing Scope of Work), Exhibit “A-4” (Kaiser Permanente Respite Care Grant Scope of Work), and Exhibit “A-5” (Homeless Housing, Assistance and Prevention Round 5 Program (HHAP-5) Grant Scope of Work). To the extent any supplemental exhibit contains funding source-specific requirements, Consultant agrees to and shall comply with all applicable grant conditions, performance requirements, eligibility requirements, documentation standards, reporting obligations, and other terms associated with the applicable funding source.
(2) The Parties further acknowledge and agree that the following separate grantfunded budgets are attached as supplemental budget exhibits: Exhibit “B-3” (Emergency Solutions Grant (ESG) Rapid Re-Housing Budget), Exhibit “B-4” (Kaiser Permanente Respite Care Grant Budget), and Exhibit “B-5” (Homeless Housing, Assistance and Prevention Round 5 Program (HHAP-5) Grant Budget).

Consultant agrees to and shall utilize grant funds solely for the purposes identified within the applicable scope of work and budget exhibit and shall maintain financial records sufficient to demonstrate compliance with all applicable funding requirements.
(3) The Services shall include all items, tasks, activities, staffing, reporting, documentation, and procedures necessary to properly complete the Services Consultant has been engaged to perform, whether specifically identified within the attached exhibits or reasonably necessary to accomplish the objectives of the applicable program or funding source.
4 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3

3. Amendment of Section 2.e – SCOPE OF SERVICES; TERMS AND CONDITIONS.

Section 2.e is hereby deleted in its entirety and replaced with the following:
e. Attached Exhibit "A-1", Exhibit "A-2", Exhibit "A-3", Exhibit "A-4", Exhibit "A-5"', Exhibit "B-1", Exhibit "'B-2"', Exhibit "B-3", Exhibit "B-4", Exhibit '"B-5", Exhibit "C", and Exhibit "D" are incorporated and made part of this Agreement by this reference. Any additional exhibits added through future written amendments shall likewise be incorporated into and made part of this Agreement upon execution by the Parties.

4. Amendment of Section 4.a– COMPENSATION (Non-ERF-3 Services). Section 4.a is hereby deleted in its entirety and replaced with the following:
a. Non-ERF-3 Services. As of the Commencement Date (as hereinafter defined in Section 6), the City shall pay Consultant a total sum not to exceed NINE MILLION ONE HUNDRED TWENTY-TWO THOUSAND SIXTY-ONE AND 86/100 DOLLARS ($9,122,061.86), which sum represents the cost of faithful performance of the Services to be rendered under this Agreement (with the exception of the ERF-3 Services described in Subsection 4.e) during the thirty-six (36) month term, subject to Section

4.g hereof, based upon the Operating Budget, Expenditure Deadlines, and Staffing List attached hereto as: Exhibit “B-1” (Third Amended Non-ERF-3 Budget - $8,931,792.50); Exhibit “B-3” (Emergency Solutions Grant (ESG) Rapid Re-Housing Program Budget - $78,189.12); Exhibit “B-4” (Kaiser Permanente Respite Care Grant Budget - $60,000.00); and Exhibit “B-5” Homeless Housing, Assistance and Prevention Round 5 Program (HHAP-5) Grant Budget - $ 52,080.24). Except as provided in Subsection 4.b, no part of said total sum shall be paid in advance or as a lump sum, but shall be paid on a monthly reimbursement basis during the term following the City's receipt and processing of Consultant's invoices as set out in Subsection 4.a(1).

5. Amendment of Section 4.a(1) – COMPENSATION (Non-ERF-3 Services). Section

4.a(1) is hereby deleted in its entirety and replaced with the following:
(1) The provisions of Exhibits “B-1”, “B-3”, “B-4”, and “B-5” notwithstanding, with the exception of the One-Time Start Up Advance payment specified in Subsection 4.b, below, in order to receive payments, Consultant shall be required to submit to the City detailed monthly invoices which include: a breakdown of service costs being billed to the City and a breakdown of service costs being offset by other funding received by Consultant; a description of all services/tasks performed (including occupancy data, services provided to clients, program participation data, housing outcomes, and client intake and exit data, as applicable); the number of hours expended on each service/task, the name of the person performing the service/task, and expense reimbursement information, if any. No expense reimbursements, including reimbursements for travel, parking, lodging, meals, participant assistance, rental assistance, deposits, utility assistance, wages, or other grant-funded expenditures shall be paid to Consultant unless such reimbursements: (i) are specifically provided for and described by nature and type in Exhibits “B-1”, “B-3”, “B-4”, or “B-5”; (ii) appear on Consultant's monthly invoices to City; (iii) are supported by receipts, proof of payment, participant eligibility documentation, lease agreements, payroll records, or 5 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 such other documentation as the City shall require; and (iv) are directly related to the Scope of Services to be performed under this Agreement. Provided that services have been satisfactorily rendered and invoices submitted include the required detail specified above, the City shall make payment approximately forty-five (45) working days following receipt of Consultant's invoice.

6. Amendment of Section 4.e(1) – COMPENSATION (ERF-3 Services). The second sentence of Section 4.e(1) is hereby deleted and replaced by the following:

As of the Commencement Date of this Agreement, the City added an additional amount of TWO HUNDRED FIFTY-SEVEN THOUSAND FIVE HUNDRED AND 00/100 DOLLARS ($257,500.00) in ERF-3 Program Grant funding to the remaining balance, such that the total sum of ERF-3 Program Grant funding available to Consultant was ONE

MILLION THREE HUNDRED SEVENTY-FOUR THOUSAND NINE HUNDRED TWENTY AND 00/100 DOLLARS ($1,374,920.00). Effective as of October 1, 2026, the City increased this funding amount by SIXTY THOUSAND AND 00/100 DOLLARS ($60,000.00), such that the total sum of ERF-3 Program Grant funding available to Consultant is ONE MILLION FOUR HUNDRED THIRTY-FOUR THOUSAND NINE HUNDRED TWENTY AND 00/100 DOLLARS ($1,434,920.00), which sum shall be expended in accordance with the Operating Budget and Staffing List attached hereto as Third Amended Exhibit "B-2''.

7. Addition of Section 4.g – COMPENSATION (Non-ERF-3 Services). Section 4.g is hereby amended in its entirety to read as follows:
g. Grant Expenditure Performance Periods for Additional Non-ERF-3 Services.

Notwithstanding the overall term of this Agreement or references to the “thirty-six (36) month term” in the provisions of Section 4, expenditures and services funded through the additional grant-funded programs identified in Exhibits “A-3” through “A-5” and Exhibits “B-3” through “B-5” shall be incurred, performed, invoiced, and reimbursed only during the applicable approved grant expenditure and performance period, unless otherwise authorized in writing by the City or the applicable funding source. The approved grant expenditure and performance periods are as set out in the following table:

Funding Source Program Approved Grant Expenditure and
Performance Period
Emergency Solutions
Grant (ESG)
Rapid Re-Housing
(RRH) Program
January 2, 2026 – September 1,
2026
Kaiser Permanente
Medical Respite Grant Respite Care Program June 16, 2026 – December 30, 2026 Homeless Housing,
Assistance and
Prevention Round 5
Program (HHAP-5)
Street Outreach October 1, 2026 – May 15, 2028
6 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 Consultant shall ensure that all costs charged to each additional grant funding source are allowable, allocable, reasonable, properly documented, and incurred within the applicable grant expenditure and performance period. Any costs incurred outside the approved grant expenditure and performance period, or otherwise determined to be ineligible by the City or the funding source, shall not be reimbursable under this Agreement unless expressly authorized in writing by the City. Consultant shall maintain separate financial records, supporting documentation, participant eligibility records, and performance records sufficient to demonstrate compliance with each grant's expenditure and performance period requirements and shall make such records available to the City upon request.

8. Replacement of Section 14.e – STATE AND FEDERAL GRANT REQUIREMENTS.

Section 14.e is hereby deleted in its entirety and replaced with the following:
e. Other/Future Grant Fund Compliance Requirements. Consultant agrees to comply with all requirements applicable to the City's grant funding sources identified in the RFPs for the Consolidated Project (including federal record-keeping, reporting, monitoring, procurement, eligibility, nondiscrimination, financial management, and other requirements set forth in 24 CFR Part 570, 24 CFR Part 578, 2 CFR Part 200, and any successor regulations), as well as all requirements associated with funding sources incorporated into this Agreement through amendment, exhibit, or other written authorization.
(1) Such funding sources may include, but are not limited to, federal, state, county, local, and private grants, cooperative agreements, contracts, awards, donations, sponsorships, and other funding mechanisms supporting services provided under this Agreement. Without limitation, Consultant shall comply with all applicable requirements associated with funding provided through the Emergency Solutions Grant (ESG) Program, Kaiser Permanente grant, Homeless Housing, Assistance and Prevention Round 5 Grant (HHAP-5) Program, and any other funding source subsequently incorporated into this Agreement.
(2) Consultant shall comply with all applicable programmatic, fiscal, reporting, monitoring, documentation, record retention, performance measurement, audit, and grant compliance requirements imposed by the applicable funding source and shall require its Subcontractors to likewise comply. The City will provide Consultant with applicable grant documents, funding requirements, special conditions, reporting requirements, and amendments necessary to facilitate compliance. Consultant acknowledges and agrees that compliance with such requirements is a material obligation of this Agreement.

9. Replacement of Section 24 – REPORTS. Section 24 is hereby deleted in its entirety and replaced with the following:
a. Upon request by the Project Manager, or as otherwise required by this Agreement, including but not limited to the Scopes of Services set forth in Exhibits “A-1” through “A-5,” any subsequently added exhibits, the provisions of the RFP, and any applicable federal, state, local, or private funding source requirements, Consultant shall prepare 7 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 and submit reports reasonably requested by the City concerning Consultant’s performance of the services required by this Agreement.

10. Replacement of Operating Budget and Staffing List for Non-ERF-3 funded Services (Exhibit “B-1”). As of the effective date of this Amendment No. 3, the amended Operating Budget and Staffing List (the “Third Amended Exhibit “B-1””) attached hereto and made a part hereof by this reference, shall supersede and replace Exhibit “B-1” attached to the Second Amended Agreement. As of such effective date, all references to Exhibit “B-1” in the Second Amended Agreement and herein shall mean and refer to the Third Amended Exhibit “B-1”.

11. Replacement of Operating Budget and Staffing List for ERF-3 funded Services (Exhibit “B-2”). As of the effective date of this Amendment No. 3, the amended Operating Budget and Staffing List (the “Third Amended Exhibit “B-2”) attached hereto and made a part hereof by this reference, shall supersede and replace Exhibit “B-2” attached to the First Amended Agreement. As of such effective date, all references to Exhibit “B-2” in the First Amended Agreement and herein shall mean and refer to the Third Amended Exhibit “B-2”.

12. HHAP-5 Grant Funding Contingency. It is mutually agreed that if the County of San Bernardino fails to execute the HHAP-5 Grant agreement with the City and/or fails to provide funds to the City thereunder, the provisions of this Amendment relating to HHAP-5 Grant funding shall be of no force and effect. In this event, the City shall have no liability to pay any HHAP-5 funds whatsoever to Consultant or furnish any other consideration under this Amendment No. 3, and Consultant shall not be obligated to perform the Services/scope of work set forth in Exhibit “A-5”.

13. No Other Terms and Conditions. Except as specifically amended by this Amendment No. 3, all the terms and conditions of and exhibits to the Second Amended Agreement remain in full force and effect.

14. Effective Date. This Amendment No. 3 shall become effective on the date when it has been fully executed by the Parties, with the City being the Party signing last in time. [SIGNATURES ON FOLLOWING PAGE]
8 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 IN WITNESS WHEREOF, the Parties hereto have caused this Amendment No. 3 to the Second Amended Agreement to be executed as of the dates following their respective signatures below.

CITY OF VICTORVILLE SYMBA CENTER
By:______________________________ By:________________________ Keith C. Metzler, Dr. Shawn Smith,
City Manager Executive Director

Dated: ___________________________ Dated: ______________________ ATTEST
By: ______________________________
Jennifer Thompson,
City Clerk

APPROVED AS TO FORM
By: _______________________________
Andre de Bortnowsky, City Attorney

RISK MANAGEMENT
By: ________________________________
Sandra Bostick, Risk Manager
P:\APPS\WPDATA\VVCA\0001-45 AGREEMENTS REVIEW & TEMPLATES\WELLNESS CENTER OPERATORS\SYMBA NEW CONSOL WCWS & SO AGMT 2025-\7000.6-SYMBA AMENDMENT NUMBER THREE DRAFT CLN 09.24.26.DOCX 9 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 EXHIBIT “A-3”
ESG – Rapid Rehousing (RRH) Scope of Services
[INSERTED BEHIND THIS PAGE]
EXHIBIT A--3
Emergency Solutions Grant (ESG) - RAPID RE-HOUSING (RRH) Approved Grant Expenditure and Performance Period:

January 2, 2026 - September 1, 2026
Scope of Work Narrative
The ESG Rapid Re-Housing Program will provide a comprehensive program of housing stabilization services designed to assist households experiencing homelessness in securing and maintaining permanent housing. Through this program, the consultant will provide short- and medium-term rental assistance, security and utility deposits, application fee assistance, housing-focused case management, housing navigation, landlord engagement, and housing placement support utilizing a progressive engagement approach.

Program services will focus on helping eligible households transition from emergency shelter, interim housing, transitional housing, or unsheltered homelessness into stable permanent housing. In addition to financial assistance, participants will receive individualized housing stabilization services, including budgeting assistance, income and benefits support, employment referrals, landlord mediation, and ongoing housing retention monitoring.

The program is expected to assist a minimum of five households, with all participating households receiving housing navigation, rental assistance, and case management services. Performance goals include achieving at least five permanent housing placements, maintaining a minimum 80 percent housing retention rate at six months, reducing returns to homelessness, and ensuring full compliance with all ESG eligibility, financial, and reporting requirements.

Required documentation will include client eligibility verification, housing assessments, executed lease agreements, rental assistance agreements, proof of payment records, case management documentation, and housing retention followup records. Through these efforts, the program will increase exits from homelessness, improve long-term housing stability, strengthen landlord partnerships, and contribute to a more efficient and effective local homelessness response system.

Scope of Work
Service Eligible Consultant Deliverables !Budget Ca I
tegory Activity Responsibilities
Provide rental
subsidies to eligible
households exiting Rental assistance
emergency shelter, payments,
Short-Term interim housing, executed lease
Rental and Medium- transitional housing, or agreements, $56,813.76 Assistance Term Rental unsheltered rental assistance Assistance homelessness. agreements, proof
Determine assistance of payment
levels using a documentation.
progressive
engagement model.

Security �ssist households with Payment records,
Deposits, housing placement receipts, utility
Financial Utility deposit
Assistance Deposits, costs necessary to documentation, $10,687.68 Application obtain permanent application fee housing. Fees documentation.

Provide housingfocused case
management, Individual housing
Housing budgeting support, stabilization plans,
Case Stabilization income and benefits monthly case $10,687.68 Management Services assistance, notes, referrals, employment referrals, retention
landlord mediation, monitoring.
and housing retention
support
Conduct housing Housing plans, Housing assessments, housing Housing Search and housing Included Navigation search assistance, placement Placement landlord recruitment and engagement. documentation,
Service Eligible Consultant Deliverables !Budget I Category Activity Responsibilities lease-up support, and landlord outreach
coordination.

Coordinate
housing placement
moving
records. □
Moving Housing assistance and basic Documentation of household items as Assistance (if Placement necessary to support assistance Included
applicable) Support provided successful housing
placement
Maintain all required Complete client Compliance & ESG ESG eligibility and files and reporting Included Documentation Compliance financial documentation documentation.

Submit programmatic
and financial reports to
Program Performance the City documenting Monthly and Included Reporting Monitoring expenditures, housing quarterly reports placements, and
outcomes.

Program Targets
'
Performance Measure ,r�al
!
Households Assisted I At least 5 Households
Households Receiving Housing Navigation �t least 5 Households' Households Receiving Rental Assistance ]tt least 5 Householdsj Households Receiving Case Management �t least 5 Households! !
Permanent Housing Placements j At least 5 Households
Housing Retention at 6 Months I Minimum 80% -
rerformance Measure IIGoal I
'
Returns to Homelessness I
I Reduced I
I
ESG Documentation Compliance 11100% I
Required Documentation
'
Required Document "
Description
Client Eligibility [Verification of Literal Homelessness Documentation Housing Assessment =i Completed intake and housing assessment Lease Agreement I Fully executed lease agreement between tenant and landlord
'
Lease Addendum(s) 1�11 required ESG and program-specific addenda Rental Assistance Agreement between service provider and landlord Agreement regarding rent payments
!
Proof of Payment I
Documentation of rental assistance and financial
assistance payments
Case Management l
jHousing stabilization case notes and service plans Documentation Housing Retention Follow- Documentation supporting outcome tracking Up Anticipated Outcomes
!Outcome I Expected Result
Permanent Housing Increased number of households exiting homelessness into Placement permanent housing
!Housing Stability I Improved housing retention at 6 months and beyond !
Landlord Engag�
ment I Increased landlord participation in housing programs System Efficiency Reduced length of time households experience homelessness
Homelessness Reduction Reduced returns to homelessness through stabilization services
Total Program Budget: $78,189.12
Estimated Households Served: 5
Funding Source: ESG Rapid Re-Housing (RRH)
10 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 EXHIBIT “A-4”
Kaiser Permanente Respite Care Grant Scope of Service
[INSERTED BEHIND THIS PAGE]
Exhibit A-4
Kaiser Respite – Scope of Work
Recuperative Care Navigator / Case Manager Services
Approved Grant Expenditure and Performance Period:

June 16, 2026 - December 31, 2026
Scope of Work Narrative
Purpose
Consultant shall provide a dedicated Recuperative Care Navigator/Case Manager to support implementation of the City's Strengthening Health and Housing Pathways Through Wellness Center Recuperative Care Navigation Project. The position will increase the Wellness Center's capacity to provide recuperative care services, improve healthcare and housing outcomes, strengthen local hospital discharge planning, support individuals experiencing homelessness (with a priority for Victorville) who require a safe environment to recover from medical conditions, and ensure clients are connected to their communities of origin (when their recuperative care time is completed) as applicable.

Responsibilities
The Case Manager shall provide comprehensive case management, care coordination, housing navigation, and benefits assistance to individuals enrolled in recuperative care services. Services shall include intake and assessment, individualized service planning, healthcare coordination, behavioral health referrals, housing placement assistance, transportation coordination, benefits enrollment assistance, and ongoing monitoring of client progress.

The Case Manager shall work collaboratively with the City Homelessness Solutions Team, hospitals, healthcare providers, managed care plans, and community partners to improve referral pathways and continuity of care for individuals exiting hospitals and transitioning toward stable housing.

Deliverables
The Project shall:

1. Provide comprehensive case management services to a minimum of 43 unduplicated clients annually during the grant period.

2. Support utilization and expansion of recuperative care bed capacity.

3. Update on # total beds (filled or vacant) available at any given time

4. Average Monthly Occupancy Rate

5. # clients admitted into Wellness Center facility

6. # of Kaiser Permanente members admitted into Wellness Center facility

7. Client referral and discharge data

8. Victorville Wellness Center will formalize at least one new hospital or health system partnership or add an additional community supports service.

9. Assist eligible clients in accessing healthcare, behavioral health, substance use treatment, benefits, and housing resources.

10. Maintain complete client records and grant-required data.

11. Submit monthly and quarterly performance reports to the City.

Expected Outcomes
Through these services, the Contractor shall assist the City in:
 Increasing recuperative care service capacity.
 Improving health outcomes for medically vulnerable individuals.  Reducing avoidable emergency room utilization and hospital readmissions.  Increasing access to healthcare and behavioral health services.  Improving housing stability and permanent housing outcomes.  Strengthening healthcare and housing partnerships.
 Connecting individuals to their communities of origin Funding Amount: $60,000
Task Area Activities Deliverables Performance
Measure
Client Intake &
Assessment
Conduct assessments for
clients referred by hospitals,
outreach teams, shelters,
and community partners.

Identify medical, behavioral
health, housing, income,
and support service needs.

Completed intake
assessments and
individualized
service plans.
100% of enrolled
clients receive
assessment and
service plan within
7 days of
enrollment.

Task Area Activities Deliverables Performance
Measure
Recuperative
Care
Navigation
Provide ongoing case
management and care
coordination for clients
recovering from illness,
injury, surgery, or
hospitalization.

Case notes,
recovery plans,
appointment
coordination
documentation.

Minimum of 43
clients served
annually during
grant period.

Healthcare
Coordination
Coordinate primary care,
specialty care, behavioral
health, substance use
treatment, and follow-up
appointments.

Referrals and
appointment
tracking records.
90% of clients
connected to
healthcare
services.

Housing
Stabilization
Assist clients with
emergency shelter, interim
housing, rapid rehousing,
permanent supportive
housing, and permanent
housing placements.

Housing
applications,
referrals, and
placement
documentation.

Increased housing
placements and
housing retention
outcomes.

Benefits
Acquisition
Assist clients in obtaining
SSI, SSDI, Medi-Cal,
CalFresh, General Relief,
Veteran's benefits,
retirement benefits, and
other income resources.

Benefit applications
and enrollment
verification.
75% of eligible
clients assisted
with benefit
applications.

Hospital
Partnership
Support
Coordinate with hospitals
and healthcare providers
regarding referrals,
discharge planning, and
continuity of care.

Participate in partnership
meetings.

Meeting
attendance
records, referral
tracking, MOU
support
documentation.

Support
establishment of at
least one new
healthcare
partnership.

Transportation
Coordination
Coordinate transportation
for medical appointments,
Transportation logs
and appointment
verification.

Reduce missed
appointments and
Task Area Activities Deliverables Performance
Measure
housing appointments, and
service connections.
improve service
engagement.

Data Collection
& Reporting
Maintain client files and
collect required grant data
and outcomes.

Monthly and
quarterly reports
submitted to City.
100% timely
submission of
reports.

Community
Resource
Linkages
Connect clients to
employment, education,
legal assistance, family
reunification, behavioral
health, and community
support services.

Referral
documentation and
follow-up records.

Increased service
utilization and
client selfsufficiency.

Program
Collaboration
Participate in
multidisciplinary case
conferences and
coordination meetings with
City staff and partners.

Meeting
attendance and
case conference
documentation.

Active participation
in all required
coordination
meetings.
11 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 EXHIBIT “A-5”
Homeless Housing, Assistance and Prevention
Round 5 Program (HHAP-5) Grant - Scope of Services
[INSERTED BEHIND THIS PAGE]
HHAP-5 Street Outreach – Symba Center | Exhibit A-5
Exhibit A-5
HHAP-5 – Scope of Work
Street Outreach
Approved Grant Expenditure and Performance Period:

October 1, 2026 – May 15, 2028
Scope of Work Narrative
Purpose
Consultant shall provide dedicated street outreach services. Services shall focus on proactive engagement of individuals experiencing unsheltered homelessness, with an emphasis on individuals and families experiencing literal homelessness, particularly persons living in places not meant for human habitation, within the City of Victorville. The purpose of the outreach effort is to identify and engage unsheltered individuals, assess immediate and housing-related needs, connect participants to the Coordinated Entry System (CES), and facilitate linkages to emergency shelter, interim or transitional housing, permanent housing resources, and supportive services.

Responsibilities
 Conduct proactive, field-based outreach and engagement at encampments, public spaces, vehicles, and other locations where unsheltered individuals are known to reside.  Build rapport and provide repeated engagement, when necessary, to support voluntary connection to shelter, housing, and services.
 Complete outreach assessments and housing problem-solving activities for persons engaged.
 Connect participants to CES and complete or coordinate required CES screening and assessment. When emergency assistance is provided before a CES referral, ensure referral to CES for assessment and prioritization within seventy-two (72) hours.  Coordinate referrals and warm handoffs to emergency shelter, interim or transitional housing, permanent housing resources, behavioral health, substance use treatment, healthcare, benefits, employment, veteran services, and other appropriate community resources.
 Assist participants, as appropriate, with identification and other vital documents needed to access housing and services.
 Coordinate transportation necessary to support shelter, housing, benefits, healthcare, or other service connections, when allowable and authorized.  Coordinate with the City Homelessness Solutions Team, CES, outreach partners, law enforcement and Code Enforcement when appropriate, and community-based service providers to reduce duplication and improve continuity of services.

HHAP-5 Street Outreach – Symba Center | Exhibit A-5
 Maintain complete outreach activity logs, client documentation, referral records, and supporting documentation required for reimbursement and monitoring.  Enter or ensure entry of required participant and service data into HMIS/LS in accordance with the prime HHAP-5 agreement and applicable City direction.

Deliverables
 Engage and serve approximately fifty (50) unduplicated unsheltered individuals during the grant performance period.
 Complete fifty (50) client assessments for individuals served through the Street Outreach component.
 Connect at least twenty-five (25) individuals to interim and/or transitional housing, consistent with the City's HHAP-5 performance requirements and participant eligibility/availability.  Document all outreach activity by date, location, staff involved, individuals engaged, assessments completed, referrals made, services provided, and disposition/outcome when known.
 Maintain intake and eligibility documentation for participants and documentation supporting all services reported to the City.
 Maintain timely and accurate HMIS/LS data. Required program entry and service data shall be entered no later than two (2) working days after program entry or date of service, and exits shall be updated within two (2) working days of the actual exit date.  Provide the City with monthly program activity and expenditure documentation and quarterly performance data in the format and timeframe required by the City.  Provide supporting documentation for reimbursement, including outreach logs, applicable intake forms, payroll/time records, salary and benefit support, and other documentation requested by the City.

Expected Outcomes
 Increased engagement with individuals experiencing unsheltered homelessness.  Increased completion of assessments and connection to CES and the regional homelessness response system.
 Increased connections to emergency shelter, interim/transitional housing, permanent housing resources, and supportive services.
 Improved coordination among street outreach teams, the City, CES, and community partners.
 Improved documentation of outreach contacts, service connections, and participant outcomes.
 Progress toward the City's HHAP-5 performance measures, including connections to mainstream benefits/services and housing stability, as applicable to Street Outreach participants.

Performance and Reporting Requirements
Consultant shall comply with all applicable HHAP-5 requirements communicated by the City and with all requirements of the City's prime HHAP-5 agreement that are applicable to the Street Outreach subcontracted services. The City remains the direct contractor with San Bernardino HHAP-5 Street Outreach – Symba Center | Exhibit A-5
County; Consultant shall provide the records and data necessary for the City to satisfy County monitoring, reimbursement, performance, HMIS, audit, and closeout requirements.

Task Area Activities Deliverables Performance
Measure
Street
Outreach &
Engagement
Conduct proactive
outreach to unsheltered
individuals; build rapport;
provide housing-focused
engagement and problemsolving.

Outreach activity logs
documenting date,
location, staff, contacts,
and services.

Approximately 50
unduplicated
individuals served.

Assessment &
CES
Connection
Complete or coordinate
assessments and connect
participants to CES; refer
emergency-assistance
participants to CES within
72 hours.

Completed
assessments, CES
referral/connection
documentation, and
intake records.
50 client
assessments; 100%
of applicable
emergencyassistance
participants referred
to CES within
required timeframe.

Shelter /
Housing
Connection
Link participants to
emergency shelter,
interim/transitional
housing, and permanent
housing resources;
facilitate warm handoffs.

Referral, placement,
and follow-up
documentation.

At least 25 individuals
connected to interim
and/or transitional
housing, subject to
eligibility and
availability.

Supportive
Service
Linkages
Connect eligible/willing
participants to healthcare,
behavioral health, SUD
treatment, benefits,
employment, veteran,
legal, and other resources.

Referral records and
follow-up/case notes.

Demonstrated
service connections;
support City progress
toward applicable
HHAP-5 measures.

Transportation
/ Document
Readiness
Coordinate allowable
transportation and assist
with identification or vital
documents needed for
housing and services.

Transportation and
document-assistance
records, as applicable.

Reduced barriers to
shelter, housing,
benefits, and service
access.

HMIS & Data
Quality
Enter or ensure entry of
required participant,
service, and exit data and
maintain complete and
accurate records.

HMIS records/reports
and data-quality
documentation.

Data entered within 2
working days of
program
entry/service/exit, as
applicable.

HHAP-5 Street Outreach – Symba Center | Exhibit A-5
Program
Coordination
Coordinate with City staff,
CES, outreach partners,
and service providers;
participate in required
case coordination or
program meetings.

Meeting participation
and coordination
documentation.

Active participation in
City-required
coordination
activities.

Fiscal
Documentation
& Reporting
Maintain documentation
supporting HHAP-5 Street
Outreach expenditures
and performance.

Monthly
activity/expenditure
support and quarterly
performance
information.
100% timely
submission of
complete reports and
supporting
documentation
requested by the
City.

Funding
Not-to-Exceed Amount: $52,080.24
Funding is limited to the HHAP-5 Street Outreach allocation. Reimbursement is contingent upon eligible, documented, and approved expenditures and shall not exceed the amount stated above.
12 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 THIRD AMENDED EXHIBIT “B-1”
Non-ERF-3 Budget
[INSERTED BEHIND THIS PAGE]
PERSONNEL/STAFFING FTE Per Hour Total Budgeted FTE Per Hour Total Budgeted FTE Per Hour Total Budgeted FTE Per Hour Total Budgeted Intake Specialist 1 $28.00 $58,240.00 1 $28.00 $58,240.00 1 $28.84 $59,987.20 1 $29.71 $61,786.82 Case Managers/HN 8 $28.00 $465,920.00 8 $28.00 $465,920.00 8 $28.84 $479,897.60 8 $29.71 $494,294.53 Occupational Therapist 0.5 $50.00 $52,000.00 0 $50.00 $0.00 0.4 $51.50 $42,848.00 0.4 $53.05 $44,133.44 Peer Support Specialists 21 $20.00 $890,240.00 21 $20 - $22 $890,240.00 21 $20.99 $916,843.20 21 $21.62 $944,348.50 PSS Lead 3 $25.00 $156,000.00 3 $25.75 $160,680.00
Licensed Vocational Nurse 4 $28.50 $237,120.00 3 $31.00 $193,440.00 4 $31.93 $265,657.60 4 $32.89 $273,627.33 Medical Assistants 5 $20.00 $208,000.00 3 $20.00 $124,800.00 3 $20.60 $128,544.00 3 $21.22 $132,400.32 LMFT Therapist 1 $75.00 $156,000.00 1 $74.52 $155,001.60 1 $76.76 $159,651.65 1 $79.06 $164,441.20 LMFT Associate 1 $40.00 $83,200.00 1 $38.63 $80,350.40 1 $39.79 $82,760.91 1 $40.98 $85,243.74 Medical Director 0.2 $0.00 0.2 $0.00 0.2 $0.00 $0.00 0.2 $0.00 $0.00 Pharmacist 0.5 $85.00 $88,400.00 0.2 $78.00 $32,448.00 0.5 $80.34 $83,553.60 0.5 $82.75 $86,060.21 Nurse Practitioner (medical recup) 0.5 $85.00 $88,400.00 0.4 $87.55 $72,841.60 0.4 $90.18 $75,026.85 0.4 $92.88 $77,277.65 Nurse Practitioner (psych recup) 0.5 $85.00 $88,400.00 0.2 $82.40 $34,278.40 0 $84.87 $0.00 0 $87.42 $0.00 Kitchen Manager 1 $30.00 $62,400.00 1 $25.00 $52,000.00 1 $25.75 $53,560.00 1 $26.52 $55,166.80 Kitchen Staff 6 $20.00 $249,600.00 5 $20.00 $208,000.00 6 $20.60 $257,088.00 6 $21.22 $264,800.64 Registered Nurse Case Manager 1 $55.00 $114,400.00 1 $55.00 $114,400.00 1 $56.65 $117,832.00 1 $58.35 $121,366.96 Security 8 $25.00 $416,000.00 10 $25.00 $494,000.00 10 $25.75 $535,600.00 10 $26.52 $551,668.00 Substance Abuse Counselor 1 $27.00 $56,160.00 1 $27.00 $56,160.00 1 $27.81 $57,844.80 1 $28.64 $59,580.14 Wellness Center Manager 1 $50.00 $104,000.00 1 $43.50 $90,480.00 1 $44.81 $93,194.40 1 $46.15 $95,990.23 Assistant Manager 1 $41.00 $85,280.00 1 $41.00 $85,280.00 1 $42.23 $87,838.40 1 $43.50 $90,473.55 Data Coordinator 1 $27.00 $56,160.00 1 $27.00 $56,160.00 1 $27.81 $57,844.80 1 $28.64 $59,580.14 Drivers 2.5 $27.00 $140,400.00 2.5 $27.00 $140,400.00 2.5 $27.81 $144,612.00 2.5 $28.64 $148,950.36 Subtotal, Personnel/Staffing $3,700,320.00 $3,404,440.00 $3,856,185.01 $3,971,870.56 Fringe @16% $592,051.20 $544,710.40 $531,293.60 $547,232.41 Payroll Taxes $409,492.21 $409,492.21 $316,783.81 $326,287.32 TOTAL, PERSONNEL $4,701,863.41 $4,358,642.61 $4,704,262.42 $4,845,390.29

PROGRAM/OPERATING
Office & Janitorial Supplies $40,000.00 $17,500.00 $18,025.00 $18,565.75 Medical Supplies $20,000.00 $15,000.00 $15,450.00 $15,913.50 FF&E $37,750.35 $37,750.35 $38,882.86 $40,049.35
Meals $887,675.00 $573,050.00 $590,241.50 $607,948.75
Client Supplies (Laundry &
Hygiene) $39,775.00 $16,000.00 $16,480.00 $16,974.40
Misc (Client) $30,600.00 $15,000.00 $15,450.00 $15,913.50 Vehicle Gas and Maint. $10,000.00 $10,000.00 $10,300.00 $10,609.00 Vehicle Lease $22,632.00 $22,632.00 $23,310.96 $24,010.29 Vehicle Washing $10,200.00 $6,000.00 $6,180.00 $6,365.40 Pest Control $2,000.00 $2,000.00 $2,060.00 $2,121.80
Mileage $20,000.00 $20,000.00 $20,600.00 $21,218.00
Supportive Services Operations
TOTAL, PROGRAM $1,120,632.35 $734,932.35 $756,980.32 $779,689.73 INDIRECT/OVERHEAD $387,032.75 $193,537.20 $199,343.32 $205,323.62 Professional Development $10,000.00 $5,000.00 $5,150.00 $5,304.50 THIRD AMENDED EXHIBIT “B-1”
NON- ERF-3 BUDGET
Contracted Balances 1st Amended Updated Budget (Year 1 budget) 2nd Amended Updated Budget (Year 2 budget) Amended Updated Budget (Year 3 budget) Meals and Team Engagement $42,000.00 $5,000.00 $5,150.00 $5,304.50 Vehicle Depreciation $12,000.00 $12,000.00 $12,360.00 $12,730.80 Miscellaneous Expenses $20,000.00 $10,000.00 $10,300.00 $10,609.00 Subcontracts (Billing Services) @
7% $248,032.75 $106,537.20 $109,733.32 $113,025.32
Capital/Equipment Van $55,000.00 $55,000.00 $56,650.00 $58,349.50 INSURANCE $184,930.82 $184,930.82 $224,164.44 $230,889.38 Facility Insurance $34,930.82 $34,930.82 $35,978.74 $37,058.11 Vehicle Insurance $25,000.00 $25,000.00 $25,750.00 $26,522.50 Section 4 (3) Insurance Costs $125,000.00 $125,000.00 $162,435.70 $167,308.77 TOTAL, INDIRECT $571,963.57 $378,468.02 $423,507.76 $436,212.99 Administrative 10% of Expenses $639,445.93 $383,043.01 $588,475.05 $606,129.30

TOTAL EXPENSES
(Personnel + Program + Indirect)
Funding from Victorville $2,825,000.00 $2,825,000.00 $2,909,750.00 $2,997,042.50 Cost to Symba Center $4,208,905.26 $3,030,085.99 $3,563,475.55 $3,670,379.82 Amount Notes
Emergency Solutions Grant - RRH 78,189.12 See Exhibit B-3 Kaiser Respite Grant - Case Management 60,000.00 See Exhibit B-4 HHAP-5 Street Outreach 52,080.24 See Exhibit B-5
$7,033,905.26 $5,855,085.99 $6,473,225.55 $6,667,422.32 13 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 THIRD AMENDED EXHIBIT “B-2”
ERF-3 Budget
[INSERTED BEHIND THIS PAGE]
THIRD AMENDED EXHIBIT B-2
ERF-3 Budget
ERF BUDGET (3rd Amended)

Category Description 1
st Amended 2
nd Amended Notes
Rapid Re-Housing (RRH) $1,159,920 $1,159,920
- Rental Subsidies Monthly rental assistance $494,676 $494,676 - Security Deposits One-time deposit support $57,665 $57,665 - Landlord Incentives Landlord engagement $17,659 $17,659 - Housing Search Assistance
Staff support and
transportation $178,280 $178,280
- Community-Based Services Access to essential services $411,640 $411,640 Contingency Fund Reserve for unexpected costs $0 $0
Outreach Case Management
Trauma-informed, clientcentered support $224,000 $284,000 Adding
$60,000.00 in
Outreach
Case Management Services Services
LVN Medical Services Basic health services $156,000 $156,000 Medical Services for Clients
Housing Navigator Landlord engagement,
aftercare $135,000 $135,000
Housing Navigation
Total (including advance of
$300,000.00) $1,674,920 $1,734,920
Total (less the expended
advance) $1,374,920 $1,434,920
14 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 EXHIBIT “B-3”
Operating Budget for ESG – Rapid Rehousing (RRH) Grant Services [INSERTED BEHIND THIS PAGE]
BUDGET
!
Budget Category
!
Rental Assistance
Financial Assistance
Housing Navigation &
Case Management
Total ESG RRH Funding
EXHIBIT B-3

EMERGENCY SOLUTIONS GRANT (ESG)

RAPID RE-HOUSING (RRH) PROGRAM
"
Eligible Activity
I Short-Term and Medium-Term Rental Assistance
Security Deposits, Utility Deposits, Rental
Application Fees, and Related Housing Costs
Housing Search, Landlord Engagement, Housing
Stabilization Services, and Case Management
I mount
$56,813.76
$10,687.68
$10,687.68
$78,189.12
15 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 EXHIBIT “B-4”
Operating Budget for Kaiser Permanente Respite Care Grant Services [INSERTED BEHIND THIS PAGE]
EXHIBIT B-4

COV/KAISER RESPITE CARE PROGRAM
Budget
Budget Category Description Amount
Personnel
Recuperative Care Navigator / Case
Manager
$60,000.00
Total Kaiser Permanente
Funding
$60,000.00
16 Consultant/PSA /Symba Center/ Wellness Center Consol. Project No. JM23-065-1/Amendment No. 3 EXHIBIT “B-5”
Operating Budget for Homeless Housing, Assistance and Prevention Round 5 Program (HHAP-5) Grant - Outreach Services
[INSERTED BEHIND THIS PAGE]
EXHIBIT B-5
HHAP-5 Street Outreach Budget
Budget
Budget Category Description Amount
Personnel Street Outreach staƯ $52,080.24
Total HHAP-5 Funding $52,080.24
EXHIBIT "C"

WELLNESS CENTER MAP
CXJ9
J
9 iu6i6LE4�
47-�FDVl<.;8tur ville Wellness Center Campus Map
Note: the subject campus map is provided to give a general understanding of campus layout and is subject to change.

BUILD:NG NOTES , PAf'tl.(!NQ P!mV1DED ·
• �F • .t.
•/;TIJtu.AO •31
• F,V�lGT.1.TO. ,. o'I !,PAC:t2
• C'..£'.H�lV�.J..li.� " :.J \'f'N.1!1
-�j,-N,.':'.!f'"i;�
• !rn'i':t:f"'A.QlfJ(.l�. 4 � IP.I.CU

1./)...:.t'f'Jftf.t_Qb!:H)
SCYClE PAAKING
::::r:;:s·:���-,?;;t):;/::�:�tt.�4-. : ��= : : .�� i'
,:x_\ ���h_��F'ti',o.o-- tr<itt<�t
"!H"M&.l�tU1'1, � n!W::fnl""'-U
t H'JM.•Po\tl1\N!J,l,/llUn:':T11'.1..t:,�
� 71'.ol-TI-5t'IC'l'.i,l}
<I)�=���-:�•:,
... ·.'lff1£0CO•ffl•'· 110'..:;:TJ
� :!•NM.•lfl)\IC.11 • tlfl:.t'J!
7,_.;-ffittO";-JU
.. , . ��re.>l'H'.J.tf�\�' J 1
• n .. ,...,tn::irM.J
.j) !,;�'��r:,�t!;f:·�i:,oJ
., �-�.L�\Fr,-r • Pl!ifitir'
.··;;.;,T':Yti'rr:r£t-1
•.+<;:ru.lC!lf�TI•IJl'f"l"·-"�MJ'.F'n't.El1•
·-•.�"M;
(�) tt-=��1�\0f. t,Xi,-SJ
•;l-1Kl..flfi:,t.,C",2•�R'TJ'l
-1<l!Q"'1';9'!!>�, .... �
� n��'"'"�,11 .. /
• .,�r,;;Tl-11.;-,,1..;.M;fl';f'.('�1,,
• '���,::14.J
(t('.· :����i��. w��;
.. t,""''Jt'.l(t:'t!N: ,: • ��
• t·OO.�E>lw.a♦ • ":I�
;;."ii(ll'T,l'l";-.
.;!'1'1'._;
-�•�:v.-t"HH"tt .. ...,'.l...,u,."u1J,,
•ft!A:t$fl�1'.)
.
;·.�) �����"�?' .. u,r,r,,J
•.+�ll{DV"T•l• •£'I'
• l'-1nn,1 !T1"!•"'•• - ""l'"IE.."'!
--
:-fcrrn"frrcrrf _ i
.. '��!U�!�(���f1ti
•'&lo-00(':7,JU
{?.) �:;t;.J:1��\ Ht)�l
•l{ltdl'rtnlffl,t• 'R.Tr.
• :,,.,00..RF!'f'l'hNTJ♦ �t'l'O':'.,:.: • �l'F:'i
��.,..i,l,fl1\l'f"'��"7,.�··
(�) ����� ,1_7r.�
• � ... fN, 1.'+f� :,-.
.. �,lflll.o. ttffif!T
... i'OLCI �·
•LJ,IJOl,;·�,4 �rr
... .,,.,,,-w!,,,�,.. �:"
.. v,,m� -��
/",
"'
."'-1��- ?'1'n-'!F
·,._,,, t�'7-EL�i
,i.e: Et-LV':llDr'J-M::.. A-:rn
(\1) �����' ��
t�•)J'.'r
�ffl. .
rry.•r1 .«(nl";.M4r.tl,1,,•l.P
• tFOl'f�\HM"Jl'f'• • 1,:..r,,r
• «:<Ul"ITt:i!.-,0,.A.'f•J. � �,.,
(ti)�Jf��' U:OJO"'
�tH.,�f"..Rl�A•t�l
(i,> .:'.Offl\l.L,OCI.Frf,'.��F',,'A;mj ·-_I IE: LNf;:s;}lt: fV."iJ (§J �Bf�&��
(,.--
1 t'!ffJf'JHt:A/�A'l"/l
',.·(�t,.lct:.+IC,..A.W,U�l
Fl',M,�LJ,t,E
l.CADff.'l!:tl-("-.J;;;:,.Y.:l
<�\ �:m'h�W3-�msr1�-:;J
:;;;�:.� :;:r:;�. ;:;;.��,,,
(�)�.��
,·_�)
\��) �1��'VN
€t f'���;�ffl''.. F'th��T'M�?N:nt,:tm)
{�),f��ilf:i�l
w.i,_1 n_�J.,.�tJC'ICIM.WM
�) �f'.Jr�'\�re.?:
(�) ���&��w,,�j
s,,·,-.ar-Vir"kAlt"Jomlr.l�}l'!ft'"A
w:��,�PJ<�
i.�"•1 �-�����;� C8:'1"'1t -tri-t".l--lll'::T�r"A1!thl
'?'f'Arl;.�Wi.LL�,Y.0'�1
G�;, ... �:1 r
.
�r,��;' :? i. , , i
\
.
�} B�r:-=rCl.k:Fl'M'JJffir.lAIF.i.)
f
�) ����'a0:1'!'>:'.N
t�) ����=?" rJ;IJ.
(�) ���f�ff'�� EOFT,1,1 Cti1/A-03
.''' '..'ltJTil l'Ol,..,O '":· '{"",'['; IJ"''''°"'1
�"
,]';',;.i:,t;'.'
;;.�1..:--rt: t/ ••t'ry:':,_l)
(f!�! ���·��,;1��
�L'tJ���!-�,
tiJ}t:ilt".i:!i:�·•l!;_{ 11
'· $,:;�.
(�\ ��l�.•\P #'Vt
:;1_:) r������ r.>.lff"!
11'"-A"�CCM""Al'M
•:�! ���t���
a-e--�"'1M, CI-SfEfl':"le..� m-r., r(fl�-,-1 .• ,,-:t.;T,".-rv.·,. ,..-r-..,. ,
-,,;
.,.l"<l", �-Hv l"tl r-,,,..: ,'.1- -t� •:w�! . �,-4;:-, ','::'1<1\""/.
--,;_ �1,:0,, ¥{!) ',fl !��"+ ;,,_;•,,,,,,
--� ;H-t' �• 'i'r 'i!C'·1
·
>',•; i'-.;,.-.
(�)rMIUifi/a
{�l f�?h�� �
(�) OG!,fU-.fff r,.M'itAi �A
(:?1���,;_,.� .,��
ce!l!Q-11.n;tmrAU.J.TDt
F' � !f,/l.CtO�lf.""'c,J¥'!"1
::17) •'-T}'J'.¥
(:�(1 �I-IC�� •-JIO'!J¥ r:eOCN NC MlA!.l.Ami ffl'MCO'..t.14\!l..t.Df#JW..YI"� (�)=��I
�!��t.�·er:,, r.
:�·'::;;/;�'?-tf;,'\':.:.;;.,_'�;;·
,.,-., ,,t� 1"!;,_,,1�.,..�)
/�>FR�r;:oM.NTL,t'l';"ln1
'.�f;, =-'&rt�vc�'frt
rm;;,m:.rer,i,LMC
7'ECR::•�
(�) �t���,.ff..J,��.�"1
{�))a.m.���-
l!,l,,!)'):i!Wt..CO,,PT
::;;,, ,�,���ff"OX'l'Ufi
,,' ��4ci'(;,_,f)j)f!)rr'ft11{
f"!:t--:l!'l!A!.l.et'X.ro°
'
.�'1 £\t.7.�l�>fflr- ,J t'f'lllfHCCJ,!CfCT!!:�} .&. WM. et, '2/�.l (i:ji]�.,�� COfi.'l:1!1,fNOJ.C��""."11,IJ !FV�
f.r.::rq_p,-�IVf-
(;,;;: �td�ME'1'91i...(')("...A,1\,"'>", ._? �,t.
tJff'inl'"tAH
(������� K"'rit ClDP�i iJQ.w.tt�
'•, .r,""1:s,1r.'r,;;r.•;'-,_•·,,.n, '.-,'f'_'
;,.r:•. r�>""r t';l t'c\.:'.""":,,.___,._ �t.>,1·
(�) ��·=�l"fl
11';:'>i '1'! �11 .,.AA"� •'1t Moy ,;;,..'(
t
!t�J,;��;;;}�, .... ,a:1. e;,""( !!"•'.
.•
,'5C, !'-C,.talot\N,J.t,:�,!
'._,1 A.T�'n�N,�� M:=-, , ___ oX.)')"1< ..,.._ r�-1. N,.�"''"'' ,,,,.,,;;,7 ;.t....-,,,;1,,_.,., C?)��;��Z�
PHr,.sE - 2
(�) �f�=�
(�) :tw;;��t Vfu;TM:
t!Q.fff'J w•Jorw.'-f'!'r
,:J:IJl\..,;;e�fM:tO',i
PLAN

ARCHITECTS
1111
1#.HJ C!'l'IC t'il'l•H'
"'FCU)f<Hl'LI,,�, :;'t ,-]111)
il>IONt 1/"il'I ,e.,••,1rn1,

PROPOSED

VICTORVILLE

WELLNESS
CENTER
VICTCfMLI..E. C�LRJANIA
""'"'"
�.,, .. ,, A-1.0
EXHIBIT "D"

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT
This BUSINESS ASSOCIATE AGREEMENT ("BAA") is made and entered into as of this 10/09, day of 10/09/2024 2024, by and between the City of Victorville, a California municipal corporation and charter city ("Covered Entitv") and Symba Center, a California non-profit corporation ("Business AssQciate"), in accordance v.rith the meaning given to those terms at 45 CFR § 160 .103). In this BAA, Covered Entity and Business Associate are each a"�" and, collectively, are the "Parties".

BACKGROUND
I. Covered Entity is either a "covered entity" or "business associate" of a covered entity as each are defined under the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 ("HIP AA") codified at 42 U.S.C. 1320d et seq., and certain privacy and security regulations promulgated by the U.S. Department of Health and Human Services ("HHS") to implement certain provisions of HIP AA and the IDTECH Act (as defined below), as modified by the Final Omnibus Rule effective as of March 26, 2013 (collectively the "IIlPAA Regulation_�") found at 45 C.F.R. Parts 160, 162 and 164, and, as such, is required to comply with HIP AA and the HIP AA Regulations regarding the confidentiality and privacy of Protected Health Information (as defined below); and
II. The Parties have entered into an agreement entitled Consultant/Professional Services Provider Agreement and dated June 6, 2023, in addition to any other agreements between the Parties hereto (collectively, the "Af!reement"), under which Business Associate provides certain specified services to Covered Entity; and
III. In providing services pursuant to the Agreement, Business Associate will have access to Protected Health Information; and
IV. By providing the services pursuant to the Agreement, Business Associate will become a ''business associate" of the Covered Entity as such term is defined under the HIP AA Regulations; and V. Both Parties are committed to complying with all federal and state laws governing the confidentiality and privacy of health information, including, but not limited to, the Standards for Privacy of Individually Identifiable Health Information found at 45 CFR Part 160 and Part 164, Subparts A and E (collectively, the "Privacv Rule"); and
VI. Both Parties intend to protect the privacy and provide for the security of Protected Health Information (''PHI") disclosed to Business Associate pursuant to the terms of the Agreement, HIP AA, the HIP AA Regulations, the lilTECH Act, and other applicable laws.

AGREEMENT
NOW, THEREFORE, in consideration of the mutual covenants and conditions contained herein and the continued provision of PHI by Covered Entity to Business Associate under the Agreement in reliance on this BAA, the Parties agree as follows:

1. Definitions. For purposes of this BAA, the Parties give the following meaning to each of the terms in this Section 1 below. Any capitalized term used in this BAA, but not otherwise defmed, has the meaning given to tl1at term in the HIPAA Regulations or pertinent law.

Pagel of8
A. "Breach" means the acquisition, access, use, or disclosure of PHI in a manner not permitted under the Privacy Rule which compromises the sccuri ty or privacy of the Pill, as defined in 45 CFR § 164 .402.

B. "Breach Notificati911 Raj�" means the portion of the IDP AA Regulations set forth in Subpart D of 45 CFR Part 164.

C. "Data Aggregation" has the same meaning as the term "data aggregation" in 45 CFR §164.501.

D. "Desirnated Record Set" has the meaning given to such term under the Privacy Rule, including 45 CFR §164.501.

E. "Electronic Protected Health Jnf ormation" or "Electronic Pill" has the same meaning as the term "electronic protected health information" in 45 CFR. § 160.103, limited to information created, or received or transmitted by Business Associate from or on behalf of Covered Entity.

F. "Health C�e Operations" has the meaning given to that term in 45 CPR§ 164.501.

G. "HITEC}l Ayt" means the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act of 2009, Public Law 111-5.

H. "Individual" has the same meaning given to that term in 45 CFR § 160. I 03 and includes a person who qualifies as a personal representative in accordance with 45 CFR § 164.502(g).

I. "Privacy RuJe" means that portion of the HIP AA Regulations set forth in 45 CFR Part 160 and Part 164, Subparts A and E.

J. "Protected Health Information" or "PHI" has the meaning given to the term "protected health information" in 45 CPR§ 160.103, limited to the information created or received by Business Associate from or on behalf of Covered Entity. Protected Health Information shall include Electronic Protected Health Information.

K. "Securit v Incident" has the meaning given to that term in 45 CFR § 164.304.

L "Securitv Rule" means the Security Standards for the Protection of Electronic Health Information provided in 45 CFR Part 160 and Part 164, Subparts A and C.

M. "E&gy.ired bv Law" has the same meaning as the tenn "required by law" in 45 CPR §164.103.

N. "Unsecured Protected l{�_alth Information" or "Unsecured PHI" means any "protected health information" as defined in 45 CFR §160.103 that is not rendered unusable, unreadable, or indecipherable to unauthorized persons through the use of a technology or methodology specified by the HHS Secretary in the guidance issued pursuant to the HITECH Act and codified at 42 USC § 17932(h).

2. Use and Disclosure of Pm.

A. Except as otherwise provided in this BAA, Business Associate may use or disclose Pill as reasonably necessary to provide the services described in the Agreement to Covered Entity, and to undertake other activities of Business Associate permitted or requ'ired of Business Associate by this BAA or as Required by Law.

B. Except as otherwise limited by this BAA or federal or state law, Covered Entity authorizes Business Associate to use the Pill in its possession for the proper management and administration of Business Associate's business and to carry out its legal responsibilities. Business Associate may disclose PHI for its proper management and administration, provided that (i) the disclosures are Required by Law; or (ii) Business Associate obtains, in writing, prior to making any disclosure to a third party (a) reasonable assurances from this third party that the PHI will he held confidential as provided under this BAA and used or further disclosed only as Required by Law or for the purpose for which it was disclosed to this third party and (b) an agreement from this third party to notify Business Associate immedfately of any breaches of the confidentiality of the Pill, to the extent it has knowledge of the breach.

C. Business Associate will not use or disclose PHI in a manner other than as provided in this BAA, as permitted under the Privacy Rule, or as Required by Law. Business Associate will use or disclose PHI, to the extent practicable, as a limited data set or limited to the nunimum necessary amount of PHI to carry out the intended purpose of the use or disclosure, in accordance with Section l 3405(b) of the HlTECH Act (codified at 42 USC § 17935(b)) and any of the Act's implementing regulations adopted by HHS, for each use or disclosure of Pill.

D. Upon request, Business Associate will make available to Covered Entity any of Covered Entity's PIIl that Business Associate or any of its agents or subcontractors have in their possession.

E. Business Associate may use PH1 to report violations of law to appropriate Federal and State authorities, consistent with45 CFR §164.502(j)(l).

3. Safeguards Against Misuse of PHI. Business Associate will use appropriate safeguards to prevent the use or disclosure of PHI other than as provided by the Agreement or this BAA and Business Associate agrees to implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the Electronic PHI that it creates, receives, maintains, or transmits on behalf of Covered Entity. Business Associate agrees to take reasonable steps, including providing adequate training to its employees to ensure compliance with this BAA and to ensure that the actions or omissions of its employees or agents do not cause Business Associate to breach the terms of this BAA.

4. Re1Jorting Disclosm·es of PID and Securit ,. Incidents. Business Associate will report to Covered Entity in writing any use or disclosure of PHI not provided for by this BAA of which it bec�mes aware, and Business Associate agrees to report to Covered Entity any Security Incident affecting Electronic PHI of Covered Entity of which it becomes aware. Business Associate agrees to report any such event within five business days of becoming aware of the event.

5. Reporting Breaches of Unsecured PHI. Business Associate will notify Covered Entity in writing promptly upon the discovery of any Breach of Unsecured PHI in accordance with the requirements set forth in 45 CFR § 164.410, but in no case later than 30 calendar days after discovery of a Breach. Business Associate will reimburse Covered Entity for any costs incurred by it in complying with the requirements of Subpart D of 45 CFR §164 that are imposed on Covered Entity as a result of a Breach committed by Business Associate.

6. Mitigation of Disclosures of PHI. Business Associate will take reasonable measures to mitigate, to the extent practicable, any bannful effect that is known to Business Associate of any use or disclosure of PHI by Business Associate or its agents or subcontractors in violation of the requirements of this BAA.

Page3 of8

7. Agreements with Agents or Subcontractors. Business Associate agrees to ensure that any agent, including a subcontractor, that creates, receives, maintains, or transmits Protected Health Infonnation on behalf of Business Associate or on behalf of Covered Entity, agrees contractually in writing to the same restrictions and conditions that apply through this BAA to Business Associate with respect to such Protected Health Information. Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides Electronic Protected Health fuformation, agrees contractually in writing to implement all reasonable and appropriate safeguards and security measures to protect such Electronic Protected Health fuformation. Prior to entering into any subcontracts or agreements relating to the Agreement where the subcontractor or agent receives PID as described in Section 1.J of this BAA, Business Associate shall seek the advance vvritten consent of Covered Entity.

8. Audit Report. Upon request, Business Associate will provide Covered Entity, or upstream Business Associate, with a copy of its most recent independent IIlPAA compliance report (AT-C 315), IDTR UST certification or other mutually agreed upon independent standards based third party audit report.

Covered Entity agrees not to re-disclose Business Associate's audit report.

9. Access to Pm bv Individuals.

A Upon request, Business Associate agrees to furnish Covered Entity with copies of the PHI maintained by Business Associate in a Designated Record Set in the time and manner designated by Covered Entity to enable Covered Entity to respond to an Individual's request for access to PHI under 45 CFR §164.524.

B. In the event any Individual or personal representative requests access to the fudividual's PHI directly from Business Associate, Business Associate within ten (] 0) business days, will forward that request to Covered Entity. Any disclosure of, or decision not to disclose, the PHI requested by an fudividual or a personal representative and compliance with the requirements applicable to an Individual's right to obtain access to Pm shall be the sole responsibility of Covered Entity.

10. Amendment of Pm.

A. Upon request and instruction from Covered Entity, Business Associate will amend Pill or a record about an Individual in a Designated Record Set that is maintained by, or otherwise within the possession of, Business Associate as directed by Covered Entity in accordance with procedures established by 45 CFR § 164.526. Any request by Covered Entity to amend such information will be completed by Business Associate within fifteen (15) business days of Covered Entity's request.

B. fu the event that any fudividual requests that Business Associate amend such Individual's PHI or record in a Designated Record Set, Business Associate within ten (I 0) business days wiU forward this request to Covered Entity. Any amendment of, or decision not to amend, the Pill or record as requested by an Individual and compliance with the requirements applicable to an Individual's right to request an amendment of PHI will be the sole responsibility of Covered Entity.

11. Accounting of Disclosures.

A Business Associate will document any disclosures of PHI made by it to account for such disclosures as required by 45 CFR § 164.528(a). Business Associate also will make available information related to such disclosures as would be required for Covered Entity to respond to a request for an accounting of disclosures in accordance with 45 CFR § 164.528. At a minimum, Business Associate will furnish Covered Entity the following with respect to any covered disclosures by Business

Associate: (i) the date of disclosure of PHI; (ii) the name of the entity or person who received PHI, and, if known, the address of such entity or person; (iii) a brief description of the PHI disclosed; and (iv) a brief statement of the purpose of the disclosure which includes the basis for such disclosure.

B. Business Associate will furnish to Covered Entity information collected in accordance with this Section 11, within ten ( I 0) business days after written request by Covered Entity, to permit Covered Entity to make an accounting of disclosures as required by 45 CFR §164.528, or in the event that Covered Entity elects to provide an Individual with a list of its business associates, Business Associate will provide an accounting of its disclosures of PHI upon request of the Individual, if and to the extent that such accounting is required under the HITECH Act or under HHS regulations adopted in connection with the HJTECH Act.

C. In the event an Individual delivers the initial request for an accounting directly to Business Associate, Business Associate will within ten (10) business days forward such request to Covered Entity.

12. Availability of Books and Records. Business Associate will make available its internal practices, books, agreements, records, and policies and procedures relating to the use and disclosure of PHI, upon request, to the Secretary of HHS for purposes of determining Covered Entity's and Business Associate's compliance with the HIP AA Regulations, and this BAA.

13. Responsibilities of Covered Entitv. With regard to the use and/or disclosure of Protected Health Information by Business Associate, Covered Entity agrees to:

A. Notify Business Associate of any limitation(s) in its notice of privacy practices in accordance with 45 CFR § 164.520, to the extent that such limitation may affect Business Associate's use or disclosure of PHI.

B. Notify Business Associate of any changes in, or revocation of, permission by an Individual to use or disclose Protected Health Information, to the extent that such changes may affect Business Associate's use or disclosure of PHI.

C. Notify Business Associate of any restriction to the use or disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR § 164.522, to the extent that such restriction may affect Business Associate's use or disclosure of PIIl.

D. Covered Entity shall not request Business Associate to use or disclose PIIl in any manner that would not be permissible under ITIPAA if done by Covered Entity. Except that Business Associate may use or disclose Protected Health Information for management, administrative, and legal activities of Business Associate and for Data Aggregation.

14. Data Ownership. Business Associate's data stewardship does not confer data ownership rights on Business Associate with respect to any data shared with it under the Agreement, including any and all forms thereof.

15. Term and Termination.

A. This BAA will become effective on the date first written above, and will continue in effect until all obligations of the Parties have been met under the Agreement and under this BAA.

B. Covered Entity may terminate immediately this BAA, the Agreement, and any other related

agreements if Covered Entity makes a determination that Business Associate has breached a material tenn of this BAA and Business Associate has failed to cure that material breach, to Covered Entity's reasonable satisfaction, within 30 days after written notice from Covered Entity. Covered Entity may report the problem to the Secretary of HHS if termination is not feasible.

C. If Business Associate determines that Covered Entity has breached a material term of this BAA, then Business Associate will provide Covered Entity with written notice of the existence of the breach and shall provide Covered Entity with 30 days to cure the breach. Covered Entity's failure to cure the breach within the 30-day period will be grounds for immediate tennination of the Agreement and this BAA by Business Associate. Business Associate may report the breach to IIBS.

D. Upon termination of the Agreement or this BAA for any reason, all PHI maintained by Busjness Associate will be returned to Covered Entity or destroyed by Business Associate. Business Associate will not retain any copies of such information. This provision will also apply to PHI in the possession of Business A.ssociate's agents and subcontractors. If return or destruction of the Pill is not feasible, in Business Associate's reasonable judgment, Business Associate will furnish Covered Entity with notification, in writing, of the conditions that make return or destruction infeasible. Upon mutual agreement of the Parties that return or destruction of the PID is infeasible, Business Associate will extend the protections of this BAA to such information for as long as Business Associate retains such infonnation and will limit further uses and disclosures to those purposes that make the return or destruction of the infoimation not feasible. The Parties understand that this Section 15.D. will survive any tennination of this BAA.

16. Effect of BAA.

A. This BAA is a pa.it of and subject to the terms of the Agreement, except that to the extent any terms of this BAA conflict with any term of the Agreement, the terms of this BAA will govern.

B. Except as expressly stated in this BAA or as provided by law, this BAA will not create any rights in favor of any third party.

17. Notices. All notices, requests and demands or other communications to be given under this BAA to a Party will be made via either first class mail, registered or certified or express courier, or electronic mail to the Party's address given below ( each Party may change its address from time to time upon written notice to the other Party of the new address:

Ifto Covered Entity, to:

Attn:

Email:

CITY OF VICTORVILLE
14343 Civic Drive
Victorville, CA 92392
Scott Webb, Deputy City Manager
[email protected]
Ifto Business Associate, to: SYMBA CENTER
2060 I HWY 18, Suite 188
Apple Valley, CA 92307
Attn: Shawn R. Smith PhannD, Executive Director
Email
: [email protected]
Notices will be deemed to have been given upon receipt (or when delivery is refused) and may be (a) delivered personally, (b) sent via certified mail (return receipt requested), (c) sent via email, fux (all with confumation of

receipt) or (c) sent by recognized air courier service. For the avoidance of doubt, confirmation of receipt with respect to any notice or communication sent by email means an email received by the sender from the individual to whom the notice or communication was sent which specifically aclmowledges receipt of the notice or communication. Automated or computer generated "read" or "sent" receipts do not qualify as confirmation of receipt.

18. Amendments and Waiver. This BAA II!ay not be modified, nor will any provision be waived or amended, except in writing duly signed by authorized representatives of the Parties. A waiver with respect to one event shall not be construed as continuing, or as a bar to or waiver of any right or remedy as to subsequent events.

19. Regulaton· References and Amendments. A reference in this BAA to a section in HIPAA, the HIP AA Regulations, or the HITECH Act means the section as in effect or as amended, and for which compliance is required. Upon the effective date of any final regulation or amendment to final regulations promulgated by HHS with respect to PHI, this Agreement will be deemed to be automatically amended such that the obligations imposed on the Parties remain in compliance with such regulations.

20. Amendments. The Parties agree to take such action as is necessary to amend this BAA from time to time as is necessary for Covered Entity to comply with the requirements of HIP AA, the IDP AA Regulations, and the illTECH Act.

21. No Third Pari\' Beneficiaries. Except as expressly provided herein or expressly stated in the HIP AA Regulations, the Parties to this BAA do not intend to create any rights in any third parties.

22. Governing Law. The provisions of this BAA are intended to establish the minimum requirements regarding Business Associate's use and disclosure of PHI under HJPAA, the HIPAA Regulations, and the HITECH Act. The use and disclosure of individually identified health information is also covered by applicable California law, including but not limited to, the Confidentiality of Medical Information Act (California Civil Code section 56 et seq.). To the extent that California law is more stringent with respect to the protection of such information, applicable California law shall govern Business Associate's use and disclosure of confidential information related to the performance of this BAA.

23. Subpoenas. In the event that a party receives a subpoena or similar notice or request from any judicial, administrative or other party in ·connection with this BAA, including, but not limited to, any unauthorized use or disclosure of PHI in breach of this BAA or in violation of the HIP AA Regulations, the party shall as soon as practicable forward a copy of such subpoena, notice or request to the other party and afford the other party the opportunity to exercise any rights it may have under the law.

24. Reimbursement for Fines or Penalties. In the event that Covered Entity pays a fine to a state or federal regulatory agency, and/or is assessed civil penalties or damages through private rights of action, based on an impermissible use or disclosure of Pill by Business Associate or its subcontractors or agents, then Business Associate shall reimburse Covered Entity in the amount of such fine or penalties or damages upon written notice from Covered Entity.

25. Interpretation. Any ambiguity in this BAA shall be resolved in favor of a meaning that permits Covered Entity to comply with HIP AA, the HIP AA Regulations, the HITECH Act, and in favor of the protection of PHI.
[END OF PAGE - SIGNATURES FOLLOW]

IN LIGHT OF THE MUTUAL AGREEMENT AND UNDERSTANDINGS DESCRJBED ABOVE, the Parties excculc this BAA as of the date first written above.

COVERED ENTITY

CITY OF VICTORVILLE
By:

Name: Scoll Webb
Title: Deputy City Manager
APPROVED AS TO FOR.1v1:

SIGNEO lN

COUITTERPART
Andre de Bortnowsky, City Allomey

VICTORVILLE RISK MANAGEMENT

BUSINESS ASSOCIATE

SYMBA CENTER
Name: Shawn R. Smith, Pham1D
Title: Execulive Director

IN LIGHT OF THE MUTUAL AGREEMENT AND UNDERSTAA"DINGS DESCRIBED ABOVE, the Parties execute this BAA as of the date first written above.

COVERED ENTITY

CITY OF VICTORVILLE
By:

S!GNEOIN
COUf\TERPART
Name: Scott Webb
Title: Deputy City Manager
APPROVED AS TO FORM:

Andre de Bortnowsky, City Allomey

VICTORVILLE RISK MANAGEMENT

BUSINESS AS SOCIA TE

SYMBA CENTER
Name: Shawn R. Smith, PbarmD
Tit.le: Executive Director

Docusign Envelope ID: A1499C01-CF55-4454-8AD9-69D9B2204803 Model Business Associate Agreerrler1i - Syt-r1ba
Center
Final Audit Report
Created:

By:

Status:

Transaction ID:
2024-09-10
Amanda Bellenes ([email protected])
Signed
CBJCHBCAABAAejlOErP6ax30Q43WQY4Vj9GlyXtT JMRn
2024-09-10
"Model Business Associate Agreement - Symba Center" History Document created by Amanda Ballanes ([email protected]) 2024-09-10 • 3:55:21 PM GMT
k� Document emailed to Shawn Smith ([email protected]) for signature 2024-09-10 • 3:55:28 PM GMT
Email viewed by Shawn Smith ([email protected])
2024-09-10- 4:52:48 PM GMT
,�) Document e-signed by Shawn Smith ([email protected]) Signature Date: 2024-09-10 • 4:54:23 PM GMT - Time Source: server e Agreement completed.
2024-09-10 - 4:54:23 PM GMT
Adobe Acrobat Sign
DocuSiglT
Certificate Of Completion
Envelope Id: A 1499C01 CF5544548AD969D9B2204803 Status: Completed Subject: Complete with Docusign: COV Business Associate Agreements with Hope the Mission & Symba Center Source Envelope:

Document Pages: 18
Certificate Pages: 4
AutoNav: Enabled
Envelopeld Stamping: Enabled
Signatures: 2
Initials: 0
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
Record Tracking
Status: Original
10/31/2024 8:17:16 AM
Signer Events
Andre de Bortnowsky
[email protected]
Partner
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:

Accepted: 9/14/2021 8:07:41 AM
ID: 89fd4926-8d5b-469d-a54e-529db0d246c 7
In Person Signer Events
Editor Delivery Events
Agent Delivery Events
Intermediary Delivery Events
Certified Delivery Events
Carbon Copy Events
Witness Events
Notary Events
Envelope Summary Events
Envelope Sent
Certified Delivered
Signing Complete
Completed
Holder: Amanda Ballanes
[email protected]
Signature
Signature Adoption: Pre-selected Style
Using IP Address: 70.173.6.99
Signature
Status
Status
Status
Status
Status
Signature
Signature
Status
Hashed/Encrypted
Security Checked
Security Checked
Security Checked
Payment Events Status
Electronic Record and Signature Disclosure
Envelope Originator:

Amanda Ballanes
[email protected]
IP Address: 24.182.14.221
Location: DocuSign
Timestamp
Sent: 10/31/2024 8:39:07 AM
Viewed: 10/31/2024 8:43:06 AM
Signed: 10/31/2024 1:18:49 PM
Tlmestamp
Timestamp
Tlmestamp
Timestamp
Tlmestamp
Tlmestamp
Timestamp
Timestamp
Timestamps
10/31/2024 8:39:08 AM
10/31/2024 8:43:06 AM
10/31/2024 1 :18:49 PM
10/31/2024 1:18:49 PM
Timestamps