Agenda packet — Yuba City City Council, August 20, 2024 (part 4 of 4)

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HRA Basic Plan Document Adoption Agreement (Single Employer Non-ERISA) 3 3.4(b) Coverage option determined as follows:

N/A
As provided in the Basic Plan Document (i.e., Full Scope Option unless affirmative election of another option)
Participants enrolled in the high deductible health plan are automatically enrolled in the following option unless they affirmatively elect another option:

Limited Scope Option.

Suspended Account Option.

3.4(c) Reimbursement rules:

N/A
As provided in the Basic Plan Document
Other:

3.5 Effective date of waiver upon termination of employment:

Date the Participant’s employment with the Employer terminates Last day of the month in which the Participant’s employment with the Employer terminates
Date on which the Participant’s coverage under the applicable group medical plan terminates
Expiration of opt out election:

At the end of the Plan Year.

N/A-Opt out election is permanent.

Other (Describe):

3.6 Termination of Contributions:

As provided in the Basic Plan Document (i.e., upon ceasing to be eligible, termination of employment, death, or termination of plan).

Other (Describe):

3.7 Termination of Participation:

As provided in the Basic Plan Document
Other (Describe):

ARTICLE IV: BENEFITS UNDER THE PLAN

4.3(a) Claims Run-out Period: In general, there is no deadline for filing claims. However, when (1) a Participant dies without a surviving Spouse or Dependent (or, if applicable a Designated Beneficiary), (2) a deceased Participant’s last surviving Spouse or Dependent (or, if applicable, the Designated Beneficiary) who has access to the Participant’s HC Account under this Plan dies, or (3) a Participant permanently opts out of the Plan, all claims incurred prior to the date on which such person’s participation ceases must be submitted to the Plan within 365 days following the date on which participation ceases. Forfeiture of the HC Account will not occur until such deadline has passed.

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HRA Basic Plan Document Adoption Agreement (Single Employer Non-ERISA) 4 4.7(a) Post-termination Access:

In lieu of COBRA continuation coverage (if applicable), the former Participant may continue to access the HC Account for purposes of obtaining reimbursement of Eligible Expenses. Such access shall continue until the earliest to occur of the events identified in Section 3.7(b), (c), or (d). Such access shall also be provided to those individuals, if any, who were the Participant’s Spouse or Dependents at the time of the termination of the Participant’s employment. Such access to the Participant’s HC Account by a Spouse and Dependents shall cease upon the earlier of the date of termination of the Participant’s access or the date the Spouse ceases to be a Spouse or the Dependent ceases to be a Dependent, as the case may be.

In lieu of COBRA continuation coverage (if applicable), the balance of the former Participant’s HC Account shall be transferred to a post-employment HRA sponsored by the Adopting Employer for the purpose of allowing the Participant to spend down the HC Account under that plan.

The balance of the Participant’s HC Account will be forfeited after a Claims Run-out Period of:

Other (Describe):

4.7(b) Post-death Access by Spouse & Dependents:

In lieu of COBRA continuation coverage (if applicable), the deceased Participant’s surviving Spouse and Dependents, if any, may continue to access the Participant’s HC Account for purposes of obtaining reimbursement of Eligible Expenses until the earlier of: (1) the date on which the HC Account balance reaches zero; or (2) the date on which the last surviving Spouse or Dependent dies.

In lieu of COBRA continuation coverage (if applicable), the balance of the former Participant’s HC Account shall be transferred to a post-employment HRA sponsored by the Adopting Employer for the purpose of allowing the surviving Spouse and Dependents to spend down the HC Account under that plan.

No access allowed. The balance of the Participant’s HC Account will be forfeited after the Claims Run-out Period.

Other (Describe):

Post-death Access by Designated Beneficiary:

The deceased Participant’s Designated Beneficiary, if any, may continue to access the Participant’s HC Account for purposes of obtaining reimbursement of Eligible Expenses until the earlier of: (1) the date on which the HC Account balance reaches zero; or (2) the date on which the Designated Beneficiary dies.

The balance of the former Participant’s HC Account shall be transferred to a postemployment HRA sponsored by the Adopting Employer for the purpose of allowing the Designated Beneficiary to spend down the HC Account under that plan.

No access allowed. The balance of the Participant’s HC Account will be forfeited after the Claims Run-out Period.

4.9 Forfeitures occur:

As provided in the Basic Document
Other (Describe):

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HRA Basic Plan Document Adoption Agreement (Single Employer Non-ERISA) 5 4.9 Use of forfeitures:

Pay administrative costs which would otherwise be paid from the Trust (i.e., Participants’ HC Account balances)
Contributed to the HC Accounts of other Participants
Other (Describe):

4.11 Which plan pays first:

This Plan
Flex plan sponsored by the Adopting Employer.

4.12(d) Other Limitations, if any:

ARTICLE V: CONTRIBUTIONS AND TRUST

5.1 Employer Contribution amount, timing, restrictions (check all that apply):

No Employer Contribution.

One Time Contribution:

Fixed dollar amount $
Fixed formula (Describe):

Restrictions, if any (Describe):

Contributed on (Identify Date):

Recurring Contributions:

Fixed dollar amount
Per month
Per quarter
Per year
Other (Describe):

Restrictions, if any
(Describe):

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HRA Basic Plan Document Adoption Agreement (Single Employer Non-ERISA) 6 Fixed formula (Describe):

Per month
Per quarter
Per year
Other (Describe):

Restrictions, if any
(Describe):

Annual Contribution of Accumulated Paid Time Off, Vacation, or Sick Leave (Describe):

Contribution of Accumulated Paid Time Off, Vacation, or Sick Leave Upon Termination of Employment (Describe):

5.3 Direction of Investments:

Plan Administrator
Participant
Other (Describe):

ARTICLE X: GENERAL PROVISIONS

10.6 Administrative expenses shall be paid as follows:

Fixed fees shall be charged to the Plan and paid from the general assets of the Adopting Employer; asset-based fees shall be charged to the Participant and paid from the Participant’s HC Account.

All fees shall be charged to the Plan and paid from the general assets of the Adopting Employer.

All fees shall be charged to the Participant and paid from the Participant’s HC Account.

Other (Describe):

If the payment is different for Participants once they terminate employment, complete again:

N/A
Fixed fees shall be charged to the Plan and paid from the general assets of the Adopting Employer; asset-based fees shall be charged to the Participant and paid from the Participant’s HC Account.

All fees shall be charged to the Plan and paid from the general assets of the Adopting Employer.

All fees shall be charged to the Participant and paid from the Participant’s HC Account.

Other (Describe): As indicated on the fee schedule for the Plan.

10.7 Governing law – State of California

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HRA Basic Plan Document Adoption Agreement (Single Employer Non-ERISA) 7 10.17 Statute of Limitations:

As provided in the Basic Plan Document
Other (Describe):

10.19(a) Grandfathered Status:

The Plan is a grandfathered plan
The Plan is not a grandfathered plan

10.19(c) The Plan is a HIPAA excepted benefit Yes No

ACKNOWLEDGEMENTS

1. Pursuant to Section 2.10(b) of the Basic Plan Document, any collectively bargained Employees participating in this Plan participate because the collective bargaining agreement provides for coverage under this Plan.

2. This Plan has been duly adopted or authorized to be adopted by the Adopting Employer.

3. This Plan is a “covered entity” for purposes of the Privacy Rules under the Health Insurance Portability and Accountability Act (HIPAA).

ADOPTING EMPLOYER: City of Yuba City
Date: By:

Its:

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Funded HRA Basic Plan Document (Single Employer ERISA)

FUNDED POST-EMPLOYMENT HEALTH REIMBURSEMENT ARRANGEMENT

BASIC PLAN DOCUMENT

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Funded HRA Basic Plan Document (Single Employer ERISA)

TABLE OF CONTENTS
ARTICLE I. INTRODUCTION ................................................................................................................1 ARTICLE II. DEFINITIONS...................................................................................................................2 ARTICLE III. ELIGIBILITY AND PARTICIPATION OF EMPLOYEES ...........................................................6 ARTICLE IV. BENEFITS UNDER THE PLAN ............................................................................................9 ARTICLE V. CONTRIBUTIONS AND TRUST .........................................................................................15 ARTICLE VI. CLAIMS DETERMINATIONS AND REVIEW OF DENIED CLAIM ...........................................16 ARTICLE VII. HIPAA PRIVACY AND SECURITY PROVISIONS ................................................................21 ARTICLE VIII. PLAN ADMINISTRATION..............................................................................................25 ARTICLE IX. PLAN AMENDMENT AND TERMINATION..........................................................................27 ARTICLE X. GENERAL PROVISIONS....................................................................................................28

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INTRODUCTION

1.1 Establishment. An executed Adoption Agreement plus this Basic Plan Document constitute the “Plan.” The effective date of the Plan is set forth in the Adoption Agreement.

1.2 Purpose. The purpose of the Plan is to provide certain former Employees with an opportunity to receive reimbursement for certain Eligible Expenses as provided in this Plan. It is the intention of the Adopting Employer that the benefits provided and payable under this Plan be eligible for exclusion from the gross income of Participants as provided by Sections 105(b) and 106 of the Code. In addition, it is the intention of the Adopting Employer that the Plan qualify as a Health Reimbursement Arrangement (“HRA”) under IRS Revenue Ruling 2002-41 (June 26, 2002) and IRS Notice 2002-45 (June 26, 2002).

1.3 HIPAA Privacy and Security Rules. This Plan is a “covered entity” for purposes of the Privacy Rules and Security Rules as described in greater detail in Article VII below.

1.4 Trust. This Plan is funded through a Trust, reflected in a separate document.

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DEFINITIONS
The following words and phrases are used in this Plan and shall have the meanings set forth in this Article unless a different meaning is clearly required by the context or is defined within an Article.

2.1 Adopting Employer means the entity that adopts this Plan by completing and executing an Adoption Agreement.

2.2 Adoption Agreement means the separate agreement, or portions thereof, completed and executed by an Adopting Employer setting forth the Adopting Employer’s selection of options under the Plan.

2.3 Authorized Representative means, for the claims and appeal procedures, the person entitled to act on behalf of the claimant with respect to a benefit claim or appeal. In order for the Plan to recognize a person as an Authorized Representative, written notification to that affect signed by the claimant and notarized must be received by the Plan. An assignment for purposes of payment is not designation of an “Authorized Representative.”

2.4 Basic Plan Document means this document, which together with an executed Adoption Agreement constitutes the Plan for an Adopting Employer.

2.5 Claims Administrator means the person or entity designated by and under contract with the Plan Administrator to perform certain administrative functions, including, but not limited to, claims administration and recordkeeping.

2.6 Claims Run-out Period means the period of time following the end of a Plan Year (Section 4.3) or the termination of a Participant’s participation in the Plan (Section 4.7) during which the Participant may submit claims to the Plan for expenses incurred during the Plan Year or the Participant’s participation (as the case may be).

2.7 Code means the Internal Revenue Code of 1986, as amended from time to time.

2.8 Covered Individual means a Participant, Dependent of a Participant and the Spouse of a Participant, and any other person appropriately covered under the Plan.

2.9 Dependent means as defined in the Adoption Agreement.

2.10 Employee means any person employed by the Adopting Employer and on the Employer’s W-2 payroll. Employee does not include the following:
(a) Any self-employed individual as described in Section 401(c) of the Code; (b) Any employee included within a unit of employees covered by a collective bargaining agreement unless such agreement expressly provides for coverage of the employee under this Plan;
(c) Any employee who is a nonresident alien and receives no earned income from the Adopting Employer from sources within the United States; (d) Any employee who is a leased employee as defined in Section 414(n)(2) of the Code;

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) (e) An individual classified by the Employer as a contract worker, independent contractor, temporary employee, or casual employee, whether or not any such persons are on the Employer’s W-2 payroll or are determined by the IRS or others to be common-law employees of the Employer; and
(f) Any individual who performs services for the Employer but who is paid by a temporary or other employment or staffing agency such as “Kelly,” “Manpower,” etc., whether or not such individuals are determined by the IRS or others to be common-law employees of the Employer.

2.11 Employer Contribution means a nonelective contribution made by the Adopting Employer on behalf of each Participant in accordance with Section 5.1. The Employer Contribution is an amount that has not been actually or constructively received by the Participant, and it is made available to the Participant exclusively for reimbursement under the Plan. Employer Contributions may include mandatory salary reduction contributions.

2.12 Entry Date means the date as of which an Employee becomes a Participant in this Plan as set forth in the Adoption Agreement.

2.13 ePHI means PHI maintained or transmitted in electronic media, including, but not limited to, electronic storage media (i.e., hard drives, digital memory medium) and transmission media used to exchange information in electronic storage media (i.e., internet, extranet, and other networks).

PHI transmitted via facsimile and telephone is not considered to be transmissions via electronic media.

2.14 ERISA means the Employee Retirement Income Security Act of 1974 and regulations thereunder, as amended from time to time.

2.15 HC Account means “health care account” and is the record keeping account established under the Plan for each Participant.

2.16 Health Care Expense means as defined in the Adoption Agreement, provided it is defined no more broadly than as allowed under applicable law. Notwithstanding the foregoing, if the Adopting Employer sponsors a cafeteria plan, Health Care Expense shall not include premiums that may be paid on a pre-tax basis in accordance with the terms of such cafeteria plan, which may include premiums for major medical coverage provided by the Employer and premiums for coverage under an insurance contract, health maintenance organization agreement, or other benefit agreement providing coverage issued on a non-group, individual basis. To the extent Health Care Expense is defined in the Adoption Agreement to include premiums for qualified long-term care insurance, the amount of such premium that will qualify as a Health Care Expense shall be limited to the portion that constitutes “eligible long-term care premiums” as defined in Section 213(d)(10) of the Code.

Notwithstanding the foregoing, if the Plan is an integrated HRA and the group medical plan in which a Participant is enrolled does not provide at least 60% minimum value, then, during the period of time in which such a Participant is receiving contributions to the Plan, Health Care Expense for such a Participant shall be defined no more broadly than allowed under applicable law. “Health Care Expense” shall not include premiums for a medical insurance policy issued in the individual insurance market or through a public exchange. Health Care Expenses are sometimes referred to herein as “Eligible Expenses.”

2.17 HIPAA means the Health Insurance Portability and Accountability Act of 1996 and regulations thereunder, as amended from time to time.

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2.18 Health Reimbursement Arrangement (“HRA”) means the Employer-funded medical reimbursement program within the meaning of IRS Revenue Ruling 2002-41 (June 26, 2002) and IRS Notice 2002-45 (June 26, 2002).

2.19 Highly Compensated Individual means an individual who is (1) one of the five highest paid officers, (2) a more than ten percent shareholder, or (3) among the highest paid 25 percent of all Employees, except (i) Employees who have not completed 3 years of service, (ii) Employees who have not attained age 25, (iii) part-time or seasonal Employees, (iv) Employees not included in the Plan who are included under a collective bargaining agreement, and (v) Employees who are nonresident aliens and who receive no earned income from a source within the United States.

2.20 Limited Scope Health Care Expense means, unless provided otherwise in the Adoption Agreement, a Health Care Expense for dental or vision care that qualifies as an expense for medical care under Section 213(d) of the Code. Limited Scope Health Care Expenses are sometimes referred to herein as “Eligible Expenses.”

2.21 Managing Body means the person or persons with authority to make decisions for the Adopting Employer.

2.22 Participant means any Employee (or former Employee) who is or may become eligible to receive a benefit through this Plan. In addition, Participant includes persons “deemed” to be Participants under a specific provision of this Plan.

2.23 PHI means health information that:
(a) Is created or received by a health care provider, health plan, or health care clearinghouse;
(b) Relates to the past, present, or future physical or mental health or condition of an individual (including “genetic information” as that term is defined in the Genetic Information Nondiscrimination Act of 2008); the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and
(c) Either identifies the individual or reasonably could be used to identify the individual.

2.24 Plan means this Plan as may be amended from time to time. It consists of a completed Adoption Agreement plus the Basic Plan Document. The name of the Plan is specified in the Adoption Agreement.

2.25 Plan Administrator means the entity, person or persons determined under Section 8.1.

2.26 Plan Year means the twelve (12) month period beginning and ending as indicated in the Adoption Agreement. The initial Plan Year may be a “short” Plan Year beginning and ending as indicated in the Adoption Agreement. The records of the Plan will be kept based upon the Plan Year.

2.27 Privacy Rules means the Standards of Privacy of Individually Identifiable Health Information at 45 C.F.R. part 160 and part 164 at subparts A and E.

2.28 Security Incident means “security incident” as defined in 45 C.F.R. Section 164.304, which generally defines “security incident” to include attempted or successful unauthorized access, use, disclosure, modification, or destruction of ePHI.

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2.29 Security Rules means the Security Standards and Implementation Specifications at 45 C.F.R. Part 160 and Part 164, subpart C.

2.30 Spouse means “Spouse” as defined in the Adoption Agreement.

2.31 Trust means the trust identified in the Adoption Agreement, created for the purpose of accepting and holding Employer Contributions, and limited other contributions, made under the Plan.

2.32 Trustee means the trustee of the Trust.

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ELIGIBILITY AND PARTICIPATION OF EMPLOYEES

3.1 Eligibility Requirements. An Employee or former Employee shall be eligible to participate in this Plan upon meeting the eligibility requirements set forth in the Adoption Agreement.

3.2 Participant Status. An Employee who has met the eligibility requirements described in Section

3.1 shall become a Participant as of the Employee’s Entry Date. Becoming a Participant does not necessarily mean the Participant may receive benefits under the Plan. See Section 4.4 for more information.

3.3 Conditions of Participation. As a condition of participation and receipt of benefits under this Plan, the Participant agrees to:
(a) Observe all Plan rules and regulations;
(b) Consent to inquiries by the Claims Administrator and Plan Administrator with respect to any provider of services involved in a claim under this Plan; (c) Submit to the Plan Administrator all notifications, reports, bills, and other information required by the Plan or which the Claims Administrator and Plan Administrator may reasonably require; and
(d) Cooperate with all reasonable requests of the Claims Administrator and Plan Administrator that may be necessary for the proper administration of the Plan.

Failure to comply with the foregoing conditions relieves the Plan, Plan Administrator, Claims Administrator, and Adopting Employer of any obligations under this Plan with respect to that Participant and any others claiming entitlement to benefits under this Plan through that Participant and shall result in the termination of the Participant’s participation in the Plan.

3.4 Coverage Options. The Plan consists of one or more of the following coverage options as described below.
(a) One or more of the following coverage options, as indicated in the Adoption Agreement, are available under the Plan:
(1) Full Scope Option. Participants may receive reimbursement for Health Care Expenses incurred by themselves and their Spouses and Dependents. (2) Limited Scope Option. Participants may receive reimbursement for only Limited Scope Health Care Expenses incurred by themselves and their Spouses and Dependents.
(3) Suspended Account Option. Participants may receive no reimbursements from their HC Accounts. However, the balance of the Participant’s HC Account will be preserved for use in subsequent Plan Years.
(b) Participants will be covered under the “Full Scope Option” unless the Participant elects in writing and in a manner specified by the Plan Administrator to participate in another available coverage option. Notwithstanding the foregoing, if provided in the Adoption Agreement, Participants enrolled in a high deductible health plan (as defined in Section 223 of the Code) sponsored by the Adopting Employer shall automatically be enrolled in

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) the coverage option specified in the Adoption Agreement. If an election of coverage options is required, such an election shall be effective on a Plan Year basis, shall be made prior to the beginning of the Plan Year, shall be irrevocable during the Plan Year, and shall automatically renew for subsequent Plan Years unless the Participant makes an election (in the manner specified above) to participate in a different coverage option for such subsequent Plan Year. Notwithstanding the foregoing, the Plan Administrator may allow an election of a coverage option mid-year when a Participant enters the Plan mid-Plan Year, the Plan is amended mid-Plan Year to include an additional coverage option, or the Adopting Employer makes changes to its group medical plan (e.g., adds a high deductible health plan) mid-Plan Year.
(c) If a Participant changes coverage options, the following rules apply with respect to claims for reimbursement under the Plan:
(1) Expenses will be eligible for reimbursement under the Plan in accordance with the coverage option in which the Participant is enrolled at the time the expense is incurred. For example, if a Participant who is enrolled in the “Limited Scope Option” incurs an expense for something other than a Limited Scope Health Care Expense, that expense cannot be reimbursed under the Plan at any time in the future (e.g., if the Participant subsequently becomes covered under the “Full Scope Option”).
(2) Notwithstanding the foregoing, unless provided otherwise in the Adoption Agreement, a Health Care Expense incurred while the Participant is covered under the “Full Scope Option” will not be reimbursed if the claim for such expense is submitted after the Participant has become covered under another coverage option and such expense is not reimbursable under the new coverage option. For example, if a Participant incurs an expense for something other than a Limited Scope Health Care Expense while covered under the “Full Scope Option,” that expense cannot be reimbursed if the claim is submitted after the Participant becomes covered under the “Limited Scope Option.”

3.5 Termination of Contributions. Unless provided otherwise in the Adoption Agreement, a Participant shall cease to be eligible to receive contributions under this Plan at midnight of the earliest of the following dates:
(a) The date of the death of the Participant;
(b) The date of termination of the Participant's employment with the Adopting Employer;
(c) The date of the Participant's failure to meet the eligibility requirements of Section

3.1, as may be amended from time to time in accordance with Article IX; or (d) The date of termination of the Plan in accordance with Article IX.

Termination of contributions under this Plan shall not prevent a former Participant from receiving continuation coverage required by applicable law.

3.6 Termination of Participation. Unless provided otherwise in the Adoption Agreement, a Participant automatically ceases to be a Participant at midnight of the earliest of the following dates:

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) (a) The date of the death of the Participant;
(b) The date the balance of the Participant’s HC Account reaches zero, if no further contributions will be made to said account under Article V; or (c) The date of termination of the Plan in accordance with Article IX.

Participation may also terminate for cause, including for failing to comply with the conditions of participation described in Section 3.3 and/or for making fraudulent or improper claims. In certain cases, if participation is terminated for cause, the Participant’s coverage may be terminated retroactively to the date on which the event giving rise to the cause occurred.

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BENEFITS UNDER THE PLAN

4.1 Benefits. The Plan shall reimburse Eligible Expenses in accordance with Section 3.4 and this Article IV.

4.2 Health Care (“HC”) Account. The HC Account will be credited with the Employer Contribution.

A Participant’s HC Account will be decreased from time to time in the amount of payments made to the Participant for Eligible Expenses.

4.3 Claims for Reimbursement. A Participant may obtain reimbursement of Eligible Expenses by submitting a paper claim or through an electronic payment card as described below. (a) Paper Claims. A Participant may make a claim by completing a claim form and submitting such form to the Claims Administrator setting forth at least the following:
(1) the amount, date and nature of the expense, including the identity of the individual who incurred the expense;
(2) the name of the person or entity to which the expense was paid or is owed; (3) the Participant’s statement that the expense has not been reimbursed and the Participant will not seek reimbursement for the expense; and (4) such other information as the Claims Administrator may require.

Such claim form shall be accompanied by such bills, invoices, receipts, explanations of benefits (“EOB”) issued by a health plan, or other statements from an independent third party as is necessary to establish that an Eligible Expense has been incurred and the amount of the expense. The Claims Administrator is entitled to rely on the information provided on the claim form in processing claims under this Plan. A claim must be submitted for payment within the time period indicated in the Adoption Agreement. Where circumstances beyond the Participant’s control prevent submission within the described time frame, notice of a claim with an explanation of the circumstances may be accepted by the Claims Administrator as a timely filing. Claims shall be determined in accordance with Article VI.
(b) Electronic Payment Card. A Participant may receive reimbursement of an Eligible Expense by use of an electronic payment card at the time the Eligible Expense is incurred. The use of the electronic payment card shall be subject following conditions:
(1) The electronic payment card will be deactivated when a Participant’s participation in the Plan terminates.
(2) The balance of the electronic payment card shall be limited to 90% of the balance of the Participant’s HC Account.
(3) A Participant must certify in writing prior to issuance of the electronic payment card that:

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) (i) the electronic payment card will be used only for Eligible Expenses that have not been reimbursed under any other plan covering similar benefits; and
(ii) the Participant will not seek reimbursement for any expense paid with the electronic payment card under any other plan covering benefits.

The electronic payment card shall include a statement providing that each use of the card shall constitute a reaffirmation of the certification. (4) The electronic payment card may be used only at merchants who are health care providers (e.g., doctor’s office, hospital, pharmacy, etc.) or other merchants identified in applicable IRS guidance.
(5) Each time the electronic payment card is used, a Participant shall obtain and retain a third party statement from the health care provider containing the information necessary to substantiate that the expense paid by the card was an Eligible Expense.
(6) Claims shall be substantiated if one of the following conditions is satisfied:
(i) The Participant provides, upon request by the Claims Administrator (or its designee), the third party statement with respect to the claim. (ii) The payment was made to a merchant who is a health care provider and it matches a specific co-payment the Participant has under a group medical or group dental plan sponsored by the Adopting Employer or a multiple of that co-payment of not more than five (5) times the dollar amount of the co-payment.
(iii) The payment was made to a merchant who is a health care provider and is for an expense with the same amount, duration, and health care provider as a previously approved expense under this Plan. (iv) The payment was made to a merchant who is a health care provider and the electronic claim file with respect to the expense is accompanied by an electronic or written confirmation from the health care provider that verifies the nature and amount of the expense and that the expense is an Eligible Expense.
(v) The electronic payment card is used at a merchant (of any kind) that participates in an inventory information approval system developed by the card provider that verifies, at the time of purchase, that the goods being purchased constitute medical care.
(7) Special rules apply to the use of the electronic payment card to purchase overthe-counter drugs and medicines other than insulin. Notwithstanding the rules described above regarding the use of the card to purchase medical care, unless and until the IRS issues guidance providing the following procedures need not be followed (in which case such guidance shall be incorporated herein by reference), the card may be used to purchase such over-the-counter drugs and medicines only in the following circumstances:

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) (i) At any 90% pharmacy if the expense is substantiated after the purchase in accordance with paragraph (6)(i) above.
(ii) At drug stores, pharmacies, non-health care merchants that have pharmacies, and mail order or web-based merchants that sell prescription drugs if (a) the cardholder presents the prescription to the pharmacist; (b) the pharmacist assigns a prescription number and dispenses the over-thecounter drug or medicine in accordance with applicable law; (c) the pharmacy retains a record of the transaction, including the name on prescription, prescription number, date, and the amount of the purchase; (d) the pharmacy’s records are accessible by the employer or its agent; (e) the debit card system does not allow over-the-counter drugs or medicines without a prescription number; and (f) the expense is substantiated in accordance with the standard rules described above in paragraph (6).
(iii) At merchants having healthcare related merchant codes (other than merchants described in item ii above) if the expense is substantiated in accordance with the standard rules described above in paragraph (6). (8) A Participant shall repay the Plan for a payment with respect to any claim not substantiated (and therefore not eligible for reimbursement) as required above.

The Plan shall handle unsubstantiated claims as required under the Code and applicable regulations.
(9) The use of an electronic payment card does not constitute a “claim” under the claims procedures.

4.4 Incurred Expenses. An expense is “incurred” when the Participant is provided with the care giving rise to the Eligible Expense, not when the service is billed or paid. Reimbursement shall not be made for future projected expenses. To be reimbursable, the Participant must have incurred an Eligible Expense after his/her Entry Date. In addition, the Participant must have incurred the Eligible Expense after termination of employment and such other event identified in the Adoption Agreement (if any). Notwithstanding the foregoing, if a Participant with an HC Account balance is rehired by the Employer after having terminated employment, then any Eligible Expenses incurred by the Participant (or the Participant’s Spouse or Dependents) during the Participant’s period of reemployment by the Employer shall not be eligible for reimbursement under the Plan. The restriction on reimbursements described in the preceding sentence shall apply regardless of: (1) the length of the period of time between the initial separation from service and the reemployment; (2) the nature of the Participant’s employment upon rehire (e.g., whether the Participant is rehired on part-time, temporary, seasonal, etc. basis); and (3) any other factor (e.g., vesting status, the number of hours per week the Participant is reemployed to work, etc.). Upon such reemployed Participants subsequent termination of employment with the Employer, the Participant shall again become eligible to receive reimbursements from his or her HC Account for Eligible Expenses incurred after his or her reemployment ends.

4.5 Timing of Reimbursement. For claims made via a paper claim, Participants shall be reimbursed weekly.

4.6 Maximum Reimbursement. The maximum reimbursement a Participant may receive at any time shall be the amount of the Participant’s HC Account balance at the time the reimbursement request is processed. The maximum reimbursement requirements apply to the Participant, Spouse, and Dependents on an aggregate basis, not an individual basis. Notwithstanding the foregoing, in

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) order to accommodate fluctuations in the market value of the assets in which an HC Account is invested, the Plan Administrator (or its designee) may limit the amount of reimbursements a Participant may receive to 90% of the Participant’s HC Account balance at the time the reimbursement request is processed. If a Participant’s claim is for an amount that is more than the maximum described above, the excess, unreimbursed part of the claim will be pended and paid as the balance of the Participant’s HC Account becomes adequate. Notwithstanding the foregoing, the excess, unreimbursed portion of a claim will not be pended if the HC Account has been exhausted and no further contributions will be made to the Participant’s HC Account under Article V.

4.7 Death of a Participant.
(a) Notwithstanding anything herein to the contrary, unless specifically provided otherwise in the Adoption Agreement, in the event a Participant’s participation in the Plan terminates because of the Participant’s death, the Participant has no surviving Spouse or Dependents, and the former Participant incurred a Eligible Expense prior to the Participant’s death that would have been reimbursable out of the Participant's HC Account but that has not been submitted for reimbursement, the deceased Participant's estate may submit such Eligible Expense for reimbursement in accordance with Section 4.3. A certified copy of the deceased Participant’s death certificate and proof that the person acting upon behalf of such Participant’s estate has authority to do so must be submitted with such claims. (b) Notwithstanding anything herein to the contrary, unless specifically provided otherwise in the Adoption Agreement, the deceased Participant’s surviving Spouse, if any, may continue to access the Participant’s HC Account for purposes of obtaining reimbursement of Eligible Expenses until the earlier of: (1) the date on which the HC Account balance reaches zero; or (2) the date on which the surviving Spouse dies. No claim shall be paid to a surviving Spouse pursuant to this subsection (ii) unless a certified copy of the deceased Participant’s death certificate has been provided to the Claims Administrator. If continuation coverage is required by applicable law, the access described in this Section 4.7(b) shall be provided only if offered as and selected in lieu of such continuation coverage. (c) Notwithstanding anything herein to the contrary, unless specifically provided otherwise in the Adoption Agreement, the deceased Participant’s surviving Dependents, if any, may continue to access the Participant’s HC Account for purposes of obtaining reimbursement of Eligible Expenses until the earlier of: (1) the date on which the HC Account balance reaches zero; or (2) the date the last surviving Dependent dies. No claim shall be paid to a surviving Dependent pursuant to this subsection (iii) unless a certified copy of the deceased Participant’s death certificate has been provided to the Claims Administrator. If continuation coverage is required by applicable law, the access described in this Section 4.7(c) shall be provided only if offered as and selected in lieu of such continuation coverage. (d) Notwithstanding anything herein to the contrary, if provided in the Adoption Agreement, upon a Participant’s death, the Participant’s Designated Beneficiary may continue to access the Participant’s HC Account for purposes of obtaining reimbursement of Eligible Expenses incurred by the Designated Beneficiary if the Participant is not survived by a Spouse or Dependent. Such access shall be provided until the earlier of: (1) the date on which the HC Account balance reaches zero; or (2) the date on which the Designated Beneficiary dies. No claim shall be paid to a Designated Beneficiary unless a certified copy of the deceased Participant’s death

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) certificate has been provided to the Claims Administrator and the Designated Beneficiary has certified that the Participant does not have a surviving Spouse or Dependent. Reimbursements paid to a Designated Beneficiary shall be reported as taxable income to the Designated Beneficiary to the extent required by law. For purposes of the Plan, a “Designated Beneficiary” is a person designated by a Participant as his/her beneficiary in accordance with the procedures established by the Claims Administrator for doing so. A Participant may designate one or more contingent Designated Beneficiaries who will become a Designated Beneficiary if the primary Designated Beneficiary predeceases the Participant. An individual who is the Participant’s Spouse or Dependent is not a Designated Beneficiary even if the Participant has attempted to designate his/her Spouse or Dependent as a beneficiary.

4.8 Nondiscrimination. This Plan is intended to be nondiscriminatory and to meet the nondiscrimination requirements under applicable sections of the Code. If the Plan Administrator or an Employer determines before or during any Plan Year, that the Plan may fail to satisfy any nondiscrimination requirement imposed by the Code or any limitation on benefits provided to Highly Compensated Individuals, the Plan Administrator or Employer shall take such action as the Plan Administrator or Employer deems appropriate, under rules uniformly applicable to similarly situated Participants, to assure compliance with such requirements or limitation.

4.9 HC Account Forfeitures. Unless provided otherwise in the Adoption Agreement, any amount remaining in a Participant’s HC Account shall be forfeited following the later to occur of: (a) the termination of Participant’s participation in the Plan, (b) the termination of any other continuation coverage provided by the Plan under applicable law, or (c) the termination of any other coverage provided by the Plan in accordance with Section 4.7; provided that where participation or coverage is terminated because of the death of the Participant, forfeiture shall not occur until the expiration of the time period contained in Section 4.3 for the submission of claims. Notwithstanding the forgoing, a Participant’s HC Account shall also be forfeited if: (i) the balance of the HC account is less than $25, (ii) no further contributions shall be made to the HC Account, and (iii) no claim has been submitted by the Participant for a period of six (6) months. In addition, the portion of the Participant’s HC Account that is not vested shall be forfeited upon the Participant’s termination of employment. A Participant’s interest in his/her HC Account shall vest as provided in the Adoption Agreement. Forfeited amounts shall be used for the purposes described in the Adoption Agreement. However, except as allowed under the Trust, no amounts will revert to the Adopting Employer. To the extent the full balance of the forfeiture subaccount cannot be allocated as provided in the Adoption Agreement (e.g., because the balance does not divide evenly among the number of Participants), any balance remaining shall be held in the forfeiture subaccount until the end of the subsequent Plan Year and allocated at that time.

4.10 Qualified Medical Child Support Orders (“QMCSOs”). Notwithstanding any provision of this Plan to the contrary this Plan shall recognize Qualified Medical Child Support Orders (“QMCSOs”).

To be a QMCSO, certain procedures established by the Plan Administrator must be followed.

Participants involved in a divorce or child custody matter should be directed to have their legal counsel contact the Plan Administrator.

4.11 Coordination with Cafeteria Plan. To the extent the Adopting Employer also sponsors a medical reimbursement program as part of its cafeteria plan within the meaning of Section 125 of the Code, a Participant participates in the medical reimbursement program, and the Participant or a Covered Individual covered through such a Participant incurs an Eligible Expense that is also eligible for reimbursement under the medical reimbursement program, the medical reimbursement program shall pay first.

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4.12 Further Limitations on Benefits.
(a) This Plan does not cover expenses incurred for any loss caused by or resulting from injury or disease for which benefits are payable under any worker's compensation law or other employer, union, association or governmental sponsored group insurance plan.
(b) This Plan does not cover expenses incurred for any loss caused by or resulting from injury or disease for which benefits are received by the Participant, the Participant's Spouse or the Participant's Dependent under any health and accident insurance policy or program, whether or not premiums are paid by the Adopting Employer or by the Participant, the Participant's Spouse or the Participant's Dependent child. (c) Amounts reimbursed under a dependent care assistance program described in Section 129 of the Code shall not be reimbursed under this Plan. (d) Other limitations, if any, as set forth in the Adoption Agreement.

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CONTRIBUTIONS AND TRUST

5.1 Employer Contributions. The Adopting Employer shall make a fixed contribution per Participant as set forth in the Adoption Agreement. The amount of the Employer Contribution, and any restrictions on the use thereof, shall be identified in the Adoption Agreement and communicated to the Participants. The amount of the Employer Contribution may change from time to time as reflected in the Adoption Agreement. In addition, if indicated in the Adoption Agreement, contributions to this Plan may consist of a transfer of a Participant’s account balance under another HRA sponsored by the Adopting Employer, which shall be made upon such Employee’s termination of employment or death. If a transfer is made to this Plan upon an eligible Employee’s death, such transfer shall be made for the benefit of such Employee’s surviving Spouse and Dependents or, if applicable, designated beneficiary under the HRA, in which case such surviving Spouse and Dependents or designated beneficiary shall be treated as a Participant under this Plan.

5.2 No Employee Contributions. Except for contributions required for continuation coverage, no contributions other than Employer Contributions are required nor will they be accepted.

5.3 Trust. All contributions shall be held in the Trust. The investment of the assets of the Trust shall be directed as provided in the Adoption Agreement. Notwithstanding the foregoing, the investment of any assets of the Trust that constitute forfeitures shall be directed by the Plan Administrator until such time, if any, that such forfeitures are allocated to the HC Accounts of other Participants.

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CLAIMS DETERMINATIONS AND REVIEW OF DENIED CLAIM
The following procedures apply:

6.1 General Provisions. All claims and appeals will be adjudicated in a manner so that the independence and impartiality of the persons involved in making the determination are ensured. Decisions regarding hiring, compensation, termination, and similar matters with respect to any individual involved in the determination (e.g., a claims adjudicator or medical expert) shall not be based upon the likelihood that the individual will support a denial of benefits.

6.2 Initial Claim Determination.
(a) Time Frame for Decision. The Plan must determine the claim within thirty (30) days of receipt of the claim.
(b) Extension of Time. If the Plan is not able to determine the claim within this time period due to matters beyond its control, the Plan may take an additional period of up to fifteen (15) days to determine the claim. If this additional time will be needed, the Plan must notify the claimant or the claimant’s Authorized Representative prior to the expiration of the initial thirty (30) day time period for determining the claim.

This extension is only available once.

Notification: The notification of the need for the extension must include a description of the “matters beyond the Plan’s control” that justify the extension and the date by which a decision is expected.
(c) Incomplete Claims. There is no special rule if a claim is incomplete. Incomplete claims can be addressed through the extension of time described above. If the reason for the extension is the failure to provide necessary information and the claimant is appropriately notified, the Plan’s period of time to make a decision is “tolled.”
Tolling: The period of time in which the Plan must determine a claim is suspended from the date upon which notification of the missing necessary information is sent until the date upon which the claimant responds.

Notification: For this purpose, notification can be made orally to the claimant or the health care professional, unless the claimant requests written notice. The notification will include a time frame in which the necessary information must be provided. Once the necessary information has been provided, the Plan must decide the claim within the extension described above. If the requested information is not provided within the time specified, the claim may be decided without that information.

6.3 Decision.
(a) Notification of Decision. Written (or electronic) notification of the Plan’s determination must be provided to the claimant or the claimant’s Authorized Representative. Such notification must be provided only where the decision is adverse. The notification will be provided in a culturally and linguistically

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) appropriate manner in accordance with 29 CFR § 2590.715-2719, to the extent such regulation applies to the Plan.
“Adverse” means:
• A denial, reduction, or termination of a benefit;
• A failure to provide or make payment (in whole or in part) for a benefit; or • A rescission of coverage under the Plan, which is a cancellation or discontinuance of coverage under the Plan that has retroactive effect other than a cancellation or discontinuance attributable to a failure to timely pay or make required premiums or contributions toward coverage. (b) Adverse Decision. For adverse claim determinations, the notification shall at a minimum:
• Include information sufficient to identify the claim involved, including the date of service, the identity of the health care provider, and the claim amount, and to inform the claimant of the right to receive, upon request, the diagnosis and treatment codes (if any) and their corresponding meanings upon request; • State the specific reason(s) for the determination, including the denial code (if any) and its corresponding meaning, and describe the Plan’s standard, if any, used to make the determination;
• Reference specific Plan provision(s) upon which the determination is based; • Describe additional material or information necessary to complete the claim and why such information is necessary;
• Describe the internal appeals and external review processes (if any) available under the Plan, including how to initiate an appeal and the procedures and time limits applicable to an appeal, and the right to sue under ERISA Section 502; • Disclose any internal rule, guidelines, protocol or similar criterion relied on in making the adverse determination (or state that such information will be provided free of charge upon request);
• Where the decision involves scientific or clinical judgment, disclose either (1) an explanation of the scientific or clinical judgment applying the terms of the Plan to claimant’s medical circumstances, or (2) a statement that such explanation will be provided at no charge upon request; and
• Disclose the availability of and contact information for any applicable office of health insurance consumer assistance or ombudsman established to assist individuals with the internal claims and appeals and external review processes (if any).

Notice of the adverse determination may be provided in written or electronic form.

Electronic notices will be provided in a form that complies with applicable legal requirements.
(c) Not Adverse Decision. For claim determinations that are not adverse, notice will be provided that informs the claimant or the claimant’s Authorized Representative the claim has been accepted.

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6.4 Access to Relevant Documents.

In order (1) to evaluate whether to request review of an adverse determination, and (2) if review is requested, to prepare for such review, the claimant or the claimant’s Authorized Representative will have access to all relevant documents.

Relevant: A document, record or other information is “relevant” if it was relied upon in making the determination, or was submitted to the Plan, considered by the Plan, or generated in the course of making the benefit determination without regard to whether it was relied upon.

6.5 Appealing a Denied Claim.

If a claim is denied, in whole or part, the claimant or the claimant’s Authorized Representative may request the denied claim be reviewed.
(a) Requesting Review. The claimant or the claimant’s Authorized Representative has a period of one-hundred eighty (180) days to appeal the claim determination.

The appeal request must be in writing and should be sent to the address specified in the notification of adverse decision described above. (b) Full and Fair Review. The clamant will have the right to review the claim file and to present evidence and testimony. The claimant will be provided, free of charge, with new or additional evidence considered, relied upon, or generated by the Plan in connection with the claim as soon as possible and sufficiently in advance of the date on which the notice of final internal adverse benefit determination is required to give the claimant a reasonable opportunity to respond prior to that date. Before the Plan issues a final internal adverse benefit determination based on a new or additional rationale, the claimant will be provided, free of charge, with the rationale as soon as possible and sufficiently in advance of the date on which the notice of final internal adverse benefit determined is required to give the claimant a reasonable opportunity to respond prior to that date. The review of the adverse benefit determinations will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination.
(c) Consultation with Independent Medical Expert. In the case of a claim denied on the grounds of a medical judgment, a health professional with appropriate training and experience will be consulted. The health care professional who is consulted on appeal will not be the individual who was consulted, if any, during the initial determination or a subordinate of that individual.

Disclosure: If the advice of a medical or vocational expert was obtained by the Plan in connection with the claim denial, the names of each such expert shall be provided, regardless of whether the advice was relied upon.
(d) Time Frame for Decision. If claimant or the claimant’s Authorized Representative requests a review of a denied claim within the time frame described above, the Plan Administrator shall review the claim and make a determination no later than sixty (60) days from the date the review request was received. (e) Decision. The review of the claim will be conducted by the Plan Administrator. It will be made by a person different from the person who made the initial determination and such person will not be a subordinate of the original decision

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) maker. The information in the administrative record shall be reviewed. Additional information submitted shall be considered. The decision shall be based upon that information plus the terms of the Plan and past interpretations of the same and similar Plan provisions. The Plan may rely upon protocols, guidelines, or other criterion.
(f) Notification of Decision. Written (or electronic) notification of the Plan’s determination must be provided to the claimant or the claimant’s Authorized Representative. Such notification must be provided whether the decision is adverse or not adverse. The notification will be provided in a culturally and linguistically appropriate manner in accordance with 29 CFR § 2590.715-2719, to the extent such regulation applies to the Plan.
“Adverse” means:
• A denial, reduction, or termination of a benefit;
• A failure to provide or make payment (in whole or in part) for a benefit, or • A rescission of coverage under the Plan, which is a cancellation or discontinuance of coverage under the Plan that has retroactive effect other than a cancellation or discontinuance attributable to a failure to timely pay or make required premiums or contributions toward coverage. (g) Adverse Decision. For adverse appeal determinations, the notification shall reflect at least the following:
• Include information sufficient to identify the claim involved, including the date of service, the identity of the health care provider, and the claim amount, and to inform the claimant of the right to receive, upon request, the diagnosis and treatment codes (if any) and their corresponding meanings upon request; • Contain a discussion of the determination, including the specific reason(s) for the determination, the denial code (if any) and its corresponding meaning, and the Plan’s standard, if any, used to make the determination; • Reference specific Plan provision(s) upon which the determination is based; • Describe the external review process (if any) available under the Plan and the right to sue under ERISA Section 502;
• Disclose any internal rules, guidelines, protocol or similar criterion relied on in making the adverse determination (or state that such information will be provided free of charge upon request);
• A statement indicating entitlement to receive upon request, and without charge, reasonable access to or copies of all documents, records or other information relevant to the determination;
• Where the decision involves scientific or clinical judgment, disclose either (1) an explanation of the scientific or clinical judgment applying the terms of the Plan to claimant’s medical circumstances, or (2) a statement that such explanation will be provided at no charge upon request; and
• Disclose the availability of and contact information for any applicable office of health insurance consumer assistance or ombudsman established to assist individuals with the external review process (if any).

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) Notice of the adverse determination may be provided in written or electronic form.

Electronic notices will be provided in a form that complies with applicable legal requirements.
(h) Not Adverse Decision. For claim determinations that are not adverse, notice will be provided that informs the claimant or the claimant’s Authorized Representative the decision has been reversed, and the claim accepted.

6.6 Deemed Exhaustion. If the Plan fails to adhere to the requirements described in 29 C.F.R. § 2590.715-2719(b)(2), the claimant will be deemed to have exhausted the internal claims and appeals process as provided in 29 CFR § 2590.715-2719(b)(2)(ii)(F), to the extent such regulation applies to the Plan.

6.7 External Review. The Plan will provide any applicable external review process that may be required to be provided by a health reimbursement arrangement under 29 CFR § 2590.715-2719, to the extent such regulation applies to the Plan.

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HIPAA PRIVACY AND SECURITY PROVISIONS
The Privacy Rules and Security Rules under HIPAA apply to the Plan.

7.1 Use and Disclosure of PHI. The Plan will use PHI to the extent allowed by, and in accordance with, the uses and disclosures permitted by HIPAA. Specifically, the Plan will use and disclose PHI for purposes related to health care treatment, payment for health care and health care operations.

The Plan will also use and disclose PHI as required by law and as permitted by authorization of the subject of PHI. If the Plan discloses PHI to the Adopting Employer in accordance with this Article VII, the Adopting Employer may use and further disclosure PHI for the same purposes and in the same situations as the Plan may use and disclose PHI, provided that such use or disclosure is for Plan administration functions performed by the Adopting Employer for the Plan or is required by law or permitted by authorization. All uses and disclosures of PHI, whether by the Plan or by Adopting Employer, shall be limited to the minimum PHI necessary to accomplish the intended purpose of the use or disclosure in accordance with HIPAA. Notwithstanding the foregoing, neither the Plan nor the Adopting Employer shall use PHI that is genetic information in a manner that is prohibited by the Genetic Information Nondiscrimination Act of 2008. (a) Payment includes activities undertaken by the Plan to obtain premiums or determine or fulfill its responsibility for coverage and provision of Plan benefits that relate to an individual to whom health care is provided. These activities include, but are not limited to, the following:
(1) Determination of eligibility, coverage and cost sharing amounts (for example, cost of a benefit, plan maximums and co-payments as determined for an individual’s claim);
(2) Coordination of benefits;
(3) Adjudication of health benefits claims (including appeals and other payment disputes);
(4) Subrogation of health benefit claims;
(5) Establishing employee contributions;
(6) Risk adjusting amounts due based on enrollee health status and demographic characteristics;
(7) Billing, collection activities, and related health care data processing; (8) Claims management and related health care data processing, including auditing payments, investigating and resolving payment disputes and responding to participant inquiries about payments;
(9) Obtaining payment under a contract for reinsurance (including stop-loss and excess of loss insurance);
(10) Medical necessity reviews or reviews of appropriateness of care or justification of charges;

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) (11) Utilization review, including pre-certification, preauthorization, concurrent review and retrospective review;
(12) Disclosure to consumer reporting agencies related to the collection of premiums or reimbursement (the following PHI may be disclosed for payment purposes:
name and address, date of birth, Social Security number, payment history, account number and name and address of provider and/or health Plan); and (13) Reimbursement to the Plan.
(b) Health care operations include, but are not limited to, the following activities:
(1) Quality assessment;
(2) Population-based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, disease management, contacting health care providers and patients with information about treatment alternatives and related functions;
(3) Rating provider and Plan performance, including accreditation, certification, licensing or credentialing activities;
(4) Underwriting, premium rating and other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits, and ceding, securing or placing a contract for reinsurance of risk relating to health care claims (including stop-loss insurance and excess of loss insurance); (5) Conducting or arranging for medical review, legal services and auditing function, including fraud and abuse detection and compliance programs; (6) Business planning and development, such as conducting cost-management and planning-related analyses related to managing and operating the Plan, including formulary development and administration, development or improvement of payment methods or coverage policies;
(7) Business management and general administration activities of the Plan, including, but not limited to:
a. Management activities relating to the implementation of and compliance with HIPAA’s administrative simplification requirements; b. Customer service, including data analyses for policyholders; (8) Resolution of internal grievances; and
(9) Due diligence in connection with the sale or transfer of assets to a potential successor in interest, if the potential successor in interest is a covered entity under HIPAA or following completion of the sale or transfer, will become a covered entity.

7.2 Adopting Employer’s Obligations under the Privacy Rules. Under the Privacy Rules, the Plan may not disclose PHI to the Adopting Employer unless the Adopting Employer certifies that the Plan document has been amended to provide that the Plan will make such disclosures only upon receipt of a certification from the Adopting Employer that the Plan has been amended to

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) include certain conditions to the Adopting Employer’s receipt of PHI and that Adopting Employer agrees to those conditions. By adopting this Plan document, the Adopting Employer certifies that the Plan has been amended as required by the Privacy Rules and that it agrees to the following conditions, thereby allowing the Plan to disclose PHI to the Adopting Employer. The Adopting Employer agrees to:
(a) Not use or further disclose PHI other than as permitted or required by the Plan document or as required by law;
(b) Ensure that any agents, including a subcontractor, to whom the Plan provides PHI received from the Plan agree to the same restrictions and conditions that apply to the Adopting Employer with respect to such PHI;
(c) Not use or disclose PHI for employment related actions and decisions unless authorized by an individual;
(d) Not use or disclose PHI in connection with any other benefit or employee benefit plan of the Adopting Employer unless authorized by an individual; (e) Report to the Plan any PHI use or disclosure of which it becomes aware that is inconsistent with the uses or disclosures permitted hereunder and/or may constitute a “breach” as that term is defined in HIPAA;
(f) Make PHI available for access by the individual who is the subject of the PHI in accordance with HIPAA;
(g) Make PHI available for amendment and incorporate any amendments to PHI in accordance with HIPAA;
(h) Make available the information required to provide an accounting of disclosures in accordance with HIPAA;
(i) Make internal practices, books and records relating to the use and disclosure of PHI received from Plan available to the HHS Secretary for the purposes of determining the Plan’s compliance with HIPAA; and
(j) If feasible, return or destroy all PHI received for the Plan that the Adopting Employer still maintains in any form, and retain no copies of such PHI when no longer needed for the purpose for which disclosure was made (or if return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction infeasible).

7.3 Adopting Employer’s Obligations under Security Rules. If the Adopting Employer creates, receives, maintains, or transmits ePHI (other than enrollment and disenrollment information and Summary Health Information, which are not subject to these restrictions), the Adopting Employer will:
(a) Implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of ePHI; (b) Ensure that any agents, including subcontractors, who create, receive, maintain, or transmit ePHI on behalf of the Plan implement reasonable and appropriate security measures to protect the ePHI;

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) (c) Report to the Plan any Security Incident of which it becomes aware; and (d) Implement reasonable and appropriate security measures to ensure that only those persons identified in Section 7.4 have access to ePHI and that such access is limited to the purposes identified in Section 7.5.

7.4 Adequate separation between the Plan and the Adopting Employer must be maintained. In accordance with HIPAA, only the following employees or classes of employees may be given access to PHI:
(a) the person employed in the position that is given primary responsibility for performing the Adopting Employer’s duties as the Plan Administrator of the Plan; and (b) staff designated by the person described in (a) above.

7.5 Limitation of PHI and ePHI Access and Disclosure. The persons described in Section 7.4 above may only have access to, and use and disclose, PHI and ePHI for Plan administration functions that the Adopting Employer performs for the Plan.

7.6 Noncompliance Issues. If the person(s) described in Section 7.4 above does not comply with this Plan document, the Adopting Employer shall provide a mechanism for resolving issues of noncompliance, including, but not limited to, disciplinary action against such person.

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PLAN ADMINISTRATION

8.1 Plan Administrator.
(a) The Plan Administrator shall be responsible for the general supervision of the Plan.

The Plan Administrator shall also be the named fiduciary of the Plan in accordance with Section 402 of ERISA and shall have authority to control and manage the operation and administration of the Plan. The Plan Administrator shall perform any and all acts necessary or appropriate for the proper management and administration of the Plan.
(b) The Adopting Employer shall be the Plan Administrator unless its Managing Body designates a person or persons other than the Adopting Employer to be the Plan Administrator. The Adopting Employer shall also be the Plan Administrator if the person or persons so designated cease to be the Plan Administrator. (c) The Plan Administrator may designate an individual or entity to act on its behalf with respect to certain powers, duties, and/or responsibilities regarding the operation and administration of this Plan.

8.2 Plan Administrator Absolute Authority. Any and all questions or controversies of whatever character, arising in any manner in connection with the Plan or the operation thereof, shall be submitted to the Plan Administrator and shall be considered and determined by the Plan Administrator. The Plan Administrator shall have the sole and absolute discretion to construe and interpret the Plan, including but not limited consideration of any and all of the provisions, rules, regulations, or procedures used to interpret the Plan. Benefits under the Plan shall be paid only if the Plan Administrator determines in its sole and absolute discretion that the claimant is entitled to such benefits. To the extent any Plan Administrator duties are delegated to others, the Plan Administrator retains the ultimate right and responsibility, in its sole and absolute discretion, to ultimately decide all appeals. Any exercise by the Plan Administrator (or its delegate) of the Plan Administrator’s sole and absolute discretionary authority with respect to the construction and interpretation of the Plan, including but not limited to eligibility for coverage and entitlement to benefits, shall be final and binding.

8.3 Agent for Service of Legal Process. The agent for service of legal process for the Plan is the Plan Administrator.

8.4 Allocation of Responsibility for Administration. The Plan Administrator shall have the sole responsibility for the administration of this Plan as is specifically described in this Plan. The designated representatives of the Plan Administrator shall have only those specific powers, duties, responsibilities, and obligations as are specifically given to them under this Plan. The Plan Administrator warrants that any directions given, information furnished, or action taken by it shall be in accordance with the provisions of the Plan authorizing or providing for such direction, information or action. It is intended under this Plan that the Plan Administrator shall be responsible for the proper exercise of its own powers, duties, responsibilities, and obligations under this Plan and shall not be responsible for any act or failure to act of an Employee of the Adopting Employer.

Neither the Plan Administrator nor the Adopting Employer makes any guarantee to any Participant in any manner for any loss or other event because of the Participant's participation in this Plan.

8.5 Rules and Decisions. Except as otherwise specifically provided in the Plan, the Plan Administrator may adopt such rules and procedures as it deems necessary, desirable, or appropriate. All rules and decisions of the Plan Administrator shall be uniformly and consistently

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) applied to all Participants in similar circumstances. When making a determination or calculation, the Plan Administrator shall be entitled to rely upon information furnished by a Participant, the Adopting Employer, or legal counsel, or other entity acting on behalf of the Adopting Employer or the Plan Administrator.

8.6 Records and Reports. The Plan Administrator shall be responsible for complying with all reporting, filing and disclosure requirements for the Plan.

8.7 Authorization of Benefit Payments. The Plan Administrator (or the Claims Administrator as its designee) shall issue directions to the Trustee concerning all benefits which are to be paid from the Trust, pursuant to the provisions of the Plan, and warrants that all such directions are in accordance with the Plan.

8.8 Other Powers and Duties of the Administrator. The Plan Administrator shall also have such other duties and powers as may be necessary to discharge its duties under the Plan including, but not limited to, the following:
(a) Discretion to construe and interpret the Plan in a non-discriminatory manner, to decide all questions of eligibility and to determine all questions arising in the administration and application of the Plan;
(b) To receive from the Adopting Employer and from Participants such information as shall be necessary for the proper administration of the Plan; (c) To furnish the Adopting Employer, upon request, such annual reports with respect to the administration of the Plan as are reasonable and appropriate; and (d) To appoint individuals to assist in the administration of the Plan and any other agents the Plan Administrator deems advisable including legal and actuarial counsel.

The Plan Administrator shall not have the power to add to, subtract from, or modify any of the terms of the Plan, to change or add to any benefits provided by the Plan, or to waive or fail to apply any requirements of eligibility for a benefit under this Plan.

8.9 Indemnification. Subject to the requirements of ERISA, the Adopting Employer does hereby indemnify and hold harmless any Employee that is deemed to be a fiduciary with respect to the Plan under the terms and provisions of ERISA, the regulations promulgated thereunder or case law which develops under ERISA against any and all losses, claims, damages, expense (including court costs and attorneys' fees) and liability arising from the Employee's duties and responsibilities in connection with the Plan unless the same is determined to be intentional or willful.

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PLAN AMENDMENT AND TERMINATION

9.1 Amendment by Adopting Employer. The Adopting Employer reserves the right to amend, alter, or wholly revise this Plan or the Adoption Agreement, prospectively or retrospectively, at any time by the action of its Managing Body, and the interest of each Participant is subject to the powers so reserved. The Adopting Employer expressly may amend, alter or wholly revise this Plan or the Adoption Agreement if it determines it necessary or desirable, with or without retroactive effect, to comply with the law. Such changes shall not affect any right to benefits that accrued prior to such amendments. Such amendment shall be made in writing and shall be delivered promptly to the Claims Administrator, Plan Administrator, and Trustee.

9.2 Adopting Employer’s Right to Terminate. Although the Adopting Employer expects the Plan to be maintained for an indefinite time, the Adopting Employer reserves the right to terminate the Plan or any portion of the Plan at any time. In the event of the dissolution, merger, consolidation, or reorganization of the Adopting Employer, the Plan shall terminate unless the Plan is continued by a successor to the Adopting Employer in accordance with the resolution of such successor's Managing Body. Such termination shall not affect any right to benefits that accrued prior to such termination. Such action shall be made in writing and shall be delivered to the Claims Administrator, Plan Administrator, and Trustee at least ninety (90) days prior to the effective date of the termination.

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GENERAL PROVISIONS

10.1 No Reversion to the Plan Administrator or Adopting Employer. Except as specifically allowed under the Trust, no part of the corpus or income of the Trust shall revert to the Adopting Employer or be used for or diverted to, purposes other than the exclusive benefit of participants and other persons entitled to benefits under the Plan.

10.2 Persons Dealing With Trust. No person dealing with the Trust shall be required to see to the application of any money paid or property delivered to the Trust, or to determine whether or not the Trust is acting pursuant to any authority granted to them under the Trust.

10.3 Non-Alienation of Benefits. Benefits payable under this Plan shall not be subject to anticipation, alienation, sale, transfer, execution, or levy of any kind either voluntary or involuntary, including any such liability which is for alimony or other payments for the support of a spouse or former spouse, or for any other relative of the Participant, prior to actually being received by the person entitled to the benefit under the terms of the Plan, and any attempt to anticipate, alienate, sell, transfer, assign, pledge, encumber, charge or otherwise dispose of any right to benefits payable under the Plan shall be void. The Adopting Employer, Plan Administrator and/or Claims Administrator shall not in any manner be made liable for, or subject to, the debts, contracts, liabilities, engagements or torts of any person entitled to benefits under the Plan.

10.4 Action by Employer. Whenever the Adopting Employer, under the terms of this Plan, is permitted or required to do or perform any act or matter or thing, it shall be done and performed by the Managing Body of the Adopting Employer or such representatives of the Adopting Employer as the Managing Body may designate.

10.5 No Guarantee of Tax Consequences. Notwithstanding any provision in this Plan to the contrary, this Plan makes no commitment or guarantee that any amounts paid to or on behalf of a Participant under this Plan will be excludable from the Participant's gross income for federal or state income tax purposes. It shall be the obligation of each Participant to determine whether each payment is excludable from the Participant's gross income for federal and state income tax purposes, and to notify the Plan Administrator if the Participant has reason to believe that any such payment is not so excludable.

10.6 Compensation and Expenses. The cost of administering the Plan and Trust shall be paid as described in the Adoption Agreement.

10.7 Governing Law. This Plan shall be construed and enforced according to the laws of the State identified in the Adoption Agreement, except to the extent preempted by federal law.

10.8 Family and Medical Leave Act of 1993 (“FMLA”). Notwithstanding any provision of this Plan to the contrary, this Plan shall be operated and maintained in a manner consistent with FMLA, to the extent the Adopting Employer is subject to such law.

10.9 Newborns’ and Mothers’ Health Protection Act (“NMHPA”). Notwithstanding any provision of this Plan to the contrary, this Plan shall be operated and maintained in a manner consistent with NMHPA. Federal law requires the following statement be included in the Plan document, verbatim:

Under federal law, group health plans and health insurance issuers offering group health insurance generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, the plan or issuer may pay for a

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Funded Post-Employment HRA Basic Plan Document (Single Employer ERISA) shorter stay if the attending physician (e.g., your physician, nurse, or midwife, or a physician assistant), after consultation with the mother, discharges the mother or newborn earlier. Also, under federal law, plans and issuers may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay. In addition, a plan or issuer may not, under federal law, require that a physician or other health care provider obtain authorization for prescribing a length of stay of up 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-of-pocket costs, you may be required to obtain precertification. For information on pre-certification, contact your Plan Administrator.

10.10 Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”). Notwithstanding any provision of this Plan to the contrary, this Plan shall be operated and maintained in a manner consistent with COBRA. The Plan Administrator may, within the parameters of the law, establish uniform policies by which to provide such continuation coverage required by COBRA and such policies shall be incorporated herein by reference.

10.11 Uniformed Services Employment and Reemployment Rights Act of 1994 (“USERRA”).

Notwithstanding any provision of this Plan to the contrary, this Plan shall be operated and maintained in a manner consistent with USERRA. The Plan Administrator may, within the parameters of the law, establish uniform policies by which to provide such continuation coverage required by USERRA and such policies shall be incorporated herein by reference.

10.12 Plan Not a Contract of Employment. The Plan is not an employment agreement and does not assure the continued employment of any Employee or Participant for any period of time. Nothing contained in the Plan shall interfere with the Adopting Employer's right to discharge an Employee at any time, regardless of the effect such discharge may have upon the individual as a Participant in this Plan.

10.13 Erroneous Payments. If the Plan makes a payment for benefits in excess of the benefits required by the Plan or makes a payment to or on behalf of an individual who is not currently covered by the Plan, the Plan shall be entitled to recover such erroneous payment from the recipient thereof.

10.14 Medicare Secondary Payer. The Plan shall comply with the Medicare secondary payer rules found in 42 U.S.C. § 1395y. In general, the Plan shall pay benefits primary to Medicare if any one of the following conditions is satisfied: (a) the Adopting Employer employed twenty (20) or more employees for each working day in at least twenty (20) weeks in either the calendar year in which the claim is made or the preceding calendar year, the Participant is employed by the Employer, and the Participant is actually covered by Medicare by reason of obtaining the age of 65; (b) the Adopting Employer employed 100 or more employees on at least 50% of its regular business days during the calendar year preceding the year in which the claim was made, the Participant is employed by the Employer, and the Participant is actually covered by Medicare by reason of disability; and (c) the Participant is entitled to Medicare by reason of end stage renal disease and the claim is made during the thirty (30) month period beginning in the first month in which such Participant is entitled to benefits under Medicare (regardless of whether he/she applies for such benefits). In all other cases, the Plan shall pay benefits secondary to Medicare.

10.15 Medicare Part D. The Plan shall cooperate with Medicare Part D prescription drug plans (and Covered Individuals who are enrolled in such plans) with respect to coordination of benefits between the Plan and the Medicare Part D plan, including the provision of information to the Medicare Part D plan (or the Covered Individuals) regarding the benefits provided under the Plan for costs covered by the Medicare Part D plan. Covered Individuals enrolled in Medicare Part D plans shall cooperate with the Plan so that the Plan may perform its obligations under this subsection.

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10.16 Exhaustion of Administrative Remedies; Statute of Limitations. For all claims subject to the administrative procedures described in Article VI, exhaustion of those administrative procedures is required prior to the initiation of a legal action. Thereafter, unless specifically provided otherwise in the Adoption Agreement, legal action by a Participant, or someone on behalf of a Participant, must be initiated within one (1) year of receipt of the written notification of denial upon appeal.

To the extent exhaustion of the appeal process is not required, a Participant, or someone on behalf of the Participant, must initiate legal action within one (1) year of having submitted the initial claim request to the Plan Administrator, or its designee. No legal action may be brought by a Participant, or someone on behalf of the Participant, after expiration of the applicable limitations period. This Section 10.17 shall apply to the extent the provisions hereof are not prohibited by applicable law.

10.17 Health Care Reform. The Plan is intended to be exempt from the provisions of the Patient Protection and Affordable Health Care Act (“PPACA”), as amended by the Health Care and Education Reconciliation Act (“Reconciliation Act”), to the fullest extent allowed by law. Because expenses must be incurred after the Participant’s termination of employment with the Employer to be reimbursable under the Plan (as provided in Section 4.4), the Plan is intended to cover fewer than two current Employees of the Employers (i.e., the Plan is a “retiree-only” HRA).

10.18 ERISA Compliance. The Trustee, Adopting Employer, Plan Administrator and/or Claims Administrator shall comply with applicable law including, but not limited to, ERISA.

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PRA Basic Plan Document Adoption Agreement (Single Employer Non-ERISA) 1 FUNDED POST-EMPLOYMENT HEALTH REIMBURSEMENT ARRANGEMENT

BASIC PLAN DOCUMENT

ADOPTION AGREEMENT
This is the Adoption Agreement referred to in the Funded Post-Employment Health Reimbursement Arrangement Basic Plan Document (“Basic Plan Document”). This Adoption Agreement plus the Basic Plan Document, as amended from time to time, constitutes the Plan.

ADOPTING EMPLOYER INFORMATION:

Name: City of Yuba City
Address: 1201 Civic Center Boulevard
City, State Zip: Yuba City, California 95993
Federal ID # 94-6000460
MISCELLANEOUS:

Addendum(s) Attached: Yes No
ARTICLE I: INTRODUCTION

1.1 Original Effective Date: January 01, 2006
(month, day, year)
Effective Date of Restatement: November 5, 2024
(month, day, year)
ARTICLE II: DEFINITIONS

2.9 Dependent means:
“Dependent” means an individual (other than the Participant and the Participant’s Spouse) with respect to whom amounts expended for medical care are excluded from the Participant’s gross income under Section 105(b) of the Code, as amended.

Other (Describe):

2.12 Entry Date means:

Date Employee becomes eligible to participate.

Other (Describe):

2.16 Health Care Expense means:

Maximum permitted by law (i.e., expenses for medical care as defined in Sections 213(d) and 106(f) of the Code).

Only expenses eligible for deductible & OOP credit under the following group medical plan:

Only expenses for dental and vision care that qualify as Section 213(d) medical expenses.

Other

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PRA Basic Plan Document Adoption Agreement (Single Employer Non-ERISA) 2 2.20 Limited Scope Health Care Expense means:

N/A
As provided in the Basic Plan Document.

Other:

2.24 Name of Plan: City of Yuba City Retiree Welfare Benefits PRA Plan

2.26 Plan Year is: January 1 through December 31
(month, day, year)
The initial “short” Plan Year is: N/A
(month, day, year)

2.30 Spouse means:

An individual who is legally married to a Participant and who is treated as a “spouse” under the Code.

Other (Describe):

2.31 Name of Trust: City of Yuba City Retiree Welfare Benefit Plans ARTICLE III: ELIGIBILITY AND PARTICIPATION OF EMPLOYEES AND FORMER

EMPLOYEES

3.1 Eligibility requirements are as follows (check and complete only those that apply):

Age (Describe):

Length of Service (Describe):

Employment Classification (e.g., union, part-time, full-time) (Describe):

Police First Level Managers, Police Mid Managers, Police Officer’s Association, Firefighters Local 3793, Fire Management Association, and Department Heads hired before January 1, 2006.

A former or deceased Employee who, at the time of termination of employment or death, is covered under the following health reimbursement arrangement sponsored
by the Adopting Employer: City of Yuba City Retiree Welfare Benefits HRA Plan
Other (Describe):

3.4(a) Coverage options available under the Plan include:

Full Scope Option.

Limited Scope Option.

Suspended Account Option.

3.4(b) Coverage option determined as follows:

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PRA Basic Plan Document Adoption Agreement (Single Employer Non-ERISA) 3 Limited Scope Option.

Suspended Account Option.

3.4(c) Reimbursement rules:

N/A
As provided in the Basic Plan Document
Other:

3.5 Termination of Contributions:

As provided in the Basic Plan Document (i.e., upon ceasing to be eligible, termination of employment, death, or termination of plan).

Upon completion of the account transfer described in Section 5.1.

Other (Describe):

3.6 Termination of Participation:

As provided in the Basic Plan Document
Other (Describe):

ARTICLE IV: BENEFITS UNDER THE PLAN

4.3(a) Claims Run-out Period: In general, there is no deadline for filing claims. However, when (1) a Participant dies without a surviving Spouse or Dependent (or, if applicable, a Designated Beneficiary), (2) a deceased Participant’s last surviving Spouse or Dependent (or, if applicable, the Designated Beneficiary) who has access to the Participant’s HC Account under this Plan dies, or (3) a Participant permanently opts out of the Plan, all claims incurred prior to the date on which such person’s participation ceases must be submitted to the Plan within 365 days following the date on which participation ceases. Forfeiture of the HC Account will not occur until such deadline has passed.

4.4 Expenses must be incurred:

After termination of the Participant’s employment with Employer Additional events:

4.7 Post-death Access by Spouse & Dependents:

As provided in the Basic Document.

Other (Describe):

Post-death Access by Designated Beneficiary:

Allowed as provided in the Basic Document.

Not allowed.

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PRA Basic Plan Document Adoption Agreement (Single Employer Non-ERISA) 4 4.9 Forfeitures occur:

As provided in the Basic Document.

Other (Describe):

4.9 Use of forfeitures:

Pay administrative costs which would otherwise be paid from the Trust (i.e., Participants’ HC Account balances)
At the close of the Plan Year in which such forfeitures occur, contributed to the HC Accounts of all Participants on a per capita basis.

Other (Describe):

4.9 Vesting:
100% vesting at Entry Date
Vesting occurs pursuant to the following schedule:

4.12(d) Other Limitations, if any:

ARTICLE V: CONTRIBUTIONS AND TRUST

5.1 Employer Contribution amount, timing, restrictions (check all that apply):

One Time Contribution:

Fixed dollar amount $
Fixed formula (Describe):

Restrictions, if any (Describe):

Contributed on (Identify Date):

Recurring Contributions:

Fixed dollar amount
Per month
Per quarter
Per year
Other (Describe):

Restrictions, if any
(Describe):

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PRA Basic Plan Document Adoption Agreement (Single Employer Non-ERISA) 5 Fixed formula (Describe):

Per month
Per quarter
Per year
Other (Describe):

Restrictions, if any
(Describe):

Annual Contribution of Accumulated Paid Time Off, Vacation, or Sick Leave (Describe):

Contribution of Accumulated Paid Time Off, Vacation, or Sick Leave Upon Termination of Employment (Describe): At time of termination, a one-time Accumulated Paid Time Off, Sick Leave, Administrative Leave and/or Compensation time.

5.1 Transfers from another HRA:

N/A
Shall be made from the HRA described in Section 3.1 as described in the Basic Document.

Other (Describe):

5.3 Direction of Investments:

Plan Administrator
Participant
Other (Describe):

ARTICLE X: GENERAL PROVISIONS

10.6 Administrative expenses shall be paid as follows:

Fixed fees shall be charged to the Plan and paid from the general assets of the Adopting Employer; asset-based fees shall be charged to the Participant and paid from the Participant’s HC Account.

All fees shall be charged to the Plan and paid from the general assets of the Adopting Employer.

All fees shall be charged to the Participant and paid from the Participant’s HC Account.

Other (Describe): as included in the fee schedule for the Plan.

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PRA Basic Plan Document Adoption Agreement (Single Employer Non-ERISA) 6 If the payment is different for Participants once they terminate employment, complete again:

All fees shall be charged to the Plan and paid from the general assets of the Adopting Employer.

All fees shall be charged to the Participant and paid from the Participant’s HC Account.

Other (Describe): As included in the fee schedule for the Plan.

10.7 Governing law – State of California

10.16 Statute of Limitations:

As provided in the Basic Plan Document
Other (Describe):

ACKNOWLEDGEMENTS

1. Pursuant to Section 2.9(b) of the Basic Plan Document, any collectively bargained Employees participating in this Plan participate because the collective bargaining agreement provides for coverage under this Plan.

2. This Plan has been duly adopted or authorized to be adopted by the Adopting Employer.

3. This Plan is a “covered entity” for purposes of the Privacy Rules under the Health Insurance Portability and Accountability Act (HIPAA).

ADOPTING EMPLOYER: City of Yuba City
Date: By:

Its:

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Agenda Item 15

CITY OF YUBA CITY

STAFF REPORT
Date: August 20, 2024
To: Honorable Mayor & Members of the City Council;
From: Police Department
Presentation By: Brent Slade, Lieutenant
Summary
Subject: Purchase of Four (4) Chevrolet Tahoe Pursuit Vehicles Recommendation: Adopt a Resolution which takes the following actions:

A. Awards the purchase of four (4) Chevrolet Tahoe Pursuit Vehicles to Winner Chevrolet, Inc., of Sacramento, CA, in the amount of $264,009.04 B. Authorizes the purchase and installation of equipment to Cop Shop Installations of Yuba City, CA, in the estimated amount of $101,729.90, with the finding that it is in the best interest of the City C. Authorizes the purchase of four (4) APX 8500 all-band radios to Sutter Buttes Communication of Yuba City, CA, in the estimated amount of $38,890.36, with the finding that it is in the best interest of the City Fiscal Impact: $264,009.04 for the vehicles plus an additional $140,620.26 for the equipment and installation for a total of $404,629.30. Funding is available in the Vehicle Replacement Fund Account 6610-69401
Purpose:

Purchase of four (4) Chevrolet Tahoe 2WD Police Pursuit Vehicles Council's Strategic Goal:

This item supports the City Council's Strategic Goal of Public Safety.

Background:

Each year, Fleet Maintenance staff reviews the City’s vehicles to determine which are recommended for replacement. This is done by reviewing the age of the vehicle, the number of miles on the vehicle and the anticipated maintenance cost if the vehicle remains in service. The Police Department is due to replace several vehicles. The following is the list of vehicles needing replacement because they have reached their threshold: 20-10, 20-11, 19-15 (K-9), and 19-16 (K9).

With the expected purchase of the Chevrolet Tahoe 2WD Police Pursuit vehicles, the City must also fit the vehicles with the needed equipment. Equipment to be purchased and/or installed includes light bars, sirens, computers, radios, and modems. The City always attempts to salvage equipment from

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vehicles going out of service and place it in new vehicles, assuming they are compatible. This allows the City to save money on equipment.

With the adoption of law enforcement agencies having the ability to use both unencrypted and encrypted radio channels, the city will need to transition to full band radios, which will allow the police department to communicate with allied agencies using those same channels.

The APX8500 supports VHF, UHF, 700/800 MHz bands, providing flexibility to operate across multiple frequency bands. The current radios, APX6500, are limited to UHF band only, which restricts its interoperability and coverage options during natural disasters such as fires and floods. The APX8500 will also be more adaptable to future changes in communication standards and technologies, ensuring a longer useful life cycle and a better return on investment. The APX8500 not only improves the communication between local law enforcement agencies, it also improves the communication with mutual aid requests outside the police department's jurisdiction, making it easier and safer for officers to communicate with different law enforcement agencies under stressful conditions. With the integration of the APX8500 radio, officers would no longer be required to carry two separate radios to communicate during mutual aid incidents.

Analysis:

The City has opted to utilize Winner Chevrolet, Inc., of Sacramento, CA, to purchase the four (4) Chevrolet Tahoe PPV’s because Winner Chevrolet, Inc. holds the state contract for vehicle procurement. This decision leverages the state’s pre-negotiated terms, ensuring the city benefits from competitive pricing, standardized vehicle specifications, and streamlined procurement processes. By utilizing the state contract, the city ensures compliance with regulatory requirements and guarantees the acquisition of reliable, high-quality vehicles that meet the specific needs of law enforcement operations. This approach not only simplifies the purchasing process but also provides cost savings and efficiency, reinforcing the city’s commitment to fiscal responsibility and operational effectiveness.

In August 2024, staff received notification from General Motors that the deadline to order 2025 police vehicles will be the first part of September 2024. If vehicles are not ordered by then, there will be an approximate one-year waiting period until 2026 when vehicles can be ordered. Delaying the acquisition of new patrol vehicles can lead to increased maintenance costs and potential downtime for the current four aging vehicles needing replacement. This can hinder the effectiveness and responsiveness of law enforcement operations, compromising public safety. The delay could also result in higher future costs due to inflation and changes in market conditions, making it financially less advantageous for the city in the long run.

Ordering vehicles for the 2025/26 fiscal year in 2024 is necessary due to the limited availability of the 2025 Chevrolet Tahoe PPV. This small window for orders means the city must act promptly to secure the needed patrol vehicles. By ordering now, the city will help ensure it receives the patrol vehicles between late spring to early fall 2025 and avoids the potential disruptions of their patrol fleet and maintaining optimal public safety services. Once received, these vehicles will need to be upfitted which, due to supply chain issues which have continued into 2024, can still take up to one to two months per vehicle to actually be put into service.

The City will also have Cop Shop Installations in Yuba City, CA to perform the installation of all the equipment that will be going into each vehicle. The City has worked with Cop Shop Installations and has been satisfied with the work done in previous years. Historically, Cop Shop Installations have been the lowest bidder and at times have been the only bidder. The Cop Shop has specialized experience and expertise in the installation of police equipment, including advanced lighting systems, communication devices, and other critical components. Their deep understanding of law enforcement needs ensures that installations are both functional and reliable, which reduces operational risks and

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enhances officer safety. The Cop Shop ensures that all installations comply with federal, state, and local regulations specific to law enforcement equipment, reducing the risk of legal issues or noncompliance. It is in the best interest of the City to sole source the equipment installation for Cop Shop Installations.

It is in the best interest of the City to sole source the Motorola APX8500 radio purchase to Sutter Buttes Communications as they are the only authorized Motorola distributor I the area. This exclusivity means that they are able to provide genuine Motorola APX8500 radios, ensuring the equipment is authentic, fully supported by the manufacturer, and covered by the appropriate warranty. Besides just supplying the radios, Sutter Buttes Communication offers integrated services, including programming and ongoing technical support. This comprehensive package ensures that the radios are fully functional and optimized for the department’s specific communication needs.

Fiscal Impact:
$264,009.04 for the vehicles plus an additional $140,620.26 for the equipment and installation for a total of $404,629.30. Funding is available in the Vehicle Replacement Fund Account 6610-69401 Alternatives:

1. Do not purchase replacement Chevrolet Tahoe Pursuit Vehicles and direct staff to wait until the next window for purchase opens in 2025 for 2026 models.

2. Direct staff to evaluate other vendors for the purchase and installation of equipment.

2. Do not purchase APX8500 radios.

Recommendation:

Adopt a Resolution which takes the following actions:

A. Awards the purchase of four (4) Chevrolet Tahoe Pursuit Vehicles to Winner Chevrolet, Inc., of Sacramento, CA, in the amount of $264,009.04.

B. Authorizes the purchase and installation of equipment to Cop Shop Installations of Yuba City, CA, in the estimated amount of $101,720.90, with the finding that it is in the best interest of the City.

C. Authorizes the purchase of four (4) APX 8500 all-band radios to Sutter Buttes Communication of Yuba City, CA, in the estimated amount of $38,890.36, with the finding that it is in the best interest of the City.

Attachments:

1. RESOLUTION

2. WINNER CHEVROLET

3. SUTTER BUTTES COMMUNICATIONS

4. COP SHOP INSTALLATIONS
Prepared By: Submitted By:

Brent Slade
Police Lieutenant
Diana Langley
City Manager

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Agenda Item
ATTACHMENT 1

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RESOLUTION NO. ___

RESOLUTION OF THE CITY COUNCIL OF THE CITY OF YUBA CITY AWARDING THE PURCHASE OF FOUR (4) CHEVROLET TAHOE POLICE

VEHICLES TO WINNER CHEVROLET INC, AUTHORIZING THE SOLE

SOURCE PURCHASE AND INSTALLATION OF VEHICLE EQUIPMENT TO

COP SHOP INSTALLATIONS, AND AUTHORZING THE SOLE SOURCE
PURCHASE OF APX8500 RADIOS TO SUTTER BUTTES

COMMUNICATIONS, WITH THE FINDINGS THAT IT IS IN THE BEST

INTEREST OF THE CITY
WHEREAS, the City intends to utilize the state’s vehicle procurement contract with, Winner Chevrolet, Inc to provide four (4) Chevrolet Tahoe Police vehicles; and WHEREAS, the City intends to sole source the purchase of four (4) APX8500 radios to Sutter Buttes Communications of Yuba City, CA due to a special situation; and WHEREAS, the City intends to sole source the purchase and installation of the required vehicle equipment to Cop Shop Installations of Yuba City, CA due to a special situation; and WHEREAS, Cop Shop Installations has historically provided the most satisfactory work at the most reasonable hourly work rate, thus leading to the most favorable pricing in the area; and, WHEREAS, the City recommends sole sourcing the purchase and installation of vehicle equipment to Cop Shop Installations and Sutter Buttes Communication of Yuba City, CA; and WHEREAS, the City has met the special situation requirement to sole source the equipment purchase and installation pursuant to the City Purchasing Policies section 9-3; and, WHEREAS, the City desires to authorize the sole source purchase of the equipment and installation for the Chevrolet Tahoe Police vehicles from Cop Shop Installations and Sutter Buttes Communication with the finding that it is in the best interest of the City.

NOW, THEREFORE, the City Council of the City of Yuba City does resolve as follows:

1. The City Council of Yuba City finds that Winner Chevrolet Inc. provided a quote at a fair and reasonable cost as set forth by the state vehicle procurement process. The City Council hereby authorizes the City Manager to purchase the four (4) Chevrolet Tahoe Police vehicles from Winner Chevrolet Inc. in the amount not to exceed $264,009.04, without additional written consent from the City, subject to approval as to legal form by the City Attorney.

2. The City Council of Yuba City finds that a sole source award is appropriate on grounds that Sutter Buttes Communication has previously provided the city with satisfactory equipment. Sutter Buttes Communication is the only business that is a certified dealer of the Motorola APX8500 radio that has the capabilities of programming the radios to fit the needs of the police department. As such, the City Council approves the purchase of radios for the vehicles to Sutter Buttes Communications of Yuba City in the amount of

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$38,890.36 and authorizes the City Manager to enter into an agreement for the same, subject to approval as to legal form by the City Attorney.

3. The City Council of Yuba City finds that a sole source award is appropriate on grounds that Cop Shop Installations has previously provided the City with satisfactory equipment and installation at a very reasonable price. Historically, Cop Shop Installations has provided the lowest hourly work rate, leading to an overall lower work cost, and has provided equipment with the design/specifications that are essential to department operations and for which departmental staff have training. The purchase and installation of Police vehicle equipment to Cop Shop Installations is in the best interest of the City as they have provided satisfactory work on Police vehicles in the past at a reasonable cost and the proposed negotiated prices are reasonable as well. As such, the City Council approves the purchase of equipment for the vehicles to Cop Shop Installations of Yuba City in the amount of $101,720.90 and authorizes the City Manager to enter into an agreement for the same, subject to approval as to legal form by the City Attorney.

4. The City Council authorizes the capital acquisition of four (4) Chevrolet Tahoe PPV to enhance the operational capabilities of the police department. These vehicles are deemed necessary to support the essential functions of the police department, ensuring safety, reliability, and efficiency in the performance of its duties. The capital acquisition shall be funded through the vehicle replacement fund (6610-69401), with all procurement process adhering to the applicable policies and procedures of the City.

5. This Resolution shall take effect immediately.

The foregoing Resolution was duly and regularly introduced, passed, and adopted by the City Council of the City of Yuba City at a regular meeting thereof held on the 20th day of August 2024.

AYES:

NOES:

ABSENT:

Shon Harris, Mayor
ATTEST:

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Ciara Wakefield, Deputy City Clerk
APPROVED AS TO FORM:

COUNSEL FOR YUBA CITY:

Shannon Chaffin, City Attorney
Aleshire & Wynder, LLP

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Agenda Item 16

CITY OF YUBA CITY

STAFF REPORT
Date: August 20, 2024
To: Honorable Mayor & Members of the City Council;
From: Community Services Department
Presentation By: Ann Gillen, Community Services Director Summary
Subject: Bogue Park Playground Replacement Project Award and Purchase Recommendation: Adopt a Resolution which takes the following actions:

A. Adopts a CEQA Class 2 Categorical Exemption
B. Awards a construction contract to BCI Burke Company in the amount of $81,140.61 through Sourcewell Contract No. 010521-BUR, with the finding that it is in the best interest of the City
C. Authorizes the City Manager to execute all necessary documents related to the project
Fiscal Impact: Total Project Cost: $81,140.61
$81,140.61 - Account No. 901222 (Annual Playground Replacement) Purpose:

To maintain and enhance the City's quality of life through safe parks and promote healthy opportunities for residents of all ages.

Council's Strategic Goal:

Improving infrastructure and improving the quality of life for our community.

Background:

As part of the comprehensive operation and maintenance of the City’s recreation facilities, staff routinely inspect and evaluate the safety and functionality of the equipment at each of the City’s 16 parks that have play structures. Recommendation for equipment replacement is based on age, condition, industry standards, and regulatory compliance. The playground equipment at Bogue Park has been identified for replacement based on these areas of evaluation. The lifespan of play equipment is typically 15-20 years. The Bogue Park playground is currently 26 years old.

Analysis:

Staff inspected and evaluated the playground equipment at Bogue Park in order to identify the current safety and risk factors. Based on the age and wear, staff recommends replacing the equipment in

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order to provide a safer environment for the residents utilizing the equipment. In order to expedite the procurement process, staff recommends utilizing the Sourcewell Cooperative Program (Sourcewell).

Sourcewell gathers nationwide bids for products and services resulting in time and cost efficiencies through the procurement process, and better purchasing leverage due to a nationwide scope. The City has utilized Sourcewell on various occasions in recent years for purchases and construction contracts, with great results. Some of these include: purchase and installation of playground equipment, the design/build contract for the bike park at Didar S. Bains Park, the Blackburn Talley LED Stadium Lighting Retrofit, and the storm drain installation for Didar S. Bains Park.

Fiscal Impact:

Burke’s Sourcewell Contract is $81,140.61 for the proposed scope of work. The project is proposed to be funded through CIP Account No. 901222 (Annual Playground Replacement). Currently, the account has a balance of $165,000.

Environmental Determination:

Staff has performed a preliminary environmental assessment of this project and determined that it falls within a Class 2 Categorical Exemption set forth in CEQA Guidelines Section 15302, as the Project’s scope consists of the replacement of the existing playground structures with new structures of substantially the same size, purpose, and capacity. Further, none of the exceptions to Categorical Exemptions set forth in CEQA Guidelines 15302 apply to this Project.

Alternatives:

Do not award the Sourcewell Contract to BCI Burke Company and utilize the standard formal bidding procedures. This will result in project delays.

Recommendation:

Adopt a Resolution which takes the following actions:

A. Adopts a CEQA Class 2 Categorical Exemption

B. Awards a construction contract to BCI Burke Company in the amount of $81,140.61 through Sourcewell Contract No. 010521-BUR, with the finding that it is in the best interest of the City

C. Authorizes the City Manager to execute all necessary documents related to the project Attachments:

1. Resolution

2. Equipment Renderings
Prepared By: Submitted By:

Maddy Laffond
Administrative Assistant
Diana Langley
City Manager

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ATTACHMENT 1

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RESOLUTION NO. _________

RESOLUTION OF THE CITY COUNCIL OF THE CITY OF YUBA CITY ADOPTING A CEQA CLASS 2 CATEGORICAL EXEMPTION; AWARDING A CONSTRUCTION CONTRACT TO BCI BURKE COMPANY, INC. IN THE AMOUNT OF $81,140.61 THROUGH SOURCEWELL CONTRACT NO. 010521-BUR, WITH THE FINDING THAT IT IS IN THE BEST INTEREST OF THE CITY; AND AUTHORIZING THE CITY MANAGER

TO EXECUTE ALL NECESSARY DOCUMENTS RELATED TO THE PROJECT WHEREAS, the City of Yuba City desires to utilize Sourcewell Cooperative Contract No. 010521-BUR for the procurement of the Bogue Park Playground Replacement Project construction contract at a competitively bid, negotiated price; and, WHEREAS, Sourcewell Cooperative awarded Contract No. 010521-BUR to BCI Burke Company, Inc of Fond du Lac, WI following a nationwide competitive Request for Quotation process; and,
WHEREAS, the City desires to award the bid to BCI Burke Company, Inc. of Fond du Lac, WI through the Sourcewell Cooperative Contract No. 010521-BUR negotiated price of $81,140.61.

NOW, THEREFORE, be it resolved by the City Council of Yuba City as follows:

Section 1. The City Council finds and determines that a Class 2 Categorical Exemption set forth in the California Environmental Quality Act (CEQA) Guidelines, Section 15301, applies to this project, as the Project’s scope consists of the replacement of the existing playground structures with new structures of substantially the same size, purpose, and capacity. Further, none of the exceptions to Categorical Exemptions set forth in CEQA Guidelines 15300.2 apply to this Project.

Section 2. The City Council of the City Yuba City awards the construction contract to BCI Burke Company Inc, of Yuba City, CA by
piggybacking on the Sourcewell Cooperative Contract No. 010521- BUR negotiated price of $81,140.61, with the finding that it is in the best interest of the City.

Section 3. The City Manager is authorized to execute any agreement or other document required for the purchase subject to approval as to legal form by the City Attorney.

Section 4. This Resolution shall take effect immediately.

The foregoing Resolution was duly and regularly introduced, passed, and adopted by the City Council of the City of Yuba City at a regular meeting thereof held on the 20th day of August 2024.

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AYES:

NOES:

ABSENT:

Shon Harris, Mayor
ATTEST:

Ciara Wakefield, City Clerk Administrator

APPROVED AS TO FORM
COUNSEL FOR YUBA CITY:

Shannon Chaffin, City Attorney
Aleshire & Wynder, LLP
Attachment(s):

Exhibit A - Quote

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EXHIBIT A

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ATTACHMENT 2

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Agenda Item 17

CITY OF YUBA CITY

STAFF REPORT
Date: August 20, 2024
To: Honorable Mayor & Members of the City Council;
From: Public Works
Presentation By: Ben Moody, Public Works & Development Services Director Summary
Subject: Harter Parkway Corridor Improvement Project (Contract Award) Recommendation: Adopt a Resolution with the following actions:

A. Awards a construction contract to JPB Designs, of Orangevale, CA in the amount of their total bid of $1,300,860.00 and authorizes the City Manager to execute the contract on behalf of the City, subject to review and approval as to legal form by the City Attorney
B. Authorizes the Finance Director to make necessary budget adjustments and supplemental appropriations
C. Adopts a CEQA Class 1 categorical exemption
Fiscal Impact: $1,515,501.90 – Total Project Cost
$1,300,860.00 - Contract Award Amount
$195,129.00 - Construction Contingency (15%)
$19,512.90 - City Administration (1.5%)
Purpose:

To facilitate and encourage the development of infill property located in the Harter Specific Plan area.

Council’s Strategic Goal:

This project addresses multiple City Council Strategic Goals: maintaining the financial stability and sustainability of the City, enhancing the business-friendly environment for the City, and developing the City’s infrastructure.

Background:

Since May 2022, City staff have been coordinating with staff from the Sacramento Area Council of Governments’ (SACOG’s) to develop the Harter Parkway Corridor Improvement Project in support of SACOG’s Green Means Go initiative. On October 27, 2022, after pre-application consultation with SACOG staff, City staff submitted a Green Means Go grant application for the Harter Parkway Corridor Improvement Project with the intention of encouraging development of a future multi-family housing at the southwest corner of Harter Parkway and Butte House Road. On March 16, 2023, SACOG notified staff that the City’s application was approved. The grant agreement was executed by the City and

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SACOG on October 18, 2023.

In February 2024, staff advertised the project for bid and on April 25, 2024, four (4) bids were received and opened. Of the four (4) bids, the apparent low bidder and second low bidder did not comply with Disadvantaged Business Enterprise bidding requirements mandated by State funding sources. The third low bidder was approximately 63.4% over the engineer’s estimate.

On June 4, 2024, Council rejected all bids, approved modified plans and specifications and authorized the Public Works Department to re-advertise the project for bids with clarified Disadvantaged Business Enterprise requirements, inclusion of recent groundwater and soil data, and the portion adjacent to the Harter North subdivision as being constructed by others, all in order to obtain the most cost competitive bid.

The Harter Parkway Corridor Improvement Project includes construction of an 18-inch diameter sanitary sewer trunk main, along with related roadway restoration improvements, and is intended to encourage development of a future multi-family housing project at the southwest corner of Harter Parkway and Butte House Road (Attachment 2).

Analysis:

The Harter Parkway Corridor Improvement Project was re-advertised for bids beginning June 6, 2024.

Plans and specifications were posted on publicpurchase.com and provided to local builder/contractor exchanges. On June 28, 2024, three (3) bids were received and opened by the City Clerk. A list of the bids received and the Engineer’s Estimate are shown below:

Company Total Bid
JPB Designs, Inc., Orangevale $1,300,860.00
Lafleur Engineering, Inc., Roseville $1,805,141.00
R&R Pacific Construction, Woodland $2,292,750.00

Engineer’s Estimate $1,318,393.00
JPB Designs, Inc. is the low responsive, responsible bidder.

Contract administration, including construction management and inspection, will be performed by Public Works Department staff.

Fiscal Impact:

The estimated total project cost is approximately $1,515,501.90 which consists of the following components:

Construction Contract $1,300,860.00
Construction Contingency (15%) $ 195,129.00
Construction Management & Inspection (1.5%) $ 19,512.90 Total: $1,515,501.90
Staff is proposing a construction contingency of 15% due to the presence of high groundwater requiring substantial trench dewatering operations in order to install the proposed pipe in dry conditions.

The complicated nature of installing and operating a large trench dewatering system present the opportunity for numerous complications and unpredictable variables.

The current funding agreement with SACOG provides $1,351,000 in grant funds for construction costs,

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however, the Governor’s budget reduces the City’s Green Means Go grant funding by 6.2% to $1,267,000.00. Staff is coordinating with SACOG to amend the grant agreement scope and cost to reflect the Governor’s budget and actual construction costs. On August 15th, 2024, the SACOG board is anticipated to approve the amended grant agreement scope and cost. On October 17, 2023, Council authorized the City Manager to execute all documents associated with the Green Means Go program.

Staff will coordinate execution of the amended grant agreement with the City Manager.

Staff proposes funding the construction through CIP Account 1331 (Harter Parkway Corridor) as follows:

SACOG Green Means Go Grant: $1,267,000.00
Budget transfer from CIP Account 1104
(Recurring Collections or Rehabilitation System Project) $248,501.90 Total: $1,515,501.90
CIP Account 1104 has an estimated $1,130,000.00.

Staff is requesting authorization for the Finance Director to make the necessary budget adjustments and supplemental appropriations to receive the grant funding and provide the required City wastewater funds.

Environmental:

Staff has determined that this project falls within the Class 1 Categorical Exemption set forth in CEQA Guideline Section 15301, as the extension of an existing sewer pipeline is defined as a repair, maintenance, or minor alteration of existing utility system involving negligible or no capacity expansion Further, none of the exceptions to Categorical Exemptions set forth in CEQA Guidelines Section 15300.2 apply to this project.

Alternatives:

Reject the bids and delay/cancel the project. Delaying/canceling the project will jeopardize SACOG funding.

Attachments:

1. Resolution - Harter Parkway Corridor Improvement Project Prepared By: Submitted By:

Nick Menezes
Associate Civil Engineer
Diana Langley
City Manager

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ATTACHMENT 1

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RESOLUTION NO. _________

RESOLUTION OF THE CITY COUNCIL OF THE CITY OF YUBA CITY ADOPTING A CEQA CLASS 1 CATEGORICAL EXEMPTION AND AWARDING A CONSTRUCTION CONTRACT TO JPB DESIGNS, INC. IN THE AMOUNT OF THEIR TOTAL BID OF $1,300,860.00 (HARTER PARKWAY CORRIDOR IMPROVEMENT PROJECT CONTRACT NO. 24-01) WHEREAS, the City of Yuba City (City) advertised for bids for the City’s Harter Parkway Corridor Improvement Project (Project); and,
WHEREAS, in response to the advertisement, the City received nine (9) bids for the Project in the following bid amounts:

JPB Designs, Inc. $1,300,860.00
LaFleur Engineering, Inc. $1,805,141.00
R&R Pacific Construction $2,292,750.00; and
WHEREAS, the City Public Works Department reviewed the three (3) bids, and examined JPB Designs, Inc. and its bid response, found it to be both the lowest qualified responsive and responsible bidder; and
WHEREAS, the City desires to award the bid to JPB Designs, Inc. of Orangevale, CA and enter into an agreement with JPB Designs to construct the Harter Parkway Corridor Improvement Project
NOW, THEREFORE, be it resolved by the City Council of Yuba City as follows:

1. The City Council of the City of Yuba City finds that all of the facts set forth in the recitals above are true and current and incorporated herein.

2. The City has performed a preliminary environmental assessment of this project relative to California Environmental Quality Act (CEQA) requirements and the City Council finds and determines that the project falls within the Class 1 Categorical Exemption set forth in CEQA Guidelines Section 15301, as the extension of an existing sewer pipeline is defined as a repair, maintenance, or minor alteration of existing utility system involving negligible or no capacity expansion. Additionally, the replacement or relocation of existing water line services will service the same property and have substantially the same purpose and capacity. Further, none of the exceptions to Categorical Exemptions set forth in CEQA Guidelines Section 15300.2 apply to this project.

3. The City Council of the City of Yuba City does hereby accept the three (3) bids received as noted above, finds that JPB Designs, Inc., is the lowest responsive and responsible bidder, and awards the construction contract to JPB Designs, Inc. in their total amount bid of $1,300,860.00 for the Harter Parkway Corridor Improvement Project. Said contract agreement shall substantially comply with the terms and conditions presented in the draft agreement attached to this Resolution, shall be subjected to review and approval as to legal form by the City Attorney, and the City Manager shall be authorized to execute the same on behalf of the City of Yuba City.

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4. The City Council of the City of Yuba City does hereby authorize the Finance Director to make the necessary budget adjustments and supplemental appropriations to fund the Harter Parkway Corridor Improvement Project.

The foregoing resolution was duly and regularly introduced, passed, and adopted by the City Council of the City of Yuba City at a regular meeting thereof held on the 20th day of August, 2024.

AYES:

NOES:

ABSENT:

Shon Harris, Mayor
ATTEST:

Ciara Wakefield, City Clerk Administrator

APPROVED AS TO FORM
COUNSEL FOR YUBA CITY:

Shannon Chaffin, City Attorney
Aleshire & Wynder, LLP
Exhibit(s):

A. (Draft) Agreement – JPB Designs, Inc. Contract No. 24-01

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EXHIBIT A

CITY OF YUBA CITY

DEPARTMENT OF PUBLIC WORKS

DRAFT CONTRACT AGREEMENT

HARTER PARKWAY CORRIDOR IMPROVEMENT PROJECT
CONTRACT NO. 24-01
THIS AGREEMENT, made and concluded this ____ day of _________________ 20___, between the City of Yuba City, party of the first part, and ________________, Contractor, party of the second part.

ARTICLE I. – WITNESSETH, that for and in consideration of the payments and agreements hereinafter mentioned to be made and performed by the said party of the first part under the conditions expressed in the two bonds bearing even date with these presents and hereunto annexed, the said party of the second part agrees with the said party of the first part, at his own proper cost and expense, to do all the work and furnish all the materials, except such as are mentioned in the specifications to be furnished by said party of the first part, necessary to construct and complete in a good, workmanlike and substantial manner and to the satisfaction of the Department of Public Works, construction on various roads, all in accordance with the Special Provisions hereto annexed and also in accordance with the State of California Department of Transportation dated 2018, the Standard Plans dated 2018, the “Labor Surcharge” and “Equipment Rental Rates” in effect on the date the work is accomplished, and the “General Prevailing Wage Rates” of the State of California Department of Transportation, which said Special Provisions, Standard Plans, Standard Specifications are hereby specially referred to and by such reference made a part hereof.

The Special Provisions and the project plans for the work to be done are entitled:

HARTER PARKWAY CORRIDOR IMPROVEMENT PROJECT
Which are hereby made part of this contract.

ARTICLE II. – The said Contractor agrees to receive and accept the following prices as full compensation for furnishing all materials and for doing all the work contemplated and embraced in this Agreement; also for all loss or damage arising out of the nature of the work aforesaid, or from the action of the elements, or from any unforeseen difficulties or obstructions which may arise or be encountered in the prosecution of the work until its acceptance by the City of Yuba City and for all risks of every description connected with the work; also for all expenses incurred by or in consequence of the suspension or discontinuance of work and for well and faithfully completing the work, and the whole thereof, in the manner and according to the plans and specifications and the requirements of the Engineer under them, to wit.

ARTICLE III. – The said party of the first part hereby promises and agrees with the said Contractor to employ, and does hereby employ, the said Contractor to provide the materials and to do the work according to the terms and conditions herein contained and referred to, for the prices hereinafter set forth, and hereby contracts to pay the same at the time, in the manner and

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upon the conditions above set forth; and the said parties for themselves, their heirs, executors, administrators, successors and assigns, do hereby agree to the full performance of the covenants herein contained.

ARTICLE IV. – By my signature hereunder, as Contractor, I certify that I am aware of the provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for Workers Compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the work of this contract.

ARTICLE V. – It is further expressly agreed by and between the parties hereto that should there be any conflict between the terms of this instrument and the bid or proposal of said Contractor, then this instrument shall control and nothing herein shall be considered as an acceptance of the said terms of said proposal conflicting herewith.

ARTICLE VI. – The City of Yuba City hereby employs Contractor to provide material and to do the work according to the terms and conditions herein contained and referred to for the following prices to be paid at the time, in the manner and upon the conditions hereinafter set forth.

ARTICLE VII. – The improvement contemplated in the performance of this contract is an improvement over which the City of Yuba City shall exercise general supervision.

ARTICLE VIII. – The statement of prevailing wages appearing in the General Prevailing Wage Rates is hereby specifically referred to and by this reference is made a part of this contract. It is further expressly agreed, by and between the terms of this instrument and the bid or proposal of said Contractor, that this instrument shall control and nothing herein shall be considered as an acceptance of the said terms of said proposal conflicting herewith.

HARTER PARKWAY CORRIDOR IMPROVEMENT PROJECT
CONTRACT NO. 24-01
Item
No. Item Description Est. Qty.

Unit of
Measure
Item Price Total Amount
Bid Schedule A Harter Parkway
1 Mobilization/Demobilization 1 LS $56,000.00 $56,000.00 2 Traffic Control 1 LS $20,000.00 $20,000.00
3 Dewatering (Includes Dewatering
System Treatment) 1 LS $25,000.00 $25,000.00
4 Pavement Restoration (Type A) 54 LF $400 $21,600.00
5 Connect to Existing Sewer 1 EA $12,000.00 $12,000.00
6 Sanitary Sewer Manhole (YC SS1) 3 EA $15,000.00 $45,000.00 7 Sanitary Sewer Stub - Cleanout
(YC SS4) 1 EA $10,000.00 $10,000.00

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8 4" Sewer Lateral Connection 1 EA 15,000.00 15,000.00
9 18-Inch Sewer Pipe - Vitrified Clay
Pipe, SDR 26 PVC, or, Epoxy
Ductile Iron Pipe (Harter Parkway
Crossing - Optional Boring 67+20.1
to 69+12.8) (Includes boring &
receiving pits and pit restoration)
203 LF $500.00 $101,500.00
10 18-Inch Sewer Pipe - Vitrified Clay
Pipe, SDR 26 PVC, or, Epoxy
Ductile Iron Pipe
549 LF $500.00 $274,500.00
11 10-Inch Sewer Pipe - Vitrified Clay
Pipe, SDR 26 PVC, or, Epoxy
Ductile Iron Pipe
82 LF $480.00 $39,360.00
12 Project SWPPP & Erosion Control
(Construction Entrance) 1 LS $8,000.00 $8,000.00
Total Bid Schedule ‘A’ = $627,960.00
Item No. Item Description Est.

Qty.

Unit of
Measure
Item Price Total Amount
Deductive Alternate Bid Schedule B - Butte House Road
1 Traffic Control 1 LS $10,000.00 $10,000.00
2 Dewatering (Includes
Dewatering System Treatment) 1 LS $20,000.00 $20,000.00 3 Pavement Restoration (Type A) 90 LF $400.00 $36,000.00 4 Sanitary Sewer Stub Plug 3 EA $10,000.00 $30,000.00
5 Sanitary Sewer Manhole (YC SS1) 1 EA $15,000.00 $15,000.00 6 18-Inch Sewer Pipe - Vitrified Clay
Pipe, SDR 26 PVC, or Epoxy
Ductile Iron Pipe (Butte House
Crossing - Optional Boring
50+42.00 to 49+61.8)(Includes
boring & receiving pits and pit
restoration)
82 LF $650.00 $53,300.00
7 12-Inch Sewer Pipe - Vitrified Clay
Pipe, SDR 26 PVC, or Epoxy
Ductile Iron Pipe
20 LF $600.00 $12,000.00
8 8-Inch Sewer Pipe - Vitrified Clay
Pipe, SDR 26 PVC, or Epoxy
Ductile Iron Pipe
20 LF $500.00 $10,000.00

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Total Bid Schedule ‘B’ = $186,300.00
Item
No. Item Description Est. Qty.

Unit of
Measure
Item Price Total Amount
Deductive Alternate Bid Schedule C - Harter Parkway Road Section
1 Mobilization/Demobilization 1 LS $45,000.00 $45,000.00 2 Class 2 Aggregate Base (22-InchRoad Section) 2,160 TON $85.00 $183,600.00 3 Asphalt Concrete (Type A) (6-Inch -
Road Section) 590 TON $300.00 $177,000.00
4 Heavy Duty Driveway (YC ST11) 1 LS $25,000.00 $25,000.00 5 Minor Concrete (YC ST4 6" Barrier
Curb) 700 LF $80.00 $56,000.00
Total Bid Schedule ‘C’ = $486,600.00
TOTAL AMOUNT BID (BID SCHEDULES A + B + C) = $1,300,860.00 City Attorney, City of Yuba City

CITY OF YUBA CITY CONTRACTOR
Diana Langley Company Name
City Manager
Date By and Title (signature)
Date
By and Title (printed)

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Address
Telephone Number

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Agenda Item 18

CITY OF YUBA CITY

STAFF REPORT
Date: August 20, 2024
To: Honorable Mayor & Members of the City Council;
From: Public Works
Presentation By: Joshua Wolffe, Associate Engineer
Summary
Subject: Sutter Bike Path Gap Closure (Plans and Specifications) Recommendation: Adopt a Resolution adopting a CEQA Class 4 Categorical Exemption, approving the plans and specifications and authorizing advertisement for bids for the Sutter Bike Path Gap Closure Project
Fiscal Impact: Engineer’s Estimate $1,900,223 – Account No. 1266 (Sutter Bike Path Gap Closure)
Purpose:

To extend the existing Sutter Bike Path to Harter Parkway and construct a ten-foot wide shared-use path along the west side of Harter Parkway.

Council Strategic Goal:

This project addresses the City Council's Strategic Goal of improving the City’s infrastructure, as it will expand the City's active transportation infrastructure, ultimately creating a more accessible and connected active transportation network.

Background:

The Public Works Department has been working to facilitate the extension of the existing Sutter Bike Path eastward. The scope of proposed improvements includes the eastward construction of a Class I shared-use path from the existing east end of the Sutter Bike Path at Hooper Road to Harter Parkway.

The improvements also include the construction of a Class I shared use path along the west side of Harter Parkway from Butte House Road to State Route 20. The proposed improvements can be seen in Attachment 2.

The Sutter Bike Path Gap Closure Project (Project) will provide a direct path for pedestrians and bicyclists traveling from as far west as the Town of Sutter to Harter Parkway in Yuba City, connecting path users to Didar S. Bains Park, and adjacent existing and proposed shopping centers. The improvements along Harter Parkway will also provide a safe area for students that walk or bike to and from River Valley High School and Feather River Academy. This will create more opportunities for recreation, exercise, and shopping.

The City has been awarded $1,984,000 in Federal grant funds through the Regional Surface

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Transportation/Surface Transportation Block Grant Program (RST/STBGP) for the construction of the project. Staff and consultants are currently working with Caltrans to secure authorization to use these funds, with completion of this process anticipated by late August.

Analysis:

The plans, specifications, and estimate for the Sutter Bike Path Gap Closure Project have been completed. With Council approval of the plans and specifications and authorization to advertise for bids, staff anticipates the following schedule:

Advertise for Bid: September 2024
Award Contract: October 2024
Start Construction: Fall/Winter 2024
Completion: Spring 2025
The plans and specifications for the project are on file in the Public Works Department at City Hall and at http://www.yubacity.net/publicworksplans. Construction management and inspection will be administered by the City’s Public Works Department staff.

Fiscal Impact:

The project's engineer's estimate totals $1,900,223, which includes a 10% contingency of $190,022 and a 2.5% allocation for construction management and inspection, amounting to $42,227. Funding for the project will be drawn from CIP Account No. 1266 (Sutter Bike Path Gap Closure), which currently has a balance of $2,231,278. Detailed fiscal impacts will be presented to the Council at the time of the award, based on actual bid amounts.

Once construction is finished, staff will seek reimbursement for the incurred costs through the awarded RST/STBGP funds.

Environmental:

Staff has performed a preliminary environmental assessment of this project and has determined that it falls within Class 4 Categorical Exemption set forth in CEQA Guidelines Section 15304, as the extension of an existing bicycle path, and construction of a shared use path within existing City right of way is a minor alteration of land which does not involve removal of healthy, mature, scenic trees.

Further, none of the exceptions to Categorical Exemptions set forth in CEQA Guidelines 15300.2 apply to this project.

Alternatives:

Instruct staff to modify the plans and specifications. The project delivery schedule will be impacted.

Reccomendation:

Adopt a Resolution adopting a CEQA Class 4 Categorical Exemption, approving the plans and specifications and authorizing advertisement for bids for the Sutter Bike Path Gap Closure Project Attachments:

1. Attachment 1 - Resolution

2. Attachment 2 - Project Exhibit

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Prepared By: Submitted By:

Josh Wolffe
Senior Civil Engineer
Diana Langley
City Manager

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ATTACHMENT 1

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RESOLUTION NO. _________

RESOLUTION OF THE CITY COUNCIL OF THE CITY OF YUBA CITY ADOPTING A CEQA CLASS 4 CATEGORICAL EXEMPTION, APPROVING THE

PLANS AND SPECIFICATIONS, AND AUTHORIZING ADVERTISEMENT FOR BIDS

FOR THE SUTTER BIKE PATH GAP CLOSURE PROJECT
WHEREAS, the Public Works Department intends to solicit bids for construction of the Sutter Bike Path Gap Closure Project.

NOW, THEREFORE, be it resolved and ordered by the City Council of Yuba City as follows:

Section 1. The City has performed a preliminary environmental assessment of this project relative to California Environmental Quality Act (CEQA) requirements and the City Council finds and determines that the project falls within Class 4 Categorical Exemption set forth in CEQA Guidelines Section 15304, as the extension of an existing bicycle path, and construction of a shared use path within existing City right of way is a minor alteration of land which does not involve removal of healthy, mature, scenic trees. Further, none of the exceptions to Categorical Exemptions set forth in CEQA Guidelines Section 15300.2 apply to this project.

Section 2. The plans and specifications for the Sutter Bike Path Gap Closure Project are approved.

Section 3. The Public Works Department is hereby authorized and directed to advertise for bids for the Sutter Bike Path Gap Closure Project.

Section 4. This Resolution shall take effect immediately.

The foregoing resolution was duly and regularly introduced, passed, and adopted by the City Council of the City of Yuba City at a regular meeting thereof held on the 20th day of August, 2024.

AYES:

NOES:

ABSENT:

Shon Harris, Mayor

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ATTEST:

Ciara Wakefield, Deputy City Clerk

APPROVED AS TO FORM

COUNSEL FOR YUBA CITY
Shannon L. Chaffin, City Attorney
Aleshire & Wynder, LLP

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ATTACHMENT 2

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Agenda Item 19

CITY OF YUBA CITY

STAFF REPORT
Date: August 20, 2024
To: Honorable Mayor & Members of the City Council;
From: Public Works
Presentation By: Ben Moody, Public Works & Development Services Director Summary
Subject: Citywide Signal Hardware Upgrades (Plans & Specifications) Recommendation: Adopt a Resolution adopting a CEQA Class 1 Categorical Exemption, approving the plans and specifications, and authorizing advertisement for bids for the Citywide Signal Hardware Upgrades Project (24-09)
Fiscal Impact: $800,000 - Engineer’s Estimate
$550,000 - Account No. 1314 (Citywide Signal Hardware Upgrades) $250,000 - Account No. 1317 (SHS Signal Hardware Upgrades) Purpose:

To promote vehicle and pedestrian safety by upgrading and improving signal hardware at various signalized intersections throughout the City.

Council’s Strategic Goal:

This project addresses the City Council’s Strategic Goal of improving the City’s infrastructure.

Background:

The City of Yuba City strives to provide better and safer transportation infrastructure to its residents and visitors. In August 2020, the City developed the Systemic Safety Analysis Report (SSAR) to identify safety issues through collision analysis and developing systemic low-cost countermeasures. Upgrading traffic signal hardware was one such countermeasure identified in the SSAR as a systemic, citywide safety project.

The SSAR was then used to submit a grant application through the Caltrans Highway Safety Improvement Program (HSIP) and to secure funding for this project. Two grants were awarded for the project, one for city-owned traffic signals, and one for Caltrans-owned traffic signals, within the City limits.

The locations to be addressed are shown on the Project Location Map (Attachment 2).

Analysis:

Public Works has prepared the project plans, specifications, and cost estimate for the Citywide Signal

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Hardware Upgrades Project. The project involves the improvements of signal hardware at fifty-three (53) signalized intersections throughout the City. The scope of improvements includes new backplates, replacing 8” light bulbs with 12” light bulbs, installation of LED internally illuminated street name signs, upgrading Type IX street name signs, and installing retroreflective tape on backplates. With Council approval of the plans and specifications and authorization to advertise for bids, staff proposes the following schedule weather permitting:

Advertise for Bid: September 2024
Award Contract: October 2024
Start of Construction: November 2024
Completion: March 2025
The plans and specifications for the project are on file in the Public Works Department at City Hall and at http://www.yubacity.net/publicworksplans for review.

Fiscal Impact:

The estimated project cost is $800,000. This estimate includes 15% contingency and 10% construction management to reflect total project cost. The project will be funded primarily with HSIP funds through CIP Account No. 1314 (Citywide Signal Hardware Upgrades) and CIP Account No. 1317 (SHS Signal Hardware Upgrades). Detailed fiscal impacts will be presented to Council at the award of the contract based on the actual bid amounts.

Environmental:

Staff has performed a preliminary environmental assessment of this project and has determined that it falls within Class 1 Categorical Exemption set forth in CEQA Guidelines Section 15301, as improving and upgrading signal hardware on existing City facilities are defined as repairs, maintenance, or minor alterations of existing public facilities, involving negligible or no expansion of existing or former use.

Further, none of the exceptions to Categorical Exemptions set forth in CEQA Guidelines 15300.2 apply to this project.

Alternatives:

A. Provide staff with alternative direction regarding priority locations and/or modify project scope.

B. Delay or cancel proposed project
Recommendation:

Adopt a Resolution adopting a CEQA Class 1 Categorical Exemption, approving the plans and specifications, and authorizing advertisement for bids for the Citywide Signal Hardware Upgrades Project (24-09).

Attachments:

1. Resolution – Approval of Plans and Specifications

2. Project Location Map
Prepared By: Submitted By:

Fabiola Vazquez
Assistant Engineer
Diana Langley
City Manager

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ATTACHMENT 1

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RESOLUTION NO. _________

RESOLUTION OF THE CITY COUNCIL OF THE CITY OF YUBA CITY ADOPTING A CEQA CLASS 1 CATEGORICAL EXEMPTION,

APPROVING THE PLANS AND SPECIFICATIONS, AND

AUTHORIZING ADVERTISEMENT FOR BIDS FOR THE CITYWIDE
SIGNAL HARDWARE UPGRADES PROJECT (24-09)
WHEREAS, the Public Works Department intends to solicit bids for construction of the Citywide Signal Hardware Upgrades Project (24-09).

NOW, THEREFORE, be it resolved and ordered by the City Council of Yuba City as follows:

1. The City has performed a preliminary environmental assessment of this project relative to California Environmental Quality Act (CEQA) requirements and the City Council finds and determines that the project falls within Class 1 Categorical Exemption set forth in CEQA Guidelines Section 15301, as improving and upgrading signal hardware on existing City facilities are qualifying repairs, maintenance, or minor alteration of existing public facilities involving negligible or no expansion. Further, none of the exceptions to Categorical Exemptions set forth in CEQA Guidelines Section 15300.2 apply to this project.

2. The plans and specifications for the Citywide Signal Hardware Upgrades Project (24-09) be approved.

3. The Public Works Department is hereby authorized and directed to advertise for bids for the Citywide Signal Hardware Upgrades Project (24-09).

The foregoing resolution was duly and regularly introduced, passed, and adopted by the City Council of the City of Yuba City at a regular meeting thereof held on the 20th day of August, 2024.

AYES:

NOES:

ABSENT:

Wade Kirchner, Mayor
ATTEST:

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Ciara Wakefield, City Clerk Administrator

APPROVED AS TO FORM
COUNSEL FOR YUBA CITY:

Shannon L. Chaffin, City Attorney
Aleshire & Wynder, LLP

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ATTACHMENT 2

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6 5
4 3
1 2
35 34
33 32
31 30
29 28
27 26
25 24
23 22
21 20
19 18
17 14 15 16 13
12 11
10 8 9
7 ¯
Miles
0 0.5 1
36B
37 38
39 40
41 42
43 45 44
46 50 49 48 47 52 51
36A

CITYWIDE SIGNAL HARDWARE UPGRADES

PROJECT LOCATION MAP

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LOCATION
1 BRIDGE ST & WALTON AVE
2 BRIDGE ST & OJI WAY
3 BRIDGE ST & PLUMAS ST
4 BRIDGE ST & SHASTA ST
5 BUTTE HOUSE RD & HARTER PKWY
6 BUTTE HOUSE RD & THARP RD
7 BUTTE HOUSE RD & STABLER LN
8 BUTTE HOUSE RD & CIVIC CENTER BLVD
9 BUTTE HOUSE RD & YUBA PLAZA
10 BUTTE HOUSE RD & GRAY AVE
11 CLARK AVE & B ST
12 CLARK AVE AT YCHS CROSSWALK
13 CLARK AVE & FRANKLIN AVE
14 FRANKLIN AVE & WALTON AVE
15 FRANKLIN AVE AT WINCO
16 FRANKLIN AVE & GRAY AVE
17 GARDEN HWY & FRANKLIN AVE
18 GARDEN HWY & PERCY AVE
19 GARDEN HWY & LINCOLN RD
20 GARDEN HWY & BURNS DR
21 GARDEN HWY & BOGUE RD
22 GARDEN HWY & SHANGHAI BEND RD
23 GARDEN HWY & EUREKA DR
24 GARDEN HWY & STEWART RD
25 GRAY AVE & QUEENS AVE
26 GRAY AVE & AINSLEY AVE
27 GRAY AVE & LOUISE AVE
28 HARTER PKWY & N COLUSA FRONTAGE RD
29 LIVE OAK BLVD & QUEENS AVE
30 SECOND ST & B ST
31 STABLER LN & QUEENS AVE
32 STABLER LN & POOLE BLVD
33 WALTON AVE & SAM'S CLUB
34 WALTON AVE & CAMINO DE FLORES
35 WALTON AVE & LINCOLN RD

SITE LOCATION
36A SR 99 & QUEENS AVE (WEST)
36B SR 99 & QUEENS AVE (EAST)
37 SR 99 & SR 20
38 SR 99 & SUNSWEET BLVD
39 SR 99 & BRIDGE ST
40 SR 99 & FRANKLIN RD
41 SR 20 & SHASTA ST
42 SR 20 & PLUMAS ST
43 SR 20 & LIVE OAK BLVD
44 SR 20 & CLARK AVE
45 SR 20 & GRAY AVE
46 SR 20 & ROCCA WAY
47 SR 20 & CIVIC CENTER BLVD
48 SR 20 & N WALTON AVE
49 SR 20 & THARP RD
50 SR 20 & HARTER PKWY
51 SR 20 & N GEORGE WASHINGTON BLVD
52 SR 20 & WESTERN PKWY
SITE

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Agenda Item 20

CITY OF YUBA CITY

STAFF REPORT
Date: August 20, 2024
To: Honorable Mayor & Members of the City Council;
From: Fire Department
Presentation By: Jesse Alexander, Fire Chief
Summary
Subject: Medical Priority Dispatch System
Recommendation: Adopt a Resolution awarding the purchase of a Medical Priority Dispatch System, ProQA, to Priority Dispatch of Salt Lake City, UT, in the amount of $113,102, with the finding that it is in the best interest of the City Fiscal Impact: $113,102 plus staff time for training and implementation - Account No. 2170- 62701
$13,310 annually ongoing cost
Purpose:

To implement a Medical Priority Dispatch System (MPDS), ProQA, at the Yuba City Dispatch Center, which will provide the ability to classify medical-aid calls based on level of acuity.

Council's Strategic Goal:

The implementation of an MPDS will address Council's goal of Public Safety.

Background:

Emergency Medical Dispatch (EMD), a system of categorizing and prioritizing emergency calls to help assess the severity of the medical incident and determine what resources need to be dispatched, is an accepted part of pre-hospital care and can significantly impact patient outcomes. The Yuba City Dispatch Center utilizes card sets, which are manual cards that dispatchers reference to ask a series of medical questions and provide instructions. However, the manual card sets are no longer supported by the vendor, Priority Dispatch, and do not provide the opportunity to record emergency medical calls based on acuity.

The Yuba City Fire Department (YCFD) responds to a variety of calls throughout the year. As reflected in Table 1, 60.6% of the calls that the YCFD responded to in 2023 were emergency medical-aid calls.

The YCFD utilizes a Code 3 response to all medical-aid calls, meaning lights and sirens are activated, to dispatch a fire apparatus and corresponding crew, regardless of level of acuity.

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Table 1: 2023 Calls for Service Broken Down by Call Type Incident Type Number Percentage
Fire 347 3.2%
Emergency Medical 6,595 60.6%
Rescue/Vehicle Accident 627 5.8%
Hazardous Materials/Conditions 188 1.7%
Good Intent/Service Calls 2,743 25.2%
False Alarm 377 3.5%
Total: 10,877 100%
Analysis:

In a fully implemented EMD system, also known as a Medical Priority Dispatch System (MPDS), EMD is interfaced with the computer-aided dispatch (CAD) system so that once the initial vital questions are asked, the software gives a determinant of the level of response required - from the highest priority - ECHO - down through DELTA, CHARLIE, BRAVO, and finally the lowest priority - ALPHA. Adopting a structured protocol EMD call-taking system has many benefits including:
• Streamlines and accelerates training, provides consistency and standards, reduces risk and cost, and improves performance.
• Increases the quality and priority of information transfer gathered and relayed to responders. • Accurately and consistently prioritizes events based on information that is gathered in a manner that addresses the most critical and scene safety/life-threatening information first. • Records medical-aid calls based on acuity.
• Allows YCFD staff to analyze call data for opportunities to make operational improvements. • Provides Bi-County Ambulance, the pre-hospital care ambulance provider within Yuba City and Sutter County, data to deploy the appropriate level of response - Advanced Life Support, Basic Life Support, Code 2 or 3, or even non-emergency referrals.

The Sutter County Sheriff's Department has an MPDS through Priority Dispatch, though it is understood that the utilization of the system is currently on hold. Staff recommends purchasing an MPDS, ProQA, from Priority Dispatch due to their long-standing established leadership in the field and for consistency within the region for Bi-County Ambulance.

Fiscal Impact:

The initial cost to purchase ProQA is $113,102, and includes the software, licenses, training, and implementation support. Once the program is implemented, the ongoing annual cost for system license renewal, services, and support is $13,310. The Communications Division of the Police Department has several vacancies which will result in significant salary savings for FY 24/25. Staff proposes to utilize salary savings to fund the upfront cost of $113,102.

Alternatives:

Do not proceed with implementing a Medical Priority Dispatch System at this time and recommend that staff submit the request as part of the FY 25/26 budget process.

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Recommendation:

Adopt a Resolution awarding the purchase of a Medical Priority Dispatch System, ProQA, to Priority Dispatch of Salt Lake City, UT, in the amount of $113,102, with the finding that it is in the best interest of the City.

Attachments:

1. Attachment 1 - Resolution - Priority Dispatch

2. Attachment 2 - ProQA Proposal
Prepared By: Submitted By:

Diana Langley
City Manager
Diana Langley
City Manager

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ATTACHMENT 1

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RESOLUTION NO. _________

RESOLUTION OF THE CITY COUNCIL OF THE CITY OF YUBA CITY

AWARDING THE PURCHASE OF A MEDICAL PRIORITY DISPATCH SYSTEM TO PRIORITY DISPATCH OF SALT LAKE CITY, UT, IN THE AMOUNT OF $113,102, WITH THE

FINDING THAT IT IS IN THE BEST INTEREST OF THE CITY
WHEREAS, Emergency Medical Dispatch (EMD) is a system of categorizing and prioritizing emergency calls to help assess the severity of the medical incident and determine what resources need to be dispatched; and
WHEREAS, the Yuba City Dispatch Center utilizes an EMD consisting of card sets manufactured by Priority Dispatch that are no longer supported; and WHEREAS, the Yuba City Fire Department responds to a variety of calls throughout the year, of which a large percentage are medical-aid calls; and WHEREAS, a fully implemented EMD system, also known as a Medical Priority Dispatch System (MPDS), would provide the ability to determine the level of response required for medical-aid calls – from the highest priority – ECHO – down through DELTA, CHARLIE, BRAVO, and finally the lowest priority - ALPHA; and
WHEREAS, implementing an MPDS has many benefits including: streamlining and accelerating training of dispatchers, providing consistency and standards, reducing risk and cost, and improving performance; and
WHEREAS, Priority Dispatch of Salt Lake City, UT, is a recognized industry vendor of MPDS’s; and
WHEREAS, the Sutter County Sheriff’s Department has an MPDS from Priority Dispatch so that the purchase of a system through Priority Dispatch would provide regional consistency, and
WHEREAS, the City has met the requirements to sole source the contract pursuant to City Purchasing Policy section 9-3.1.2; and
WHEREAS, the City Council now desires to authorize the sole source purchase of a MPDS from Priority Dispatch.

NOW, THEREFORE, be it resolved by the City Council of Yuba City as follows:

1. The City Council finds that all the facts set forth in the recitals above are true and correct and incorporated herein.

2. The City Council finds that a sole source award is appropriate on grounds including that Priority Dispatch is an established and recognized provider of MPDS’s throughout the nation, and that purchasing a system from Priority Dispatch maintains consistency within the region, which is important for Bi-County Ambulance’s operations. Given this, the City Council finds that it is in the best interest of the City to make a sole source award to Priority Dispatch for a Medical Priority Dispatch System. As such, the City Council of the

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City of Yuba City awards the purchase of a Medical Priority Dispatch System to Priority Dispatch of Salt Lake City, UT, in the amount of $113,102.

The foregoing Resolution was duly and regularly introduced, passed, and adopted by the City Council of the City of Yuba City at a regular meeting thereof held on the 20th day of August, 2024.

AYES:

NOES:

ABSENT:

Shon Harris, Mayor
ATTEST:

Ciara Wakefield, Deputy City Clerk

APPROVED AS TO FORM
COUNSEL FOR YUBA CITY:

Shannon Chaffin, City Attorney
Aleshire & Wynder, LLP

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110 Regent Street, Suite 500 Agency: Yuba City Police Department Salt Lake City, UT 84111 Agency ID#: 1696
USA Quote #: Q-71563
www.prioritydispatch.net Date: 3/10/2024
Prepared By: Tim Martin Offer Valid Through: 5/2/2024
Phone: (800) 363-9127
Direct:

Payment Terms Net 30
Email: [email protected] Currency: USD
Bill To: Ship To:

Yuba City Police Department Yuba City Police Department PO BOX 3447 1545 Poole Blvd
Yuba City, California 95992-3447 Yuba City, California 95993-2615 United States United States
Year 1 Implementation and Support
Product Qty Amount
Xlerator: 1-20 License 1 USD 3,850.00
ProQA Supervisor License
Supervisor Software Licenses Monitoring and reporting software 1 USD 2,475.00
ProQA Production/Live License
Automated calltaking software
5 USD 23,375.00
AQUA Case Review Software
Quality Assurance (case review) software base engine and discipline module 1 USD 2,750.00
Installation and Configuration
technical assistance for software installation and configuration for IT personnel 1 USD 6,353.00
ProQA & AQUA Reports Training Remote -
(4 hours) for administrators, managers and supervisors on ProQA and AQUA reporting functions 1 USD 179.00
ProQA Software Training Remote
Per person cost for four hours of ProQA software
training completed in a virtual, instructor-led environment 8 USD 1,432.00
AQUA Software Training Remote
Per person cost for a 6 hour course completed in a virtual, instructor-led environment 4 USD 916.00
Certification Training ED-Q On-site (Per)
Materials, tuition and certification (2 days, 16 hours) 4 USD 2,620.00
Implementation Support
Implementation support and quality management program development 1 USD 33,000.00
Q Plus (Per Call)
Expert case review and reporting. Subscription auto-renews without written cancellation 936 USD 20,592.00
ACE Accreditation New Application
IAED fee for accreditation
1 USD 2,250.00
The One Plan Maintenance Package
System License Renewal, Services & Support
1 USD 13,310.00
Year 1 Implementation and Support TOTAL: USD 113,102.00 "To lead the creation of meaningful change in public safety and health."

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Year 2 Service and Support
Product Qty Amount
The One Plan Maintenance Package
System License Renewal, Services & Support
1 USD 13,310.00
Year 2 Service and Support TOTAL: USD 13,310.00
Subtotal USD 113,102.00
Estimated Tax
Total USD 113,102.00
Customer Signature: Date:

Customer Name: Purchase Order ID:

Expiration Date:

TERMS AND CONDITIONS
This quote is valid for 120 days from date of issue. All prices quoted are exclusive of any applicable taxes, duties, or government assessments relating to this transaction, which are the sole obligation of Buyer. You can find it here: https://prioritydispatch.net/licensing/ "To lead the creation of meaningful change in public safety and health."

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Agenda Item 21

CITY OF YUBA CITY

STAFF REPORT
Date: August 20, 2024
To: Honorable Mayor & Members of the City Council;
From: Administration Department
Presentation By: Diana Langley, City Manager
Summary
Subject: 2024 Nagar Kirtan Sikh Parade
Recommendation: Receive an update from the Sikh Parade Ad Hoc Committee on the planning efforts for the 2024 Nagar Kirtan Sikh Parade
Fiscal Impact: None
Purpose:

To receive an update on the public safety planning efforts for the annual Sikh Parade, scheduled for November 3, 2024.

Council's Strategic Goal:

This addresses Council's goal of Public Safety.

Background:

Every year on the first Sunday in November, the Gurdwara Sahib Sikh Temple (Temple) on Tierra Buena Road hosts the Nagar Kirtan which includes a parade that begins at the Temple, which is located in Sutter County, and continues through the northwestern portion of Yuba City. In December 2023, City Council designated Mayor Harris and Vice Mayor Shaw to lead a Sikh Parade Ad Hoc Committee to work with Temple representatives on coordination of the required Special Event Permit from the City.

Analysis:

Mayor Harris and Vice Mayor Shaw will provide a status update on planning efforts and the Special Event Permit.

Fiscal Impact:

None.

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Recommendation:

Receive an update from Sikh Parade Ad Hoc on the planning efforts for the 2024 Nagar Kirtan Sikh Parade.

Attachments:

None
Prepared By: Submitted By:

Diana Langley
City Manager
Diana Langley
City Manager

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CITY OF YUBA CITY
Future Agenda Items
- Councilmember Boomgaarden
- Councilmember Kirchner
- Councilmember Pasquale
- Vice Mayor Shaw
- Mayor Harris

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CITY OF YUBA CITY
Reports and Communications
The following reports and communication items are provided for the Council’s information. No action can be taken on items under this section unless the Council agrees to include it on a subsequent agenda
City Council Reports
- Councilmember Boomgaarden
- Councilmember Kirchner
- Councilmember Pasquale
- Vice Mayor Shaw
- Mayor Harris
Adjournment

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Yuba City City CouncilAugust 20, 2024

Yuba City City Council
August 20, 2024