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HomeMy WebLinkAboutAGMT - Orange County Health Care Agency (Point of Dispensing Site Equipment Services) Pending return from OC.\: I AGREEMENT FOR PROVISION OF 2 POINT OF DISPENSING SITE EQUIPMENT SERVICES 3 BETWEEN 4 COUNTY OF ORANGE 5 AND 6 CITY OF SEAL BEACH 7 JULY 1, 2015 THROUGH JUNE 30, 2020 8 9 THIS AGREEMENT entered into this Ist day of July 2015, which date is enumerated for purposes 10 of reference only, is by and between the COUNTY OF ORANGE (COUNTY) and CITY OF SEAL I I BEACH, a local government agency (CONTRACTOR). This Agreement shall be administered by the 12 County of Orange Health Care Agency (ADMINISTRATOR). 13 14 WITNESSETH: 15 16 WHEREAS, COUNTY wishes to contract with CONTRACTOR for the provision of Point of 17 Dispensing Site Equipment Services described herein to the residents of Orange County; and 18 WHEREAS, CONTRACTOR is agreeable to the rendering of such services on the terms and 19 conditions hereinafter set lbrft 20 NOW, THEg =FORE., IT IS MUTUALLY AGREED AS FOLLOWS: 21 H 22 H 23 H 24 H 25 H 26 // 27 H 28 29 30 31 32 H 33 // 34 H 35 H 36 H 37 // 1 2 3 4 5 6 7 8 9 10 II 12 11) 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 CONTENTS CONTENTS EXHIBIT A PAGE 1. Definitions ................................................................................................. ............................... I II. Services ..................................................................................................... ............................... 1 2 of 25 X.ACON'I RAUS - 201 i - A2015- 2020AMSIP0D- EpuiPMEn1 MASnx 15 -20 13G.00CX CSB04 MAPOD03M IKK20 CRY OF SEAL. BEACH PARAGRAPH PAGE TitlePage ................................................................................................... ............................... 1 Contents..................................................................................................... ............................... 2 ReferencedContract Provisions ............................................................... ............................... 3 I. Acronyms-- ..................... .......... ........ .. . ...... — ................................................... ............... 4 II. Alteration of Terms ................................................................................... ............................... 5 111. Compliance ............................................................................................... ............................... 5 IV. Confidentiality ........................................................................................... ...............I............... 8 V. Delegation, Assignment and Subcontracts ............................................... ............................... 8 VI. Employee Eligibility Verification ............................................................ ............................... 10 VII. Facilities, Payments and Services ............................................................................................ 10 VIII. Indemnification and Insurance ................................................................. ............................... 10 IX. Inspections and Audits .............................................................................. ............................... 14 X. Licenses and Laws .................................................................................... ............................... 15 XI. Literature, Advertisements, and Social Media ......................................... ............................... 16 XII. Maximum Obligation ................................................................................ ............................... 16 XIII. Nondiscrimination ..................................................................................... ............................... 17 XIV. Notices ....................................................................................................... ............................... 19 XV. NCtifir_ation Of Public Events And Meetings ---- .... ........................................................... 19 XVI. Records Management and Maintenance .................................................. ..................I............ 19 XVII. Research and Publication. ....... ................................. .............................................................. 20 XVII1. Right to Work and Minimum Wage Laws ............................................... ............................... 20 XIX. Severability ................................................................................................ ............................... 21 XX. Status of Contractor .................................................................................. ............................... 21 XXI. Term .......................................................................................................... ............................... 21 XXII. Termination ............................................................................................... ............................... 22 XXIII. Third Party Beneficiary ............................................................................ ............................... 23 XXIV. Waiver of Default or Breach ..................................................................... ............................... 24 SignaturePage .......................................................................................... ............................... 25 CONTENTS EXHIBIT A PAGE 1. Definitions ................................................................................................. ............................... I II. Services ..................................................................................................... ............................... 1 2 of 25 X.ACON'I RAUS - 201 i - A2015- 2020AMSIP0D- EpuiPMEn1 MASnx 15 -20 13G.00CX CSB04 MAPOD03M IKK20 CRY OF SEAL. BEACH I REFERENCED CONTRACT PROVISIONS 2 3 Term: July 1, 2015 through June 30. 2016 4 5 Maximum Obligation: $0 ' 6 7 Notices to COUNTY and CONTRACTOR: 8 COUNTY: County of Orange 9 Health Care Agency 10 Contract Services 11 405 West 5th Street, Suite 600 12 Santa Ana, CA 92 70 1 -463 7 13 County of Orange 14 Health Care Agency 15 Program Manager 16 Health Disaster Management Division 17 405 West 5th Street. Suite 310 18 Santa Ana, CA 92701 19 CONI'IZACTOR: City of Seal Beach 20 Mike Henderson 21 911 Seal Beach Blvd. Seal Beach, CA 90740 22 mhenderson@sealbeachca.gov 23 562- 799 -4100 24 // 25 // 26 // 27 // 28 // 29 // 30 31 32 // 33 // 34 // 35 // 36 // 1 37 3 of 25 X' \CONTRACTS- 2015- L1015- 2020VOMNOD- EQUIF6IENT MASTER I5 -20 nG.DOCX CS1304 MAPOD03M I KK20 CITY OF SEAT BEACH 1. ACRONYMS 2 IlThe following standard definitions are for reference purposes only and may or may not apply in their 3 entirety throughout this Agreement: 4 A. ARRA American Recover), and Reinvestment Act 5 B. ASRS Alcohol and Drug Programs Reporting System 6 C. CCC California Civil Code 7 D. CCR California Code of Regulations g E. CEO County Executive Office 9 F. CFR Code of Federal Regulations 10 G. CHPP COUNTY 1-IfPAA Policies and Procedures I 1 H. CI IS Correctional Health Services 12 1. COI Certificate of Insurance 13 J. D /MC Drug /Medi -Cal 14 K. DI ICS Department of Health Care Services 15 L. DPFS Drug Program Fiscal Systems 16 M. DRS Designated Record Set 17 N. ePHI Electronic Protected Health Information 18 O. GAAP Generally Accepted Accounting Principles 19 P. 1 -ICA Health Care Agency 20 Q. 111 IS Health and Human Services 21 R. 1-II13AA Health Insurance Portability and Accountability Act of 1996. Public 22 Law 104 -191 23 S. I ISC California Health and Safety Code 24 T. ISO Insurance Services Office 25 U. MHP Mental Health Plan 26 V. OCJS Orange County Jail System 27 W. OCPD Orange County Probation Department 28 X. OCR Office for Civil Rights 29 Y. OCSD Orange County Sheriffs Department 30 Z. OIG Office of Inspector General 31 AA. OMB Office of Management and Budget 32 A13. OPM Federal Office of Personnel Management 33 AC. PA DSS Payment Application Data Security Standard 34 AD. PC State of California Penal Code 35 AE. PCI DSS Payment Card Industry Data Security Standard 36 AF. 13111 Protected Health Information 37 AG. PII Personally Identifiable Information 4 of 25 X: \CO,N' l ]iACrS - 2015 - \2015- 2020 \MS \POD- EQUIPAIItNI MASrER i S ?013G.DOCX CSBO4MAPODOW IKK20 CITY OF SHAL BEACH I AFI. PRA Public Record Act 2 AI. SIR Self- Insured Retention 3 AJ. The I IITECI I Act The 1-lealth Information Technology for Economic and Clinical Health 4 Act, Public Law 111 -005 5 AK. USC United States Code 6 AL. WIC State of California Welfare and Institutions Code 7 g H. ALTERATION OF TERMS 9 A. This Agreement, together with Exhibit A attached hereto and incorporated herein, fully 10 expresses the complete understanding of COUNTY and CONTRACTOR with respect to the subject 1 1 matter of this Agreement. 12 B. Unless otherwise expressly stated in this Agreement, no addition to, or alteration of the terms of 13 this Agreement or any Exhibits, whether written or verbal, made by the parties, their officers, employees 14 or agents shall be valid unless made in the form of a written amendment to this Agreement, which has 15 been formally approved and executed by both parties. 16 17 III. COMPLIANCE 18 A. ADMINISTRATOR has established a Compliance Program for the purpose of ensuring 19 adherence to all rules and regulations related to federal and state health care programs. 20 L ADMINISTRATOR shall provide CON'TRAC'TOR with a copy of the relevant FICA 21 policies and procedures relating to FICA's Compliance Program, ACA's Code of Conduct and General 22 Compliance Trainings. 23 2. CONTRACTOR has the option to adhere to I -ICA's Compliance Program and Code of 24 Conduct or establish its own, provided CONTRACTOR'S Compliance Program and Code of Conduct 25 have been verified to include all required elements by ADMINISTRATOR's Compliance Officer as 26 described in subparagraphs below. 27 3. If CONTRACTOR elects to adhere to I -ICA's Compliance Program and Code of Conduct; 28 the CONTRACTOR shall submit to the ADMINISTRATOR within thirty (30) calendar days of award 29 of this Agreement a signed acknowledgement that CONTRACTOR shall comply with I -ICA's 30 Compliance Program and Code of Conduct. 31 4. If CONTRACTOR elects to have its own Compliance Program and Code of Conduct then it 32 shall submit a copy of its Compliance Program, Code of Conduct and relevant policies and procedures 33 to ADMINISTRATOR within thirty (30) calendar days of award of this Agreement. 34 ADMINISTRATOR'S Compliance Officer shall determine if CONTRACTOR Compliance Program 35 and Code of Conduct contains all required elements. CONTRACTOR shall take necessary action to 36 meet said standards or shall be asked to acknowledge and agree to the FICA's Compliance Program and 37 H 5 of'25 S: \CON I' RAC 'I'S - 2015 - \1015- 2020 \NIS \1101)- 1`- pulvmen r MASTER 15 -20 n(i.DOCY CS 1304MAPOD03NI IKK20 Cn Y OF SFAI. nrACH 3 4 5 6 7 8 9 10 II 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Code of Conduct if the CONTRACTOR's Compliance Program and Code of Conduct does not contain all required elements. 5. Upon written confirmation from ADMINISTRATOR'S Compliance Officer that the CONTRACTOR Compliance Program and Code of Conduct contains all required elements, CONTRACTOR shall ensure that all Covered Individuals relative to this Agreement are made aware of CONTRACTOR's Compliance Program, Code of Conduct and related policies and procedures. 6. Failure of CONTRACTOR to submit its Compliance Program, Code of Conduct and relevant policies and procedures shall constitute a material breach of this Agreement. Failure to cure such breach within sixty (60) calendar days of such notice from ADMINISTRATOR shall constitute grounds for termination of this Agreement as to the non - complying party. 13. SANCTION SCRELNING — CONTRACTOR shall adhere to all screening policies and procedures and screen all Covered Individuals employed or retained to provide services related to this Agreement to ensure that they are not designated as Ineligible Persons, as pursuant to this Agreement. Screening shall be conducted against the General Services Administration's Excluded Parties List System or System for Award Management, the Health and Human Services /Office of Inspector General List of Excluded Individuals/Entities, and the California Medi -Cal Suspended and Ineligible Provider List and /or any other as identified by the ADMINISTRATOR. 1. Covered Individuals includes all contractors, subcontractors, agents, and other persons who provide health care items or services or who perform billing or coding functions on behalf of A DiviiNi°i T RA vR. Not ..ithstandmg the above this term does not include part-time or per -diem employees, contractors, subcontractors, agents, and other persons who are not reasonably expected to work more than one hundred sixty (160) hours per year; except that any such individuals shall become Covered Individuals at the point when they work more than one hundred sixty (160) hours during the calendar year. CONTRACTOR shall ensure that all Covered Individuals relative to this Agreement are made aware of ADMINISTRATOR'S Compliance Program, Code of Conduct and related policies and procedures. 2. An Ineligible Person shall be any individual or entity who: a. is currently excluded, suspended, debarred or otherwise ineligible to participate in federal and state health care programs; or b. has been convicted of a criminal offense related to the provision of health care items or services and has not been reinstated in the federal and state health care programs after a period of exclusion, suspension, debarment, or ineligibility. 3. CONTRACTOR shall screen prospective Covered Individuals prior to hire or engagement. CONTRACTOR shall not hire or engage any Ineligible Person to provide services relative to this Agreement. 4. CONTRACTOR shall screen all current Covered Individuals and subcontractors semi- annually to ensure that they have not become Ineligible Persons. CONTRACTOR shall also request that 6 of 25 X.ACONTILACIS- 2015- A2015 -2020AMSVPOD- Epulrmr.Nr MASTER 15- 20nG.DOCx CS1304MAPOD03MIRIC20 Cm or SEAL BRACH I its subcontractors use their best efforts to verify that they are eligible to participate in all federal and 2 State of California health programs and have not been excluded or debarred from participation in any 3 federal or state health care programs, and to further represent to CONTRACTOR that they do not have 4 any Ineligible Person in their employ or under contract. 5 5, Covered Individuals shall be required to disclose to CONTRACTOR immediately any 6 debarment, exclusion or other event that makes the Covered Individual an Ineligible Person. 7 CONTRACTOR shall notify ADMINISTRATOR immediately if a Covered Individual providing g services directly relative to this Agreement becomes debarred, excluded or otherwise becomes an 9 Ineligible Person. I0 6. CONTRACTOR acknowledges that Ineligible Persons are precluded from providing I I federal and state funded health care services by contract with COUNTY in the event that they are 12 currently sanctioned or excluded by a federal or state law enforcement regulatory or licensing agency. t3 If CONTRACTOR becomes aware that a Covered Individual has become an Ineligible Person, 14 CONTRACTOR shall remove such individual from responsibility for, or involvement with. COUNTY 15 business operations related to this Agreement. 16 7. CONTRACTOR shall notify ADMINISTRATOR immediately if a Covered Individual or 17 entity is currently excluded, suspended or debarred, or is identified as such after being sanction 18 screened. Such individual or entity shall be immediately removed from participating in any activity 19 associated with this Agreement. ADMINISTRATOR will determine appropriate repayment from, or r,,. �nwrr "I TOT: — Ser i ,ided by ineliaihla person or individual. 20 sanctionk'n) to �I 1 11-1.v r 21 CONTRACTOR shall promptly return any overpayments within forty -five (45) business days alter the 22 overpayment is verified by the ADMINISTRATOR. 23 C. COMPLIANCE TRAINING — ADMINISTRATOR shall make General Compliance Training 24 and Provider Compliance Training, where appropriate, available to Covered Individuals. 25 1. CONTRACTOR shall use its best efforts to encourage completion by Covered Individuals; 26 provided, however, that at a minimum CONTRACTOR shall assign at least one (1) designated 27 representative to complete all Compliance Trainings when offered. 28 2. Such training will be made available to Covered Individuals within thirty (30) calendar 29 days of employment or engagement. 30 3. Such training will be made available to each Covered Individual annually. 31 4. Each Covered Individual attending training shall certify, in writing, attendance at 32 compliance training. CONTRACTOR shall retain the certifications. Upon written request by 33 ADMINISTRATOR, CONTRACTOR shall provide copies of the certifications. 34 D. MEDICAL BILLING, CODING, AND DOCUMENTATION COMPLIANCE STANDARDS 35 1. CONTRACTOR shall take reasonable precaution to ensure that the coding of health care 36 claims, billings and /or invoices for same are prepared and submitted in an accurate and timely manner 37 and are consistent with federal, state and county Taws and regulations. 7 of 25 X VC0N I RAC'IS- 2013-A2015 2020AMSTOD- EQUIPMENT MASTER 15 -20 nG.00cx CSB04 MA POD03NI I KK20 CI FY OF SEAL 13[-Am 1 2. CONTRACTOR shall not submit any false, fraudulent, inaccurate and /or fictitious claims 2 for payment or reimbursement of any kind. 3 3. CONTRACTOR shall bill only for those eligible services actually rendered which are also 4 fully documented. When such services are coded, CONTRACTOR shall use accurate billing codes 5 which accurately describes the services provided and must ensure compliance with all billing and 6 documentation requirements. 7 4. CONTRACTOR shall act promptly to investigate and correct any problems or errors in 8 coding of claims and billing, if and when, any such problems or errors are identified. 9 5. CONTRACTOR shall promptly return any overpayments within forty -five (45) business 10 days after the overpayment is verified by the ADMINISTRATOR. I 12 IV. CONFIDENTIALITY 13 A. CONTRACTOR shall maintain the confidentiality of all records, including billings and any 14 audio and /or video recordings, in accordance with all applicable federal, state and county codes and 15 regulations, as they now exist or may hereafter be amended or changed. 16 B. Prior to providing any services pursuant to this Agreement, all members of the Board of 17 Directors or its designee or authorized agent, employees, consultants, subcontractors, volunteers and I g interns of the CONTRACTOR shall agree, in writing, with CONTRACTOR to maintain the 19 confidentiality of any and all information and records which may be obtained in the course of providing L Tti: Agree.. K II �:f., that 't Aff' l: racneCtiye of all cnhcemlent Zu Su 11 SCr'viCCS. X11 S 11��wulent Sua.. spe.,.., 21 resignations or terminations of CONTRACTOR members of the Board of Directors or its designee or 22 authorized agent, employees, consultants, subcontractors, volunteers and interns. 23 C. If CONTRACTOR is a public institution, COUNTY understands and agrees the 24 CONTRACTOR is subject to the provisions of the California Public Records Act. In the event 25 CONTRACTOR receives a request to produce this Agreement , or identify any term, condition, or 26 aspect of this Agreement, CONTRACTOR shall notify COUNTY no less than three (3) business days 27 prior to releasing such information. 28 29 V. DELEGATION. ASSIGNMENT AND SUBCONTRACTS 30 A. CONTRACTOR may not delegate the obligations hereunder, either in whole or in part, without 31 prior written consent of COUNTY. CONTRACTOR shall provide written notification of 32 CONTRACTOR's intent to delegate the obligations hereunder, either in whole or part, to 33 ADMINISTRATOR not less than sixty (60) calendar days prior to the effective date of the delegation. 34 Any attempted assignment or delegation in derogation of this paragraph shall be void. 35 B. CONTRACTOR may not assign the rights hereunder, either in whole or in part, without the 36 prior written consent of COUNTY. 37 // 8 of 25 X' \CONTRAC "I S- 2015 -\2015- 2020 \MS\1'OD - EQUIPMENT MASfHK I5 -20 13G.DOCX CS1104 MAPOD03M I KK20 CITY OF SEAL BEACH 1 1. If CONTRACTOR is a nonprofit organization, any change from a nonprofit corporation to 2 any other corporate structure of CONTRACTOR, including a change in more than fifty percent (50 %) 3 of the composition of the Board of Directors within a two (2) month period of time, shall be deemed an 4 assignment for purposes of this paragraph, unless CONTRACTOR is transitioning from a community 5 clinic /health center to a Federally Qualified Health Center and has been so designated by the Federal 6 Government. Any attempted assignment or delegation in derogation of this subparagraph shall be void. 7 2. If CONTRACTOR is a for -profit organization, any change in the business structure, g including but not limited to, the sale or transfer of more than ten percent (10 %) of the assets or stocks of 9 CONTRACTOR. change to another corporate structure, including a change to a sole proprietorship, or a 10 change in fifty percent (50 %) or more of Board of Directors of CONTRACTOR at one time shall be 11 deemed an assignment pursuant to this paragraph. Any attempted assignment or delegation in 12 derogation of this subparagraph shall be void. 13 3. If CONTRACTOR is a governmental organization, any change to another structure, 14 including a change in more than fifty percent (50 %) of the composition of its governing body (i.e. Board 15 of Supervisors, City Council, School Board) within a two (2) month period of time, shall be deemed an 16 assignment for purposes of this paragraph. Any attempted assignment or delegation in derogation of 17 this subparagraph shall be void. 18 4. Whether CONTRACTOR is a nonprofit, for - profit, or a governmental organization, 19 CONTRACTOR shall provide written notification of CONTRACTOR's intent to assign the obligations 20 l u hl L : , t, 6o � — lenda days pri. or to hereunde_ , c• tho_ • m wwole or par . .V ADMINISTRATOR not 1BSS than sxn, 21 the effective date of the assignment. 22 5. Whether CONTRACTOR is a nonprofit, for - profit, or a governmental organization, 23 CONTRACTOR shall provide written notification within thirty (30) calendar days to 24 ADMINISTRATOR when there is change of less than fifty percent (50 %) of Board of Directors of 25 CONTRACTOR at one time. 26 C. CONfRACTOR's obligations undertaken pursuant to this Agreement may be carried out by 27 means of subcontracts, provided such subcontracts are approved in advance, in writing by 28 ADMINISTRATOR, meet the requirements of this Agreement as they relate to the service or activity 29 under subcontract, and include any provisions that ADMINISTRATOR may require. 30 1. After approval of a subcontract, ADMINISTRATOR may revoke the approval of a 31 subcontract upon five (5) calendar days written notice to CONTRACTOR if the subcontract 32 subsequently fails to meet the requirements of this Agreement or any provisions that 33 ADMINISTRATOR has required. 34 2. No subcontract shall terminate or alter the responsibilities of CONTRACTOR to COUNTY 35 pursuant to this Agreement. 36 3. ADMINISTRATOR may disallow, from payments otherwise due CONTRACTOR, 37 amounts claimed for subcontracts not approved in accordance with this paragraph. 9 of 25 XACON'1'RAC'IS - 2015 A2015- 202OWSTOD- EQUIPMENT MASTER I5 -20 BG.Docs CS1304MAPOD03MIKK20 CITY OF SEA[. BEACH 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 4. This provision shall not be applicable to service agreements usually and customarily -ntered into by CONTRACTOR to obtain or arrange for supplies, technical support, and professional services provided by consultants. VI. EMPLOYEE ELIGIBILITY VERIFICATION CONTRACTOR warrants that it shall fully comply with all federal and state statutes and regulations regarding the employment of aliens and others and to ensure that employees, subcontractors, and consultants performing work under this Agreement meet the citizenship or alien status requirement set forth in federal statutes and regulations. CONTRACTOR shall obtain, from all employees, subcontractors, and consultants performing work hereunder, all verification and other documentation of employment eligibility status required by federal or state statutes and regulations including, but not limited to, the Immigration Reform and Control Act of 1986, 8 USC §1324 et seq., as they currently exist and as they may be hereafter amended. CONTRACTOR shall retain all such documentation for all covered employees, subcontractors, and consultants for the period prescribed by the law. VIL FACILITIES PAYMENTS AND SERVICES CONTRACTOR agrees to provide the services, staffing, facilities, and supplies in accordance with Exhibit A to this Agreement. COUNTY shall compensate, and authorize, when applicable, said services. CONTRACTOR shall operate continuously throughout the term of this Agreement with at least the minimum number and type of staff vvhich meet applicable federal and state requirements. and which are necessary for the provision of the services hereunder. VIII. INDEMNIFICATION AND INSURANCE A. CONTRACTOR agrees to indemnify, defend with counsel approved in writing by COUNTY, and hold COUNTY, its elected and appointed officials, officers, employees, agents and those special districts and agencies for which COUNTY's Board of Supervisors acts as the governing Board (COUNTY INDEMNITEES) harmless from any claims, demands or liability of any kind or nature, including but not limited to personal injury or property damage, arising from or related to the services, products or other performance provided by CONTRACTOR pursuant to this Agreement. Ifjudgment is entered against CONTRACTOR and COUNTY by a court of competent jurisdiction because of the concurrent active negligence of COUNTY or COUNTY INDEMNITEES, CONTRACTOR and COUNTY agree that liability will be apportioned as determined by the court. Neither party shall request a jury apportionment. B. COUNTY agrees to indemnify, defend and hold CONTRACTOR, its officers, employees, and /or agents harmless from any claims, demands, or liability of any kind or nature, including but not limited to personal injury or property damage, arising from or related to the services, products or other performance provided by COUNTY pursuant to this Agreement. If judgment is entered against 10 of 25 x %, coNTRACCS- 20ti- A2015- 202MMSVPOD- EQUtYa1ENT MASTER r5 -206G ooCx CS R04MAPOD03MIK t:20 CRY or SLLL REACH I COUNTY and CONTRACTOR by a court of competent jurisdiction because of the concurrent active 2 negligence of CONTRACTOR, COUNTY and CONTRACTOR agree that liability will be apportioned 3 as determined by the court. Neither party shall request a jury apportionment. 4 C. Each party agrees to provide the indemnifying party with written notification of any claim 5 related to services provided by either party pursuant to this Agreement within thirty (30) calendar days 6 of notice thereof, and in the event the indemnifying party is subsequently named party to the litigation, 7 each party shall cooperate with the indemnifying party in its defense. g D. Prior to the provision of services under this contract, CONTRACTOR agrees to purchase all 9 required insurance at CONTRACTOR's expense, including all endorsements required herein, necessary 10 to satisfy the County that the insurance provisions of this contract have been complied with. 11 CONTRACTOR agrees to keep such insurance coverage, Certificates of Insurance, and endorsements 12 on deposit with the COUNTY during the entire term of this contract. In addition, all subcontractors 13 performing work on behalf of CONTRACTOR pursuant to this contract shall obtain insurance subject to 14 the same terms and conditions as set forth herein for CONTRACTOR. 15 E. Contractor shall ensure that all subcontractors performing work on behalf of CONTRACTOR 16 pursuant to this agreement shall be covered under Contractor's insurance as an Additional Insured or 17 maintain insurance subject to the same terms and conditions as set forth herein for CONTRACTOR. 18 CONTRACTOR shall not allow subcontractors to work if subcontractors have less than the level of 19 coverage required by COUNTY from CONTRACTOR under this agreement. It is the obligation of 2O (`OLITP ACTOR tO provtde notie Of the insurance requirements to every subcontractor and to receive 21 proof of insurance prior to allowing any subcontractor to begin work. Such proof of insurance must be 22 maintained by Contractor through the entirety of this agreement for inspection by COUNTY 23 representative(s) at any reasonable time. 24 F. All self - insured retentions (SIRS) and deductibles shall be clearly stated on the Certificate of 25 Insurance. If no SIRs or deductibles apply, indicate this on the Certificate of Insurance with a zero (0) 26 by the appropriate line of coverage. 27 G. If the Contractor fails to maintain insurance acceptable to COUNTY for the full term of this 28 contract, COUNTY may terminate this contract. 29 H. QUALIFIED INSURER 30 1. The policy or policies of insurance must be issued by an insurer with a minimum rating of 31 A- (Secure A.M. Best's Rating) and VIII (Financial Size Category as determined by the most current 32 edition of the Best's Key Rating Guide/I ' roperty- Casualty /United States or ambest.com). It is preferred, 33 but not mandatory, that the insurer be licensed to do business in the state of California (California 34 Admitted Carrier). 35 2. If the insurance carrier does not have an A.M. Best Rating of A- /VIII, the CEO /Office of 36 Risk Management retains the right to approve or reject a carrier after a review of the company's 37 performance and financial ratings. I 1 of 25 X \CON'I RACPS - 2015 - \2015- 2020\MS\POD- EQDIPmENT MAST FR 15 -20 nG.DOCx CSn04MAPOD03M IKK20 CITY OF SEAL BEACH 1 3. The policy or policies of insurance maintained by CONTRACTOR shall provide the 2 minimum limits and coverage as set forth below: 3 4 Coverage Minimum Limits 5 6 Commercial General Liability $1,000,000 per occurrence 7 $2,000,000 aggregate 8 9 10 Automobile Liability including coverage $1,000,000 per occurrence I I for owned, non -owned and hired vehicles 12 13 Workers' orkers' Compensation Statutory 15 16 Employers' Liability Insurance $1,000,000 per occurrence 17 18 1. REQUIRED COVERAGE FORMS 19 1. The Commercial General Liability coverage shall be written on Insurance Services Office 20 (ISO) form CG 00 01, or a substitute form providing liability coverage at least as broad. 21 2. The Business Auto Liability coverage shall be written on ISO form CA 00 01, CA 00 05, 22 CA 0012, CA 00 20, or a substitute form providing coverage at least as broad. 23 J. REQUIRED ENDORSEMENTS — The Commercial General Liability policy shall contain the 24 following endorsements, which shall accompany the Certificate of Insurance: 25 1. An Additional Insured endorsement using ISO form CG 2010 or CG 2033 or a form at least 26 as broad naming the County of Orange its elected and appointed officials, officers, agents and 27 employees as Additional Insureds. 28 2. A primary non - contributing endorsement evidencing that the Contractor's insurance is 29 primary and any insurance or self - insurance maintained by the County of Orange shall be excess and 30 non - contributing. 31 K. The Workers' Compensation policy shall contain a waiver of subrogation endorsement waiving 32 all rights of subrogation against the County of Orange, its elected and appointed officials, officers, 33 agents and employees. 34 L. All insurance policies required by this contract shall waive all rights of subrogation against the 35 County of Orange, its elected and appointed officials, officers, agents and employees when acting within 36 the scope of their appointment or employment. 37 /1 12 of 25 X \CON " IRA CI S- 2015 -\2015- 2020 \MS \POD- I:QUIrmENT MASTER 15 -20 BG. DOCX CS 1304M APO D03NI IKK20 CITY nF SFAI. HEACH I M. CONTRACTOR shall notify COUNTY in writing within thirty (30) days of any policy 2 cancellation and ten (10) days for non - payment of premium and provide a copy of the cancellation 3 notice to COUNTY. Failure to provide written notice of cancellation may constitute a material breach 4 of the contract, upon which the County may suspend or terminate this contract. 5 N. The Commercial General Liability policy shall contain a severability of interests clause also 6 known as a "separation of insureds" clause (standard in the ISO CG 0001 policy). 7 O. Insurance certificates should be forwarded to the agency /department address listed on the 8 solicitation. 9 P. If CONTRATOR fails to provide the insurance certificates and endorsements within seven (7) 10 days of notification by CEO /Purchasing or the agency /department purchasing division, award may be 11 made to the next qualified vendor. 12 Q. County expressly retains the right to require CONTRACTOR to increase or decrease insurance 13 of any of the above insurance types throughout the term of this contract. Any increase or decrease in 14 insurance will be as deemed by County of Orange Risk Manager as appropriate to adequately protect 15 COUNTY. 16 R. COUNTY shall notify CONTRACTOR in writing of changes in the insurance requirements. If 17 CONTRACTOR does not deposit copies of acceptable Certificates of Insurance and endorsements with 1g COUNTY incorporating such changes within thirty (30) days of receipt of such notice, this contract may 19 be in breach without further notice to CONTRACTOR, and COUNTY shall be entitled to all legal LU reined ics. 21 S. The procuring of such required policy or policies of insurance shall not be construed to limit 22 CONTRACTOWs liability hereunder nor to fulfill the indemnification provisions and requirements of 23 this contract, nor act in any way to reduce the policy coverage and limits available from the insurer. 24 T. SUBMISSION OF INSURANCE DOCUMENTS 25 I. The COI and endorsements shall be provided to COUNTY as follows: 26 a. Prior to the start date of this Agreement. 27 b. No later than the expiration date for each policy. 28 c. Within thirty (30) calendar days upon receipt of written notice by COUNTY regarding 29 changes to any of the insurance types as set forth in Subparagraph F. of this Agreement. 30 2. The COI and endorsements shall be provided to the COUNTY at the address as referenced 31 in the Referenced Contract Provisions of this Agreement. 32 3. If CONTRACTOR fails to submit the COI and endorsements that meet the insurance 33 provisions stipulated in this Agreement by the above specified due dates, ADMINISTRATOR shall 34 have sole discretion to impose one or both of the following: 35 // 36 // 37 H 13 of 25 x VCON I RACI'S -2015 -A3015 2020AMSVPOD- EQUIPMENT NIASTflR IS -20 nC OOC CS1304N1AP0D03NIIKK20 CI IN OF SEAL BLACl1 l a. ADMINISTRATOR may withhold or delay any or all payments due CONTRACTOR pursuant to any and all Agreements between COUNTY and CONTRACTOR until such time that the 3 required COI and endorsements that meet the insurance provisions stipulated in this Agreement are 4 submitted to ADMINISTRATOR. 5 b. CONTRACTOR may be assessed a penalty of one hundred dollars ($100) for each late 6 COI or endorsement for each business day, pursuant to any and all Agreements between COUNTY and 7 CONTRACTOR, until such time that the required COI and endorsements that meet the insurance g provisions stipulated in this Agreement are submitted to ADMINISTRATOR. 9 c. If CONTRACTOR is assessed a late penalty, the amount shall be deducted from 10 CONTRACTOR's monthly invoice. 11 4. In no cases shall assurances by CONTRACTOR, its employees, agents, including any 12 insurance agent, be construed as adequate evidence of insurance. COUNTY will only accept valid 13 COI's and endorsements, or in the interim, an insurance binder as adequate evidence of insurance. 14 15 IX. INSPECTIONS AND AUDITS 16 A. ADMINISTRATOR, any authorized representative of COUNTY, any authorized representative 17 of the State of California, the Secretary of the United States Department of Health and Human Services, 18 the Comptroller General of the United States, or any other of their authorized representatives, shall have 19 access to any books, documents, and records, including but not limited to, financial statements, general 20 ledgers, relevant accounting systems, medical and client records, of CONTRACTOR Ltat are d1rCGiiy 21 pertinent to this Agreement, for the purpose of responding to a beneficiary complaint or conducting an 22 audit, review, evaluation, or examination, or making transcripts during the periods of retention set forth 23 in the Records Management and Maintenance Paragraph of this Agreement. Such persons may at all 24 reasonable times inspect or otherwise evaluate the services provided pursuant to this Agreement, and the 25 premises in which they are provided. 26 B. CONTRACTOR shall actively participate and cooperate with any person specified in 27 Subparagraph A. above in any evaluation or monitoring of the services provided pursuant to this 28 Agreement, and shall provide the above — mentioned persons adequate office space to conduct such 29 evaluation or monitoring. 30 C. CONTRACTOR shall not be subject to disallowances as the result of audits of the cost of 31 services. 32 D. AUDIT RESPONSE 33 1. Following an audit report, in the event of non — compliance with applicable laws and 34 regulations governing funds provided through this Agreement, COUNTY may terminate this Agreement 35 as provided for in the Termination Paragraph or direct CONTRACTOR to immediately implement 36 appropriate corrective action. A plan of corrective action shall be submitted to ADMINISTRATOR in 37 writing within thirty (30) calendar days after receiving notice from ADMINISTRATOR. 14 of 25 X. \CONTRACTS - 2015 - \2015- 2020 \MS \P0I - EQUIPn1ENT MASTER I5 -20 BG.Docx CS604MAP0D03M1 KK20 CrrY OF SEAL BEACI I 1 2. If the audit reveals that money is payable from one party to the other, that is, reimbursement 2 by CONTRACTOR to COUNTY, or payment of sums due from COUNTY to CONTRACTOR, said 3 funds shall be due and payable from one party to the other within sixty (60) calendar days of receipt of 4 the audit results. If reimbursement is due from CONTRACTOR to COUNTY, and such reimbursement 5 is not received within said sixty (60) calendar days, COUNTY may, in addition to any other remedies 6 provided by law, reduce any amount owed CONTRACTOR by an amount not to exceed the 7 reimbursement due COUNTY. g E. CONTRACTOR shall forward to ADMINISTRATOR a copy of any audit report within 9 fourteen (14) calendar days of receipt. Such audit shall include, but not be limited to, management, 10 financial, programmatic or any other type of audit of CONTRACTOR's operations, whether or not the I 1 cost of such operation or audit is reimbursed in whole Or in part through this Agreement. 12 13 X. LICENSES AND LAWS 14 A. CONTRACTOR, its officers, agents, employees, affiliates, and subcontractors shall, throughout 15 the term of this Agreement, maintain all necessary licenses, permits, approvals, certificates, 16 accreditations, waivers, and exemptions necessary for the provision of the services hereunder and 17 required by the laws, regulations and requirements of the United States, the State of California, 19 COUNTY, and all other applicable governmental agencies. CONTRACTOR shall notify 19 ADMINISTRATOR immediately and in writing of its inability to obtain or maintain, irrespective of the 20 pendency of any hearings or appeals, permits, licenses, approvals, certi cates. accreditations, waivers 21 and exemptions. Said inability shall be cause for termination of this Agreement. 22 B. ENFORCEMENT OF CHILD SUPPORT OBLIGATIONS 23 1. CONTRACTOR agrees to furnish to ADMINISTRATOR within thirty (30) calendar days 24 of the award of this Agreement: 25 a. In the case of an individual contractor, his/her name, date of birth, social security 26 number, and residence address; 27 b. In the case of a contractor doing business in a form other than as an individual, the 28 name, date of birth, social security number, and residence address of each individual who owns an 29 interest of ten percent (10 %) or more in the contracting entity; 30 c. A certification that CONTRACTOR has fully complied with at[ applicable federal and 31 state reporting requirements regarding its employees; 32 d. A certification that CONTRACTOR has fully complied with all lawfully served Wage 33 and Earnings Assignment Orders and Notices of Assignment, and will continue to so comply. 34 2. Failure of CONTRACTOR to timely submit the data and /or certifications required by 35 Subparagraphs La., Lb., I.e., or I.d. above, or to comply with all federal and state employee reporting 36 requirements for child support enforcement, or to comply with all lawfully served Wage and Earnings 37 Assignment Orders and Notices of Assignment, shall constitute a material breach of this Agreement; 15 of25 X ACOi " I RACTS - 2015 - \2015- 2020 \MS \POD- EQUIPMEN I MAST Ea 15 -20 60.DOCx CSU04MA 1'OD03 M IKK20 CITY OF SEAL 13LACII I and failure to cure Such breach within sixty (60) calendar days of notice from COUNTY shall constitute 2 grounds for termination of this Agreement. 3 3. It is expressly understood that this data will be transmitted to governmental agencies 4 charged with the establishment and enforcement of child support orders, or as permitted by federal 5 and /or state statute. 6 7 XI. LITERATURE ADVERTISEMENTS, AND SOCIAL I%IEDIA 8 A. Any written information or literature, including educational or promotional materials, 9 distributed by CONTRACTOR to any person or organization for purposes directly or indirectly related 10 to this Agreement must be approved at least thirty (30) days in advance and in writing by 11 ADMINISTRATOR before distribution. For the purposes of this Agreement, distribution of written 12 materials shall include, but not be limited to, pamphlets, brochures, flyers, newspaper or magazine ads, 13 and electronic media such as the Internet. 14 B. Any advertisement through radio, television broadcast, or the Internet, for educational or 15 promotional purposes, made by CONTRACTOR for purposes directly or indirectly related to this 16 Agreement must be approved in advance at least thirty (30) days and in writing by ADMINISTRATOR. 17 C. If CONTRACTOR uses social media (such as Facebook, Twitter, YouTube or other publicly 18 available social media sites) in support of the services described within this Agreement, 19 CONTRACTOR shall develop social media policies and procedures and have them available to 20 ADM,Ni�TRA TOR upon reaSOliabiC notice. CONTly :CTOR S all .nF ,,,, ADMINISTRATOR of all 21 forms of social media used to either directly or indirectly support the services described within this 22 Agreement. CONTRACTOR shall comply with COUNTY Social Media Use Policy and Procedures as 23 they pertain to any social media developed in support of the services described within this Agreement. 24 CONTRACTOR shall also include any required funding statement information on social media when 25 required by ADMINISTRATOR. 26 D. Any information as described in Subparagraphs A. and B. above shall not imply endorsement 27 by COUNTY, unless ADMINISTRATOR consents thereto in writing. 28 29 XII. MAXIMUM OBLIGATION 30 The Aggregate Maximum Obligation of COUNTY for services provided in accordance with all 31 agreements for Point of Dispensing Site Services is as specified in the Referenced Contract Provisions 32 of this Agreement. This specific Agreement with CONTRACTOR is only one of several agreements to 33 which this Aggregate Maximum Obligation applies. it therefore is understood by the parties that 34 reimbursement to CONTRACTOR will be only a fraction of this Aggregate Maximum Obligation. 35 // 36 // 37 // 16 of 25 X \CONTRACTS -2015 - \2015- 2020 \MS \POD- EQUIPNIENf MASFER 15- 2013G.UOCX CSn04MAPOD03MIKK20 Cm' OF SEAL I3rACu I XIIt. NONDISCRIMINATION 2 A. EMPLOYMENT 3 1. During the term of this Agreement, CONTRACTOR and its Covered Individuals shall not 4 unlawfully discriminate against any employee or applicant for employment because of his /her ethnic 5 group identification, race, religion, ancestry, color, creed, sex, marital status, national origin, age (40 6 and over), sexual orientation, medical condition, or physical or mental disability. Additionally, during 7 the term of this Agreement. CON"T"RACTOR and its Covered Individuals shall require in its 8 subcontracts that subcontractors shall not unlawfully discriminate against any employee or applicant for 9 employment because of his /her ethnic group identification, race, religion, ancestry, color, creed, sex, 10 marital status, national origin, age (40 and over), sexual orientation, medical condition, or physical or 1 I mental disability. 12 2. CONTRACTOR and its Covered Individuals shall not discriminate against employees or 13 applicants for employment in the areas of employment, promotion, demotion or transfer; recruitment or 14 recruitment advertising; layoff or termination; rate of pay or other forms of compensation; and selection 15 for training, including apprenticeship. 16 3. CONTRACTOR shall not discriminate between employees with spouses and employees 17 with domestic partners, or discriminate between domestic partners and spouses of those employees, in 18 the provision of benefits. 19 4. CONTRACTOR shall post in conspicuous places, available to employees and applicants for 20 employment, notices from ADMINISTRATOR and /or the United States Equal Employment 21 Opportunity Commission setting forth the provisions of the Equal Opportunity clause. 22 5. All solicitations or advertisements for employees placed by or on behalf of 23 CONTRACTOR and /or subcontractor shall state that all qualified applicants will receive consideration 24 for employment without regard to ethnic group identification, race, religion, ancestry, color, creed, sex, 25 marital status, national origin, age (40 and over), sexual orientation, medical condition, or physical or 26 mental disability. Such requirements shall be deemed fulfilled by use of the term EOE. 27 6. Each Tabor union or representative of workers with which CONTRACTOR and /or 28 subcontractor has a collective bargaining agreement or other contract or understanding must post a 29 notice advising the labor union or workers' representative of the commitments under this 30 Nondiscrimination Paragraph and shall post copies of the notice in conspicuous places available to 31 employees and applicants for employment. 32 B. SERVICES, BENEFITS AND FACILITIES — CONTRACTOR and /or subcontractor shall not 33 discriminate in the provision of services, the allocation of benefits, or in the accommodation in facilities 34 on the basis of ethnic group identification, race, religion, ancestry, color, creed, sex, marital status, 35 national origin, age (40 and over), sexual orientation, medical condition, or physical or mental disability 36 in accordance with Title IX of the Education Amendments of 1972 as they relate to 20 USC §1681 - 37 §1688; Title VI of the Civil Rights Act of 1964 (42 USC §2000d); the Age Discrimination Act of 1975 17 of 25 X:\CONTItACTS- 2015 - \2015- 2020 \MS \POD- EQUIP,\ILNI MASTER 15 -20 BG.DQCX CS1304 MAPOD03M I KK20 CITY OF SEAL BEACH 1 (42 USC §6101); and Title 9, Division 4, Chapter 6, Article 1 (§10800, et seq.) of the California Code of 2 Regulations,) as applicable, and all other pertinent rules and regulations promulgated pursuant thereto, 3 and as otherwise provided by state law and regulations, as all may, now exist or be hereafter amended or 4 changed. For the purpose of this Nondiscrimination paragraph, Discrimination includes, but is not 5 limited to the following based on one or more of the factors identified above: 6 1 . Denying a client or potential client any service, benefit, or accommodation. 7 2. Providing any service or benefit to a client which is different or is provided in a different g manner or at a different time from that provided to other clients. 9 3. Restricting a client in any way in the enjoyment of any advantage or privilege enjoyed by 10 others receiving any service or benefit. 11 4. Treating a client differently from others in satisfying any admission requirement or 12 condition, or eligibility requirement or condition, which individuals must meet in order to be provided 13 any service or benefit. 14 5. Assignment of times or places for the provision of services. 15 C. COMPLAINT PROCESS —CONTRACTOR shall establish procedures for advising all clients 16 through a written statement that CONTRACTOR and /or subcontractor's clients may file all complaints 17 alleging discrimination in the delivery of services with CONTRACTOR, subcontractor, and 18 ADMINISTRATOR or the U.S. Department of Health and Human Services' OCR. 19 1. Whenever possible, problems shall be resolved informally and at the point of service. ZV 1111n L u u•..L 1 informal I I °.,. wvlttt' "",.$ for e1:e. t net ahle to COiJTRAi Ir Ik shall establish an internal in .anal problem resolution proce ^ s . 21 resolve such problems at the point of service. Clients may initiate a grievance or complaint directly with 22 CONTRACTOR either orally or in writing. 23 2. Within the time limits procedurally imposed, the complainant shall be notified in writing as 24 to the findings regarding the alleged complaint and, if not satisfied with the decision, may file an appeal. 25 D. PERSONS WITH DISABILITIES — CONTRACTOR and /or subcontractor agree to comply 26 with the provisions of §504 of the Rehabilitation Act of 1973, as amended, (29 USC 794 et seq., as 27 implemented in 45 CPR 84.1 et seq.), and the Americans with Disabilities Act of 1990 (42 USC 12101 28 et seq.),as applicable, pertaining to the prohibition of discrimination against qualified persons with 29 disabilities in all programs or activities; and if applicable, as implemented in Title 45, CFR, §84.1 et 30 seq., as they exist now or may be hereafter amended together with succeeding legislation. 31 E. RETALIATION —Neither CONTRACTOR nor subcontractor, nor its employees or agents shall 32 intimidate, coerce or take adverse action against any person for the purpose of interfering with rights 33 secured by federal or state laws, or because such person has filed a complaint, certified, assisted or 34 otherwise participated in an investigation, proceeding, hearing or any other activity undertaken to 35 enforce rights secured by federal or state law. 36 F. In the event of non - compliance with this paragraph or as otherwise provided by federal and 37 state law, this Agreement may be canceled, terminated or suspended in whole or in part and 18 of 25 X \CON'I RAC 'I S -201i - 2015- 2020 \MS\I'OD- EQUIPMEN r MAS'rca 15 -20 6G Docx CSI304MAPOD03M I F K20 Crry or SrAI, Brnal I CONTRACTOR or subcontractor may be declared ineligible for further contracts involving federal, 2 state or county funds. 3 4 XIV. NOTICES 5 A. Unless otherwise specified, all notices, claims, correspondence, reports and /or statements 6 authorized or required by this Agreement shall be effective: 7 1. When written and deposited in the United States mail, first class postage prepaid and g addressed as specified in the Referenced Contract Provisions of this Agreement or as otherwise directed 9 by ADMINISTRATOR; 10 2. When faxed, transmission confirmed; 11 3. When sent by Email; or 12 4. When accepted by U.S. Postal Service Express Mail, Federal Express, United Parcel 13 Service, or other expedited delivery service. 14 B. Termination Notices shall be addressed as specified in the Referenced Contract Provisions of 15 this Agreement or as otherwise directed by ADMINISTRATOR and shall be effective when faxed, 16 transmission confirmed, or when accepted by U.S. Postal Service Express Mail, Federal Express, United 17 Parcel Service, or other expedited delivery service. 18 C. CONTRACTOR shall notify ADMINISTRATOR, in writing, within twenty -four (24) hours of 19 becoming aware of any occurrence of a serious nature, which may expose COUNTY to liability. Such 20 occurrences shall .,.clua °, I Ut ..Ot be h...lted to accidents, in iariPC nr arfc of negligence, or IOSg Or 21 damage to any COUNTY property in possession of CONTRACTOR. 22 D. for purposes of this Agreement, any notice to be provided by COUNTY may be given by 23 ADMINISTRATOR. 24 25 XV. NOTIFICATION OF PUBLIC EVENTS AND MEETINGS 26 A. CONTRACTOR shall notify ADMINISTRATOR of any public event or meeting funded in 27 whole or part by the COUNTY, except for those events or meetings that are intended solely to serve 28 clients or occur in the normal course of business. 29 B. CONTRACTOR shall notify ADMINISTRATOR at least thirty (30) business days in advance 30 of any applicable public event or meeting. The notification must include the date, time, duration, 31 location and purpose of public event or meeting. Any promotional materials or event related flyers must 32 be approved by ADMINISTRATOR prior to distribution. 33 34 XVI. RECORDS MANAGEMENT AND MAINTENANCE 35 A. CONTRACTOR, its officers, agents, employees and subcontractors shall, throughout the term 36 of this Agreement, prepare, maintain and manage records appropriate to the services provided and in 37 accordance with this Agreement and all applicable requirements. 19 of 25 XACONTRAC IS- 2015- A2015- 2020AMSVPOD- F- QDIP�II.NI MASTER 15- 20BG.DOCx CS604MAP0D03MIKK20 Cnr Or SEAL Ii6A(:H I B. CONTRACTOR shall ensure appropriate financial records related to cost reporting, 2 expenditure, revenue, billings, etc., are prepared and maintained accurately and appropriately. 3 C. CONTRACTOR shall ensure all appropriate state and federal standards of documentation, 4 preparation, and confidentiality of records related to participant, client and /or patient records are met at 5 all times. 6 D. CONTRACTOR shall retain all Financial records for a minimum of seven (7) years from the 7 commencement of the contract, unless a longer period is required due to legal proceedings such as 8 litigations and /or settlement of claims. 9 E. CONTRACTOR shall make records pertaining to the costs of services, participant fees, charges, 10 billings, and revenues available at one (1) location within the limits of the County of Orange. I I F. If CONTRACTOR is unable to meet the record location criteria above, ADMINISTRATOR 12 may provide written approval to CONTRACTOR to maintain records in a single location, identified by 13 CONTRACTOR. 14 G. CONTRACTOR may be required to retain all records involving litigation proceedings and 15 settlement of claims for a longer term which will be directed by the ADMINISTRATOR. 16 H. CONTRACTOR shall notify, ADMINISTRATOR of any PRA requests related to, or arising out 17 of, this Agreement, within forty -eight (48) hours. CONTRACTOR shall provide ADMINISTRATOR 18 all information that is requested by the PRA request. 19 2O X.xr" DTi CG RCH A PUBLICATION A. .ND 21 CONTRACTOR shall not utilize information and data received from COUNTY or developed as a 22 result of this Agreement for the purpose of personal publication. 23 24 XVIII. RIGHT TO WORK AND MINIMUM WAGE LAWS 25 A. In accordance with the United States Immigration Reform and Control Act of 1986, 26 CONTRACTOR shall require its employees directly or indirectly providing service pursuant to this 27 Agreement, in any manner whatsoever, to verify their identity and eligibility for employment in the 28 United States. CONTRACTOR shall also require and verify that its contractors, subcontractors, or any 29 other persons providing services pursuant to this Agreement, in any manner whatsoever, verify the 30 identity of their employees and their eligibility for employment in the United States. 31 B. Pursuant to the United States of America Fair Labor Standard Act of 1938, as amended, and 32 State of California Labor Code, § 1178.5, CONTRACTOR shall pay no less than the greater of the 33 federal or California Minimum Wage to all its employees that directly or indirectly provide services 34 pursuant to this Agreement, in any manner whatsoever. CONTRACTOR shall require and verify that 35 all its contractors or other persons providing services pursuant to this Agreement on behalf of 36 CONTRACTOR also pay their employees no less than the greater of the federal or California Minimum 37 Wage. 20 of 25 X_ \CONI PACTS- 2015 - \2015- 2020 \MS \POD- EQUIPMENr MASTER 15 -20 BG DOCx CSB04MAPOD03MIKK20 CITY OF SHAT. BEACH I C. CONTRACTOR shall comply and verify that its contractors comply with all other federal and 2 State of California Taws for minimum wage, overtime pay, record keeping, and child labor standards 3 pursuant to providing services pursuant to this Agreement. 4 D. Notwithstanding the minimum wage requirements provided for in this clause, CONTRACTOR, 5 where applicable, shall comply with the prevailing wage and related requirements, as provided for in 6 accordance with the provisions of Article 2 of Chapter 1, Part 7, Division 2 of the Labor Code of the 7 State of California (§§1770, et seq.), as it exists or may hereafter be amended. 8 9 XIX. SEVERABILITY 10 If a court of competent jurisdiction declares any provision of this Agreement or application thereof I I to any person or circumstances to be invalid or if any provision of this Agreement contravenes any 12 federal, state or county statute, ordinance, or regulation, the remaining provisions of this Agreement or 13 the application thereof shall remain valid, and the remaining provisions of this Agreement shall remain 14 in fill force and effect, and to that extent the provisions of this Agreement are severable. 15 16 XX. STATUS OF CONTRACTOR 17 CONTRACTOR is, and shall at all times be deemed to be, an independent contractor and shall be 18 wholly responsible for the manner in which it performs the services required of it by the terms of this 19 Agreement. CONTRACTOR is entirely responsible for compensating staff, subcontractors, and Ir is o toyed H C "A1TRA(-TC)I1 This Agreement shall not be construed as creating the 20 consultants employed .,} Agreement 21 relationship of employer and employee, or principal and agent, between COUNTY and CONTRACTOR 22 or any of CONTRACTOR's employees, agents, consultants, or subcontractors. CONTRACTOR 23 assumes exclusively the responsibility for the acts of its employees, agents, consultants, or 24 subcontractors as they relate to the services to be provided during the course and scope of their 25 employment. CONTRACTOR, its agents, employees, consultants, or subcontractors, shall not be 26 entitled to any rights or privileges of COUNTY'S employees and shall not be considered in any manner 27 to be COUNTY'S employees. 28 29 XXL TERM 30 A. This specific Agreement with CONTRACTOR is only one of several agreements to which the 31 term of this Agreement applies. This specific Agreement shall commence as specified in the Reference 32 Contract Provisions of this Agreement or the execution date, whichever is later. This specific 33 Agreement shall terminate as specified in the Referenced Contract Provisions of this Agreement, unless 34 otherwise sooner terminated as provided in this Agreement; provided, however, CONTRACTOR shall 35 be obligated to perform such duties as would normally extend beyond this term, including but not 36 limited to, obligations with respect to confidentiality, indemnification, audits, reporting and accounting. 37 H 21 of 25 XACON'I RAC "IS - 2015 -A201 2020AMSVI'OD- CQU1PmcNr MASreR 15 -20 nG.DOCx CSN04MAP0D03MIKK20 C11) OF SEAL BFAC11 2 3 4 5 6 7 8 9 10 II 12 13 14 15 16 17 is 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 B. Any administrative duty or obligation to be performed pursuant to this Agreement on a weekend or holiday may be performed on the next regular business day. XXII. TERMINATION A. Either party may terminate this Agreement, without cause, upon thirty (30) calendar day's written notice given the other party. B. Unless otherwise specified in this Agreement, COUNTY may terminate this Agreement upon five (5) calendar days written notice if CONTRACTOR fails to perform any of the terms of this Agreement. At ADMINISTRATOR'S sole discretion, CONTRACTOR may be allowed up to thirty (30) calendar days for corrective action. C. COUNTY may terminate this Agreement immediately, upon written notice, on the occurrence of any of the following events: 1. The loss by CONTRACTOR of legal capacity. 2. Cessation of services. 3. The delegation or assignment of CONTRACTOR's services, operation or administration to another entity without the prior written consent of COUNTY. 4. The neglect by any physician or licensed person employed by CONTRACTOR of any duty required pursuant to this Agreement. 5. The loss of accreditation or any license required by the Licenses and Laws Paragraph of this Agre ....xt. 6. The continued incapacity of any physician or licensed person to perform duties required pursuant to this Agreement. 7. Unethical conduct or malpractice by any physician or licensed person providing services pursuant to this Agreement; provided, however, COUNTY may waive this option if CONTRACTOR removes such physician or licensed person from serving persons treated or assisted pursuant to this Agreement. D. CONTINGENT FUNDING Any obligation of COUNTY tinder this Agreement is contingent upon the following: a. The continued availability of federal, state and county funds for reimbursement of COUNTY's expenditures, and b. Inclusion of sufficient funding for the services hereunder in the applicable budget approved by the Board of Supervisors. 2. In the event such funding is subsequently reduced or terminated, COUNTY may suspend, terminate or renegotiate this Agreement upon thirty (30) calendar day's written notice given CONTRACTOR. If COUNTY elects to renegotiate this Agreement due to reduced or terminated funding, CONTRACTOR shall not be obligated to accept the renegotiated terms. 22 of 25 XACOW RACTS- 2015-\2015- 2020 \MS \I'OD- EpuienmNF MASTER 15 -20 nG.nocx CSB04MAP0D03M I KK20 Cm' OE SEAL BEACH I L. In the event this Agreement is suspended or terminated prior to the completion of the term as 2 specified in the Referenced Contract Provisions of this Agreement, ADMINISTRATOR may, at its sole 3 discretion, reduce the Maximum Obligation of this Agreement in an amount consistent with the reduced 4 Tenn of the Agreement. 5 F. In the event this Agreement is terminated by either party pursuant to Subparagraphs B., C. or D. 6 above, CONTRACTOR shall do the following: 7 1. Comply with termination instructions provided by ADMINISTRATOR in a manner which 8 is consistent with recognized standards of quality care and prudent business practice. 9 2. Obtain immediate clarification from ADMINISTRATOR of any unsettled issues of contract 10 performance during the remaining contract term. I I 3. Until the date of termination, continue to provide the same level of service required by this 12 Agreement. 13 4. If clients are to be transferred to another facility for services, furnish ADMINISTRATOR, 14 upon request, all client information and records deemed necessary by ADMINISTRATOR to effect an 15 orderly transfer. 16 5. Assist ADMINISTRATOR in effecting the transfer of clients in a manner consistent with 17 client's best interests. 18 6. If records are to be transferred to COUNTY, pack and label such records in accordance 19 with directions provided by ADMINISTRATOR. LV 7. Return to COUNIT", .. the i....... ..nd:cated by A Il AA1NnCTR ATrlR any equipment and 21 supplies purchased with funds provided by COUNTY. 22 8. To the extent services are terminated, cancel outstanding commitments covering the 23 procurement of materials, supplies, equipment, and miscellaneous items, as well as outstanding 24 commitments which relate to personal services. With respect to these canceled commitments, 25 CONTRACTOR shall submit a written plan for settlement of all outstanding liabilities and all claims 26 arising out of such cancellation of commitment which shall be subject to written approval of 27 ADMINISTRATOR. 28 G. The rights and remedies of COUNTY provided in this Termination Paragraph shall not be 29 exclusive, and are in addition to any other rights and remedies provided by law or under this Agreement. 30 31 XXIII. THIRD PARTY BENEFICIARY 32 Neither party hereto intends that this Agreement shall create rights hereunder in third parties 33 including, but not limited to, any subcontractors or any clients provided services pursuant to this 34 Agreement. 35 U 36 37 23 of 25 X VCOn rRACI S- 20l i- A2015- 2020AMSVPOD- EQu1PMENT MASIEK 15 -20 FIG DOCX CS1304MAPOD03NIIKK20 CITY OF SEAT, BEACH I XXIV. WAIVER OF DEFAULT OR BREACH 2 Waiver by COUNTY of any default by CONTRACTOR shall not be considered a waiver of any 3 subsequent default. Waiver by COUNTY of any breach by CONTRACTOR of any provision of this 4 Agreement shall not be considered a waiver of any subsequent breach. Waiver by COUNTY of any 5 default or any breach by CONTRACTOR shall not be considered a modification of the terms of this 6 Agreement. 7 // 8 // 9 10 II // 12 // 13 // 14 // 15 // 16 // 17 // 18 // 19 // LV 21 // 22 // 23 // 24 25 26 27 // 28 // 29 // 30 // 31 // 32 // 33 // 34 // 35 // 36 // 37 // 24 of 25 X.ACON'I KACIS -2015 - L015- 2020AMSVPOD- EQuiPnnINT MASTER 15 -20 BG.nocx CS1304MAPOD03MIKK20 CITI OF SEAL. BEACH 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 �n GV 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 IN WITNESS WHEREOF, the parties have executed this Agreement, in the County of Orange, State of California. CITY OF SEAL BEACH BY: _ DATED: TITL G BY: DATED: % 14: TITLE: COUNTY OF ORANGE BY: HEALTH CARE AGENCY APPROVED AS TO FORM OFFICE OF THE COUNTY COUNSEL ORANGE COUNTY, CALIFORNIA C DEPUTY DATED: DATED: If the contracting party is a corpolatiom, two (2) signatures are required: one (1) signature by the Chairman of the Board, the President or any Vice President; and one (1) signature by the Secretary, any Assistant Secretary, the Chief Financial Officer or any Assistant Treasurer. If the contract is signed by one (1) authorized individual only, a copy of the corporate resolution or by -laws whereby the board of directors has empowered said authorized individual to act on its behalf by his or her signature alone is required by ADMINISTRATOR. 25 of 25 XACONTRAC IS -2015 - 02 0 1 5- 2 02 01NISVPOD- F.QuiFNII:N'I MASTER 1$ -20 BO.DOCX CrrY OF SISAL BEACH CS1304MA POD03M IKK20 I EXHIBIT A 2 TO AGREEMENT FOR PROVISION OF 3 POINT OF DISPENSING SITE EQUIPMENT SERVICES 4 BETWEEN 5 COUNTY OF ORANGE 6 AND 7 CITY OF SEAL BEACH g July 1, 2015 THROUGH June 30, 2020 9 10 I. DEFINITIONS 11 A. "Equipment" means moveable property of a relatively permanent nature with significant value. 12 Equipment which costs $5,000 or over, including sales taxes, freight charges and other taxes are 13 considered Fixed Assets. Equipment which cost less than $5,000, including sales taxes, freight charges 14 and other taxes are considered Minor Equipment or Controlled Assets. 15 B. "Exercise" means an event designed to test and evaluate the POD site plan using the guidelines 16 set forth by Homeland Security Exercise and Evaluation Program (HSEEP) requirements. 17 C. "Health Emergency" means a situation where a potential threat to the health of the community I8 from a disease agent (i.e. Anthrax, Smallpox, Influenza, etc.) requires medication, medical supplies, 19 and/or equipment to be dispensed in mass quantity. Designation of a situation as a Health Emergency 2O requires an c`i'icrgeiiC "y' declaration by uiC n.Gilnt'y' Exeelitive �ffiC... "..d the Pub11c Health OffiC &. 21 D. "Point of Dispensing (POD) Site" means any pre- identified location within a city and /or agency 22 designed to provide public citizens with medications, supplies, equipment, and /or other resources in the 23 event of a Health Emergency. 24 25 I1. SERVICES 26 A COUNTY is loaning CONTRACTOR Equipment. Title to these items shall remain vested in 27 COUNTY and the Equipment shall be deemed to be "Loaned Equipment" while in the possession of 28 CONTRACTOR. 29 B. CONTRACTOR agrees to the transportation, presence, and storage of Loaned Equipment at 30 designated POD site(s) or location of CONTRACTOR's choosing with ADMINISTRATOR'S written 31 approval, in support of this Agreement. POD site locations may be changed with written mutual consent 32 of CONTRACTOR and ADMINISTRATOR. The Loaned Equipment, listed in Table A below, is 33 appropriate for preparation of a public health emergency and /or exercise. Ina public health emergency 34 or exercise, the Loaned Equipment shall serve to: 35 1. Identify staff within the POD site; 36 2. Provide instructions to direct and orientate individuals through the POD site; and 37 H 1 of EXHIBITA x:ACONT RAC TS - 2015- L015- 2020AMS \1'01)- IiQU]PNIENT MASTER 15 -20 nG.l)ocg CSB04MAPOD03MIKK20 CITY OF SEAL 1117ACII 1 3. Allow individuals to receive the necessary material during an exercise or Health 2 Emergency. 3 C. With respect to the Loaned Equipment, CONTRACTOR and /or authorized representatives 4 shall: 5 1. Establish a defined and designated secure location(s) and storage area for the Loaned 6 Equipment; 7 2. Continuously and properly maintain and store Loaned Equipment; 8 3. Develop internal policy and procedures for: 9 a. The preparation for mobilization of Loaned Equipment; 10 b. Transportation of Loaned Equipment; I 1 c. The training of assigned staff on these policies and procedures; and 12 D. CONTRACTOR may use Loaned Equipment in the course of its everyday provision of services 13 or for training purpose; provided, however, said Loaned Equipment are readily available and in good 14 working order in the event of a public health emergency and/or exercise. 15 E. During a public health emergency and /or exercise, CONTRACTOR is responsible for: 16 1. Transporting Loaned Equipment to POD site and returning Loaned Equipment to the 17 designated secure locations expressed in II.C. above; 18 2. Setting -up and breaking down the POD site; 19 3. Providing all non - medical POD staff; 20 4. pro !;ding all --n- medical Equipment neluding but not limited in tants, tahles and rhairr 21 5. Notifying the local community of the event; 22 6. Providing traffic and /or crowd control; 23 7. Disseminating forms to the public; and 24 8. Providing general assistance to the public and COUNTY staff. 25 F. COUNTY shall loan to CONTRACTOR the following Equipment for each of CONTRACTOR'S 26 POD Sites: 27 28 Item Quantity 29 POD Storage Case & Step Stool 1 30 Signage 31 Fill Out Form (36 x 48) 1 32 Show Form (36 x 48) t 33 Pick Up Medicine (36 x 48) 1 34 Get Vaccine (36 x 48) 1 35 Turn In Form & Exit (36 x 48) 1 36 Medical Services Facility (22 x 28) 1 37 Bioterrorism Agent Information (22 x 28) 6 2 of4 EXHIBIT A X- ACOiN'I RAC I S - 2015- A2015- 2020AMSVI'01)- FpuIPNIFNI MASTER 15 -20 BG DOCX CSIW4M APO DOW I KK20 CITY OF SFAS BEACII I Signage Quantity 2 Bioterrorism Symptoms (22 x 28) 6 3 Four Simple Steps (22 x 28) 2 4 Prohibited (22 x 28) 1 5 Exit (11 x 17) 2 6 No Exit (I 1 x 17) 2 7 Incident Command Post (I 1 x 17) 1 8 Staff Person Wearing Vest can Assist (11 x 17) 1 9 Break/Staging (11 x 17) 1 10 First Aid (I 1 x 17) 1 11 Ambulance (II x 17) 1 12 Staff Registration (11 x 17) 1 13 Please Wait (1 I x 17) 2 14 Family Line (l l x 17) 2 15 Adult Line (1 I x 17) 3 16 Arrows 8 17 Entrance Banner (22 x 28) 2 18 Stop - Fill Out Form (22 x 28) 1 19 Stop -Turn in Form & Exit (22 x 28) 1 2V Lra rdi:a re 21 Metal A- frames 4 22 Collapsible Easels 4 23 Metal Stantions (Part# 05- 015CH) 4 24 6 -foot Cardboard Poles and Mount Caps 13 25 Wire Feet 26 26 Plastic Display Sleeves 10 27 Vests 28 Red - XL 80 29 Orange - XL 25 30 Blue - XL 5 31 Yellow - XL 6 32 Lime Green - XL 30 33 General Supplies 34 Clipboards 20 35 Pens - Boxes 1 36 POD Field Operations Guide 1 37 3 of EXHIBIT A X VCON'IRACFS - 2015 - A2015- 2020AMSVPOD- iiQUIPMENT MASTER 15 -20 BG. oocx CR304 MAPOD03M I K K20 CnY OF SFAL Bencn I G. CONTRACTOR and ADMINISTRATOR may mutually agree, in writing, to modify the 2 Equipment set forth in subparagraph 11. F., above. 3 // 4 // 5 // 6 // 7 8 9 10 // II // 12 // 13 // 14 // 15 // 16 // 17 18 19 LV 21 // 22 // 23 // 24 // 25 // 26 // 27 // 28 // 29 // 30 // 31 // 32 // 33 // 34 // 35 // 36 // 37 // 4 of 4 EXI-11131T A X'VCONTRACTS- 2015- A2015- 2020AMSVPOD- EQUIFp1F.N "f MASTER 15- 20BG.Docs CS1304MA11OD03MIKK20 CRY OF SEAL 13EACI1 Point of Dispensing Equipment Box Inventory Item POD Storage Case & Step Stool Signage Fill Out Form (36x48) 1 Show Form (36x48) 1 Pick Up Medicine (36x48) 1 Get Vaccine (36x48) 1 Turn In Form & Exit (36x48) 1 Medical Services Facility (22x28) 1 Bioterrorism Agent Information (22x28) 6 Bioterrorism Symptoms (22x28) 6 Four Simple Steps (22x28) 2 Prohibited (22x28) 1 Exit (11x17) 2 No Exit (11x17) 2 Incident Command Post (11x17) 1 Staff Person Wearing Vest can Assist (11x17) 1 Break /Staging (11x17) 1 First Aid (11x17) 1 Ambulance (11x17) 1 Staff Registration (11x17) 1 Please Wait (11x17) 2 Family Line (11x17) 2 Adult Line (11x17) 3 Arrows 8 Entrance Banner (22x28) 2 Stop — Fill Out Form (22x28) 1 Stop — Turn in Form & Exit (22x28) 1 Hardware Metal A- Frames 4 Collapsible Easels 4 Metal Stanchions (Part # 05- 015CH) 4 6 -foot Cardboard Poles and Mount Caps 13 Wire Feet 26 Plastic Display Sleeves 10 Vests Red — XL 80 Orange — XL 25 Blue — XL 5 Yellow — XL 6 Lime Green — XL 30 General Supplies Clipboards 20 Pens— Boxes 1 POD Field Operations Guide 1 il"T 11111' Rossrnoor Center POD 12325 Seal Beach Blvd. Seal Beach Ca, 90740 COCY , P y � 467s ,._- I ���� / \ \ \���/ �\ � \ /��� � \; %,« «, . y/\ folio 't 0 fir zkfiA, ro !,Lq a Lo a v d Pon I City: Seal Beach FSte:. Rossmor Shopping Center ( Address: 333 St Cloud Dr., Seal Beach CA 90740 YVU Jlie nnaD Uescrivilve -Mal I Consideration Site Access Main site ingress point will be via Olive Street. Main egress will be via St. Cloud with a left Main Access turn only. Drive through Drive through patients will enter the site and form two traffic lanes proceeding south. Traffic will flow from two lanes for dispensing down to one lane prior to exit onto St. Cloud. Walk through Patients will travel on the sidewalk on Olive St. and proceed east to dispensing in the parkinq lot. Patients will exit back onto the sidewalk. Medical Delivery Delivery vehicles will enter through the southwest driveway on St. Cloud Dr. and proceed Route to the Community room. Vehicles will exit onto St. Cloud going eastbound. Dtiva ° °. f' Walk � Dnve.Through s: Walk Throu In P P Public Parking Public parking will not be available. Station Location(s) a. Check -in and Screening will occur in the a. Check -in will occur on the sidewalk on C a. Check -in northeast lot after entrance to the site. Olive St. b. See above. s O b. Screening c. Two lanes of dispensing will occur in the b. See above. West lot. c. Dispensing d. Exit will occur in the West lot. Traffic c. Dispensing will occur on the sidewalk O lanes will merge into one lane prior to with two dispensing lanes. d. Exit site exit eastbound onto northbound onto E O Montecito. d. Exit will occur on the sidewalk. e. Adult Line e. Adult lane will be lane 1. f. Family and vulnerable populations lane e. Adult lanes will be lanes 3 and 4. AL f. Family/ will be lane 2. Vulnerable f. Family and vulnerable populations lanes F L populations line will be lanes 3 and 4. ®T Restroom facilities Portable toilets will be requested for Portable toilets will be requested for } placement in the parking lot. placement in the parking lot. Security personnel 1. Two at each entrance and exit 4. One at each entrance and exit O 1. Perimeter 2. One in the dispensing area 5. One in the parking area 2. Interior 3. One at medical storage area & one for 6. One at medical storage area & one for 3. Medications medicine transportation medicine transportation Traffic /Crowd Control Please refer to map for barricade locations. Please refer to map for barricade locations. Operation Considerations' I Incident Command West section of parking lot Post rX Medical Storage Area Community room n Staff Parking I Parking lot behind Sprouts UStaff Registration Southeast corner of parking lot R Area Staff Break Area Northwest corner of parking lot a EMS & First Aid Southwest corner of parking lot Stations Point of Dispensing Equipment Suggested Supplies and Equipments List POD Site: Shops at Rossmoor Address 12501 Seal Beach Blvd. Seal Beach CA 90740 Type I Supplies and"EquipmentL "I Tents (pop-up) Nli�&e'r'�: e 2 1 12 • - on Sit* X Nu •• •' Location Available. 12 Refrigerator w /freezer 1 X 7 Photocopier(s) 1 X 7 Dollies and /or push carts 2 X 2 General POD Box knife w /razor blades 2 X Supplies Clipboards 20 X HCA POD Supplies Trash cans and bas 10 X Paper clips 500 X Paper — pads lined 20 X Pens, pencils, highlighters 50 X Check -in Tables 1 1 X 100 Station (s) Chairs 2 2 X 200 Screening Tables 1 N/A X 100 Station Chairs 2 N/A X 200 Tables 11 8 X 100 Chairs 22 16 X 200 Dispensing Station (s) First aid kit 1 X NCC Hand sanitizer` _ HCA z Gloves (S -XL) (Vaccination Only) Syringes &Needles Vaccination On( Shar g s containers Vaccination Only) - V Band -Aids Vaccination Only) 'Cotton swabs Vaccination Only) " Alcohol'wi es Vaccination Only)'. Box for forms collection 2. Exit Tables 1 2 X 100 Chairs 2 4 X 200 ICS Vests 1 set POD Si na e 1 set POD Specific Field Operation Guide FOG As needed — provided by HCA Medication/Vaccines ' <- As required -. HCA A ent °information'sheets'.. ` As re uired Dru "information sheets.... As re uired'',, Patieni,history forms i'> As required, Cones /Poles & chains 100 X Seal Beach PD Site specific si na e 5 X Public Works Yard Crowd/Traffic Barricades 5 X Public Works Yard Control K -rails 0 Radios i.e. 800 MHz, 2-way, etc. 15 X SBPD Easels & pads 2 X White Boards w /markers 2 X Tape: Scotch, Duct, Caution, Packing 4 X NCC Additional Manila Folders 100 X NCC Site Supplies Stapler & staples 10 X NCC — as needed Scissors 10 X NCC Ladder 4 X NCC Rubber bands 500 X NCC Paper towels 500 X NCC Flashlight w /batteries 7 X Seal Beach PD ' 'PROVIDED BY HCA DURING,EVENT ICS 202 1. INCIDENT NAME 2. DATE 3. TIME INCIDENT OBJECTIVES Seal Beach POD 4. OPERATIONAL PERIOD (DATE /TIME) Duration of the POD 5. GENERAL CONTROL OBJECTIVES FOR THE INCIDENT (INCLUDE ALTERNATIVES) 1) To have an orderly and efficient POD 2) To process all cars through the POD within the operational period 3) Ensure that all staff and volunteers are safe 6. WEATHER FORECAST FOR OPERATIONAL PERIOD 7. GENERAL SAFETY MESSAGE Keep your eyes on the drivers of the cars passing through the POD. Never pass in front of a car unless you make eye contact with the drive. 6. Attachments (© if attached) ❑ Organization List (ICS 203) ❑ Medical Plan (ICS 206) ❑ ❑ Assignment Lists (ICS 204) ❑ POD Maps ❑ • Communications Plan (ICS 205) ❑ POD Organizational Chart ❑ • General Message (ICS 213) ❑ Unit Log (ICS 214) ❑ • Safety Analysis (ICS 215A) ❑ Demobilization Checkout (ICS 221) ❑ 9. PREPARED BY (NAME and POSITION) 10. APPROVED BY (NAME and POSITION) ICS 202 ORGANIZATION ASSIGMENT LIST t. INCIDENT NAME Seal Beach POD 2. DATE PREPARED 3. TIME PREPARED 4. OPERATIONAL PERIOD (DATEITIME) POSITION I NAME "5. UNIFIED COMMAND AND STAFF .. - 9.OPERATIONS SECTION FIRE REP. LAW REP. HEALTH REP. SAFETY OFFICER PUBILC INFORMATION OFFICER PUBILC INFORMATION OFFICER COMMUNITY LIAISON OFFICER Chief CHIEF DEPUTY BRANCH DIRECTOR PERIMETERIPARKING COMMAND POST CLINIC SECURITY MEDICAL STORAGE/TRANSPORT TRAFFICICROWD CONTROL b. - C - LINIC BRANCH (Drive Through) BRANCH DIRECTOR DEPUTY CHECK -IN VACCINATION/DISPENSING FORMS COLLECTION c. CLINIC BRANCH (Walk Through) BRANCH DIRECTOR DEPUTY CHECK -IN VACCINATION/DISPENSING FORMS COLLECTION MEDICAL BRANCH DIRECTOR CERT O 5 Lead VIPs Supervisor VIPs CERT Leader VIPS Supervisor Community Services VIPS Supervisor OCHCA TBD TBD OCHCA TBD - CCHCA TBD TBD OCHCA TBD OCHCA ESC CERT Volunteer PIO PIO Community Services Supervisor 6. AGENCY REPRESENTATIVES AGENCY NAME OCHCA OCFA Seal Beach 7. PLANNING SECTION •' - CHIEF SITUATION STATUS UNIT RESOURCES UNIT DEMOBILIZATION UNIT DOCUMENTATION UNIT CER,r Planning Lead CERT Volunteer CERT Volunteer CERT Volunteer CERTVolunleer 18. LOGISTICS SECTION` CHIEF DEPUTY 'a: SUPPORT BRANCH DIRECTOR SUPPLY UNIT FACILITIES UNIT GROUND SUPPORT UNIT PHARMACY TEAM LEAD STAFF REGISTRATION B. SERVICE BRANCH DIRECTOR COMMUNICATIONS UNIT MEDICAL UNIT FOOD UNIT CERT Los Lead CERT Logs Assistant CERTVol. Coordinator CERT Volunteer CERT Volunteer CERT Volunteer OCHCA CERT Volunteer RACES RACE$ CERT EMT CERT Member ADDITONAL ASSIGNMENTS PREPARED BY (NAME and POSITION) ICS 203 1. Incident Name 2. Date 3. Operational Period INCIDENT SECURITY PLAN Point of Dispensing (POD) - Shops at Rossmoor Channel Time Location Radio Frequency Report Time and Location 12501 Seal Beach Blvd. • The primary security response agency will be the Seal Beach Police Department. • The role of the Seal Beach Police Department will be traffic and crowd control, as well as overall security for the site. • Vehicular traffic by POD Staff will be from Seal Beach, west on XXXX to the parking lot entrance. Drive west through the first parking lot (south side of shopping center) and park in the west parking lot (designated Lot A). • The site for dispensing of medications /vaccinations will be a drive through location with a separate area for walk up patients. • Vehicular traffic by public will be from Seal Beach, west on XXXX to the entrance. Vehicles will continue west through the parking lot and exit the parking lot onto XXXXX. and proceed south towards Seal Beach Blvd. • Foot traffic by pedestrian will be from Seal Beach Blvd, west on XXXX to the entrance. They will continue west through the parking lot and exit the parking lot onto XXXX and proceed south towards Seal Beach Blvd. • The west parking lot will be designated as Lot A and will be for public use. There are 80 regular parking spots and 6 handicap parking spots in this parking lot. The east parking lot will be designated Lot B and will be for POD Staff use. There are 71 regular and 2 handicap parking spots in the school's west parking lot. • The Community Center containing supplies for this location is on the south side of the complex near the south exitt. It is marked with a yellow square on the aerial map. A _Vulnerability of?site and sitelfacility strengths 6 weaknesses ' a • This site has many strengths from a security standpoint. • The location makes it ideal as vehicular traffic enters from the north and exits to the south. The main entrance is located off of a side street (XXXX) and the main exit is located near a main street (Seal Beach Blvd). The vehicle traffic can flow through this location with relative easy and minimal manpower directing it due to its design. • This site has security measures (locked doors, and locked storage area) which will require community service administration to open prior to setting -up the POD location. B. Site ingress /Egress points - x Example: • Vehicular traffic by POD Staff will be from Seal Beach Blvd, west on XXXX to the Parking lot entrance. Drive west through the first parking lot (west side of complex) and park in the east parking lot (designated Lot B). Vehicle traffic for POD Staff leaving the location will be south out of the west parking lot onto Seal Beach Blvd. • The site for dispensing of medications /vaccinations will be a drive through. If the POD is inside the community center, the public will be directed to park in the north parking lot of the building and walk into the south -east door of the community center room. They will exit the community center from the south -west door and walk back to their vehicles. • Vehicular traffic by public will be from Seal Beach Blvd, west on XXXX to the entrance. Vehicles will continue south through the parking lot and exit the parking lot onto XXXX. and proceed east towards Seal Beach Blvd. • Foot traffic by pedestrian will be from Seal Beach Blvd Ave, west on XXX to the entrance. They will continue west through the parking lot and exit the parking lot onto XXXX and proceed east towards Seal Beach Blvd. . C. Traffic/Crowd Control Plan - Role'ot,Law Enforcement personnel` • . Law enforcement personnel will direct traffic into and out of the POD location. They will direct the parking of POD staff to Lot B on the east side of the location. They will assist in placement of signs /cones /barricades as needed. Officers may be reassigned to other positions /responsibilities if the need arises. D'Public Safety,'Offlcer Responsibilities -' , ' . _' `' ' ' - FF N ame & Badge Number —Call Sign 2. Assigned POD Position 3. Location Security Branch Director 4. Duties • Supervise Security Group Supervisors 1. Officer Name & Badge Number — Call Sign 2. Assigned POD Position 3. Location Perimeter /Parking Control Security Group Supervisor 4. Duties 1. Officer Name & Badge Number— Call Sign 2. Assigned POD Position 3. Location Command Post Security Group Supervisor 4. Duties 1. Officer Name & Badge Number —Call Sign 2. Assigned POD Position 3. Location Clinic Security Group Supervisor 4. Duties 1. Officer Name & Badge Number —Call Sign 2. Assigned POD Position 3. Location Medical Storage /Transport Security Group Supervisor 4. Duties 1. Officer Name & Badge Number —Call Sign 2. Assigned POD Position 3. Location Traffic /Crowd Control Security Group Supervisor 4. Duties IL SITE SECURITY BREACH The POD site security personnel are responsible for coordinating a review of any security breach that potentially involves the unauthorized access of personal information or unauthorized personnel onto or within the site. The personnel will: 1. Inform users granted access to personal information of their responsibilities to secure such data from unauthorized release and that this data is properly processed. 2. Develop and maintain control records in a secure environment. 3. Establish monitoring procedures to identify unauthorized access to or anomalous activity. 4. Report suspected unauthorized acquisition of personal information to the Security Branch Director. 5. Report any suspicious behavior to supervisor or Security Branch Director immediately. 6. Ensure staff security and safety is maintained at all times. 7. In the event of a security breach, please use the phrase "[Insert common terminology phrase]." • In the event of emergency, employees are alerted by law enforcement or fire personnel by voice commands or mass communication / public address systems. Reason(s) for site evacuation would include: Building fires, vehicle fires, earthquakes, rioting, active shooter, or order from higher authority. • In the event of fire or other emergency, ALL employees shall evacuate immediately. • In the event of an emergency, employees shall evacuate by means of the nearest available marked exit. • Portable fire extinguishers are provided in the workplace for employee use. In the event of fire, any employee may use extinguishers to attempt to extinguish the fire before evacuating. • After an emergency evacuation, employees are to gather in the following locatiorl Primary location — parking lot designated as Lot B, Secondary location — The grass field located in the north -west portion of the school. • All vehicles leaving the site should exit the XXXX exit in order to allow for emergency police and fire personnel to enter the site off of XXXX •- • This site Incident Security Plan is designed to be used in case,of a real incident and was not made to facilitate a trairingexercise a - Prepared by (Security Branch Director) Approved by (Planning Section Chief) Date Time DIVISION ASSIGNMENT LIST t. Branch Security 2, Division /Group Command Post 3. Incident Nome 4. Operational Period Date: rime: 5. - Operations Personnel - Operations Chief Command Post Security Group Supervisor Branch Director Air Attack Supervisor No. b. - Resources Assigned this Period Strike Team /Task Force/ Resource Designator Leader Number Persons Trans. Needed Drop Off PT. /Time Pick Up PT. /Time 7. Control Operations Provide security to Incident Command Post and Staff within post. Prevent access from unauthorized personnel to include: Media, Press, public citizens, efc. 8. Special Instructions Conduct security sweep of ICP prior to /end of operations /shift change /demobilization. Establish Law Enforcement Post at ICP which is to be established on the concrete slab in front of the school near the flag pole (south side of school, south of main office and east of Multi- Purpose room. Ensure communication is maintained between all Law Enforcement staff. 9. Division /Group Communication Summary Function Freouency System Channel Function Frequency System Channel Command. King NIFC Logistics King NIFC Tactical Div /Group King NIFC Air to Ground King NIFC Prepared by (Resource Unit Leader) Approved by (Planning Section Chief) Dale Time DIVISION ASSIGNMENT LIST 1. Branch Security 2. Division /Group Perimeter/ Parking Control 3. Incident Nome 4. Operational Period Date: Time 5. Operations Personnel Operations Chief Perimeter /parking Security Group Supervisor Branch Director Air Attack Supervisor No. b. Resources Assigned this Period Strike Team /Task Force/ Resource Designator Leader Number Persons Trans. Needed Drop Off PT. /Time Pick Up PT. /Time 7. Control Operations 1. Provide site perimeter security. Conduct exterior security sweep prior to /end of operations /shift change /demobilization. 2. Control access to facility /site via traffic, parking and crowd control Access Locations: 3. Control vehicular traffic flow Ingress /Egress points: 8. Special Instructions Refer to Security Plan section I.A Site security - Vulnerability of site and site /facility strengths & weaknesses for possible perimeter security issues. [Officer type (i.e. deputies /units, etc.)] will be roving perimeter of site with special emphasis placed on areas outlined. List: Specialized unit needs (i.e. tactical, traffic, etc.): Additional barriers /control: 9. Division /Group Communication Summary Function Frequency System Channel Function -' Frequency System Channel Command King NIFC Logistics King NIFC Tactical. "' Div /Group King NIFC Air to Ground. - King NIFC Prepared by (Resource Unit Leader) Approved by (Planning Section Chief) Date lime DIVISION ASSIGNMENT LIST 1. Branch Security 2. Division /Group Traffic /Crowd Control 3. Incident Nome d. Operational Period Dole: Time 5. Operations Personnel Operations Chief traffic /Crowd Control Secunty Group Supervisor Branch Director Air Attack Supervisor No. b. Resources Assigned this Period Strike Team /Task Force/ Resource Desi nator Leader Number Persons Trans. Needed Drop Off PT. /Time Pick Up Pl. /Time 7. Control Operations Traffic control on [list streets /access points]. Traffic control will be on an "as needed basis:' All personnel will be assigned roving locations to monitor traffic. Informational signs will be placed [location] to inform POD staff and public of parking locations. Parking restrictions will be posted on [List streets) To facilitate on street cueing of vehicles. In the event of severe traffic back up on the listed streets, officers will be assigned to stationary traffic control posts at major intersections. 8. Special Instructions Refer to site map for parking locations. Refer to Security Plan for Evacuation and Security Breach procedures. Site Ingress Point(s): Site Egress Point(s): 9. Division /Group Communication Summary Function Frequency System Channel Function Frequency System Channel Command King NBC _ Logistics - King NIFC tactical "Div /Group King NBC .Air to Ground King NIFC Prepared by (Resource Unit Leader) Approved by (Planning Section Chief) Date Time DIVISION ASSIGNMENT LIST 1. Branch Security z. Division /Group Clinic /Crowd Control 3. Incident Name 4. Operational Period Dale, Time. 5. Operations Personnel Operations Chief Clinic Security Group Supervisor Branch Director Air Attack Supervisor No. b. Resources Assigned this Period Strike Team /Task Force/ Resource Designator Leader Number Persons Trans. Needed Drop Off PT. /Time Pick Up PT. /Time 7. Control Operations 1. Provide site interior /clinic area security. Conduct security sweep prior to /end of operations /shift change /demobilization. 2. Routine patrol in and around the area of staff registration, patient check -in, screening and dispensing to be conducted throughout all POD clinic areas to ensure the safety and crowd control of participants as they stand in line to register. 8. Special Instructions Refer to Security Plan for Evacuation and Security Breach Procedures. Refer to POD site map for station and clinic operation location(S). Site Ingress Point(s): Site Egress Point(s): 9. Division /Group Communication Summary - Function. Frequency S stern Channel Function Freauency System Channel Command - King NIFC Logistics - King NIFC Tactical - Div /Group King NIFC Air to Ground King NIFC Prepared by (Resource Unit Leader) Approved by (Planning Section Chief) Date Time DIVISION ASSIGNMENT LIST I. Branch Security 2, Division /Group Medical Storage /Transport Security 3. Incident Name 4, Operational Period Date: Time 5. Operations Personnel I Operations Chief Medical Storage /Transport Security Group Supervisor Branch Director Air Attack Supervisor No. b. Resources Assigned this Period Strike Team /Task Force/ Resource Designator Leader Number Persons I Trans. Needed oven Ofl PT. /Time Pick Up FT.)Time 7. Control Operations 1. Provide pharmacy area security. Conduct security sweep prior to /end of operations /shift change /demobilization. 2. Provide armed security transport during medications /vaccination transport within site and clinic area. 3. Provide security transportation escort during medication /vaccination arrival to designated delivery area. 4. Ensure 24/7 unblocked access to medication /vaccination delivery poini(s). 8. Special Instructions Refer to Security Plan for Evacuation and Security Breach Procedures. Refer to POD site map for pharmacy, clinic and delivery operation locations). Deliver Point(s): Storage Area: 9. Division /Group Communication Summary - -. Function. Frequency system Channel Funclion f. Frequency System Channel Command _ King - Logistics . _ King " NIFC NIFC ,Tactical King Air to Ground King _ -'Div /Group NIFC NIFC Prepared by tResource Unit Leader) Approved by (Planning Section Chief) Date Time Sample Assignment List, ICS Form 204 1.13RANCH Medical 2. DIVISION /GROUP EMT ASSIGNMENT LIST 3. INCIDENT NAME Seal Beach POP 4. OPERATIONAL PERIOD DATE TIME 5. OPERATIONAL PERSONNEL OPERATIONS CHIEF CERT Ops Lead DIVISION /GROUP SUPERVISOR As Assigned BRANCH DIRECTOR As Assigned AIR TACTICAL GROUP SUPERVISOR NIA 6. RESOURCES ASSIGNED TO THIS PERIOD STRIKE TEAM /TASK FORCE/ RESOURCE DESIGNATOR EMT LEADER NUMBER PERSONS TRANS. NEEDED PICKUP PT. /TIME DROP OFF PT./TIME 7. CONTROL OPERATIONS: Support on scene workers, any citizen will be treated by OCFA 8. SPECIAL INSTRUCTIONS 9. DIVISION /GROUP COMMUNICATIONS SUMMARY FUNCTION FREQ. SYSTEM CHAN. FUNCTION FREQ.1 SYSTEM CHAN. COMMAND LOCAL REPEAT SUPPORT LOCAL REPEAT DIVJGROUP TACTICAL GROUND TO AIR PREPARED BY (RESOURCE UNIT LEADER) APPROVED BY (PLANNING SECT. CH.) -7-7 ME 0 N E 0 ILL ^ V/ U C a C O f0 U C 3 E E O U w c d U c N U U E C a q O N °o E - `a m rc a N C O iJ m 6 0 L 9 C v N O W Q O a` a a N 0 0 r IO � T i a j c L m v a G u m C A _ � i N U 0 9 U N b m O � C LL z J a y Z O H Q � F U z t " O U o O E 0 0 Q a L L q U � R W � a E °o ? a m n a a` N N U U 1. BRANCH Command 2. DIVISION ASSIGNMENT LIST 3. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME 5. OPERATIONAL PERSONNEL INCIDENT Deputy COMMANDER LAW IC Manager INCIDENT COMMANDER HCA HCA IC 6. RESOURCES ASSIGNED TO THIS PERIOD RESOURCE DESIGNATOR LEADER NUMBER PERSONS TRANS. NEEDED PICKUP PT./TIME DROP OFF PT./TIME PIO 3 Safety Officer 1 Community Liaison 2 7. CONTROL OPERATIONS Facilitate command and control of POD operation 8. SPECIAL INSTRUCTIONS 9. DIVISION /GROUP COMMUNICATIONS SUMMARY FUNCTION ZONE SYSTEM CHAN. FUNCTION FRED. SYSTEM CHAN. COMMAND LOCAL REPEAT 1 0C 800MHz % SUPPORT LOCAL REPEAT D(v�ceouP TACTICAL PREPARED BY (NAME and POSITION) APPROVED BY (NAME and POSITION) DATE TIME ICS 204 2. BRANCH Security 2. DIVISION Command Post ASSIGNMENT LIST 3. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME S. OPERATIONAL PERSONNEL INCIDENT Deputy COMMANDER LAW IC Manager INCIDENT COMMANDER HCA HCA IC 6. RESOURCES ASSIGNED TO THIS PERIOD RESOURCE DESIGNATOR LEADER NUMBER PERSONS TRANS. NEEDED PICKUP PT.ITIME DROP OFF PT./TIME Seal Beach Police Officer ICP Security GS 1 7. CONTROL OPERATIONS Provide security of ICP B. SPECIAL INSTRUCTIONS 9. DIVISION /GROUP COMMUNICATIONS SUMMARY FUNCTION ZONE SYSTEM CHAN. FUNCTION FREQ. SYSTEM CHAN. =COMMAND oc 800 MHz 4 SUPPORT LOCAL REPEAT DIVIGROUP TACTICAL PREPARED BY and POSITIONI APPROVED BY(NAME.A POSITION) DATE TIME ICS 204 3. BRANCH Security Y 2. DIVISION Clinic Security SSIGNMENT LIST 3. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME 5. OPERATIONAL PERSONNEL INCIDENT Deputy COMMANDER LAW IC Manager INCIDENT COMMANDERHCA HCAIC 6. RESOURCES ASSIGNED TO THIS PERIOD RESOURCE DESIGNATOR LEADER NUMBER PERSONS TRANS. NEEDED PICKUP PT./TIME DROP OFF PT. /TIME Seal Beach Police Officer Clinic Security GS 2 7. CONTROL OPERATIONS Provide security of the clinic 8. SPECIAL INSTRUCTIONS 9. DIVISION /GROUP COMMUNICATIONS SUMMARY FUNCTION ZONE SYSTEM CHAN. FUNCTION FREQ. SYSTEM CHAN. COMMAND LOCAL REPEAT 800 MHz 4 SUPPORT LOCAL REPEAT DIVJGROUP TACTICAL PREPARED BY (NAME and POSITION) APPROVED BY (NAME and POSITION) DATE TIME ICS 204 4. BRANCH Security 2. DIVISION Medical Stara e(Trans ort ASSIGNMENT LIST 3. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME 5. OPERATIONAL PERSONNEL INCIDENT Deputy COMMANDER LAW IC Manager INCIDENT COMMANDER HCA HCA IC 6. RESOURCES ASSIGNED TO THIS PERIOD RESOURCE DESIGNATOR LEADER NUMBER PERSONS TRANS. NEEDED PICKUP PT./TIME DROP OFF PTJTIME Seal Beach Police Officer Medical StgrTransp GS 2 7. CONTROL OPERATIONS Provide security for medical stockpile and stockpile transportation 6. SPECIAL INSTRUCTIONS 9. DIVISION /GROUP COMMUNICATIONS SUMMARY FUNCTION ZONE SYSTEM CHAN. FUNCTION FREQ. SYSTEM CHAN. COMMAND LOCAL REPEAT g00 MHZ 4 SUPPORT LOCAL REPEAT DIV. /GROUP TACTICAL PREPARED BY (NAME and POSITION) APPROVED BV tNAME and POSITION) DATE THE ICS 204 5. BRANCH Security 2. DIVISION Perimeter Traffic/Security ASSIGNMENT LIST 1. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME 5. OPERATIONAL PERSONNEL INCIDENT Deputy COMMANDER LAW IC Manager INCIDENT COMMANDER HCA HCA IC 6. RESOURCES ASSIGNED TO THIS PERIOD RESOURCE DESIGNATOR LEADER NUMBER PERSONS TRANS. NEEDED PICKUP PTJTIME DROP OFF PTJTIME Seal Beach Police Officer Perimeter Traffic Control GS 4 7. CONTROL OPERATIONS Provide traffic control for the perimeter of the POD site. Provide security for the perimeter of the POD site. 9. SPECIAL INSTRUCTIONS 9. DIVISION /GROUP COMMUNICATIONS SUMMARY FUNCTION ZONE SYSTEM CHAN. FUNCTION FREQ. SYSTEM CHAN. COMMAND LOCAL REPEAT 1 Oc 800 MHZ 5 SUPPORT LOCAL REPEAT DIVJGROUP TACTICAL PREPARED BY and POSITION) APPROVED BY and POSITION) DATE TIME ICS 204 6. BRANCH Securit Y 2. DIVISION Site Traffic /Crowd Control ASSIGNMENT LIST 3. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME 6. OPERATIONAL PERSONNEL INCIDENT Deputy COMMANDER LAW IC Manager INCIDENT COMMANDER HCA HCA IC 6. RESOURCES ASSIGNED TO THIS PERIOD RESOURCE DESIGNATOR LEADER NUMBER PERSONS TRANS. NEEDED PICKUP PTJTIME DROP OFF PTJTIME Seal Beach Police Officer Site Traffic/ Crowd Control GS 7 7. CONTROL OPERATIONS Provide traffic control for the POD site. Provide crowd control for die POD site. B. SPECIAL INSTRUCTIONS 9. DIVISION /GROUP COMMUNICATIONS SUMMARY FUNCTION ZONE SYSTEM CHAN. FUNCTION I FREQ. I SYSTEM CHAN. COMMAND LOCAL REPEAT g00 MHz 4 SUPPORT LOCAL REPEAT DIV. /GROUP TACTICAL PREPARED BY (NAME and POSITION) APPROVED BY NAME and POSITION) DATE TIME ICS 204 1. RANCH Logistics 2. DIVISION Scrvicc Branch ASSIGNMENT LIST 3. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME 5. OPERATIONAL PERSONNEL LOGISTICS CHIEF Cottonwood DIVISION /GROUP SUPERVISOR Facilities Manager Deputy Chief 6. RESOURCES ASSIGNED TO THIS PERIOD RESOURCE DESIGNATOR LEADER NUMBER PERSONS TRANS. NEEDED PICKUP PT./TIME DROP OFF PT. /TIME FOOD UNIT Food Unit Leader 4 MEDICAL UNIT Medical Unit Leader 2 COMMUNICATIONS Comm. Unit Leader 2 7. CONTROL OPERATIONS 8. SPECIAL INSTRUCTIONS 9. DIVISION /GROUP COMMUNICATIONS SUMMARY FUNCTION ZONE SYSTEM CHAN. FUNCTION FREQ. SYSTEM CHAN. COMMAND LOCAL REPEAT Oc g00 MHz 4 SUPPORT LOCAL REPEAT DIVJGROUP TACTICAL PREPARED BY (NAME and POSITION) APPROVED BY (NAME and POSITION) DATE TIME ICS 204 2. RANCH 2. DIVISION ASSIGNMENT LIST LO IStICS Su ort Branch 3. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME S. OPERATIONAL PERSONNEL Cottonwood LOGISTICS CHIEF DIVISION /GROUP SUPERVISOR Facilities Manager Deputy Chief S. RESOURCES ASSIGNED TO THIS PERIOD RESOURCE NUMBER TRANS. PICKUP DROP OFF PERSONS NEEDED PT.ITIME PT. /TIME DESIGNATOR LEADER FACILITIES UNIT Facilities Unit Leader 1 GROUND SUPPORT Ground Support Unit UNIT Leader 3 SUPPLY UNIT Supply Unit Leader 4 Pharmacy Unit PHARMACY UNIT Leader 3 Staff Reg. Team STAFF REG. TEAM Leader 6 7. CONTROL OPERATIONS 8. SPECIAL INSTRUCTIONS 9. DIVISION /GROUP COMMUNICATIONS SUMMARY FUNCTION ZONE SYSTEM CHAN. FUNCTION FRED. SYSTEM CHAN. OC LOCAL 1 g00 MHz 4 LOCAL COMMAND SUPPORT REPEAT REPEAT DIVJGROUP TACTICAL PREPARED BY and POSITION) APPROVED BY and POSITION) DATE TIME ICS 204 1. BRANCH Planning 2. DIV ISION ASSIGNMENT LIST 3. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME 5. PLANNING PERSONNEL PLANNING CHIEF Fire DIVISIONIGROUP SUPERVISOR BRANCH DIRECTOR Fire 6. RESOURCES ASSIGNED TO THIS PERIOD RESOURCE DESIGNATOR LEADER NUMBER PERSONS TRANS. NEEDED PICKUP PT./TIME DROP OFF PT. /TIME CHECK IN DOCUMENTATION UNIT LEADER SIT -STAT RESOURCE UNIT LEADER DEMOB 7. CONTROL OPERATIONS Provide staff check -in, documentation, situation status updates, resources and demobilization. 8. SPECIAL INSTRUCTIONS 9. DIVISIONIGROUP COMMUNICATIONS SUMMARY FUNCTION ZONE SYSTEM CHAN. FUNCTION FRED, SYSTEM CHAN. COMMAND LOCAL REPEAT 1 800 MHz 4 SUPPORT LOCAL REPEAT DN.IGROUP TACTICAL PREPARED BY and POSITION) APPROVED BY and POSITION) DATE TIME ICS 204 2. BRANCH OPERATIONS 2. DIVISION Clinic Branch ASSIGNMENT LIST 3. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME S. OPERATIONAL PERSONNEL OPERATIONS CHIEF Law Supervisor DIVISION /GROUP SUPERVISOR BRANCH DIRECTOR HCA Staff 6. RESOURCES ASSIGNED TO THIS PERIOD RESOURCE DESIGNATOR LEADER NUMBER PERSONS TRANS. NEEDED PICKUP PT. /TIME DROP OFF PT.ITIME CHECK -IN / SCREENING Check -in / Screening GS VACCINE / DISPENSING Vaccine / Dispensing GS FORMS COLLECTION Clinic Branch Dir. 7. CONTROL OPERATIONS Clinic Operations 8. SPECIAL INSTRUCTIONS 9. DIVISION /GROUP COMMUNICATIONS SUMMARY FUNCTION ZONE SYSTEM CHAN. FUNCTION FRED. SYSTEM CHAN. COMMAND LOCAL REPEAT I 800 Oc MHz 4 SUPPORT LOCAL REPEAT DIVJGROUP TACTICAL PREPARED BY (NAME and POSITION) APPROVED BY (NAME and POSITION) DATE TIME ICS 204 3. BRANCH Operations 2. DIVISION Medical Branch ASSIGNMENT LIST S. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME 5. OPERATIONAL PERSONNEL OPERATIONS CHIEF Law Supervisor DIVISION /GROUP SUPERVISOR BRANCH DIRECTOR HCA Staff 6. RESOURCES ASSIGNED TO THIS PERIOD RESOURCE DESIGNATOR LEADER NUMBER PERSONS TRANS. NEEDED PICKUP PT./TIME DROP OFF PT. /TIME 7. CONTROL OPERATIONS 8. SPECIAL INSTRUCTIONS 9. DIVISION /GROUP COMMUNICATIONS SUMMARY FUNCTION ZONE SYSTEM CHAN. FUNCTION FRED. SYSTEM CHAN. COMMAND LOCAL REPEAT 800 oc MHz 4 SUPPORT LOCAL REPEAT DIV./GROUP TACTICAL PREPARED BV INAME and POSITION) APPROVED BY (NAME and POSITION) DATE TIME ICS 204 MEDICAL PLAN 1. Incident Name Seal Beach POD 2. Date Prepared 3 Time Prepared 4, Operational Period 5. Incident Medical Aid Station's' " Medical Aid Stations Location Paramedics Yes No CERT EMT Team Next to the MCP X 6. Transportation A. Ambulance Services Name Address Phone Paramedics Yes No Care Ambulance 1517 W. Braden Ct. Orange CA, 92868 714 - 248 -3800 X B. Incident Ambulances j Name Location Paramedics Yes No Care Ambulance Next to the Medical Tent X OCFA Next to the Medical Tent X „4 7.' Hospitals - Name Address Travel Time Air Ground Phone Helped Yes No Burn Center Yes No Los Alamitos Med. 3751 Katella Avenue Los Alamitos, CA 90720 10 (562) 598 -1311 X X Long Beach Mem. 2801 Atlantic Avenue, Long Beach, CA 2 15 (562) 933 -2000 X X 8. Medical '.Emergency Procedures, In case of an emergency OCFA medics will take the lead on the pt. Transportation to LAMC will be provided by Care Ambulance. If the pt. requests an alternative receiving hospital and is within the catchment area than that will be the destination of the pt. All trauma pts. Will be transported to Long Beach Memorial unless diverted. Prepared by (NAME and POSITION) 10. Renewed by (NAME and POSITION) ICS 206 a N U 0 v c o O o o u 0. U u c o o v E c O c •u c+i o u c o C E C o a a. N y O O O a 0 m ° C o u V E 0 D fl v � E u u w m u a ` u o O y OI V u � c O c y C a a a N C C E C _ 4 O C a C \ `a O c L n a a a o C C N V v m N o a v u 'O d C C C O O 0 O N r u o K N d Q Type of Hazard ❑ ❑ ❑ ❑ ❑ ❑ Type of Hazard: 1:1 El El El F-1 El Other O`. Type of Hazard: ® ® ❑ ,. Weather N.. z u .° Type of Hazard: Medical Problem ❑ ❑ 1:1 ® E:1 N. o m p `5 Type of Hazard: ® ® ❑ n v Trip /Fall 0 q Type of Hazard: Reaction to Vaccine ❑ ❑ ❑ ® ❑ N > - Type of Hazard: Q Cross Contamination ❑ ❑ ® ❑ ❑ Z Q Type of Hazard: Traffic ❑ ® ❑ ❑ ❑ v_ Q yr Z Q J c o � d Z Q p d 0 0 V O Q c O _ U N E Z a p U Z Z W D 7 D 'D C m C r a T 9 u a E m o u u - o 0 Z E 'u u c '0 'rn c a - U vUi U � 0 D a a N U DEMOBLIZATION CHECKOUT LIST ICS -221 1. Incident Name / Number 2. Date/ Time 3. Demob. No. 4. Unit/ Personnel Released 5. Transportation Type / No. 6. Actual Release Date / Time 7. Manifest Yes No Number 8. Destination 9. Area / Region /Agency Notified Name Date 10. Unit Leader Responsible for Collecting Performance Rating 11. Unit / Personnel You and your resources have been released subject to sign -off from the following: [DEMOB Unit Leader Check ✓ the appropriate box(es)] Logistics Section • SUPPLY UNIT LEADER • COMMS UNIT LEADER • FAC. UNIT LEADER • GROUND SUPPORT UNIT LEADER Planning Section ❑ DOCUMENTATION UNIT LEADER Finance/Administration Section ❑ TIME UNIT Other 12. Remarks ICS Form 221 Prepared by (NAME and POSITION) wPG� II Cy�� O (IB' +��/ August 29, 2016 Orange County Health Care Agency Admin Manager I Contract Services 405 W. 5th Street, Suite 600 Santa Ana, CA 92701 Attn: Brian Greene RE: Agreement for Provision of Point of Dispensing Site Equipment Services Dear Brian: CITY HALL 211 EIGHTH STREET SEAL BEACH, CA 90740 (562) 431 -2527 www.sealbeachca.gov Please find enclosed three sets of the above referenced agreement. Please return one fully executed copy to the attention of City Clerk Robin Roberts at the City of Seal Beach, 211 Eighth Street, Seal Beach, CA 90740. Thank you for your promptness in handling this matter. Sincerely, 7� Winnie Bell Part-time Executive Assistant City Clerk's Office City of Seal Beach (562) 431 -2527 Ext, 1304 wbell@sealbeachca.gov Enclosures