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HomeMy WebLinkAboutCalifornia Forensic Phlebotomy, Inc. - 2015-10-13PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND CALIFORNIA FORENSIC PHLEBOTOMY, INC. FOR ON -CALL BLOOD WITHDRAWAL AND TESTING SERVICES THIS AGREEMENT ("Agreement") is made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as "CITY," and California Forensic Phlebotomy, Inc, a California corporation, hereinafter referred to as "CONSULTANT " WHEREAS, CITY desires to engage the services of a consultant to provide on -call blood withdrawal and testing services, and Pursuant to documentation on file in the office of the City Clerk, the provisions of the Huntington Beach Municipal Code, Chapter 3.03, relating to procurement of professional service contracts have been complied with; and CONSULTANT has been selected to perform these services, NOW, THEREFORE, it is agreed by CITY and CONSULTANT as follows: 1. SCOPE OF SERVICES CONSULTANT shall provide all services as described in Exhibit "A," which is attached hereto and incorporated into this Agreement by this reference. These services shall sometimes hereinafter be referred to as the "PROJECT " CONSULTANT hereby designates Russell Liedholm, who shall represent it and be its sole contact and agent in all consultations with CITY during the performance of this Agreement. 15-4949 1 of 11 2. CITY STAFF ASSISTANCE CITY shall assign a staff coordinator to work directly with CONSULTANT in the performance of this Agreement. 3 TERM; TIME OF PERFORMANCE Time is of the essence of this Agreement. The services of CONSULTANT are to commence on 6(M& ;e , /3, Aj/,5" (the "Commencement Date"). This Agreement shall automatically terminate three (3) years from the Commencement Date, unless extended or sooner terminated as provided herein. All tasks specified in Exhibit "A" shall be completed no later than three (3) years from the Commencement Date The time for performance of the tasks identified in Exhibit "A" are generally to be shown in Exhibit "A." This schedule may be amended to benefit the PROJECT if mutually agreed to in writing by CITY and CONSULTANT In the event the Commencement Date precedes the Effective Date, CONSULTANT shall be bound by all terms and conditions as provided herein. 4 COMPENSATION In consideration of the performance of the services described herein, CITY agrees to pay CONSULTANT on a time and materials basis at the rates specified in Exhibit "B," which is attached hereto and incorporated by reference into this Agreement, a fee, including all costs and expenses, not to exceed Ninety-nine Thousand Dollars ($99,000) 5 EXTRA WORK In the event CITY requires additional services not included in Exhibit "A" or changes in the scope of services described in Exhibit "A," CONSULTANT will undertake such work only after receiving written authorization from CITY Additional 15-4949 2ofII compensation for such extra work shall be allowed only if the prior written approval of CITY is obtained 6 METHOD OF PAYMENT CONSULTANT shall be paid pursuant to the terms of Exhibit "B." 7. DISPOSITION OF PLANS, ESTIMATES AND OTHER DOCUMENTS CONSULTANT agrees that title to all materials prepared hereunder, including, without limitation, all original drawings, designs, reports, both field and office notices, calculations, computer code, language, data or programs, maps, memoranda, letters and other documents, shall belong to CITY, and CONSULTANT shall turn these materials over to CITY upon expiration or termination of this Agreement or upon PROJECT completion, whichever shall occur first. These materials may be used by CITY as it sees fit. 8 HOLD HARMLESS CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims, damages, losses, expenses, judgments, demands and defense costs (including, without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in connection with CONSULTANT's (or CONSULTANT's subcontractors, if any) negligent (or alleged negligent) performance of this Agreement or its failure to comply with any of its obligations contained in this Agreement by CONSULTANT, its officers, agents or employees except such loss or damage which was caused by the sole negligence or willful misconduct of CITY. CONSULTANT will conduct all defense at its sole cost and expense and CITY shall approve selection of CONSULTANT's counsel. This indemnity shall 154949 3of11 apply to all claims and liability regardless of whether any insurance policies are applicable The policy limits do not act as limitation upon the amount of indemnification to be provided by CONSULTANT. 9. PROFESSIONAL LIABILITY INSURANCE CONSULTANT shall obtain and furnish to CITY a professional liability insurance policy covering the work performed by it hereunder This policy shall provide coverage for CONSULTANT's professional liability in an amount not less than One Million Dollars ($1,000,000.00) per occurrence and in the aggregate. The above - mentioned insurance shall not contain a self -insured retention without the express written consent of CITY, however an insurance policy "deductible" of Ten Thousand Dollars ($10,000.00) or less is permitted. A claims -made policy shall be acceptable if the policy further provides that: A The policy retroactive date coincides with or precedes the initiation of the scope of work (including subsequent policies purchased as renewals or replacements) B. CONSULTANT shall notify CITY of circumstances or incidents that might give rise to future claims. CONSULTANT will make every effort to maintain similar insurance during the required extended period of coverage following PROJECT completion. If insurance is terminated for any reason, CONSULTANT agrees to purchase an extended reporting provision of at least two (2) years to report claims arising from work performed in connection with this Agreement. If CONSULTANT fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the CITY with required proof that 154949 4of11 insurance has been procured and is in force and paid for, the CITY shall have the right, at the CITY's election, to forthwith terminate this Agreement. Such termination shall not effect Consultant's right to be paid for its time and materials expended prior to notification of termination. CONSULTANT waives the right to receive compensation and agrees to indemnify the CITY for any work performed prior to approval of insurance by the CITY. 10. CERTIFICATE OF INSURANCE Prior to commencing performance of the work hereunder, CONSULTANT shall furnish to CITY a certificate of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverage as required by this Agreement; the certificate shall: A provide the name and policy number of each carrier and policy, B state that the policy is currently in force, and C. shall promise that such policy shall not be suspended, voided or canceled by either party, reduced in coverage or in limits except after thirty (30) days' prior written notice, however, ten (10) days' prior written notice in the event of cancellation for nonpayment of premium. CONSULTANT shall maintain the foregoing insurance coverage in force until the work under this Agreement is fully completed and accepted by CITY. The requirement for carrying the foregoing insurance coverage shall not derogate from CONSULTANT's defense, hold harmless and indemnification obligations as set forth in this Agreement CITY or its representative shall at all times have the right to demand the original or a copy of the policy of insurance CONSULTANT shall pay, in a prompt and timely manner, the premiums on the insurance hereinabove required 154949 5of11 11 INDEPENDENT CONTRACTOR CONSULTANT is, and shall be, acting at all tunes in the performance of this Agreement as an independent contractor herein and not as an employee of CITY CONSULTANT shall secure at its own cost and expense, and be responsible for any and all payment of all taxes, social security, state disability insurance compensation, unemployment compensation and other payroll deductions for CONSULTANT and its officers, agents and employees and all business licenses, if any, in connection with the PROJECT and/or the services to be performed hereunder. 12. TERMINATION OF AGREEMENT All work required hereunder shall be performed in a good and workmanlike manner CITY may terminate CONSULTANT's services hereunder at any time with or without cause, and whether or not the PROJECT is fully complete. Any termination of this Agreement by CITY shall be made in writing, notice of which shall be delivered to CONSULTANT as provided herein. In the event of termination, all finished and unfinished documents, exhibits, report, and evidence shall, at the option of CITY, become its property and shall be promptly delivered to it by CONSULTANT 13. ASSIGNMENT AND DELEGATION This Agreement is a personal service contract and the work hereunder shall not be assigned, delegated or subcontracted by CONSULTANT to any other person or entity without the prior express written consent of CITY. If an assignment, delegation or subcontract is approved, all approved assignees, delegates and subconsultants must satisfy the insurance requirements as set forth in Sections 9 and 10 hereinabove 15-4949 6ofII 14. COPYRIGHTS/PATENTS CITY shall own all rights to any patent or copyright on any work, item or material produced as a result of this Agreement. 15. CITY EMPLOYEES AND OFFICIALS CONSULTANT shall employ no CITY official nor any regular CITY employee in the work performed pursuant to this Agreement No officer or employee of CITY shall have any financial interest in this Agreement in violation of the applicable provisions of the California Government Code. 16. NOTICES Any notices, certificates, or other communications hereunder shall be given either by personal delivery to CONSULTANT's agent (as designated in Section 1 hereinabove) or to CITY as the situation shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and depositing the same in the United States Postal Service, to the addresses specified below. CITY and CONSULTANT may designate different addresses to which subsequent notices, certificates or other communications will be sent by notifying the other parry via personal delivery, a reputable overnight carrier or U. S certified mall -return receipt requested. TO CITY City of Huntington Beach ATTN Dale Miller, HBPD 2000 Main Street Huntington Beach, CA 92648 15-4949 7ofII TO CONSULTANT. California Forensic Phlebotomy, Inc ATTN Russell Liedholm 27762 Antonio Parkway, Ste. L1-647 Ladera Ranch, CA 92694 17 CONSENT When CITY's consent/approval is required under this Agreement, its consent/approval for one transaction or event shall not be deemed to be a consent/approval to any subsequent occurrence of the same or any other transaction or event. 18 MODIFICATION No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both parties. 19 SECTION HEADINGS The titles, captions, section, paragraph and subject headings, and descriptive phrases at the beginning of the various sections in this Agreement are merely descriptive and are included solely for convenience of reference only and are not representative of matters included or excluded from such provisions, and do not interpret, define, limit or describe, or construe the intent of the parties or affect the construction or interpretation of any provision of this Agreement 20 INTERPRETATION OF THIS AGREEMENT The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the parties If any provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining covenants and provisions of this Agreement No covenant or provision shall be deemed dependent upon any other unless so expressly provided here As used in this Agreement, the masculine or neuter gender and singular or plural number shall be deemed to include the other whenever the context so indicates or requires Nothing contained herein shall be construed so as to require the commission of any act 15-4949 8ofII contrary to law, and wherever there is any conflict between any provision contained herein and any present or future statute, law, ordinance or regulation contrary to which the parties have no right to contract, then the latter shall prevail, and the provision of this Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements of the law 21 DUPLICATE ORIGINAL The original of this Agreement and one or more copies hereto have been prepared and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of the date of its execution and delivery, be deemed an original Each duplicate original shall be deemed an original instrument as against any party who has signed it 22. IMMIGRATION CONSULTANT shall be responsible for full compliance with the immigration and naturalization laws of the United States and shall, in particular, comply with the provisions of the United States Code regarding employment verification 23 LEGAL SERVICES SUBCONTRACTING PROHIBITED CONSULTANT and CITY agree that CITY is not liable for payment of any subcontractor work involving legal services, and that such legal services are expressly outside the scope of services contemplated hereunder. CONSULTANT understands that pursuant to Huntington Beach City Charter Section 309, the City Attorney is the exclusive legal counsel for CITY; and CITY shall not be liable for payment of any legal services expenses incurred by CONSULTANT 15-4949 9of11 24. ATTORNEY' S FEES In the event suit is brought by either party to construe, interpret and/or enforce the terms and/or provisions of this Agreement or to secure the performance hereof, each parry shall bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its attorney's fees from the nonprevailing party 25. SURVIVAL Terms and conditions of this Agreement, which by their sense and context survive the expiration or termination of this Agreement, shall so survive. 26. GOVERNING LAW This Agreement shall be governed and construed in accordance with the laws of the State of California. 27. SIGNATORIES Each undersigned represents and warrants that its signature herembelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn 28 ENTIRETY The parties acknowledge and agree that they are entering into this Agreement freely and voluntarily following extensive arm's length negotiation, and that each has had the opportunity to consult with legal counsel prior to executing this Agreement The parties also acknowledge and agree that no representations, inducements, promises, agreements or warranties, oral or otherwise, have been made by that party or anyone acting on that party's behalf, which are not embodied in this Agreement, and that that party has not executed this Agreement in reliance on any representation, inducement, 15-4949 10ofII promise, agreement, warranty, fact or circumstance not expressly set forth in this Agreement This Agreement, and the attached exhibits, contain the entire agreement between the parties respecting the subject matter of this Agreement, and supersede all prior understandings and agreements whether oral or in writing between the parties respecting the subject matter hereof 29. EFFECTIVE DATE This Agreement shall be effective on the date of its approval by the City Attorney This Agreement shall expire when terminated as provided herein. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. CONSULTANT, CALIFORNIA FORENSIC PHLEBOTOMY, INC., a California corporation print name ITS' (circle one) Chatrm res ice President rmt n e ITS' (circle ne) Secret hiefFmanctal Officer/Asst Secretary — Tre Receive and File Cfy Merk 15-4949 11 of 11 CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California , _ U y " i City Manager INITIATED VED: /Z"//=/ 114t Chief of Police APPROVED / City Attorney bh to Its l� /11171— A. STATEMENT OF WORK: (Narrative of work to be performed) Contractor to provide employees who shall remain available on an on -call basis at all times, seven (7) days per week, twenty-four (24) hours per day, three hundred sixty five (365) days a year, and agree to said employees to conduct tests identified in the City's agreement as requested. Locations for taking of blood samples shall include, but not limited to: Huntington Beach Police Department local hospitals, Orange County Jail, field locations in and around the City of Huntington Beach Contractor to provide related employees to appear and conduct requested tests within forty-five (45) minutes of such request. Contractor to provide twenty-four (24) hour access to a supervisor to remedy any problems or questions that may arise. Contractor to provide medical supplies and equipment necessary to conduct tests at no cost to the City. Contractor to provide transportation for employees at no cost to the City. Contractor's employees, upon request of the City and/or the Orange County District Attorney, shall take blood samples and appear in court or any other designated location, at no additional cost, for the purpose of discussion or testimony concerning collecting samples. Contractor's said employees agree to appear in court at the time designated by the City and/or the Orange County District Attorney. The City and/or the Orange County District Attorney will provide at least one -hour notice to such appearance. In addition to applicable laws, all blood sample collection and subsequent handling shall be conducted in accordance with direction and procedures prescribed by the Orange County Sheriff ZD Department Forensic Science Services Division. Only employees of the Contractor, deemed acceptable by the City, hereunder shall perform services; the City will refuse to permit blood samples to be collected by any employee of Contractor considered, by the City in its sole discretion, to be unacceptable. All blood samples shall be refrigerated immediately and deposited by the Contractor at the County or Orange's refrigerated blood locker within six (6) hours of withdrawal. Contractor to provide, at Contractor's expense, supplies necessary to ensure that blood samples are properly refrigerated as directed by the Orange County Sheriff Department Forensic Science Services Division. Upon request, with advanced notice, the City may require the Contractor to provide an employee at a fixed post (i.e. DUI Checkpoint) to perform contracted services. Contractor shall charge a flat hourly rate, rather than an individual fee for each blood test conducted at the fixed post. A minimum of three (3) hours of service would be required. B. CONSULTANT'S DUTIES AND RESPONSIBILITIES: Weekly letters sent to the District Attorney and Victim Witness offices at each of the Justice Centers, the DMV, and the Orange County Crime Lab detailing employee availability and vacation schedules; • Subpoenas returned on a weekly basis for former personnel with detailed forwarding information on said personnel, • Extensive program to assure employee availability; • Company management readily available to testify to business records as needed; • Continued increased dialog with District Attorney's Office and the DMV; • Continued increase in employee retention rate, EXHIBIT A • Soliciting increased feedback from the District Attorney's Office and the DMV; • Continued promotion of a company wide attitude of overall importance of the criminal courts and the DMV Division of Driver Safety Program. • New communication system that allows law enforcement agencies or the District Attorney's Office immediate direct access to our on -duty supervisor 24 hours a day without going through our answering service or waiting for a page to be returned. C. CITY'S DUTIES AND RESPONSIBILITIES: Pay contractor within 30 days after invoice is received from CONSULTANT. Review all reports submitted by CONSULTANT. D WORK PROGRAM/PROJECT SCHEDULE: Ongoing and as -needed effective October 1, 2015-September 30, 2018 4CI1: Payment Schedule (Hourly Payment) A. Hourly Rate CONSULTANT'S fees for such services shall be based upon the following hourly rate and cost schedule: Our prices will remain constant at $99.25 per subject and per hour for DUI Checkpoints for this contract period 10-1-2015 to 9-30-2016. $101.25 for contract period 10-1-2016 to 9-30-2017. $103.25 for contract period 10-1-2017 to 9-30-2018 It is estimated that the costs per FY will be as follows: FY15/16: $33,000 FY16/17: $33,000 FY17/18: $33,000 B Travel. Charges for time during travel are not reimbursable C Billing 1 All billing shall be done monthly in fifteen (15) minute increments and matched to an appropriate breakdown of the time that was taken to perform that work and who performed it. 2. Each month's bill should include a total to date. That total should provide, at a glance, the total fees and costs incurred to date for the project 3 A copy of memoranda, letters, reports, calculations and other documentation prepared by CONSULTANT may be required to be submitted to CITY to demonstrate progress toward completion of tasks. In the event CITY rejects or has comments on any such product, CITY shall identify specific requirements for satisfactory completion. 4 CONSULTANT shall submit to CITY an invoice for each monthly payment due. Such invoice shall: A) Reference this Agreement; B) Describe the services performed; C) Show the total amount of the payment due, D) Include a certification by a principal member of CONSULTANT's firm that the work has been performed in accordance with the provisions of this Agreement; and E) For all payments include an estimate of the percentage of work completed Upon submission of any such invoice, if CITY is satisfied that CONSULTANT is making satisfactory progress toward completion of tasks in accordance with tlus Agreement, CITY shall approve the invoice, in which event payment shall be made within thirty (30) days of receipt of the invoice by CITY. Such approval shall not be unreasonably withheld. If CITY does not approve an invoice, CITY shall notify 1 Exhibit B CONSULTANT in writing of the reasons for non -approval and the schedule of performance set forth in Exhibit "A" may at the option of CITY be suspended until the parties agree that past performance by CONSULTANT is in, or has been brought into compliance, or until this Agreement has expired or is terminated as provided herein. �. Any billings for extra work or additional services authorized in advance and in writing by CITY shall be invoiced separately to CITY. Such invoice shall contain all of the mformation required above, and in addition shall list the hours upended and hourly rate charged for such time. Such invoices shall be approved by CITY if the work performed is in accordance with the extra work or additional services requested, and if CITY is satisfied that the statement of hours worked and costs incurred is accurate. Such approval shall not be unreasonably withheld. Any dispute between the parties concerning payment of such an invoice shall be treated as separate and apart from the ongoing performance of the remainder of this Agreement. 2 Exhibit B Prospective Bidders for Project As Needed Phlebotomy Services (2015-0806) Issued on 08/06/2015 Bid Due on August 27, 2015 4 00 PM (Pacific) Exported on 09/29/2015 VendorlD Company Name Address City State Zip Code Country Contact Name Phone Email Downloaded Bidder Status 147897 Onvia 509 Olive Way Seattle WA 98101 United States Source Management 206-373-9500 sourcemgmt@onvia ne X Bidder 218922 Reliable Supply, Inc PO Box 40444 Grand Junction CO 81504 United States Lovely Banquil 970-243-1929 lovely@reliable-supply X Bidder 233816 Prime Vendor Inc 4622 Cedar Avenue Wilmington NC 28403 United States Bid Clerk 800-746-9554 sujita@prime-vendor c X Bidder 258760 California Forensic Phlebotomy, Inc 27762 Antonio Parkway Ladera Ranch CA 92694 United States Russell A Liedholm 949-309-2459 ext 5 cvc23158@aol com X Bidder 386321 maxim healthcare services 735 tank farm rd suite 140 san luis Obispo CA 93401 United States jadd martinez 805-489-2685 jamartin@maxhealth o X Bidder 389477 Sdxray & Lab, Inc 8772 Cuyamaca St, Ste 102 Santee CA 92071 United States Lisa Chow 909-895-8736 lisa@sdxrayandlab com X Bidder A� D® VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE DAT2015DITlYrY17 09/2512015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER4S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND TA CERTIFICATE HOLDER This forth is used to report coverages provided to a single specific vehicle or equipment Do not use this form to report liability coverage provided to multiple vehicles under a single policy Use ACORD 25 for that purpose PRODUCER Stafefdrm John Galea • • 1102 E Chapman Ave Fullerton CA 92831 NAMEACT John Galea E E,d 714-526-3344 FAX Nd 714-526-2262 ADDR )ohn oh aiea_com UCER CUSTPRODOMER IDS INSURE S AFFORDING COVERAGE NAIC r INSURED Calffomta Forensic Phlebotomy Inc 27762 Antonio Pkwy Ste L1-647 Ladera Ranch, CA 92694-1140 INSURER A State Farm Mutual AutomoWe Insuranoe Company 25178 INSURER INSURERC INSURER D INSURER E DESCRIPTION OF VEHICLE OR EQUIPMENT YEAR NAKEr MANUFACTURER MODEL BODY TYPE VEHICLE IDENTIFICATION NUMBER DESCRIPTION ENOL/HIRED AUTO SERIAL NUMBER COVERAGES CERTIFICATE NUMBER REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HASIHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD(S) INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TQ WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICY(IES) DESCRIBED HEREIN ISIARE SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCY(IES) iNSR LTR ADDL asap TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMK*NYYY) POLICY EXPIRATION DATE (MMOMYYYY) LIMITS X VEHICLE LIABILITY COMBINED SINGLE LIMIT $ 1,000.000 A Y V616946-C11-75Z 09111l2015 03115l2016 BODILY INJURY (Per Penton) $ BODILY INJURY (Per atxJdertl) $ t PROPERTY DAMAGE $ GENERALLIABILITY EACH OCCURENCE $ GENERAL AGGREGATE $ OCCURRENCE $ CLAIMS MADE fNSR LTR LOSE PAY915 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (NtMnW"YY) POLICY EXPIRATION DATE (MMIDMTYYI) LIMITS r DEDUCTIBLE VEH COLLISION LOSS ❑ ACV ❑ AGREED AMT S LMIT H❑ ❑ STATED AMT $ DED VEH COMP LiVEH OTC ❑ ACV ❑ AGREED AMT $ LIMIT ❑ ❑ STATED AMT $ DED PROPERTY BASIC BROAD ❑ ACV ❑ AGREED AMT ❑ RC ❑ STATED AMT $ LIMIT $ DED SPECIAL ❑ REMARKS (INCLUDING SPECIAL CONDITIONS 1 OTHER COVERAGES) (Attach ACORD 161, Additional Remarks Schedule, tf mom sWce Is required) AnnITIONAi_ INTEREST CANCELLATION Select one of thefolotlring SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED X The additional rderest described below has been added to the policy(tas) listed harem by policy number(s) A request has bsen submitted to add the add,bonal rserest described bellow to the P011dy(Ies) BEFORE THE EXPIRATION DATE THEREOF, NOTICE YYtLL BE DELIVERED IN ACCORDANCE WTH THE POLICY PROVISIONS Wed hW. I ntmbola) VEHICLE/ WLNPME14T INTEREST LEASED FINANCED DESCRIPTION OF THE ADDITIONAL INTEREST X ADDITIONAL INSURED LOSS PAYEE NAME AND ADDRESS OF ADDITIONAL INTEREST City of Huntington Beach LENDER'S LOSS PAYEE LOAN frASE NUMBER Attn Jim Slobo)an - 2000 Main Street AUTN0 D'RIT1RESPITATrIf � Huntington Beach CA 92648 O 1"7-2010 ACORD CORPORATION All rights reserved- ACORD 23 (2010/05) The ACORD name and logo are registered marks of ACORD 1004361 142987 2 01-28-2013 I H CITY OF HUNTINGTON BEACH Professional Service Approval Form PART II RECEIVED OCT 052015 Date 9/24/2015 Project Manager Dale Miller Finance Department Requested by Name if different from ;Project Manager Department Police,, PARTS I & II OF THE PROFESSIONAL SERVICES CONTRACTS APPROVAL FORM MUST BE COMPLETED BY THE REQUESTING DEPARTMENT AND SIGNED FOR APPROVAL. PART I & Il MUST BE FILED WITH ALL APPROVED CONTRACTS. 1) Name of consultant California Forensic Phlebotomy 2) Contract Number POL 2015-18 (Contract numbers are obtained through Finance Administration x 5630) J 3) Amount of this contract $99,000 Account number Contractual Dollar Amount Business unit object # Fiscal Year 2015/16 Fiscal Year 2016/17 Fiscal Year 2017/18 10070601-69360 $33,000 $33,000 $33,000 4) Is this contract less than $50,000? ❑ Yes ® No 5) Does this contract fall within $50,000 and $100,000? ® Yes ❑ No 6) Is this contract over $100,000? ❑ Yes ® No (Note Contracts requiring City Council Approval need to be signed by the Mayor and City Clerk Make sure the appropriate signature page is attached to the contract ) 7) Were formal written proposals requested from at least three available qualified consultants? ❑ Yes ® No 8) Attach a list of consultants from whom proposals were requested (including a contact telephone number ) 9) Attach Exhibit A, which describes the proposed scope of work 10) Attach Exhibit B, which describes the payment terms of the contract Fiscal Se Man r ( rchasing) Date Budg7tage ro Signature ate Director of Finance (or designee) Signature Date phlebotomy services professional service approval form - part ii doc REV February 2015 Requested by Name if different from Project Manager, Dale Miller, Detention Administrator Department Police PARTS I OF THE PROFESSIONAL SERVICES CONTRACTS APPROVAL FORM MUST BE COMPLETED BY THE REQUESTING DEPARTMENT AND SIGNED BY THE CITY MANAGER, FOR APPROVAL, BEFORE PROCEEDING WITH THE SOLICITATION OR CONTRACT PROCESS. PART I MUST BE FILED WITH ALL APPROVED CONTRACTS. 1) Briefly provide the purpose for the agreement On -call 24/7, Licensed Phlebotomy Services for the collection of blood evidence in drug and alcohol related crimes 2) Estimated cost of the services being sought $ 99,000 over 3 years I--, 3) Are sufficient funds available to fund this contract? ® Yes ❑ No If no, please explain 4) Check below how the services will be obtained ® A Bid solicitation process in accordance to the MC 3 03 060 procedures will be conducted ❑ MC 3 03 08(b) - Other Interagency Agreement procedure will be utilized ❑ MC 3 03 08 - Contract Limits of $30,000 or less exempt procedure will be utilized 5) Is this contract generally described on the list of professional service contracts approved by the City Council? If the answer to this question is "No," the contract will require approval from the City Council ) -� ® Yes ❑ No ature (Purchasing 6) Amount, Business Unit (8 digits) and Object Code (5 digits) where funds are budgeted (Please note that a budget check will occur at the object code level): Date Account number Contractual Dollar Amount Business unit object # Fiscal Year S- 2016 Fiscal Year /G - 2017 Fiscal Year /7 — 2018 10070601.69360 $33000 $33000 $33000 $ $ $ $ $ $ Assistant City Manager's Signature APPROVED D Signature new psa form - part i blood draw REV February 2015 bb L(>b1s Date `?- 9-/S"' Date - 2, Date Date Date \A Police Psychological exams, polygraph, legal consultations, rape and medical exams, crime prevention, hazmat physical exams, flight crew physicals, blood withdraws, transcription, juvenile diversion, gang prevention and other related consulting and professional services. 9/29/2015 9/29/2015 CFP 4,000.00 $ 33,000.00 $ $ 37,000.00 $ 296,408.00 Contract Value 12,000.00 99,000.00 inmate health services Blood draw services Notes