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HomeMy WebLinkAboutCoast Community College District - 2000-11-20CITY OF HUNTINGTON BEACH 2000 MAIN STREET CALIFORNIA 92648 OFFICE OF THE CITY CLERK CONNIE BROCKWAY CITY CLERK LETTER OF TRANSMITTAL OF ITEM APPROVED BY THE CITY COUNCIL/ REDEVELOPMENT AGENCY OF THE CITY OF HUNTINGTON BEACH DATE: June 7, 2001 TO: Health Professions ATTENTION: Linda Stevens, MSN, RN Name 15744 Goldenwest Street DEPARTMENT: Street . Huntington Beach, CA 92647 REGARDING: Non -Standard Affiliation City, State, Zip Agreement See Attached Action Agenda Item E—S Date of Approval 6-4-01 Enclosed For Your Records Is An Executed Copy Of The Above Referenced Agenda Item. Remarks: Please return an executed copy of {S the agreement to the City Clerk's Office at Connie Brockway the above address. Thank you. City Clerk Attachments: Action Agenda Page x Agreement x Bonds Insurance x RCA Deed Other CC: R. Hagan Comm. Serv. x Name Department RCA Agreement Insurance Other .r Comm. Serv. x Name Department RCA AWeement Insurance Other Tame Department RCA AFeement Insurance Other Name Department RCA Agreement Insurance Other C. Mendoza Risk Mgmt. x x Name Department RCA Insurance (Telephone: 714-53"227 n 4AN, c1W -sue Council/Agency Meeting Held: Deferred/Continued to: A roved ❑ Conditionatl A proved ❑Denied µ� — IJ -� 6�Cv _ IQ City Cl k's Signature Council Meeting Date: June 4, 2001 Department ID Number: CS 01 037 CITY OF HUNTINGTON BEACH REQUEST FOR COUNCIL ACTION SUBMITTED TO: HONORABLE MAYOR AND CITY COUNCIL MEMBERS N � � SUBMITTED BY: RAY SILVER, City Administratoreg!)e O� z PREPARED BY: RON HAGAN, Director,. Community Service �, 8::;-<c SUBJECT: APPROVE NON-STANDARD AFFILIATION AGREEMENT6NI � COAST COMMUNITY COLLEGE DISTRICT c"3 X Eem:9n:t:o:fIssue, Funding Source, Recommended Action, Alternative Actlon(s), Analysis, Environmental Statp, A&chment(s) Statement of Issue: At the City Council meeting of November 20 2000 an agreement was approved t experience September requesting approval). allow nursing students at Golden West College to participate in a community rotation at Rodgers Seniors' Center. The effective date of the agreement was 1, 2000 (prior to approval). Therefore, the Coast Community College District is approval of a new agreement with an effective date of August 1, 2001, (after Funding Source: Not applicable Recommended Action: Approve the Non -Standard Affiliation Agreement between the City and Coast Community College District and authorize the Mayor and City Clerk to execute. Alternative Action(s): Do not approve the agreement and require the nursing program to seek alternative avenues for their community experience rotation. Analysis: Due to a delay in approving the agreement the first time, the Coast Community College District was reluctant to sign off an agreement which had an effective date (September 1, 2000) prior to the actual approval by the City on November 20, 2000. The agreement has been revised to show an effective date of August 1, 2001. This should give enough time to have all approvals completed prior to that date. The nursing program at Golden West College is desirous of fostering community health education by allowing the nursing students to participate in a rotation at the Rodgers Seniors' Center. The registered nursing students have visited the Seniors' Center for the past five years. They have considered their experiences invaluable and wish to continue to utilize the Rodgers Seniors' Center for their community experience rotation. *QUEST FOR COUNCIL ACON MEETING DATE: June 4, 2001 DEPARTMENT ID NUMBER: CS 01 037 Environmental Status: Not applicable Attachment(s): 1. Non -Standard Affiliation Agreement 2. Student Participation Agreement 3. Certificate of Insurance RCA Author: Bill Fowler Document2 -2- 5124/01 9:50 AM ATTACHMENT #1 VIEST 00 0 o a Kenneth D. Yglesias, Ed.D., President VZ196 15744Golden West Street - P.O. Box 2748 • Huntington Beach, CA 92647-2748 •(714) 892-7711 6—zoo1TON $ July 26, 2001 0 s W O Mr. Ron Hagan o ZZ) Director of Community Services A City of Huntington Beach c� P.O. Box 190, 2000 Main Street 77 =` Huntington Beach, CA 92648 ISO w > Dear Ron: Attached is a copy of the Non -Standard Hospital/Clinical Affiliation Agreement between the Coast Community College District (Golden West College) and the City of Huntington Beach (Rogers Senior Center). As required, please instruct your insurance carrier to forward a Certificate of Insurance covering comprehensive general liability insurance naming Coast Community College District as the certificate holder. A thirty (30) day notice of cancellation clause should be noted on the Certificate of Insurance. Golden West College is most anxious to continue our affiliation with your organization. If you have any questions or concerns about this agreement please call me at 714/895-8157. 1 will be happy to work with you to resolve any issues regarding the agreement. Sincerely, Linda Stevens, R.N., M.S.N. Dean, Math, Science and Health Professions Enclosure cc: Mary Siegfried, CCCD Ad William M. Vega, Ed.D., Chancellor Coast Community College District Board of Trustees: Paul G. Berger • George E. Brown - Walter G. Howald Jerry Patterson • Armando R. Ruiz • Student Trustee M1 f; ; r s . -STANDARD AFFILIATIONAGREEMENT This NON-STANDARD AFF1LiAT10` AGREEMENT (:he `-Aszreenlen-":) is Blade and entered into this,/5 day of 5 2001. by and between the Coast Community College District. a p'.i'a lc 2c:[:cr::.0110: ageacv (-`District" ), located a: ',370 Mantis Aveatre, Cosh? Mesa, Cahto-lita, and the City of H,.,.min2ton Beach.. a mullicipal corporation ("City"). loct :ed at k- 2000 Main Street. Flurltinuton Beach. Califomia. WHEREAS, District and Cite desire to contribute to community health education: WHEREAS. District operates Golden W'est College ("College") and College is a duly accredited edticatior:al institute that conducts the prograrn(s) described and identified In Attachment 1 to this Agreement ("the Program-); WHEREAS, District has obtained all necessary licenses, consents and -or approvals to conduct the Program front the State of California and any' other s pplicable governmental agency; WHEREAS, City owns and operates the -Michael E. Rodgers Senior Center, located at 1706 Orange Avenue. Hurii;-.-ton Beach, California ("Center"), and has obtainec all, necessa-v licenses, consents, and approvals to do so; WHEREAS, as part of the Program, students are required to participate in a conlnitinity experience rotation; WHEREAS, District desires to affiliate with City in order that students may particip to in a cot 111IL litY experience rotation at the Center; WHEREAS? District and Clt%' desire to enter Into this Agreement to memorialize [ilea respective rights, duties and obligations with respect to the community' experience rotation of students of the College's Program. ru A2rcc;\on•a.vidurd i-1401 For palposc of this 2recment, the Following definitions shall apply: -District" shall refer to the Coast Commua:ty Co'lege District, its mel.lber Colleges, t;:e District's GoverlllnQ Board, and Cac l of their tl'Llsice5. employees. agents, rep"c5enta t:ves, successor' and assigns; 'College' shall refer to Golden %Vest Collcge, and each o+ its en:p oye;.5. agents - representatives and assigns; "City" shall refer to the City of Huntington Beach, is elected and appointed officials, officers, directors, einployee5, agents, reoresma' ves, successors, and assigns; ConnnlLlnity Experience Rota'lon" or "Rotation" sha!1 refer to the activities of the Program's S-Udents (such as C011dLlcting interviews, socializing or the common eating ofll?gals) in interacting with the Center's participating sehioi's; "Center" shall refer to the tilichael E. Rodgers Senior Center, located at :?06 Orange AVCnLl-_, HUIltlnaton Beach. Calltorn: . NOW, THEREFORE_ in co-rs:dcrauo:i of the followin�iz covenants. conditions and agreements, the parties hereto agree as follows: TERNIS 1. C0111n1Llnit`' Experience Rotation. City agrees to providc students of the Program �t ho are specified by College with a clinical experience ro'ation ("Rotation'), in accordance with standards established by goL Ier-r- ?1Cnta ' Llizencles aria{ recog:m:zL—d professional accredliii'.g a-encies. and sLlb��c' cc) the tc mns anC.l �onr.itloios of t:::s A=,:!r'.c n,.e:;t. ?. D?%e�onment of C.lrri.l: ,lal. D:strict s! ali be fa':!} respotaibl: for the developme:lt. planning and administration ofti.e Program. McLiding, without lim.z.tation. programming. administration, n-atricL:la'iorl, prorl?otion and 21-aiL:atio'.n. District ackno« ledges 51�0 and agrees that the Rotation is intended to meet certain edtcational perforrnance objectives, and College shall provide a cope of such perforniance objectives to Cite on or before student placement. City shall be fully responsible for the availability and appropriateness of the learning env ronmem in relation to t'.7e Program's writer, objectiVes. 3- Exposure to B'oodbo-ne Pathogens. Program srudenIs :7d Co'.le�e facultV WIH compIV -With the Final reclulations Issued by the Occup:ltlonal Safety and Health Administration go�•ernir- employee exposure' to bloo dborno pathogens in the workp':ace under Section VI(b) of the Occupatio:sa ! Safety and Hcatth Act of t9-0, which regulations became effect:vc March 6, 1992 (the `'Regulations'), including but not limited to responsibility as the employer to provide. all Program students with (a) information and training about till- hazards associated with blood and other potentially inf:etlotl5 materials, (b) in. brn:ation and training about the protective measures to be taken to minimize the risk of occupational exposure to bloodborne pathogens, (c) training in the appropriate actions to take in an emergency iing exposure to blood and other - Potentially infectious materials. and (d) information as to the reasons the Program student should particip^« in Hepatitis B vaccination and post-eXposure eValuation,, and follo%V-up. 4. Application Procedure; acceptance. College agrees to provide City with a list of the naml,(s) ofsrudcilts \%-no wil be participating ill a Rotation. 5. 'Nondiseriminatiot,. The parties agree not to discriminate in the selection, placement or evaluation of any student or faculty member because of race, creed, national origin, sex, marital stat..s, ale. i:and ca .. rcc:gio:1, p, a ndfor medical condition 6. Academic Year. The academic yeav consis,s of Fat! a i,d Sp,:ng scmes.ers, summer session and «inter break intersession. 7. Rotation Schedule. The Rotation schedule shall be determined by College and Cw,- and may be arner.ded from time co time by agreement of the parties. The number of students in each Rotation shall be limited to a number mlltL:a! %1 agreed upon by both parties. not to exceed tL-e number specified by the accredi,ins7 a�,ency(iesj. S. Orientation. City- and College shall provide an orientation for assigned studentS participating in each Rotation. 9. Confidentiality of Records. Students, and the employees and Officials of both District and CO''le_e understand and agree that City's files are confidential. 10. Clln:cal Coordinator (College). College agrees to designate a coordinator for each program. The coordinator, who may be an academic instructor, shall be responsible for all teaching activities. 1 I. City Advisor. City agrees to designate an ack'ISor or coordinator who sha'.l provide inp.l. to the Rotation perfom:•ance and eVZl1l1a±ion Of StLlden,s(s), be a resource person for College's facul:v and students, and shall communicate %vith the clinica': coordinator clesianed by the College regarding the proposed curriculum and the performance of ineuvidual students and shall arrange formal orientation to the Center for the faculty and students. 12. Supervision of Students. The superylSlon and direction Of Students «-bile or, site at t11e Center shall be t;;e respo::sibility of t!le Clinical Coord'nator (Coi.lege) or designee as guided by t:,e instructional ob;ectives. No, direct, hands-on patient care shall be provided by participating students at the Center, except in accordance with all applicable laws, City rules. re2LIlations. polices and procedures. District and College rz-cognize the seniors' rights to refuse care provided by a student at the Center. rj%vAerve',NLin -SLand ard 4 5 1-7: I Removal of Students. City retains the right to exclude any student at any time from anv area of the Center. Any StUdent who is asked to leave by City shall do so promptly and' without protest. City shall also have the right. a: any time, to request College t0 remove a student perrnanemly from the Rotation. Except as othet-%VISe prOVided Wider an}' applicable policies, proced'_Lres, rLdes. reguk tiOns, all b Under a::y law, and s.:cl, removal shall not require compliance with an%, notice_ hearing or other procedure 1 regl:irementS. 14. Senior Care. Nothing in this Agreement shall be construed as conferring any riOlt or dllty upon. District, itS StLLdOntS 01' facuhy members. to control or direct senior care or operations at the Center. City shall maintain sole responsibility and accountability for senior activities and shall provide adequate staffing in number and competency at the Center to ensure safe continuous supel-VISion during the tenzi of this AUreemer.t. 15. On?olnJ Com:rllit,icanon'E%-aLL:atlo[,,. College has the privilege Ot t-e2Llla]-lv scheduled meetings with City staff, including both selected unit personnel and administrative level representatives for the pLL:aose of interpreting, discussing. and evaltiating College's health care programs at a n—,ut-ally agreed upon time. 16. 'Materials. District and College agree to provide Skidents with all educational materials required during the clinical program. 17. No Pa%-nients or Other Remuneration. District a --roes that no fees or n:onetary payments of any kind shall be exchanLed between City, its agents and ennploy-ees, and District. its agents, einplovees and studentS Linder the terllls of this ALreentent. Further, neither District. its stW members or other representatives. shall attempt to bi'.l or collet from an%• cllelit:'senior or from any ogler source fees for services provided to seniors by said student. j,'!46! IS. No Ri2ht to Employment. The parties agree that the students of College shall not be considered employees, agents or volunteers of City. nor shall any student be entitled to any right, compensation or benefits nornaliv afforded to eMployees of City, including but not limi--ed to, So:ral Sectrritl'. WiCillp'01,111er:i and workers' compensation insurance. 19. I115-,rraII' e Canjed by District. District shall assure coverage o F professlonall liabilinv insurance for each student participating in the Rotation of not less than one mill on dollars (S1.000,000) per occurrence and three million dollars (S3,000,000) in the augregate, and said pc�iicy shall remain in full force and effect during, the tern hereof. District sha':l provide workers' compensation coverage for students pa,-ticlpating in the Rotation. These coverages are in effect while the student is on -site at the Center. District shall provide City with written evidence ofeach type and fOnll of insurance described in this paragraph. 20. Confidentiality of Student Records. City shall keep confidential and shall not disclose to any person or entity (1) student applications; (ii) student health records or reports; and/or (iii) any student records as defined in California Education Code Section 76210 and the Fa:nlily Educational and Privacy :act of i 974. 20 U.S.C., paragraph 1232(g), concerning any student participating in the Rotation, unless disclosure is authorized by (1) the student in writing, or (ii) disclosure is ordered by a court of competent jurisdiction. City shall adopt and enforce whatever policies and procedures are necessary to protect the confidentiality of student record; as defined herein. 21. Verification. District warrants and represents that it has obtained all necessary apa:'ov.i1.s an.` consents t-om any any': all :agencies to enable Ci:v to offer the Rotation to Colle('G s students participating in the Program. If reduested by City, District shall provide City with ve;:tication that t[:- Prour,191 1s e.U'V hCCI13tO.. Cully ccCedlter. and`or certi ied, as app'.:cab"-, rjc Ag -_ sr_ Ja 6 5 14 i. by appropriate agencies. District COVCnants and agrees that at all times during the term hereof it shall retail, such ltcensure, accreditation and. or cert; ilcation, and its Program and faCL:ltV members ;hall continue to meet any and all federal. state and local requirements. 2'. Indemnification by District. District agrees to indemnify, defend. and hold harmless City and its officers, employees, agents and volunteers from any and all claims, actions, losses, da;na;es and/or liability arising out of the performance ofthis agreement or from anv cause whatsoever which may arise becaLlse of the negligence, misconduct, or other fault of District, including any acts, errors, or omissions of any officers, employees, instructors, students, or agents of District, and for any costs and expenses incurred by City on account of anv claims . therefore except where such indemnification is prohibited by law. 23. Indemnification by City. Citv aurees to indemnify. defend and hold harmless District alai is authorized aveats, officers, trustees, volunteers, employees and students, from any and all claims, actions, losses, damages and'or lability arising out of the performance of this Agreemen- or frown any cause whatsoever which may arise beCallse of the negligence, miscoidU41 or Ocher faLllt OI CILV. NICIUdlrlc-1 a nv acts. C,'TOrS. omissions of a ny oft°Cers, emp'.ovees. IristrLlcto:"s. Or agents of Clty, and for any costs and expenses InCUrred by District on account of a:.v claims therefore except where such indemnification is prohibited by law. 24. Governinw Law. This :agreement shall be -overnzd by and construcled in accordanc: with the la,.vs of the State of California- 2 5. assignment. Nelt';'.er party hereto may assign this \`rCemCnt or delegate its duties hereL:nder withOLlt the prior written copse;,L of the other party that can and m2v be «-ithheld b%, either party in its sole and absolute discretion. rj%%A!!r:c Non-S:anda:d i'I_ 0; 26. Effective Date of Termination. This areement shall become effective on August 1, 2001, and shall remain in effect until July 31, 2006, unless sooner terminated by either par:}' in accordance with thls section. Either party nlay terminate this Agreement with or %%-Ithot:t cause b}' �ivin� ninety (90) da}s prior written notice to the otller party of its 3ntennon to terminate. In the even[ a Rotation is In progress, any written notice to telmii ]a[e :'.1:1' or Wli!t'011t cause shall become effective at the expiration of the Rotation. Notwithstand1ng-the foregolnu, i,l the event the Program is discontinued by College during its Term, this Agreement shall in:nledia[el� ternli�,ate without further action by the parties hereto. 27. Notices. Anv notices to be given hereunder by zither party to the other may be . of ectuatet: only in writing and delivered. either by persona! delivery, or by US. mail_ Mailed notices shall be addressed to the persons at the addresses set forth below, but each party nlay change the address by written notice in accordance with this paragraph. Notices delivered personally will be deemed communicated as of actual receipt. \•,ailed notices will be deemed communicated as of ten (10) days after mailin'. To Faci'lty: Mr. Ron Hagan Director of Community Services City of Huntington Beach P. O. Box 190, 2000 Main Street Huntington Beach, CA 92618 To College: Health Professions 157-44 Golden NVest Street Huntington, Beach, CA 92647 With a Copy to: Coast Co[llmunity Colleg. District Attention: Vice Chancellor, Administrative Services 1 : 70 :dams Avenue Costa Nlesa, CA 92626 28. Entire A�_>reemert. This Agreement and all attachm.nts hereto constitute the entire agreement of the parties. There are no representations. covenants or warranties other than rj%%Agree,Noil •S:^_ndnrd 8 "IaG! those expressly stated herein. \o waivers or mod fications of any ofthe temis hereof sha:t be valid unless in wrinn` and signed by both parties. IN WIT\ESS WHEREOY, the parties hereto have caused this Agreenient to be executed by and throt:gh the;r atlt-orl7ed o Aces t:;e da`', month and year fist lbox•0 )X'Fit.erl. COAST CO-WNT \ITS' COLLEGE. a public educational agncy By: Kenneth Y.a rzs dent Golden Wet liege Date: 6—��—a/ Bv; 6+1h JPt Vice Chan"ellor. Admirisira:iye Services C.M. BRAHMBHATT, VICE CHANCELLOR Typed Nam ADMINISTRATIVE SERVICES CITY OF HU TINGTON BEACH. a rl�-,micipa: corporation of the State o Ca ifbmia N12yo r ATTEST: City Clerk APPROVED AS TO FORM: Date: IzL jpl City Atzorrey S,lI REVIEWED AND APPROVED: City !kcministrator .7 1\IT . v AN PPROVED. -D reof Community Se-rvlces 1 r+`.:1 •. rr' r.�,�..�rV Lyi -:1 47-�•7V ?I F1. ATTACHMENT rt1 - STUDENT PARTICIPATION AGREEMENT Alfred Healer' Programs - Orange Coast College Nurs.ng Land Allied Health Programs - Golden West College This Student Participation Agreement is entered into by and between the Coast Community College District, a public educational agency ("District") and ("Student). concerning the Students particrpieion in a eiinical experience rotation ("Cynical Rotation") in consideration o` District allowing Student to participate in the Clinical Rotation at Clinical Facility, Student agrees as follows: 1 Corrtoliance With Laws. Rules and R@guiatigns. Where parbripatirrg in the ClWcal Rotation. Student at all timare shall abide by"comply with all applicable Vzt , rules, statutes. ordinances, regulations, policies and procedures• inciuding but riot limited to those of District and Clinical FavRy. The supervision of students at Clinical Facility shall be the responsibility of Clinical Coordinator 2 No Unsupervised Patient Care. There shall be no direct, hands -an patient care by any student participating in the Cynical Rotation unless said care is provided under the supervision and control of medical or nursing steff and in conformance with all applicable laws, rules, regulations, statutes. ordinances and policies. 3. Confidential• • Students must maintain the confidentiality rights of patients in all Circumstances. Student shall keep all patient records confidential! and shall not reveal or release any information contained therein unless (a) authorized to do so, in writing, by the patient-. or (b) ordered to do so by a court of competent jurisdiction 4. Release a[4 Hold Hgrmless. Student hereby releases, discharges, and agrees to hold harmless District, Distriet's governing board ("Board"), and each of their trustees, employees, agents ano representatives from any and all liability ansing out of or in connection with Student's enrollment in the nursing program (Golden West College) or alliod health programs (Orange Coast College) and participation in its classes, training course$, activities. held trips. practice sessions, hospftal ciinical experiences, and rvleeDd exercises. For the purpose of this release, liability means all claims, demands; losses, causes of action, salts or judgmeMs of any kind that Student at Student's heirs, executors, administrstors, and assigns may have against,, Dstnct, Board, College, and any of their trustees, employees, agents, and representatives or that any other person or entity may have against District. Board, College, and any of their trustees, employees, agents, and representativ" because of Student's failure to pass any course or class or obtain any particular grades, personal injury, accident, illness or death, or because.of any lou of or damage to property that occurs to StudeM or hia or her property during Students parUcipatian in the numing program or allied health program including classes, training coursim. a&vdies. field trips, practice Sessions. hospital clinical experiences, and rested exercim that result from any cause, including but not lirr led to Dts!ricfs. Board's, Colleges, or their trustees', employees', agents', or representatives' own passive or active negligence pr other acts other than fraud, vvillf:rl misconduct or yioiabon of any law, StudeM's Initials 5. Acknowledgment of Inherently Dangerous _AGtfvitras and Assumption of the Risk rteregf. Student acknowledges that the nature of Student's ;raining tit the nursing program/allied health programs r say involve dangerous and hazardous activities, including but rat limited to exposure to disease, blood pa"ens, illness, personall injuries and possibi'e death. Student acknowledges the inccrsntly hazardous and dangerous nature of those activities and voluntafily participates therein and es$urnes el? risk of injury. illness. or death from Student's padicipation therein Student represents and warrants that Stet is menta Vy and pnysicany fit, capable, able and wtilling to participate in these inhe, ontiy hazardous and dangerous activities without any limitations_ Student's lnibels 6. No Right to Err to ment ftriaval. Student understands and agrees that Student's participation in the Clinical Rotation does not create any right to employment at Clrricat Facility Student uraderutafts end agrees tt-rat Student may be removed from the Clinical Rotation at eny time for any reason, except in violation of any law. Any student who is asked to leave by any representative of Clinical Facility shall do so promptly and without protest. f gvlrslDCClfsY iaedlwi�lGi -Z 1-9s FF _Ir' 7 General Rule5. Slvdent9 antanng the Clinical phase of their education are required to meet the fallowing requirements a. Clinicals are scheduled courses with spacfic days and times. Students are to adhere to these and adjust any outside work or activities accordingly. b Student must complete 8 physiCsl within a six-month perod prior to the start of the clinical phase (see aupplied form). The physiCel may be completed at this college health center. St�ent's private physician, or group health care facility. Xood work. urnnajysls, and an�nue T.S. tests or chest s-fays are required Rs rney be IrTnunirabons (rubella. rubeola and varicella titre) or proof of imrnurr ty. Haps',itis 8 vaccine is Nighty MCOrnmended by College or waiver must ba signed Certain clinical sizes will not allow student 17articipation without lt$pwtdis B vaccinator, The completed information must be r+yturried to the clinical coordinator or director of Student's program. See Student's program or clrniCal coordinator far specific details. c Any Student participating in a Rotation shall, at the request of Clinical Facility, provide a current slatenwt trout a physican that the student is in good health and capable of participating in the Rotation. Clinical Facility may require thait any student, reWmirg from an axferided absence caused by illness or injury, submit to a physical examination or present a stared! from a physician indleating that the student is gpable of resuming zlinical activities. Any such physical exarrn nation shall be the financial respen;sitWity of Student d. All students in a clinical rotation must have an active CPR card (per specific program protoeoj). It Students CPR card expires at any time during ciirriral bWnbsg, it is Studenru responsibility to boco," receR;fled. Student will be removeo from clinical experience rotation if Student does not have an active CPR card. In progfiams which require Anted Health 11 S--Patient Care, Student must enroll In Patient Care just pnor to entry into the clinical phase, in accordance with the prograrn schedule sequence. Studenfa taking Allied Health 115 will become CPR certified. e Students must adhere to appropriate dress code end greornrng standards designated by Clinical Facility. This may include a laboratory pout or uniform_ Closed, soft Soled shorn are required. A nano tag Trill be provided that must be wom at all times at Clinicai Facility site. See Student's program disec'tor or cynical coordinator for specific requirements for Student's program. f. Specific clinical sites may have certain health ralated requirements and may include drug testing. hepatitis 8 vaccination, or blood work Students are expected to meet the requirements at the site When scheduled to be at that sits- 9 There may be exposure to hazardous materials and bioodboume pathogens in the Oink-* setting. Students must adnene to atl sty and univewl precauftlUiry measures. h, Students must have adequate reliable transportation to the dinical site and will be respo+tsible for harking. 8. A knout gm nt. Student has read the Student Parti6pation Agreement including the ROaaae provisions in paragraph 4 and the Assumption of Risk provis;oris in paragraph 5 and agrees to abide by and comply with all its terms. Doted: Dated. gweiottjrsrlsetllaWV'J -2148 By - Student Student ID Number By: Parent or Gua dian (if Student is a Minor) 2 0 ATTACHMENT #2 FROM 02/05t'VI 10:19 114-byDob FAX Na. Mdy. 03 2081 08:57AAf `PII ATTACHMENT $1 - STUDENT PARTICIPATION AGREEMENT Allied Health Programs - Orange Coast College Nursing end Allied Health Programs - Golden Wrest College This Student Participation Agreement is entered into by and imWeen the Coast Community College District, a public educational agency ("DiWct") and r'Student), concerning the Students participation in a clinical experience rotation ("Clinical Rotation"). In consideration of District allowing Sword to participate in the Ckn" Rotation at Clinical Fatdttty, Student agrees as follows: 1, Comotienae WithIMM &M a nd_RNtrlatiga. WhM perWpating in ft Clinical Rotation. Student at all times shelf abide by sled comply mvllh aeit applicable laws, ram, AWafte, ocdimms, reW*ions, pollow And procedures. includ ng but not firnited to loess of District and Cfinicai Facility. The supervision of students at Clinical Facility shalt be the responsibility of Clinical Coordinator 2- YNo Vnsugaar, ;antlam- Them shall be no direct, hands-on patient care by any student participating in ft Clinical RotaWn unites said care is provided under V* supwwsien and control of medical or nursing staff and in canformance with all applicable tsws. rules, regulations, statutes, ordinances and policies. 3. Cariftentiardy. Students must nteirttain the confoentlality rights of patients in an cimumstances. Swom shall keep all patient reords confidential and shall not reveal or ►robase any information conWr*d therein unlssi (a) Suftrizad to do so, in writing, by the patient; or (b) ordered to do so by a court of cornpetent jur€"etion. 4. Rslegss and Hold Hanntvss.. Student hereby releases, discharges, and agrees to hold harmless District. District's governing board ("Board'?, and each of their trustem employees, agents and representatives from any and all liability ;arising out of or in connection with Student's enrolimaM in the nursing program (Golden West College) or allied health programs (Orange Coast College) and par iapation in its classes, lraiNrrg courses, activities. Reid trips, precuts sesalam, hospital C4inical experiences, and WaWd exeteises. For the purpose of this release, liability means 00 claims. demands, tosses, causes of action, suits or judgments of any KM that Student or Student's heirs, executors, admirimtrotors. and assigns may have spins( District, Siml^d, Collegp, and any of U*V trustees, employees, agents, and representatives or that any 09w won or entity may have against District, Board, College, and any of their trusw", employees, agar". and representatives beogwee of 3tudeM'a failure to Pon any course or Gass or obtain any particular grades, personal irrlwy, accident, illness or death, or because of any WS of or damap to property tl'tet occum to Student or his or her propeft during Student's participation in the ntmirg program or shied hearth program including dunes, training courses. attvities. field trips, practice sessions. hospital clinical experiences, and relakid exerci". that result from any cause, including but riot iirnged to DWers, Board's. Colleges, or their trustees', employees'. agents'. or representatives' own passive or alive mWigence or other acts other than fraud, witfiul misconduct or violation of any law. Student's fnitiats S. ha3M0edgMnj St IrrnsretztjX jf2f amiLs -60viti w and blWM2fiM of the Rick Themgf. Student acknowledges that the nature of SWderit's training in the nursing program/allied hesith programs may involve dangerous and hazardous activities, Including M not limited to exposure to disease, blood paten, illness, persoral injuries and possible death. Student acknowledges the inherently hazardous and dangerous MAure of these activities and voluntarily participates therein and essurnes all risk of injury, illness, or death from Student's participation therein. ShMent represents w►d v mmft that Student * menlegy and phys"Iy fit, capable, " and witting to participate in (tress inherently hwrdoua and dangerous ec*vities without any limitations. Students Initials U. Na Eli ht too EmpM913Bemov - Student understands end agrm afar StWenfe participation in"Clinical Rota bon dues not create any right to employment at Clinical Facility. $Went urxkrAends and agrees that Student may be removed from the Clinical Rotation at any time for any reason, except in violation of any law. Any student who is asked to leave by any representative of Clinical Facility shalt do so promptly and YAh9A protest. 1 8wtlocerrev issdltr�'�-�1.9t3 FRAM FAX NO. 02/05/2001 w.19 i14-8906 {[_t.� fL L L* 441ee �y• 03 2H02 @8:58fit� �'i2 fIF HL I.I f'Fly. 4JJi V'� 7. QWEV RuLa. Sty entering the Clinical phase of their education are required to meet the following r�uiremt'rita: . G. 00wls are scheduled covraea with spocihc days and bm8s. Students are tv adhere to these sr4 otljust any outwe work or eativilies acmdingty. b. Student must comptate a physlosi within a 9&-month period prior to the start of the dmicat phase (wo aup I*rm). The pfiyaical may be completed Who caifte heatth mnter, Student's private physician. or group health Cage ". Blood Work. urMalysts, and I,,nggl T.B. testa or Owg x-rays are nMuired as msy be 4,111wnizati0rrs trube11a, n bewa an0 vancella titre) or proof d immunity. Hepatitis B Vaccine is highty re0orttraasrww by College or waiver must by signed. min clinical sites will not allow student participation without hapaws 8 veexination- Tiro cornphiiled informaton mud be returned to the cTtnicel coordinator w eriteGtor of Student's program. See Student's program or clinical coordinator for specific defaiia. c. Any Student partippating in a Rotation shall, at the requaw of rAnical Facility. provide n current steterrient from a phys cim that the Student is in good hwlth and capsMe of piatcipOng in the Rotation. Clmical Facility may mquire that any suRmt. retur wV from an extended absence caused by iftm or in3tlry, submit to a Physical examin Mon w prda M a statement from A physician indieaWV that ft student is capable of fewming Clirdcal acuities. Any such O"ical exar#iins an shall be ttte financial mono" of Student- d. Al studerits in a clinical rotation must have an ac ve CPR card (per specific program pratocol). If ShMarifs CPR wd a Vhm at any tmw during Clinical training, it is Student's mspeaasibility to berm a recertified. StueieM vet be removed front dinwel axperwoe rotation if Stredertt does slat have an actnre CPR card. In prograrrls ~ mquire AAied Health 115--Patient Care, Student must enroll In Patient Care gt pw to es"into the clinical phase, in accordarim with the program schedule sequence. Students takintg AW Health 115 will becom CPR certified. ea..SttMw is must adhere to appraprieb dress cods and groom" WwWards dewgnated by Clinical Far itity. This may kiclude a laboratory oval or uniform. Clused, soft soled shoes are required. A nwM tso will to pmvkW . Q* mutt be worn art et! times at Clinicmi Facility &t@. See Students program director or clinical coordinator fw spuffiic requirements for Student's program. f. Specific dinical sites may have certain hsslth mated requirements and may include drug testing, hapetitis B vaccination, or blood work Studw a we expected to n*M ft r9quiraments of the aits when txlteduled to be at that site. g. There may be exposure to hUNdous materials and bloodbewme pathogens in ft cunicai setting. Scuts must adhere to all safety and unnrersat precautronary maasUMS. h. Students must have adequate Wisbie transportation to the dinicai Sits and will be re2weible lot parking. B. &&a0Rd!gWmj1Et Student has road the Student Participation Agreement including this ReWee pw!Woras in paragraph 4 and the Assumption of Risk provisions in paragraph 5 and agrees to ate by emd correpry with all its terms. Dated: Dated. By: Student Student ID Number By: Parent or Guardian (if Student is a Minor) vwtjoCCftvia"�vt 21-96 ATTACHMENT #3 Q.,A 1 CERTIFICATE OF COVERAGE ISSUE DATE 06/19/00 ADMINISTRATOR: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION KEENAN & ASSOCIATES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LICENSE # 0451271 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2355 CRENSHAW BOULEVARD, SUITE 200 ALTER THE COVERAGES AFFORDED BY THE COVERAGE TORRANCE, CA 90501 DOCUMENTS BELOW. COVERED PARTY: ENTITIES AFFORDING COVERAGE ENTITY A STATEWIDE ASSOCIATION OF COMMUNITY COLLEGES COAST COMMUNITY COLLEGE DISTRICT 1370 AbAMS AVENUE COSTA MESA, CA 92628-0118 . ATTN: MS. JUDY NEAL THIS IS TO CERTIFY THAT THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE COVERED PARTY NAMED ABOVE FOR THE PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM, OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED HEREIN IS SUBJECT TO ALL THE TERMS. CONDITIONS OF SUCH COVERAGE DOCUMENTS. ENT TYPE OF COVERAGE COVERAGE EFFECTIVE 1 MEMBER LIMITS LTR DOCUMENTS EXPIRATION DATE RETAINED LIMIT I DEDUCTIBLE GENERAL LIABILITY 1XICOMMERCIAL GENERAL LIABILITY COMBINED SINGLE LIMIT A I ]CLAIMS MADE [XIOCCURRENCE EACH OCCURRENCE IXIGOVERNMENT CODES SWC 01100-4 06-30-00 ! 01 $25,000 S 4,975,000 IXIERRORS & OMISSIONS I AUTOMOBILE LIABILITY 1X]ANY AUTO COMBINED SINGLE LIMIT [ ]HIRED AUTO EACH OCCURRENCE A [ INON-OWNED AUTO SWC 01100-4 06-30-001 01 $25,000 $ 4,975,000 [XIGARAGE LIABILITY [X1AUTO PHYSICAL DAMAGE A PROPERTY ALL 81SK SWC 01100-4 06-30-00 101 $25,000 $ 500,000,000. EXCLUDES EARTHQUAKE & FLOOD PER OCCURRENCE DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES 1 RESTRICTIONS 1 SPECIAL PROVISIONS: CLINICAL AGREEMENT BETWEEN COAST COMMUNITY COLLEGE DISTRICT/GOLDEN WEST COLLEGE AND RODGERS SENIOR CENTER JUNE 30, 2000 THROUGH JUNE 30, 2001. U" ` Q��ov�alel� ON �ii+.i5 tinKuLr,y+c+L Cer�.Ca b�ca+��+t �� i� AuA LOeat" COOLLWAL" �{ CO cay iof w►'� W�w W�-_ CERTIFICATE HOLDER: CANCELLATION ....... SHOULD ANY OF THE ABOVE DESCRIBED.COVERAGES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING ENTITY/JPA WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ENTITYMPA, ITS AGENTS OR REPRESENTATIVES. CITY OF HUNTINGTON BEACH AND RODGERS SENIOR CENTER 1706 ORANGE AVENUE HUNTINGTON BEACH, CA 92684 ATTN: KAREN FOSTER AUTHORIZED REPRESENTATIVE K&A..P1L..0612000 RCA*ROUTING 9HEET INITIATING DEPARTMENT: Community Services Department SUBJECT: Approve Non -Standard Affiliation Agreement with Coast Community College District COUNCIL MEETING DATE: June 4, 2001 .RCA ATTACHMENTS_` Ordinance wlexhibits & legislative draft if applicable) Not Applicable Resolution (w/exhibits & legislative draft if applicable) Not Applicable Tract Map, Location Map and/or other Exhibits Not Applicable Contract/Agreement (w/exhibits if applicable) (Signed in full b the City Attome Attached Subleases, Third Party Agreements, etc. (Approved as to form by City Attome Not Applicable Certificates of Insurance (Approved by the City Attome) Attached Financial Impact Statement Unbud et, over $5,000 Not Applicable Bonds If applicable) Not Applicable Staff Report if applicable) Not Applicable Commission, Board or Committee Report If applicable)____ Not Applicable Findings/Conditions for Approval and/or Denial Not Applicable EXPLANATION FOR MISSING ATTACHMENTS = REVIEWED,-'... 'RETURNED. FORWARDED' Administrative Staff . � J/ Rn EVE Assistant City Administrator Initial Administrator Initial o. -City City Clerk�T EXPLANATION FOR RETURN'OF'.ITEM A, CITY OF HUNTINGTON BEACH 2000 MAIN STREET CALIFORNIA 92648 OFFICE OF THE CITY CLERK CONNIE BROCKWAY CITY CLERK LETTER OF TRANS HTTAL OF ITEM APPROVED BY THE CITY COUNCIL/ REDEVELOPMENT AGENCY OF THE CITY OF HUP;TTNQTON BEACH DATE: February 5, 2001 TO: Health Professions ATTENTION: Linda Stevens, MSN, RN Name 15744 Golden West Street DEPART MEIN T: street !Luntincrton Beach CA 92647 REGARDING: Non -Standard Affiliation City, state, zip Agreement �— See Attached Action Agenda Item E-10 Date of Approval 11-20-00 Enclosed For Your Records Is An Executed Copy Of The Above Referenced Agenda Item. Remarks: Connie. Brockway City Clerk Please return an executed copy of the agreement to the City Clerk's Office at the above address. Thank You. Attachments: Action Agenda Page x Agreement x Bonds Insurance x RCA Deed Other CC: R. Hagan Com Serv. x x x _ Dame Department RCA Agreement Insurance Other Dame Department RCA AFcetnent Insurance Other Name Department RCA Agreement Insurance Other Dame Department RCA Ag-eecnent Insurance Other C. Mendoza x x x Risk Management Dept. Insurance (Telephone: 714.536.5227 ) (22) • November 20, 2000 - Council/Aecy Agenda - Page 22 E-9. (City Council) Adopt Resolution No. 2000-108 Designating a Redevelopment Survey Area to Study Feasibility of Establishing a Southeast Coastal_Proiect Area in the Vicinity of the ASCON Superfund Property/AES Generating Plant at Beach Boulevard_ Hamilton Avenue. Magnolia Street and Pacific Coast Highway (400.20) Adopt Resolution No. 2000-108 - "A Resolution of the City Council of the City of Huntington Beach Designating a Redevelopment Survey Area for Project Study Purposes." Submitted by the Economic Development Director. Funding Source: Not applicable. [Deferred to 12-04-00 (7-0)] E-10. (City Council) Approve Non -Standard Affiliation Agreement between the City and Coast Community College District to Allow Community Experience Rotation at Rodgers Senior Center for Nursing Students (600.10) —Approve the Non -Standard Affiliation Agreement between the City and Coast Community College District and authorize the Mayor and City Clerk to execute. Submitted by the Administrative Services Director and the Community Services Director. Funding Source: Not applicable. [Approved 7-0] E-11. (City Council) Approve Extension of Professional Services Contract between the City and Blanchard SoNtions Group for "Raving Fans" Customer Service Training in Conjunction with the BEST(Building Excellent Service Today/Tomorrow) Pro ram (600.10) — Approve the Professional Services Contract between the City of Huntington Beach and Blanchard Solutions Group for Customer Service Training and authorize the Mayor and City Clerk to execute same. Submitted by thp Acting Administrative Services Director. Funding Source — FY 2000-01 Non - departmental budget - $100,000. [Approved 7-0] E-12. (City Council) Authorize Appropriation from the Assembly Bill 2928 Revenues (Currently on Deposit in the Gas Tax Fund) and the Transfer into a Public Works Expenditure Account for Additional Street Improvements (Resurfacing and Tree-Removal/Replacement Petition Street Requests) (320.10) — Approve the appropriation of $700,000 in AB 2928 funds for street improvements and authorize the Director of Finance to transfer the funds into an expenditure account. Submitted -by the Public Works_ Director. Funding Source: The funds from AB 2928 revenues on deposit in the Gas Tax Fund will be transferred into an assigned expenditure account upon approval of the Executive Steering Committee. [Approved 7-0] E-13. (City Council)Adopt Resolution No. 2000-112 Agreeinq to a Redistribution of Property Taxes for Holly Seacl ff Parcel 7A Linear Park (340.90) — Adopt Resolution No. 2000-112 "A Resolution of the City Council of the City of Huntington Beach Agreeing to a Redistribution of Property Taxes for a Property Commonly Known as Holly Seacliff Parcel 7A." Submitted by the Planning Directg_r. Funding Source: Not applicable. [Adopted 7-0] E-14. (City Council) Adopt Resolution No. 2000-113 Approving MOU (Memorandum of Understanding) between the City and the Firefighters Association for October 1. 2000 to September 30, 2003 — Authorize Appropriation of Funds for Increased 2000-01 Salary and Benefits (720.20) —1. Adopt Resolution No. 2000-113 "A Resolution of the City Council of the City of Huntington Beach Approving and Implementing the Memorandum of Understanding between the Huntington Beach Firefighters Association and the City of Huntington Beach for October 1, 2000 to September 30, 2003;"and 2. Authorize the appropriation of $97,172 to pay the increased salary and benefit costs for 2000-01. Submitted by the -Acting Administrative Services Director. Funding Source: Per above. [Adopted 4-1-2 (Sullivan No; Julien, Green absent from room)] rci-�c�c.C. Gft CITY OF HUNTINGTON BEA# MEETING DATE: 11/20/00 DEPARTMENT ID NUMBER: Council/Agency Meeting Held: — O— 0 Deferred/Continued to: 4Approved ❑ Conditionally Approved ❑ Denied _ _� City Clerk's Signature Council Meeting Date: 11/20/00 Department ID Number: G CITY OF HUNTINGTON BEACH REQUEST FOR ACTION SUBMITTED TO: HONORABLE AND MAYOR AND CITY COUNCIL MEMBERS SUBMITTED BYjONHAGAN, A VER, PREPARED BY: CITY ADMINISTRATOR 4PAW COMMUNITY SERVICES DIRECTOR and JOHN REEKSTIN, DIRECTOR OF ADMINISTRATIVE SERVICES 1.� SUBJECT: Approve Non Standard Affiliation Agreement with Coast Community College District Statement of Issue, Funding Source, Recommended Action, Alternative Actlon(e), Analysis, Environmental Status, Attachment(s) Statement of Issue: The City and Coast Community College District are desirous of formalizing an agreement to allow the nursing students at Golden West College to participate in a community experience rotation at Rodger's Senior Center. Funding Source: Not applicable Recommended Action: Approve the .Non -Standard Affiliation Agreement between the City and Coast Community College District and authorize the Mayor and City Clerk to execute. Alternative Action(s): Do not approve the agreement and required the nursing program to seek alternative avenues for their community experience rotation. Analysis: Coast Community College District operates Golden West College. The nursing program at Golden West College is desirous of fostering community health education by allowing the nursing students to participate in a rotation at the Rodger's Senior Center. The registered nursing students have visited the Senior's Center for the past five years. They have considered their experiences invaluable and wish to continue to utilize the Rodger's Senior Center for their community experience rotation. This agreement has been extensively reviewed by d the attorney's office. The City does incur some liability exposure by allowing the nursing students into our facility as well as from the reciprocal indemnification clause contained in the agreement. Rca -2- 1112100 4:23 PM REQUEST FOR ACTION 0 MEETING DATE: 11/20/00 DEPARTMENT ID NUMBER: Environmental Status: Not applicable Attachment(s): RCA Author; Karen Foster Rca .3- 1112/00 3:61 PM ATTACHMENT #1 0 NON-STANDARD AFFILIATION AGREEMENT This NON-STANDARD AFFILIATION AGREEMENT (the "Agreement") is made and entered into this 20th day of November 2000, by and between the Coast Community College District, a public educational agency ("District"), located at 1370 Adams Avenue, Costa Mesa, California, and the City of Huntington Beach, a municipal corporation ("City"), located at 2000 Main Street, Huntington Beach, California. WHEREAS, District and City desire to contribute to community health education; WHEREAS, District operates Golden West College ("College") and College is a duly accredited educational institute that conducts the program(s) described and identified in Attachment I to this Agreement ("the Program"); WHEREAS, District has obtained all necessary licenses, consents and/or approvals to conduct the Program from the State of California and any other applicable governmental agency; WHEREAS, City owns and operates the Michael E. Rodgers Senior Center, located at I706 Orange Avenue, Huntington Beach, California ("Center"), and has obtained all necessary licenses, consents, and approvals to do so; WHEREAS, as part of the Program, students are required to participate in a community experience rotation; WHEREAS, District desires to affiliate with City in order that students may participate in a community experience rotation at the Center; WHEREAS, District and City desire to enter into this Agreement to memorialize their respective rights, duties and obligations with respect to the community experience rotation of students of the College's Program. ri%%-AgTee%NOn-SEandard 9126!00 r1 LJ For purpose of this Agreement, the following definitions shall apply: "District" shall refer to the Coast Community College District, its member Colleges, the District's Governing Board, and each of their trustees, employees, agents, representatives, successor and assigns; "College" shall refer to Golden West College, and each of its employees, agents, representatives and assigns; "City" shall refer to the City of Huntington Beach, its elected and appointed officials, officers, directors, employees, agents, representatives, successors, and assigns; "Community Experience Rotation" or "Rotation" shall refer to the activities of the Program's students (such as conducting interviews, socializing or the common eating of meals) in interacting with the Center's participating seniors; "Center" shall refer to the Michael E. Rodgers Senior Center, located at 1706 Orange Avenue, Huntington Beach, California. NOW, THEREFORE, in consideration of the following covenants, conditions and agreements, the parties hereto agree as follows: TERMS 1. Community Experience Rotation. City agrees to provide students of the Program who are specified by College with a clinical experience rotation ("Rotation"), in accordance with standards established by governmental agencies and recognized professional accrediting agencies, and subject to the terms and conditions of this Agreement. Development of Curriculum. District shall be fully responsible for the development, planning and administration of the Program, including, without limitation, programming, administration, fiiatriculation, promotion and graduation. District acknowledges rjr%-Agree%yon-Standard T^6 00 and agrees that the Rotation is intended to meet certain educational performance objectives, and College shall provide a copy of such performance objectives to City on or before student placement. City shall be fully responsible for the availability and appropriateness of the learning environment in relation to the Program's written objectives. 3. Ex osure to Bloodborne Patho ens. Program students and College faculty will comply with the final regulations issued by the Occupational Safety and Health Administration governing employee exposure to bloodborne pathogens in the workplace under Section VI(b) of the Occupational Safety and. Health Act of 1970, which regulations became effective March 6, 1992 (the "Regulations"), including but not limited to responsibility as the employer to provide all Program students with (a) information and training about the hazards associated with blood and other potentially infectious materials, (b) information and training about the protective measures to be taken to minimize the risk of occupational exposure to bloodborne pathogens, (c) training in the appropriate actions to take in an emergency involving exposure to blood and other potentially infectious materials, and (d) information as to the reasons the Program student should participate in Hepatitis B vaccination and post -exposure evaluation and follow-up. 4. ARplication Procedure- Acceptance. College agrees to provide City with a list of the name(s) of students who will be participating in a Rotation. Nondiscrimination. The parties agree not to discriminate in the selection, placement or evaluation of any student or faculty member because of race, creed, national origin, religion, sex, marital status, age, handicap, andlor medical condition. 6. Academic Year. The academic year consists of Fall and Spring semesters, summer session and winter break intersession. rik%Agee Non -Standard 92600 7. Rotation Schedule. The Rotation schedule shall be determined by College and City and may be amended from time to time by agreement of the parties. The number of students in each Rotation shall be limited to a number mutually agreed upon by both parties, not to exceed the number specified by the accrediting agency(ies). 8. Orientation. City and College shall provide an orientation for assigned students participating in each Rotation. 9. Confidentiality of Records. Students, and the employees and officials of both District and College understand and agree that City's files are confidential. 10. Clinical Coordinator (ColleQe1. College agrees to designate a coordinator for each program. The coordinator, who may be an academic instructor, shall be responsible for all teaching activities. 11. City Advisor. City agrees to designate an advisor or coordinator who shall provide input to the Rotation performance and evaluation of students(s), be a resource person for College's faculty and students, and shall communicate with the clinical coordinator designed by the College regarding the proposed curriculum and the performance of individual students and shall arrange formal orientation to the Center for the faculty and students. 12. Supervision of Students. The supervision and direction of students while on site at the Center shall be the responsibility of the Clinical Coordinator (College) or designee as guided by the instructional objectives. No direct, hands-on patient care shall be provided by participating students at the Center, except in accordance with all applicable laws, City rules, regulations, polices and procedures. District and College recognize the seniors' rights to refuse care provided by a student at the Center. ri%%-A2rec\Non-Standard 4 13. Removal of Students. City retains the right to exclude any student at any time from any area of the Center. Any student who is asked to leave by City shall do so promptly and without protest. City shall also have.the right, at any time, to request College to remove a student permanently from the Rotation. Except as otherwise provided under any applicable policies, procedures, rules, regulations, and/or under any law, any such removal shall not require compliance with any notice, hearing or other procedural requirements. 1.4. Senior Care. Nothing in this Agreement shall be construed as conferring any right or duty upon District, its students or faculty members, to control or direct senior care or operations at the Center. City shall maintain sole responsibility and accountability for senior activities and shall provide adequate staffing in number and competency at the Center to ensure safe continuous supervision during the term of this Agreement. 15. Ongoing_ Communication/Evaluation. College has the privilege of regularly scheduled meetings with City staff, including both selected unit personnel and administrative level representatives for the purpose of interpreting, discussing, and evaluating College's health care programs at a mutually agreed upon time. 16. Materials. District and College agree to provide students with all educational materials required during the clinical program. 17. No Payments or Other Remuneration. District agrees that no fees or monetary payments of any kind shall be exchanged between City, its agents and employees, and District, its agents, employees and students under the terms of this Agreement. Further, neither District, its staff members or other representatives, shdll'..atieinpt tb bill or collect from any client/senior or from any other source fees for services provided to.seniors.by said student. 0 %%,A ereexNon -Standard 9.. 2 6, 00 • • I.S. No Right to Employment. The parties agree that the students of College shall not be considered employees, agents or volunteers of City, nor shall any student be entitled to any right, compensation or benefits normally afforded to employees of City, including but not limited to, Social Security, unemployment and workers' compensation insurance. 19. Insurance Carried by District. District shall assure coverage of professional liability insurance for each student participating in the Rotation of not less than one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the aggregate, and said policy shall remain in full force and effect during the term hereof. District shall provide workers' compensation coverage for students participating in the Rotation. These coverages are in effect while the student is on -site at the Center. District shall provide City with written evidence of each type and form of insurance described in this paragraph. 20. Confidentiality of Student Records. City shall keep confidential and shall not disclose to any person or entity (i) student applications; (ii) student health records or reports; and/or (ill) any student records as defined in California Education Code Section 76210 and the Family Educational Rights and Privacy Act of 1974, 20 U.S.C., paragraph 1232(g), concerning any student participating in the Rotation, unless disclosure is authorized by (i) the student in writing, or (ii) disclosure is ordered by a court of competent jurisdiction. City shall adopt and enforce whatever policies and procedures are necessary to protect the confidentiality of student records as defined herein. 21. Verification. District warrants and represents that it has obtained all necessary approvals and consents from any and all agencies to enable City to offer the Rotation to College's students participating in the Program. If requested by City, District shall provide City with verification that the Program is duly licensed, duly accredited and/or certified, as applicable, ri„Ageec'Non-Standard 6 9:26-00' by appropriate agencies. District covenants and agrees that at all times during the term hereof it shall retain such licensure, accreditation and/or certification, and its Program and faculty members shall continue to meet any and all federal, state and local requirements. 22. jndemnification by District. District agrees to indemnify, defend, and hold harmless City and its officers, employees, agents and volunteers from any and all claims, actions, losses, damages and/or liability arising out of the performance of this Agreement or from any cause whatsoever which may arise because of the negligence, misconduct, or other fault of District, including any acts, errors, or omissions of any officers, employees, instructors, students, or agents of District, and for any costs and expenses incurred by City on account of any claims therefore except where such indemnification is prohibited by law. 23. •Indemnification by City. City agrees to indemnify, defend and hold harmless District and its authorized agents, officers, trustees, volunteers, employees and students, from any and all claims, actions, losses, damages and/or liability arising out of the performance of this Agreement or from any cause whatsoever which may arise because of the negligence, misconduct or'other fault of City, including any acts, errors, omissions of any officers. employees, instructors, or agents of City, and for any costs and expenses incurred by District on account of any claims therefore except where such indemnification is prohibited by law. 24. Governing Law. This Agreement shall be governed by and constructed in accordance with the laws of the State of California. 25. Assignment. Neither party hereto may assign this Agreement or delegate its duties hereunder without the prior written consent of the other party that can and may be withheld by either party in its sole and absolute discretion. rjwAgree`Non-S:a_^.dard 7 92Gmo0 26. Effective Date of Termination. This Agreement shall become effective on September 1, 2000, and shall remain in effect until July 31, 2005, unless sooner terminated by either party in accordance with this section. Either party may terminate this Agreement with or without cause by giving ninety (90) days prior written notice to the other party of its intention to terminate. In the event a Rotation is in progress, any written notice to terminate with or without cause shall become effective at the expiration of the Rotation. Notwithstanding the foregoing, in the event the Program. is discontinued by College during its Tenn, this Agreement shall immediately terminate without further action by the parties hereto. 27. Notices. Any notices to be given hereunder by either party to the other may be effectuated only in writing and delivered either by personal delivery, or by U.S. mail. Mailed notices shall be addressed to the persons at the addresses set forth below, but each party may change the address by written notice in accordance with this paragraph. Notices delivered personally will be deemed communicated as of actual receipt. Mailed notices will be deemed communicated as of ten (10) days after mailing. To Facility: Mr. Ron Hagan Director of Community Services City of Huntington Beach P. O. Box 190, 2000 Main Street Huntington Beach, CA 92648 To College: Health Professions 15744 Golden West Street Huntington Beach, CA 92647 With a Copy to: Coast Community College District Attention: Vice Chancellor, Administrative Services 1370 Adams Avenue Costa Mesa, CA 92626 28. Entire Agreement. This Agreement- and all attachments hereto constitute the entire agreement of the parties. There are no representations, covenants or warranties other than ijwAgrcc`Non -Standard 8 9 2G;GD those expressly stated herein. No waivers or modifications of any of the terms hereof shall be valid unless in writing and signed by both parties. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized offices the day, month and year first above written. COAST COivlMUNITY COLLEGE, a public CITY OF HUNTINGTON BEACH, a educational agency municipal corporation of the State of California EM Kenneth Yglesias, President _C L.A.� Golden West College Mayor Date: ATTEST: By: Vice Chancellor, [ ' Administrative Services City Clerk Typed Name: APPROVED AS TO FORM: Date: - - G Cit. A torney r 9 �a6 Oo REVIEWED AND APPROVED: C- Administrator g VD_ APPROVED: r of Community Services rj wA gree .lion -Standard 9%2 G. 00 ULIUZJrZ001 10:1J 714-895-8166 HEALTH PROFESSIONS PAGE 02 ATTACHST #1 - STUDENT PARTICIPATION MEEMENT Allied Health Programs - Orange Coast College Nursing and Allied Health Programs - Golden West College This Student Participation Agreement is entered into by and between the Coast Community College District, a public educational agency ("District") and ("Student), conceming the Student's participation in a clinical experience rotation ("Clinical Rotation"). In consideration of District allowing Student to participate in the Clinical #potation at Clinical Facility, Student agrees as follows: 1. CgM2Iia_njM With Laws, Rules and Regulations. While participating in the Clinical Rotation, Student at all times shell abide by and comply with all applicable laws, rules, statutes, ordinances. regulations, policies and procedures, including but not limited to those of District and Clinical Facility. The supervision of students at Clinical Facility shall be the responsibility of Clinical Coordinator. 2. No U u rvised Patient Care. There shall be no direct, hands-on patient care by any student participating in the Clinical Rotation unless said care is provided under the supervision and control of medical or nursing staff and in conformance with all applicable laws, rules, regulations, statutes, ordinances and policies. 3. Confidentiality. Students must maintain the confidentiality rights of patients in all circumstances. Student shall keep all patient records confidential and shall not reveal or release any information contained therein unless (a) authorized to do so, in writing, by the patient; or (b) ordered to do so by a court of competent jurisdiction. 4. Release and Hard Harmless. Student hereby releases, discharges, and agrees to hold harmless District, District's governing board ("Board'), and each of their trustees, employees, agents and representatives from any and all liability arising out of or in connection with Student's enrollment in the nursing program (Golden West College) or allied health programs (Orange Coast College) and participation in its classes, training courses, activities, field trips, practice sessions, hospital clinical experiences, and related exercises. For the purpose of this release, liability means all claims, demands, losses, causes of action, suits or judgments of any kind that Student or Student's hairs, executors, administrators, and assigns may have against District, Beard, College, and any of their trustees, employees, agents, and representatives or that any other person or entity may have against District, Board, College, and any of their trustees, employees, agents, and representatives because of Student's failure to pass any course or class or obtain any particular grades, personal injury, accident, illness or deeth, or because of any loss of or damage to property that occurs to Student or his or her property during Student's participation in the nursing program or allied health program including classes, training courses, activities, field trips, practice sessions, hospital clinical experiences, and related exercise, that result from any cause, including but not limited to District's, Board's, Colleges, or their trustees', employees', agents', or representatives' own passive or active negligence or other acts other than fraud, willful misconduct or violation of any law. Student's initials S. Acknowledgment of Inherently Dann-erous Activities and Assumption of the Risk Thereof. Student acknowledges that the nature of Student's training in the nursing programiallied health programs may involve dangerous antl hazardous activities, including but not limited to exposure to disease, blood pathogens, illness, personal injuries and possible death. Student acknowledges the inherently hazardous and dangerous nature of these activities and voluntarily participates therein and assumes all risk of injury, illness, or death from Student's participation therein. Student represents and warrants that Student is mentally and physically flit, Capable, able and willing to participate in these inherently hazardous and dangerous activities without any limitations. Student's Initials 6. No Right to Employment Removal. Student understands and agrees that Student's participation in the Clinical Rotation does not create any right to employment at Clinical Facility. Student understands and agrees that Student may be removed from the Clinical Rotation at any time for any reason, except in violation of any law. Any student who is asked to leave by any representative of Clinical Facility shall do so promptly and without protest- 1 gwc oCCJmvisAdla##Vdj-Zi-9B e2/d5/2981 10.19 714-895--B1b6 HEALTH PRSFESSIONS PAGE 83 7. Qgneral Rules. Students entering the clinical phase of their education are required to meet the following requirements: a. Clinicals are scheduled courses with specific days and times. Students are to adhere to these and adjust any outside work or activities accordingly. b. Student must complete a physical within a six-month period prior to the start of the clinical phase (see supplied form). The physical may be completed at the college health center, Student's private physician, or group health care facility. Blood work, urinalysis, and annual T.B. tests or chest x-rays are required as may be immunizations (rubella, rubeoia and varicella titre) or proof of immunity. Hepatitis B vaccine is highly recortimended by College or waiver must be signed. Certain clinical sites will not allow student participation without hepatitis B vaccination. The completed information must be returned to the clinical coordinator or director of Student's program. See Student's program or clinical coordinator for Specific details. c. Any Student participating in a Rotation shall, at the request of Clinical Facility, provide a current statement from a physician that the student is In good health and capable of participating in the Rotation. Clinical Facility may require that any student, returning from an extended absence caused by illness or injury, submit to a physical examination or present a statement from a physician indicating that the student is capable of resuming clinical activities. Any such physical examination shall be the financial responsibility of Student. d. All students in a clinical rotation must have an active CPR card (per specific program protocol). If Student's CPR card expires at any time during clinical training, it is Students responsibility to become recertified. Student will be removed from clinical experience rotation if Student does not have an active CPR card. in programs which require Allied Health 115--Patient Care, Student must enroll in Patient Care just prior to entry into the clinical phase, in accordance with the program schedule sequence. Students taking Allied Health 115 will become CPR certified. e. Students must adhere to appropriate dress code and grooming standards designated by Clinical Facility. This may include a laboratory coat or uniform. Closed, soft soled shoes are required. A name tag will be provided that must be wom at all times at Clinical Facility site. See Student's program director or Ginical coordinator for specific requirements for Student's program. f. Specific clinical sites may have certain health related requirements and may include drug testing. hepatitis B vaccination, or blood work. Students are expected to meet the requirements of the site when scheduled to be at that site. g. There may be exposure to hazardous materials and bloodbourne pathogens in the clinical setting. Students must adhere to all safety and universal precautionary measures. h. Students must have adequate reliable transportation to the clinical site and will be responsible for parking. 8. Aeknowleduement. Student has read the Student Participation Agreement including the Release provisions in paragraph 4 and the Assumption of Risk provisions in paragraph 5 and agrees to abide by and comply with all its terms. Dated: By: Dated: By: Student Student ID Number Parent or Guardian (if Student is a Minor) gwelocclrevis sdfaaxlal -21-Si Can CERTIFICATE OF COVERAGE ISSUE DATE 06/19/00 ADMINISTRATOR: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION KEENAN & ASSOCIATES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LICENSE # 0451271 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2355 CRENSHAW BOULEVARD, SUITE 200 ALTER THE COVERAGES AFFORDED BY THE COVERAGE TORRANCE, CA 90501 DOCUMENTS BELOW. COVERED PARTY: ENTITIES AFFORDING COVERAGE ENTITY A STATEWIDE ASSOCIATION_ OF COMMUNITY COLLEGES COAST COMMUNITY COLLEGE DISTRICT 1370 ADAMS AVENUE COSTA MESA, CA 92628-011 B ATTN: MS. JUDY NEAL THIS IS TO CERTIFY THAT THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE COVERED PARTY NAMED ABOVE FOR THE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM, OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS OF SUCH COVERAGE DOCUMENTS. ENT TYPE OF COVERAGE COVERAGE EFFECTIVE I MEMBER LIMITS LTR DOCUMENTS DATE EXPIRATION DATE RETAINED LIMIT DEDUCTIBLE GENERAL LIABILITY [X]COMMERCIAL GENERAL LIABILITY COMBINED SINGLE LIMIT A [ ICLAIMS MADE [XIOCCURRENCE EACH OCCURRENCE [X]GOVERNMENT CODES SWC 01100.4 06-30-00 101 $25,000 $ 4,975,000 [XIERRORS & OMISSIONS [I AUTOMOBILE LIABILITY (XIANY AUTO COMBINED SINGLE LIMIT [ ]HIRED AUTO EACH OCCURRENCE A [ ]NON -OWNED AUTO SWC 01 100-4 06-30-00 ! 01 $25,000 $ 4,975,000 [XIGARAGE LIABILITY [X]AUTO PHYSICAL DAMAGE A PROPERTY ALL RISK SWC 01100-4 06-30-00 101 $25,000 $ 500,000,000. EXCLUDES EARTHQUAKE & FLOOD PER OCCURRENCE DESCRIPTION OF OPERATIONS 1 LOCATIONSIVEHICLES 1 RESTRICTIONS 1 SPECIAL PROVISIONS: CLINICAL AGREEMENT BETWEEN COAST COMMUNITY COLLEGE DISTRICT/GOLDEN WEST COLLEGE AND RODGERS SENIOR CENTER JUNE 30, 2000 THROUGH JUNE 30, 2001. .Qlto�►.�a►b4� aN '�•:4 in+Guu,le�+c� Cer s atw�...f_ _ 4� _ C,a, Au Ca "i` CERTIFICATE HOLDER: CANCELLATION ....... SHOULD ANY OF THE ABOVE DESCRIBED ,COVERAGES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING ENTITY/JPA WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE —LEFT, BUT FAILURE TO MAIL SUCH/ SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THEiENTITYIJPA. ITS AGENTS OR REPRESENTATIVES. I CITY OF HUNTINGTON BEACH AND RODGERS SENIOR CENTER 1706 ORANGE AVENUE HUNTINGTON BEACH, CA 92684 AUTHORIZED REPRESENTATIVE ATTN: KAREN FOSTER K&A..PIL..0612000 44 Ja CITY OF HUNTINGTON BEACH Inter -Department Communication TO: JOHN REEKSTIN, Director of Administrative Services (original) RON HAGAN, Director of Community Services (copy) FROM: GAIL HUTTON, City Attorney DATE: August 21, 2000 SUBJECT: RLS 00-549. Proposed Non -Affiliation Agreement Between the City of Huntington Beach and the Coast Community College District Regarding the Rodgers Senior Center This agreement must be approved by the City Council, particularly because of the added liability the City is undertaking by allowing its facility, to be used by the college's nursing students and because of the indemnification provisions of Paragraph 23 of the proposed agreement. This RLS was assigned to Special Counsel Robert J. Wheeler. Mr. Wheeler made a number of minor, clarifying changes to the district's draft of the agreement. Mr. Wheeler also added the City's standard signature page. A copy of Mr. Wheeler's "marked -up" draft of the agreement is attached to this memorandum. We also thought it important to define the term "community experience rotation" as it is used in the agreement. In this regard, Mr. Wheeler, after speaking on August 17'h with Ms. Linda Stevens of the college, included a definition of this term in the revised draft of the agreement. Due to the nature of Mr. Wheeler's changes, we decided it best to type the revised agreement on this office's computer. Also attached is the original revised agreement which both Mr. Wheeler and I have approved and initialed. At Ms. Stevens' request, we are sending her both a copy of Mr. Wheeler's marked up draft of the agreement, and a copy of the revised agreement my office prepared. We are also sending back to John all of the documents and papers'that were sent under cover of RLS 00-549. ��+ r GAIL HLTTON, City Attorney Attachments as noted cc (with attachments): Linda Stevens, RN, MSN, Dean Health Professions, Golden West College ,7 (without attachments): Karen Foster, Risk Manager w100me molfls00-549proposed 02/16/2008 13:59 714-895-8166 Ft � 16 00 12: 33 PROM: ELMO ar.rr 0/ c��,ro�Hu—sr,�rt Iwo cows BFRVi HEALTH PROFESSIONS PACE 02 6265757090 TO:AJ&L 9% 8166 P14GE:02,02 BOARD OF REGISTERED NURSING e 107 SOUTH SADAO'"V, GOATE B03V Wf1MW 608 AWILE& CA9012 fti% lewoft"s. 12121887•sw Roth Ann Terry, MPH, RN Execuaive Officer September 17, 1997 Linda Stevens, MSN, RN Director of Nursing Program Golder, West College 15744 Golden West Street Huntington Beach, CA 92647 SUBJECT.- BOARD ACTION Dear Ms. Stevens: The Board of Registered Nursing, at its September 12, 1997 meeting in Sacramento, voted the following actions: "Continue approval and approve minor curriculum mvibion for Golden West College Associalt Degrees Nursing Progmam." I I' further information is nteded. please do not hesitate to contact Mulene Bowman. MSN. RN, Nursing Education Consultant at (213) 907-3590. Sincerely. BOARD OF REGISTERED NURSING '�� ?— pa-.� Maria E. Brdroni. MN, RN. NP Supervising Nursing Education Consultant MBIntaa c: Kenneth D. Yglesias, President -.Marivad Bowman, NEC FEB-16-2000 14:01 714 895 8166 9?% P-02 02/16/2000 13:59 714-895-8166 HEALTH PROFESSIONS NLNAC` _ National League for Nursing Accrediting Commission NLMAC COMMI511ONIAS NURSING EDUCATION RBPRESENTATIVIIB SAti1at'. L. Lu!'. PrD. RN Associate Professar. SChoof of Nursing The unm r, of Taaas F•aallh Sum& Come, San A^ta-'o-Texas LAG _ ll 0-2. P..D. RN, FAAN Oeai. Cc lege or Nulling and Awed Haman Prefessiens Ch.cagd State un.res:ty Ch;CA jo. 11kmd.a fuJ TA S 7utrfm. MSN, AN Chalrptrsor, Health S,-tMe Div1l:or issuer Col ege Caster Wyoming July 15, 1998 Kenneth D. Yglesias. EdD President Golden West College 15744 GoldenWest Street Huntington Beach, CA 92647-2748 President Yglesias'. PAGE 03 Mona B. MCCART.y. "IS. APJ The National League for Nursing Accrediting Commission reviewed for Via& Pras.Ceni for Em4htioA continuing accreditation the associate degree program in nursing offered by La ,Wit Mtrnoral Hotpaal Sch001 of Nurling Golden West College. Mcillero. vasm:husetU KIT-LSEN A_ POv.FRI. EDO. RN Alicia Pres;delt Deliberations centered on the self study report. the school catalogue, the st...tGtFe• College program M11Ltator report. and flue recommendation for accreditation proposed Rochncvr Ntvrrork by the program evaluators fund the evaluation review panel. SH.NN01, E. FEcLk-. PI.D- RN. FAAN Director. School of Kissing This letter is forniii notification of Ilte action taken by the Commission at its San Franc4td State Unwen.ty meeting an July 10. 1998. when it voted to grant continuing accreditation to son FrsncitCG. Gl,fdrnia die associate degree progratin in nursing. The next visit scheduled for Pwv:.-t 'J. Hot.s. 05N. R.ki reaccreditation or the associate degree program in nursing is Spring 2006. 0e4n.'drerestor.30001 of Nur4111 East Caro:ina Univertlte Green,' a Norm carol Aa The strengths, concerns, and advice offered by fete evaluation review panel Moir Lo,, mo-,cw. EoD, 4"1 and the program evaluator report are to be used by the progrxrn in musing for Sein+or Associate Dian for Academic Progrtty,s continuing improvement. The Evaluation Review Panel Sutntttdry Report is Aflaghenr Ve;verollr 0rthe Health Sao -rat attached. Pnda]elph a- Parnsylvan'a MURBI 1X9CUTIYe 6EPR95FMTATIVES On behalf of the Commission, 1 thatlk you and your associates for your MAty E. M.nc v MSN, Ah, CKA PAAN cooperation, If you have questions about this action or about Commission San;o-Yf(:a Prowtnt. Nvsirg Adminisvilion policies and procedures, please write or call the Execuutive Director or a Parkland Health 6 Hospital System member of the NLNAC staff. Dalut.reaat P-mZ;A K. TR-C.O. PHD. RN. FAAN Semrof Vice Presrdent)"hief Nursing Officer The Mathodio Hoo'u Houser:+. Texas );Jy I- A. R.A,y. P.D. RN, FAAN Associate D ntitor Fo• .NursFg and Patient Can Sarr.cas Tna Unn.en[ty cT Iowa *Iosp.tali and Chres to»•a Gt f 10•r4 PUBLIC REPt1t/IFITATIVIS A,Iear Ly ND. Pao AIIOciale'vice Prttieant of A:adamic Affa l Ue—&1shy cr Camera Ok a+a+*a Edmond. Ok ah0ma w.-L A� E. HOC+(. P,•0 V ;t rhaMtllor for A:aJem1, Aft.,; SGJlhern Lnwerttty Baton Rouge. Louisiana IC-n A. CRO✓.ra, PhD Pre,•At. H.AlIh Ed —atom Center St. Pawsh,rg sun.& College S;. Prvsburg. F o•-da Ger'tildene Felton. EdD. RN, FAAN Executive Director GF:bn1 cc: Lindn Stevens. MSN. RN Dealt. Health Professions Nancy Caputo. MSN. RN. Program Evaluator Caro] Fountain. MSN. RN, ONC. Program Evaluator 61 Broadway, New York, NY 1 0006 2 1 2.363-5555 x 1 53 - Fax- 2 1 2-8 t 2-0390 www.ninac.org FEP-1.6-2000 14:01 714 895 8166 9?% P.03 ICITY OF HUNTINGTON BEACH INTER -DEPARTMENT COMMUNICATION HUNTINGTON BEACH Connie Brockway, City Clerk Office of the City Clerk Liz Ehrin Deputy City Clerk It 9� P Y n + G / To:v-Gi3 Date: %' Meeting Date: Agenda Item: f roposed_City Council Agenda Items: The City Clerk's Office/City Administrator's Office must return your agenda item due to the following requirements that have not been met. When your Agenda Item is ready to resubmit, please return to: Elaine Kuhnke, Management Assistant, Administration < 1. 1 Signature(s) Needed' • A On RCA B On Agreement C Other .• r� f 2. Attachments JX A Missing A d B Not identified C Other s 3. Exhibits A Missing B Not identified C Other 4. Insurance Certificate (Proof Of Insurance) A Not attached B Not approved by City Attorney's Office f Signed form notifying City Clerk that department will,P responsible for obtaining insurance certificate on this item. (See form attached Ic 4-;'7 i - Wording On Request For Council Action A) Unckar {75y A Recommended Action on RCA not comple B Clarification needed on RCA C Other 6. City Attorney Approval Requir 7. Agreement Needs To Be Chg ged A Page No. 8. Other G: egendahnianccaform RCA ROUTING SHEET INITIATING DEPARTMENT: Comm Svc/Admin Svc SUBJECT: ' Non Standard Affiliation Agreement with -Coast -Community College District COUNCIL MEETING DATE: November 20, 2000 RCA ATTACHMENTS STATUS Ordinance (w/exhibits & legislative draft if applicable) Not Applicable Resolution (w/exhibits & legislative draft if applicable) Not Applicable Tract Map, Location Map and/or other Exhibits Not Applicable Contract/Agreement (w/exhibits if applicable) Si ned in full by the City Attome Attached Subleases, Third Party Agreements, etc. (Approved as to form by City Aftome Not Applicable Certificates of Insurance (Approved by the City Attome Attached Financial Impact Statement Unbud et, over $5,000 Not Applicable Bonds If applicable) Not Applicable Staff Report (If a licable) Not Applicable Commission, Board or Committee Report If applicable) Not Applicable Findings/Conditions for Approval and/or Denial Not Applicable EXPLANATION FOR MISSING ATTACHMENTS. REVIEWED_ _ RETURNED 'FORWARDED Administrative Staff (L Assistant City Administrator Initial City Administrator Initial Ci Clerk EXPLANATION FOR RETURN OP ITEM: