HomeMy WebLinkAboutAgreement A-21-302 with Unilab Corporation dba Quest Diagnostics.pdf-1-
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AGREEMENT
THIS AGREEMENT is made and entered into this ______ day of ____, 2021, by and between the
COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as
"COUNTY", and UNILAB CORPORATION dba QUEST DIAGNOSTICS, a California Corporation, whose
address is 3714 Northgate Boulevard, Sacramento, California 95834, hereinafter referred to as
"CONTRACTOR".
W I T N E S S E T H
WHEREAS, COUNTY, through its Department of Public Health (DPH) and Department of
Behavioral Health (DBH), has a need for toxicology and clinical laboratory testing services including,
but not limited to, supplies for specimen collections, phlebotomy services, specimen pickup and
delivery, laboratory testing, critical value reporting, and routine laboratory orders for health programs
for COUNTY’s consumers and clients; and
WHEREAS, CONTRACTOR is qualified and willing to provide such services pursuant to the
terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions,
hereinafter set forth, the sufficiency of which is acknowledged, the parties agree as follows:
1.SERVICES
A.CONTRACTOR shall perform all services and fulfill all responsibilities for both
COUNTY’s DPH and DBH, as identified in Exhibit A, attached hereto and by this reference
incorporated herein.
B.In addition, CONTRACTOR shall perform all services and fulfill all responsibilities
in a manner consistent with COUNTY's Request for Quotation (RFQ) No. 21-030 dated February 1,
2021 and Addendum No. One (1) to COUNTY’s RFQ No. 21-030, dated February 25, 2021, hereinafter
collectively referred to as COUNTY’s Revised RFQ No. 21-030, and CONTRACTOR's Response to
said Revised RFQ No. 21-030, dated March 5, 2021, all incorporated herein by reference and made
part of this Agreement. In the event of any inconsistency among these documents, the inconsistency
shall be resolved by giving precedence in the following order of priority: 1) to this Agreement, including
all Exhibits, 2) to the Revised RFQ, 3) to the Response to the Revised RFQ. A copy of COUNTY's
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F Agreement No. 21-302
10th Aug.
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Revised RFQ No. 21-030 and CONTRACTOR's Response shall be retained and made available during
the term of this Agreement by COUNTY's Internal Services Department, Purchasing Division.
C.CONTRACTOR shall be Clinical Laboratory Improvement Amendments (CLIA)
certified as identified in Paragraph Sixteen (16) of this Agreement.
D.CONTRACTOR shall perform blood draws and pick up specimens as deemed
necessary by appropriate COUNTY staff requesting services.
E.CONTRACTOR shall complete all routine blood draws and other specimen
collections as specified by each COUNTY Department’s collection requirements.
F.Routine results shall be returned to the requesting COUNTY facility within twenty-
four (24) hours of collection of specimen or specimen pick up.
G.Location and hours of operation of CONTRACTOR’s Patient Service Centers
(PSCs) are identified in Exhibit B, attached hereto and incorporated herein by reference.
CONTRACTOR shall notify COUNTY in advance when any of the PSCs are to be closed and alternate
arrangements for specimen collection shall be mutually agreed to.
H.CONTRACTOR may subcontract with local laboratories within Fresno County in
the event that CONTRACTOR is not able to perform all tests and provide all services required
hereunder, but only if such laboratories are able to provide the same or better level and quality of
service as CONTRACTOR. CONTRACTOR may subcontract when esoteric testing is not performed or
to ensure continuity of services during hours other than CONTRACTOR’s regularly scheduled business
hours, including weekends and holidays. Should CONTRACTOR subcontract with local laboratories
pursuant to this subparagraph, CONTRACTOR shall bear sole and primary responsibility for all
services, including results, provided by their subcontractors. COUNTY will consider CONTRACTOR to
be the sole point of contact with regard to contractual matters, including payment of any and all
charges resulting from this Agreement, even if such services are provided by a subcontractor.
COUNTY shall not deal with any subcontractor for any services or test results. CONTRACTOR shall
be responsible for collecting all results and sending them to the requesting COUNTY Department and
clinic within the timeframes listed in this Agreement. CONTRACTOR shall be solely responsible for all
supplies, fees and payments when they have another clinical laboratory run any tests. CONTRACTOR
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
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shall require its subcontractors to comply with all terms and conditions of this Agreement.
CONTRACTOR shall inform its subcontractors of all terms and conditions of this Agreement and of all
applicable Federal, State of California and local laws.
I.CONTRACTOR shall provide “STAT Testing” as follows:
1)“STAT Testing” is defined herein as immediate testing requested by an
appropriate COUNTY staff physician.
2)CONTRACTOR shall respond to COUNTY’s request for STAT Testing
within two (2) hours, which shall be measured from the time COUNTY’s request is made until the time
when CONTRACTOR picks up the specimen or when CONTRACTOR’s phlebotomist arrives to draw
the specimen, whichever is applicable.
3)STAT testing results will be provided to requesting physician or designated
staff within two to four (2-4) hours from specimen pick up time regardless if testing was done by
CONTRACTOR or their subcontractor.
2.TERM
The term of this Agreement shall be for a period of three (3) years, retroactively
commencing on July 1, 2021 through and including June 30, 2024. This Agreement may be extended for
two (2) additional consecutive twelve (12) month periods upon written approval of both parties no later than
thirty (30) days prior to the first day of the next twelve (12) month extension period. The COUNTY’s
Department of Public Health or his or her designee is authorized to execute such written approval on behalf
of COUNTY based on CONTRACTOR’S satisfactory performance.
3.TERMINATION
A.Non-Allocation of Funds - The terms of this Agreement, and the services to
be provided hereunder, are contingent on the approval of funds by the appropriating government
agency. Should sufficient funds not be allocated, the services provided may be modified, or this
Agreement terminated, at any time by giving the CONTRACTOR sixty (60) days advance written
notice.
B.CONTRACTOR’s Breach of Contract - The COUNTY may immediately suspend or
terminate this Agreement in whole or in part, where in the determination of the COUNTY there is:
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
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1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to the COUNTY.
4) Improperly performed service.
In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any
breach of this Agreement or any default which may then exist on the part of the CONTRACTOR. Neither
shall such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or
default. The COUNTY shall have the right to demand of the CONTRACTOR the repayment to the
COUNTY of any funds disbursed to the CONTRACTOR under this Agreement, which in the judgment of
the COUNTY were not expended in accordance with the terms of this Agreement. The CONTRACTOR
shall promptly refund any such funds upon demand.
C. COUNTY’s Breach of Contract – The CONTRACTOR may terminate this
Agreement in the event of a material breach by the COUNTY by giving the COUNTY ten (10) days
written notice of the identified breach. If the COUNTY fails to cure the breach within ten (10) day cure
period, the CONTRACTOR may terminate the Agreement immediately upon written notice to the
COUNTY.
D. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by either party upon the giving of sixty (60) days advance written notice
of an intention to terminate to the other party.
4. COMPENSATION
A. COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation for services provided to each COUNTY Department as stated herein, as follows:
1) DPH
Compensation paid by COUNTY’s DPH to CONTRACTOR shall be based on a
fee for service per test at the rate identified in the DPH Schedule of Fees, attached hereto as Exhibit C,
and by this reference incorporated herein. In no event shall the maximum amount of compensation
paid to CONTRACTOR by COUNTY’s DPH exceed Five Hundred Forty-three Thousand and no/100
Dollars ($543,000.00) during each twelve-month period of this Agreement.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
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2)DBH
Compensation paid by COUNTY’s DBH to CONTRACTOR shall be based on a
fee for service per test at the rate identified in the DBH Schedule of Fees, attached hereto as Exhibit D,
and by this reference incorporated herein. In addition, CONTRACTOR shall provide phlebotomy
services as described in Exhibit A. In no event shall the total maximum amount of compensation paid
to CONTRACTOR by COUNTY’s DBH exceed One Hundred Ten Thousand and no/100 Dollars
($110,000.00) during each twelve-month period of this Agreement.
3)CONTRACTOR shall invoice COUNTY and COUNTY shall only pay for services
provided to clients with Medically Indigent Services Program (MISP) Certification and/or clients with
Uniform Method to Determine Ability to Pay (UMDAP) Certification, (hereinafter, "Certified Individuals")
in accordance with Paragraph Five (5) of this Agreement.
4)Except for Certified Individuals, CONTRACTOR shall seek compensation directly
from the individuals for whom the services were rendered, or from third-party payers (i.e. Medicare,
Medi-Cal or private health insurance) as applicable, and CONTRACTOR agrees COUNTY shall have
no financial liability for services provided to such non-certified individuals. CONTRACTOR further
agrees that in the event any Certified Individual subsequently becomes eligible for Medi-Cal or other
third-party insurance, then CONTRACTOR shall have no right to receive or retain compensation from
COUNTY for services provided for such individuals.
5)COUNTY shall, to the best of its knowledge, attempt to identify every DPH or DBH
client at the time of referral for a clinical or toxicology test if they have Medi-Cal, Medicare or any other
third-party insurance. CONTRACTOR shall adjust their billing to switch payment to Medi-Cal, Medicare or
other third-party insurance if at a later time (as long as CONTRACTOR is provided the complete
billing information needed to file the claim by the COUNTY and within the timely filing guidelines
of the payor), or when invoiced, that said client had any other health insurance coverage. In the event
COUNTY fails to provide any information that is necessary for CONTRACTOR to bill and collect from a
third party payor, whether public or private, and CONTRACTOR is unable to collect for any Services as
result of such failure, CONTRACTOR shall bill COUNTY, and COUNTY shall pay CONTRACTOR for
Services at the fees set forth in Exhibits C and D. Notwithstanding the foregoing, in the event COUNTY
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
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subsequently provides CONTRACTOR with accurate billing information within 75 days from the date of
service CONTRACTOR shall transfer the charges billed to COUNTY to the applicable third party payor
and adjust the charges from the COUNTY account accordingly. If an invoice for such a client has been
paid by the COUNTY, then CONTRACTOR shall credit the COUNTY for that amount already paid within
two (2) months after the pertaining information for Medi-Cal, Medicare or other health insurance coverage
is provided to the CONTRACTOR.
6)Patients who receive an invoice from CONTRACTOR for laboratory testing services
may also apply for patient financial assistance. This program is available to all patients, regardless of
insurance status, to reduce or waive patient responsibility amounts, which may include but not limited to
copays, deductibles, or other laboratory testing services fees owed by patient to CONTRACTOR, in
accordance with the US Department of Health and Human Service (“HHS”) federal poverty guidelines, as
may be amended or modified from time to time, without prior written notice. COUNTY may access and
review the CONTRACTOR’s Patient Financial Assistance Program by accessing the following link: .
CONTRACTOR acknowledges that COUNTY shall not be responsible for compensation
for these consumers for performed services.
7)In the event a DPH or DBH client receives clinical or toxicology testing from a
subcontract of the CONTRACTOR as provided for in Paragraph One (1), Subparagraph H, such testing
shall be provided pursuant to the terms of this Agreement and payment for such services shall be made
by COUNTY to CONTRACTOR as provided for in Paragraph 1.H.
B.In no event shall the total maximum compensation amount for this Agreement
paid to CONTRACTOR by COUNTY for actual services rendered exceed Six Hundred Fifty-Three
Thousand and no/100 Dollars ($653,000.00) during each twelve-month period of this Agreement.
C.It is understood that all expenses incidental to CONTRACTOR’s performance of
services under this Agreement shall be borne by CONTRACTOR. Payments by COUNTY shall be in
arrears, for services provided during the preceding month, within forty-five (45) days after receipt and
verification of CONTRACTOR’s invoices by COUNTY’s DPH and DBH, as applicable.
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DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
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5.INVOICING
CONTRACTOR shall invoice DPH and invoice DBH for services rendered to each
Department in arrears, on the tenth (10th) of the month for services provided in the prior month as
follows:
A.Invoices shall be submitted to the responsible COUNTY Department, as
applicable, detailing the Department; appropriate cost center(s); patient’s full name, date of birth, and
Fresno County Medical Record number; date of service; and name of laboratory test performed along
with the CPT code to the following addresses:
DPH: County of Fresno, Department of Public Health, P.O. Box 11867, Fresno,
CA 93775, Attention: DPH Business Office; or by email to dphboap@fresnocountyca.gov.
DBH: by email to 1) dbhinvoicereview@fresnocountyca.gov, 2) dbh-
invoices@fresnocountyca.gov; and 3) dbhcontractedservicesdivision@fresnocountyca.gov with a copy
to the assigned COUNTY’s DBH Staff Analyst.
B.Documented services provided at DBH’s Metro Outpatient Services shall be
accompanied by time sheets of CONTRACTOR’s phlebotomist at the request of COUNTY’s DBH.
Invoices shall be in a form and in such detail as acceptable to COUNTY’s DBH.
C.At the discretion of COUNTY’s DBH Director or DPH Director, or their designee(s), if
an invoice is incorrect or is otherwise not in proper form or substance, COUNTY’s DBH Director or DPH
Director, or their designees, shall have the right to withhold payment as to only that portion of the invoice
that is incorrect or improper after five (5) days prior notice to CONTRACTOR. CONTRACTOR agrees to
continue to provide services for a period of ninety (90) days after notification of an incorrect or improper
invoice. If after the ninety (90) day period, the invoice is still not corrected to the COUNTY’s satisfaction,
the COUNTY’s DBH Director or DPH Director, or their designees, shall either elect to terminate their
portion of this Agreement, pursuant to the termination provisions stated in Section Three (3) of this
Agreement, or retain the right to deny payment on such invoices. In addition, for invoices received ninety
(90) days after the expiration of each term of this Agreement or termination of this Agreement, at the
discretion of COUNTY’s DBH Director or DPH Director, or their designee(s), the COUNTY shall have the
right to deny payment of any additional invoices received.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
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D.For services performed by CONTRACTOR prior to the termination date of this
Agreement but that remain unpaid by County as of the same date, CONTRACTOR shall submit all
invoices to COUNTY for services provided within ninety (90) days after Agreement is terminated. If
invoices are not submitted within ninety (90) days following termination date of the Agreement,
COUNTY shall have the right to deny payment on such invoices.
6.INDEPENDENT CONTRACTOR
In performance of the work, duties and obligations assumed by CONTRACTOR under this
Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of the
CONTRACTOR'S officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right
to control or supervise or direct the manner or method by which CONTRACTOR shall perform its work and
function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the rules and
regulations, if any, of governmental authorities having jurisdiction over matters the subject thereof.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely no right
to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be solely liable
and responsible for providing to, or on behalf of, its employees all legally-required employee benefits. In
addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all matters relating
to payment of CONTRACTOR'S employees, including compliance with Social Security withholding and all
other regulations governing such matters. It is acknowledged that during the term of this Agreement,
CONTRACTOR may be providing services to others unrelated to the COUNTY or to this Agreement.
7.MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent
of all the parties without, in any way, affecting the remainder.
Notwithstanding the above, minor changes, as mutually agreed upon in writing between
CONTRACTOR and COUNTY’s DPH or DBH Director, or designees, as applicable, may be made to
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
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Exhibit A, Exhibit C and/or Exhibit D. Minor changes may include, but are not limited to, the addition of
clinical laboratory tests, the addition or deletion of a urine/blood collection/draw or pick up site, and
changes in addresses to which notices, or invoices are to be sent. Such minor changes shall not
significantly alter the responsibilities outlined in Exhibit A or result in an increase to the maximum
compensation under this Agreement.
8.NON-ASSIGNMENT
Except as provided in Paragraph One (1), Subparagraph H, neither party shall assign,
transfer or sub-contract this Agreement nor their rights or duties under this Agreement without the prior
written consent of the other party.
9.HOLD HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY'S request,
defend the COUNTY, its officers, agents, and employees from any and all costs and expenses including
attorney’s fees and costs, damages, liabilities, claims, and losses occurring or resulting to COUNTY in
connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents, employees
or subcontractors under this Agreement, and from any and all costs and expenses (including attorney’s
fees and costs), damages, liabilities, claims, and losses occurring or resulting to any person, firm, or
corporation who may be injured or damaged by the performance, or failure to perform, of
CONTRACTOR, its officers, agents, employees or subcontractors under this Agreement.
COUNTY agrees to indemnify, save, hold harmless, and at CONTRACTOR’S request, defend the
CONTRACTOR, its officers, agents, and employees from any and all costs and expenses including
attorney’s fees and costs, damages, liabilities, claims, and losses occurring or resulting to CONTRACTOR
in connection with the performance, or failure to perform, by COUNTY, its officers, agents, employees or
subcontractors under this Agreement, and from any and all costs and expenses (including attorney’s fees
and costs), damages, liabilities, claims, and losses occurring or resulting to any person, firm, or corporation
who may be injured or damaged by the performance, or failure to perform, of COUNTY, its officers,
agents, employees or subcontractors under this Agreement.
10.INSURANCE
Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any
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third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following
insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement:
A.Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two Million
Dollars ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00).
This policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
completed operations, products liability, contractual liability, or any other liability insurance deemed
necessary because of the nature of this contract.
B.Automobile Liability
Comprehensive Automobile Liability Insurance with limits of not less than One
Million Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should
include any auto used in connection with this Agreement.
C.Professional Liability
If CONTRACTOR/S employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W., M.F.C.C.) in
providing services, Professional Liability Insurance with limits of not less than One Million Dollars
($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate. CONTRACTOR
agrees that it shall maintain, at its sole expense, in full force and effect for a period of three (3) years
following the termination of this Agreement, one or more policies of professional liability insurance with
limits of coverage as specified herein.
D.Worker's Compensation
A policy of Worker's Compensation insurance as may be required by the California
Labor Code.
E.Molestation
Sexual abuse/molestation liability insurance/self-insurance with limits of not less
than One Million Dollars ($1,000,000.00) per occurrence. Two Million Dollars ($2,000,000.00) annual
aggregate. This policy shall be issued on a per occurrence basis. This coverage/limit shall be provided
using a combination of insurance and self-insurance.
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F.Additional Requirements Relating to Insurance
CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance
including the County of Fresno, its officers, agents, and employees, individually and collectively, as
additional insured, but only insofar as the operations under this Agreement are concerned. Such coverage
for additional insured shall apply as primary insurance and any other insurance, or self-insurance,
maintained by COUNTY, its officers, agents and employees shall be excess only and not contributing with
insurance provided under CONTRACTOR’ policies herein. This insurance shall not be cancelled or
changed without a minimum of thirty (30) days advance written notice given to COUNTY.
CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and
employees any amounts paid by the policy of worker’s compensation insurance required by this
Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
necessary to accomplish such waiver of subrogation, but CONTRACTOR’s waiver of subrogation under
this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
Within Thirty (30) days from the date CONTRACTOR signs and executes this Agreement,
CONTRACTOR shall provide certificates of insurance and copies of blanket endorsement as stated above
for all of the foregoing policies, as required herein, to the County of Fresno, Department of Public Health,
P.O. Box 11867, Fresno, CA 93775, Attention: Contracts Section – 6th Floor, stating that such insurance
coverage have been obtained and are in full force; that the County of Fresno, its officers, agents and
employees will not be responsible for any premiums on the policies; that such Commercial General Liability
insurance including the County of Fresno, its officers, agents and employees, individually and collectively,
as additional insured, but only insofar as the operations under this Agreement are concerned; that such
coverage for additional insured shall apply as primary insurance and any other insurance, or self-insurance,
maintained by COUNTY, its officers, agents and employees, shall be excess only and not contributing with
insurance provided under CONTRACTOR’ policies herein; and that this insurance shall not be cancelled or
changed without a minimum of thirty (30) days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
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All policies shall be issued by admitted insurers licensed to do business in the State of
California, and such insurance shall be purchased from companies possessing a current A.M. Best, Inc.
rating of A FSC VII or better.
11.AUDITS AND INSPECTIONS
CONTRACTOR shall during business hours, as reasonably required and with thirty (30)
days advanced written notice from COUNTY, make available to the COUNTY for examination all of its
relevant records and data with respect to the matters covered by this Agreement. CONTRACTOR shall,
upon request by the COUNTY, permit the COUNTY to audit and inspect all of such records and data
necessary to ensure CONTRACTOR's compliance with the terms of this Agreement. COUNTY will comply
with CONTRACTOR’s customer audit standards, a copy of which is attached hereto as Exhibit I.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00), CONTRACTOR
shall be subject to the examination and audit of the State Auditor for a period of three (3) years after final
payment under contract (Government Code Section 8546.7).
12.DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of
COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter
into a contractual relationship with the COUNTY for the purpose of providing services under this
Agreement must employ adequate data security measures to protect the confidential information
provided to CONTRACTOR by the COUNTY, including but not limited to the following:
A.CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1)CONTRACTOR has received authorization by COUNTY for
telecommuting purposes;
2)Current virus protection software is in place;
3)Mobile device has the remote wipe feature enabled; and
4)A secure connection is used.
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B.CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief Information
Officer, and/or designee(s), including but not limited to mobile storage devices. If data is approved to
be transferred, data must be stored on a secure server approved by the COUNTY and transferred by
means of a Virtual Private Network (VPN) connection, or another type of secure connection. Said data
must be encrypted on transit over public networks and in storage.
C.COUNTY-Owned Computer Equipment
CONTRACTOR or anyone having an employment relationship with the COUNTY,
may not use COUNTY computers or computer peripherals on non-COUNTY premises without prior
authorization from the COUNTY’s Chief Information Officer, and/or designee(s).
D.CONTRACTOR may not store COUNTY’s private, confidential or sensitive data
on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E.CONTRACTOR shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY’s confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files, program documentation, data
processing systems, data files and data processing equipment which stores or processes COUNTY
data internally and externally.
F.Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128
BIT or higher. Additionally, a password or pass phrase must be utilized.
G.CONTRACTOR is responsible to promptly notify COUNTY of any violations,
breaches or potential breaches of security related to COUNTY’s confidential information, COUNTY’s
data maintained in computer files, program documentation, data processing systems, data files and
data processing equipment which stores or processes COUNTY data internally or externally.
H.To the extent practicable, COUNTY shall provide oversight to CONTRACTOR’s
response to all incidents arising from a possible breach of security related to COUNTY’s confidential
client information provided to CONTRACTOR. CONTRACTOR will be responsible to issue any
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notification to affected individuals as required by law or as deemed necessary by COUNTY in its sole
discretion. CONTRACTOR will be responsible for all costs incurred as a result of providing the required
notification.
13. CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating to
confidentiality.
14. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered entities
as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-191
(HIPAA) and agree to use and disclose protected health information as required by law. COUNTY and
CONTRACTOR acknowledge that the exchanges of protected health information between them is only for
treatment, payment, and health care operations.COUNTY and CONTRACTOR intend to protect the privacy
and provide for the security of Protected Health Information (PHI) pursuant to the Agreement in compliance
with HIPAA, the Health Information Technology for Economic and Clinical Health Act, Public Law 111-005
(HITECH), and regulations promulgated thereunder by the U.S. Department of Health and Human Services
(HIPAA Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require CONTRACTOR to enter
into a contract containing specific requirements prior to the disclosure of PHI, as set forth in, but not limited
to, Title 45, Sections 164.314(a), 164.502€ and 164.504€ of the Code of Federal Regulations (CFR).
15. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR shall not unlawfully discriminate
against any employee or applicant for employment, or recipient of services, because of race, religious
creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic
information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, military
status or veteran status pursuant to all applicable State of California and Federal statutes and regulation.
16. LICENSES
CONTRACTOR warrants that it possesses and shall maintain the Clinical Laboratory
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Improvement Amendments (CLIA) Certification and all other licenses and/or certificates required by
local, State of California and/or Federal laws and regulations for the conduct of its business and shall
operate its business in accordance with all applicable laws and regulations. CONTRACTOR further
warrants that all of its personnel performing services under this Agreement shall be licensed and/or
certified where required to lawfully perform their duties and shall maintain such licensure and/or
certifications throughout the term of this Agreement. CONTRACTOR shall maintain copies of all
licenses and/or certifications noted above and shall allow COUNTY to review these documents upon
request.
17.CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION - LOWER TIER COVERED TRANSACTIONS:
A.COUNTY and CONTRACTOR recognize that CONTRACTOR is a recipient of
Federal funds under the terms of this Agreement. By signing this Agreement, CONTRACTOR agrees
to comply with applicable Federal suspension and debarment regulations, including but not limited to: 7
CFR 3016.35, 29 CFR 97.35, and Executive Order 12549. By signing this Agreement, CONTRACTOR
attests to the best of its knowledge and belief, that it and its principals:
1)Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded by any Federal department or agency; and
2)Shall not knowingly enter into any covered transaction with an entity or
person who is proposed for debarment under Federal regulations, debarred, suspended,
declared ineligible, or voluntarily excluded from participation in such transaction.
B.CONTRACTOR shall provide immediate written notice to COUNTY if at any time
during the term of this Agreement CONTRACTOR learns that the representations it makes above were
erroneous when made or have become erroneous by reason of changed circumstances.
C.CONTRACTOR shall include a clause titled “Certification Regarding Debarment,
Suspension, Ineligibility, and Voluntary Exclusion – Lower Tier Covered Transactions” and similar in nature
to this paragraph in all lower tier covered transactions and in all solicitations for lower tier covered
transactions.
D.CONTRACTOR shall, prior to soliciting or purchasing goods and services in excess
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of $25,000 funded by this Agreement, review and retain the proposed vendor’s suspension and debarment
status at https://sam.gov/SAM/.
18.DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR is required to disclose if any of the following conditions apply to them, their
owners, officers, corporate managers, and partners (hereinafter collectively referred to in this Section as
“CONTRACTOR”):
A.Within the three (3) year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1)Fraud or a criminal offense in connection with obtaining, attempting to obtain,
or performing a public (federal, state, or local) transaction or contract under a public transaction;
2)Violation of a federal or state antitrust statute;
3)Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
or
4)False statements or receipt of stolen property.
B.Within the three (3) year period preceding the Agreement award, they have had a
public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate CONTRACTOR from
further business consideration. The information will be considered as part of the determination of whether
to continue and/or renew this Agreement and any additional information or explanation that CONTRACTOR
elects to submit with the disclosed information will be considered. If it is later determined that
CONTRACTOR failed to disclose required information, any contract awarded to such CONTRACTOR may
be immediately voided and terminated for material failure to comply with the terms and conditions of the
award.
CONTRACTOR must sign a “Certification Regarding Debarment, Suspension, and Other
Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit H, attached hereto
and by this reference incorporated herein and made part of this Agreement. Additionally, CONTRACTOR
must immediately advise the COUNTY’s DBH and DPH in writing if, during the term of this Agreement: (1)
CONTRACTOR becomes suspended, debarred, excluded, or ineligible for participation in Federal or State
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funded programs or from receiving federal funds as listed in the excluded parties’ list system
(http://www.epls.gov); or (2) any of the above listed conditions become applicable to CONTRACTOR.
CONTRACTOR shall indemnify, defend, and hold COUNTY harmless for any loss or damage resulting
from a conviction, debarment, exclusion, ineligibility, or other matter listed in the signed Certification
Regarding Debarment, Suspension, and Other Responsibility Matters.
19.PROHIBITION ON PUBLICITY
None of the funds, materials, property or services provided directly or indirectly under this
Agreement shall be used for CONTRACTOR’s advertising, fundraising, or publicity (i.e., purchasing of
tickets/tables, silent auction donations, etc.) for the purpose of self-promotion. Notwithstanding the
above, publicity of the services described in Section One (1) of this Agreement shall be allowed as
necessary to raise public awareness about the availability of such specific services when approved in
advance by the Director or designee.
20.CONFLICT OF INTEREST
No officer, employee or agent of the COUNTY who exercises any function or responsibility for planning
and carrying out of the services provided under this Agreement shall have any direct or indirect personal
financial interest in this Agreement. In addition, no employee of the COUNTY shall be employed by the
CONTRACTOR under this Agreement to fulfill any contractual obligations with the COUNTY. The
CONTRACTOR shall comply with all Federal, State of California and local conflict of interest laws,
statutes and regulations, which shall be applicable to all parties and beneficiaries under this Agreement
and any officer, employee or agent of the COUNTY.
22.DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a
for-profit on non-profit corporation) or if during the term of this agreement, the CONTRACTOR changes
its status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
is a party and in which one or more of its directors has a material financial interest. Members of the
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Board of Directors shall disclose any self-dealing transactions that they are a party to by completing
and signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit F and incorporated
herein by reference, and submitting it to the COUNTY prior to commencing with the self-dealing
transaction or immediately thereafter.
23.LOBBYING ACTIVITY
None of the funds provided under this Agreement shall be used for publicity, lobbying or
propaganda purposes designed to support or defeat legislation pending in the Congress of the United
States of America or the Legislature of the State of California
24.SINGLE AUDIT CLAUSE
A.If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000) or
more Federal and Federal flow-through monies, CONTRACTOR agrees to conduct an annual audit in
accordance with the requirements of the Single Audit Standards as set forth in Office of Management and
Budget (OMB) Title 2 of the Code of Federal Regulations, Chapter II, Part 200. CONTRACTOR shall
submit said audit and management letter to COUNTY. The audit must include a statement of findings or a
statement that there were no findings. If there were negative findings, CONTRACTOR must include a
corrective action plan signed by an authorized individual. CONTRACTOR agree to take action to correct
any material non-compliance or weakness found as a result of such audit. Such audit shall be delivered to
COUNTY’S DPH Administration for review within nine (9) months of the end of any fiscal year in which
funds were expended and/or received for the program. Failure to perform the requisite audit functions as
required by this Agreement may result in COUNTY performing the necessary audit tasks, or at the
COUNTY’S option, contracting with a public accountant to perform said audit, or, may result in the inability
of COUNTY to enter into future agreements with the CONTRACTOR.
B.A single audit report is not applicable if all CONTRACTOR’ Federal contracts do not
exceed the Seven Hundred Fifty Thousand Dollars ($750,000) requirement or CONTRACTOR’ federal
funding is through Drug Medi-Cal. If a single audit is not applicable, a program audit must be performed and
a program audit report with management letter shall be submitted by CONTRACTOR to COUNTY as a
minimum requirement to attest to CONTRACTOR solvency. Said audit report shall be delivered to
COUNTY’s DBH Finance Division and DPH Administration Division, Finance Section for review no later
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than nine (9) months after the close of the fiscal year in which the funds supplied through this Agreement
are expended. Failure to comply with this Act may result in COUNTY performing the necessary audit tasks
or contracting with a qualified accountant to perform said audit. All audit costs related to this Agreement
are the sole responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under this
paragraph shall be billed to CONTRACTOR at COUNTY cost, as determined by COUNTY’s Auditor-
Controller/Treasurer-Tax Collector.
C.CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
least three (3) years following final payment under this Agreement or the closure of all other pending
matters, whichever is later.
25.REPORTS
CONTRACTOR shall provide DPH and DBH with a respective quarterly usage report that
shall include but is not limited to, statistical data on the types of tests conducted and the amount invoiced
by cost center. In addition, CONTRACTOR shall include in said quarterly reports the number of tests
conducted at each facility (including pick up location) and the amount invoiced per location.
26.REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended during the term thereof,
the parties hereto agree to comply with the amended provision as of the effective date of such
amendment.
27.COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY’s DBH operates its mental health system
under an agreement with the State of California Department of Mental Health, and that under said
agreement the State imposes certain requirements on COUNTY and its subcontractors.
CONTRACTOR shall adhere to all applicable State requirements, including those identified in Exhibit E,
attached hereto and by this reference incorporated herein.
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28.TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under section 1861(v)(1)
(I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four (4) years after
the furnishing of services under this Agreement, CONTRACTOR shall make available, upon written request
to the Secretary of the United States Department of Health and Human Services, or upon request to the
Comptroller General of the United States General Accounting Office, or any of their duly authorized
representatives, a copy of this Agreement and such books, documents, and records as are necessary to
certify the nature and extent of the costs of these services provided by CONTRACTOR under this
Agreement. CONTRACTOR further agrees that in the event CONTRACTOR carries out any of its duties
under this Agreement through a subcontract, with a value or cost of Ten Thousand and No/100 Dollars
($10,000.00) or more over a twelve (12) month period, with a related organization, such Agreement shall
contain a clause to the effect that until the expiration of four (4) years after the furnishing of such services
pursuant to such subcontract, the related organizations shall make available, upon written request to the
Secretary of the United States Department of Health and Human Services, or upon request to the
Comptroller General of the United States General Accounting Office, or any of their duly authorized
representatives, a copy of such subcontract and such books, documents, and records of such organization
as are necessary to verify the nature and extent of such costs.
29.GOVERNING LAW
The parties agree, that for the purposes of venue, performance under this Agreement is
to be in Fresno County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
30.STATE ENERGY CONSERVATION
CONTRACTOR must comply with the mandatory standard and policies relating to energy
efficiency which are contained in the State Energy Conservation Plan issued in compliance with 42 United
States (US) Code sections 6321, et. seq.
31.CLEAN AIR AND WATER
In the event the funding under this Agreement exceeds One Hundred Thousand and No/100
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Dollars ($100,000), CONTRACTOR shall comply with all applicable standards, orders or requirements
issued under the Clean Air Act contained in 42 U.S. Code 7601 et seq.; the Clean Water Act contained in
U.S. Code 1368 et seq.; and any standards, laws and regulations, promulgated thereunder. Under these
laws and regulations, CONTRACTOR shall assure:
A.No facility shall be utilized in the performance of the Agreement that has been
listed on the Environmental Protection Agency (EPA) list of Violating Facilities;
B.COUNTY shall be notified prior to execution of this Agreement of the receipt of
any communication from the Director, Office of Federal Activities, U.S. EPA indicating that a
facility to be utilized in the performance of this Agreement is under consideration to be listed on
the EPA list of Violating Facilities;
C.COUNTY and U.S. EPA shall be notified about any known violation of the
above laws and regulations; and,
D.This assurance shall be included in every nonexempt subgrant, contract, or
subcontract.
32.DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is disclosing entities, fiscal agents, or managed
care entities, as defined in Code of Federal Regulations (C.F.R.), Title 42 §§ 455.101, 455.104 and
455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR by completing Exhibit G, “Disclosure of
Ownership and Control Interest Statement”, attached hereto and by this reference incorporated herein and
made part of this Agreement. CONTRACTOR shall submit this form to the COUNTY within thirty (30) days
of the effective date of this Agreement. Additionally, CONTRACTOR shall report any changes to this
information within thirty-five (35) days of occurrence by completing Exhibit G. Submissions shall be
scanned portable document format (pdf) copies and are to be sent via email to COUNTY’s DBH and DPH
assigned Staff Analyst.
CONTRACTOR is required to submit a set of fingerprints for any person with a five (5)
percent or greater direct or indirect ownership interest in CONTRACTOR. COUNTY may terminate this
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Agreement where any person with a five (5) percent or greater direct or indirect ownership interest in the
CONTRACTOR did not submit timely and accurate information and cooperate with any screening
method required in CFR, Title 42, Section 455.416. Submissions shall be scanned pdf copies and are
to be sent via email to DBHContractedServices@fresnocountyca.gov and
DPHContracts@fresnocoutyca.gov. COUNTY may deny enrollment or terminate this Agreement where
any person with a five (5) percent or greater direct or indirect ownership interest in CONTRACTOR has
been convicted of a criminal offense related to that person’s involvement with the Medicare, Medicaid, or
Title XXI program in the last ten (10) years.
33.CHANGE OF LEADERSHIP/MANAGEMENT
In the event of any change in the status of CONTRACTOR’s leadership or management,
CONTRACTOR shall provide written notice to COUNTY within thirty (30) days from the date of change.
Such notification shall include any new leader or manager’s name, address and qualifications.
“Leadership or Management” shall include any employee, member, or owner of CONTRACTOR who
either a) directs individuals providing services pursuant to this Agreement, b) exercises control over the
manner in which services are provided, or c) has authority over CONTRACTOR’s finances.
35.NOTICES
The persons and their addresses having authority to give and receive notices under this
Agreement include the following:
COUNTY CONTRACTOR
Director, County of Fresno Unilab Corporation, dba Quest Diagnostics
Department of Public Health Commercial Contracting
P.O. Box 11867 1201 S. Collegeville Road
Fresno, CA 93775 Collegeville, PA 19426
DPHContracts@fresnocoutyca.gov commercialcontracting@questdisgnostics.com
Director, County of Fresno
Department of Behavioral Health
1925 E. Dakota Ave.
Fresno, CA 93726
DBHContractedServices@fresnocountyca.gov
All notices between the COUNTY and CONTRACTOR provided for or permitted under this Agreement
must be in writing and delivered either by personal service, by first-class United States mail, by an
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overnight commercial courier service, or by telephonic facsimile transmission or delivered via email. A
notice delivered by personal service is effective upon service to the recipient. A notice delivered by first-
class United States mail is effective three COUNTY business days after deposit in the United States
mail, postage prepaid, addressed to the recipient. A notice delivered by an overnight commercial
courier service is effective one COUNTY business day after deposit with the overnight commercial
courier service, delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
the recipient. A notice delivered by telephonic facsimile is effective when transmission to the recipient is
completed (but, if such transmission is completed outside of COUNTY business hours, then such
delivery shall be deemed to be effective at the next beginning of a COUNTY business day), provided
that the sender maintains a machine record of the completed transmission. For all claims arising out of
or related to this Agreement, nothing in this section establishes, waives, or modifies any claims
presentation requirements or procedures provided by law, including but not limited to the Government
Claims Act (Division 3.6 of Title 1 of the Government Code, beginning with section 810).
36.ELECTRONIC SIGNATURE
The parties agree that this Agreement may be executed by electronic signature as provided
in this section. An “electronic signature” means any symbol or process intended by an individual signing
this Agreement to represent their signature, including but not limited to (1) a digital signature; (2) a faxed
version of an original handwritten signature; or (3) an electronically scanned and transmitted (for example
by PDF document) of a handwritten signature. Each electronic signature affixed or attached to this
Agreement (1) is deemed equivalent to a valid original handwritten signature of the person signing this
Agreement for all purposes, including but not limited to evidentiary proof in any administrative or judicial
proceeding, and (2) has the same force and effect as the valid original handwritten signature of that
person. The provisions of this section satisfy the requirements of Civil Code section 1633.5, subdivision
(b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part 2, Title 2.5, beginning with
section 1633.1). Each party using a digital signature represents that it has undertaken and satisfied the
requirements of Government Code section 16.5, subdivision (a), paragraphs (1) through (5), and agrees
that each other party may rely upon that representation. This Agreement is not conditioned upon the
parties conducting the transactions under it by electronic means and either party may sign this Agreement
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with an original handwritten signature.
37.SEVERABILITY
The provisions of this Agreement are severable. The invalidity or unenforceability of any
one provision in the Agreement shall not affect the other provisions.
38.ENTIRE AGREEMENT
This Agreement, including all exhibits, constitutes the entire agreement between the
CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understanding of any nature whatsoever unless expressly included in this Agreement.
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IN WITNESS WHEREOF , the parties hereto have executed this Agreement as of the day and year
first hereinabove written .
4 CONTRACTOR:
UNILAB CORPORATION dba QUEST
5 DIAGNOSTICS
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10 Patrick Plewman
11 Print Name & Title
VP & GM -west Region
(Chairman of the Board , or President or Vice
12 President)
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(Authorized Signature)
COUNTY OF FRESNO:
ATTEST:
, Chairman of the Board of
the County of Fresno
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno, State of California
By :
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Jean-Marc Halbout vice President, west Region
Print Name & Title
(Corporation, or any Assistant Secretary , or Chief
Financial Officer, or any Assistant Treasurer)
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23 Fund/Subclass:
Account:
24 Organization:
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0001/10000
7295
5620 ($543,000)
1620 ($57 I 000)
1639 ($35,000)
1645 ($30 ,000)
1648 ($12 ,000)
1650 ($287,000)
1019 ($122 ,000)
5630 ($110,000)
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EXHIBIT A
SCOPE OF WORK
GROUPS I AND II
DEPARTMENTS OF PUBLIC HEALTH
AND BEHAVIORAL HEALTH SERVICE REQUIREMENTS
The contractor will be responsible for providing all needed supplies for specimen
collection, collecting and picking up from the various sites.
Services include, but are not limited to, supplies for specimen collections, phlebotomy
services, specimen pick-up and delivery, laboratory testing, critical value reporting and
timely response for STAT and routine laboratory orders. These services will be required
for the operation of County of Fresno and metropolitan Fresno-Clovis sites as outlined
below.
Contractor will provide all laboratory services and necessary supplies. Contractor must
be CLIA (Clinical Laboratory Improvement Amendments) certified. Laboratory services
will be provided in response to telephone or fax requests from authorized nursing or
clerical staff acting as agents of assigned licensed physicians or from requests ordered
through the computer system.
1. Blood draws/specimen collection will be performed by the Contractor.
Occasionally, County staff will do the collection, as deemed necessary, by
County staff ordering the testing. Contractor will provide a lab book to DBH
outlining specific procedures for specimen collection that are necessary for
processing/testing, such as collection requirements, storage requirements,
minimum volumes, etc.
2. The Contractor will provide blood draw services up to 3 days each week for a
period of up to 3.5 hours at the DBH Metro Outpatient site located at: 4441 E.
Kings Canyon Road, Fresno, CA 93702. The specific days will be determined by
the DBH Medical Director, or designee.
3. The Contractor shall provide services at the collection sites during the hours of
operation set forth in Exhibit B of this Agreement.
4. All STAT services will be provided Monday – Sunday 7:00am – 7:00pm. at
designated DBH facilities. All specimen pick-ups, where necessary, will be
performed by the Contractor or a subcontractor of Contractor. STAT response
time will be within two hours of receipt of request. In the event a STAT is needed
between 7:00pm – 7:00am, Contractor will make every effort to accommodate
the request. DBH have approximately 10 STAT requests per year.
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5. Contractor will make all reasonable efforts with Reporting of Critical Test Values
within 30 minutes after verification and ordering physician will be called with
name, date and time of specimen collection, along with test results, as well as
patient’s/client’s DOB (Date of Birth) when necessary. Reporting of Critical Test
Values. ordered during regular business hours (Monday through Friday 8:00 am
– 5:00 pm) for DBH shall be provided to the Metro Outpatient nurses with name,
date and time of specimen collection, and test results, as well as patient’s/client’s
DOB (Date of Birth) when necessary. Reporting for Critical Test Values ordered
outside regular business hours for DBH shall be provided directly to the DBH
Nurse Manager, and if the manager is not available, then the values shall be
provided to the Medical Director with name, date and time of specimen collection,
and test results, as well as patient’s/client’s DOB (Date of Birth) when necessary.
Critical Test Value reporting is rare for DBH and DPH. Critical Test Values also
known as “critical values” and “critical results” are test results that fall significantly
outside the normal range and may represent life-threatening values even if from
routine tests. Reporting of Critical Test Values will be in accordance with
Contractor’s Policy for Priority Result Reporting. Reporting process may be
adjusted as needs arise as mutually agreed.
6. Billings for services will be submitted on a monthly invoice statement and are to
be listed by Department and cost center, listing the full name of the patient/client,
date of birth, Fresno County Medical Record Number, date of service and name
of laboratory test. Payments may be delayed if invoices are incomplete or
incorrect.
Invoices are to be sent to:
Department of Public Health (DPH) P.O. Box 11867
Fresno, CA 93775
(email: dphboap@fresnocountyca.gov)
Department of Behavioral Health
(DBH)
4441 E. Kings Canyon Road
Fresno, CA 93702
7. Billing Discrepancies: The County prefers the Contractor provide one
centralized person as the contact to address billing questions and discrepancies
for DPH and DBH. The Contractor is to respond to inquiries in a timely manner –
within 7 business days.
8. Public Health requires a daily 4:30 pm specimen pick-up. All DPH specimens are
to be picked up in the TB Clinic. Located at 1221 Fulton Street, First Floor,
Fresno, CA 93721.
9. Specimen pick-up for DBH shall be no later than 4:00 pm.
10. The Contractor shall be responsible for billing Medi-Cal for Medi-Cal eligible
clients as well as other applicable third-party insurances. The Contractor shall
collect necessary information pertinent to billing Medi-Cal and third-party
insurances from clients. DBH reports that currently approximately 45% of their
outpatient billings are Medi-Cal. These Medi-Cal percentages could change if
the department can see only Medi-Cal recipients. Approximately 46% of the
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Page 3 of 7
clients DPH treats are Medi-Cal or Medi-Cal eligible, or have other third-party
insurance.
11. The Contractor shall provide online access to printable test results, requests and
lab results twenty-four hours (24) per day 365 days per year.
12. The Contractor shall provide online access to lab results to medical staff and
these results must be printable. Common tests, such as CBCs, will be available
online within 24 hours of collection. Specialty tests such as Medication level and
Hep-C tests will be available online within 5 days.
13. The County requires at least 60 days’ prior notice, or reasonable notice, of any
and all system changes that impact portal access, invoicing and requisition
forms. The notice should include what change is taking place, when it is
happening, what is causing the change, what will be impacted (i.e., internet
access, account numbers, test codes, etc.) and how it will be implemented. If the
changes will impact existing account numbers, the Contractor will provide
detailed steps that will be taken to avoid duplicate billing.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Page 4 of 7
EXHIBIT A
SCOPE OF WORK
GROUP I
DEPARTMENT OF PUBLIC HEALTH
TYPES OF REQUIRED CLINICAL LABORATORY TESTS
The following are the types of tests that the Public Health Department believes will be required
and are best estimates only The County does not guarantee any minimums for any of the tests
listed below.
Program Types of Tests
County Laboratory Majority of tests are T-Lymphocyte Helper CD
Panels and miscellaneous other tests
Chest Clinic Tests include Coccidiodal Serology Panels, liver
function panels, TSH and miscellaneous other tests
HIV Prevention Testing HIV Screening, HIV-1/2 Antigens and Antibodies
(CPT Code 91431), HIV-1/2 Antibody- HIV-
Differentiation (CPT Code 91432), and HIV-1 RNA
comprise the bulk of testing in this area.
COVID-19 Approximately 145 RNA diagnostic tests per month,
or 1,740 tests annually
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Page 5 of 7
EXHIBIT A
SCOPE OF WORK
GROUP II
DEPARTMENT OF BEHAVIORAL HEALTH
TYPES OF REQUIRED CLINICAL LABORATORY TESTS
The following are the types of tests that the Behavioral Health Department believes will be
required and are best estimates only The County does not guarantee any minimums for any of
the tests listed below.
Program Types of Tests
Metro Outpatient Services Majority of tests are CBC differential, mostly for Clozaril monitoring
(30%) and Blood Drawing (15%). Other tests include TSH,
Comprehensive Metabolic Panel, Valproic Acid, Lipid Profile,
Lithium, Hepatic Function Panel, Glucose Plasma, Triglycerides,
AST, Glucose Random, Prolactin, Urine Toxicology, Hemoglobin
A1C Immunoassay, EtOH serum, Drug Abuse Panel 9 Serum, and
miscellaneous other tests.
Pathways to Recovery Tests include, but are not limited to, Urine Toxicology and
miscellaneous other tests.
Older Adult Mental Health
Clinic
Tests include, but are not limited to, Comprehensive Metabolic
Panel, CBC differential, Lipid Panel, Hemoglobin A1C
Immunoassay, TSH, Urinalysis Reflex, Valporic Acid, etc.
COVID-19 Approximately 166 RNA diagnostic tests per month, or 2,000 tests
annually at the facilities below:
Central Star Behavioral Health, Inc.
Youth Psychiatric Health Facility
4411 E Kings Canyon Rd Building 319
Fresno, CA 93702
Central Star Behavioral Health, Inc.
Crisis Residential Treatment Facility
496 S Barton Ave
Fresno, CA 93702
Exodus Crisis Stabilization Center
4411 E Kings Canyon Rd Building 319
Fresno, CA 93702
Exodus Adult Psychiatric Health Facility
4411 E Kings Canyon Rd Building 319
Fresno, CA 93702
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Page 6 of 7
EXHIBIT A
SCOPE OF WORK
GROUP I
DEPARTMENT OF PUBLIC HEALTH
LABORATORY SERVICES FOR FACILITIES THAT OPERATE
MONDAY THROUGH FRIDAY, 8:00 A.M. TO 5:00 P.M.
Please note that Billing/Cost Center numbers listed at the end of each program below are for
internal use only. DPH facilities and programs that require Contractor’s services in clude, but are
not limited, to the following:
1. Chest Clinic, 1221 Fulton Street, Fresno, CA 93721, phone: (559) 600-3413.
(BILLING/COST CENTER #56201650)
The Chest Clinic provides services for the detection, prevention and treatment of TB,
specifically, skin testing, chest X-rays, prevention treatment, and diagnosis of an active
disease. The clinic also operates a Directly Observed Therapy outreach unit which
monitors and ensures patient compliance with the prescribed treatment plan. The state
and federal government have established priorities and objectives which are designed to
address the highest priorities in TB control: (1) The first priority is to identify persons who
have active TB cases and ensure that they complete appropriate therapy, including using
confinement measures in exceptional cases. (2) The second priority is to find and screen
persons who have been in contact with TB clients to determine whether they have TB
infection or disease and provide them with appropriate treatment. (3) The third is to
screen high-risk populations to detect persons who are identified with Multiple Drug
Resistant TB.
2. Drug Alcohol Testing, 1221 Fulton Street, Fresno, CA 93721, phone: (559) 600-3434.
(BILLING/COST CENTER # 56201639)
HIV counseling and screening services are provided to individuals who are currently
participating in drug/alcohol treatment programs, both residential as well as outpatient
programs. The program is supported through an interagency agreement with the
Substance Abuse Division. In addition to counseling and testing services, group
education is provided to clients as well as regular program updates with the staff of
participating programs.
3. HIV Prevention Testing, 1221 Fulton Street, Fresno, CA 93721, phone: (559) 600-3434
(BILLING/COST CENTER #56201645)
HIV counseling and screening services are provided to individuals who demonstrate an
increased risk for HIV transmission. This program is supported through a grant from the
California Department of Public Health.
4. COVID-19 Testing. 1221 Fulton Street, Fresno, CA 97321, phone (559) 600-3200,
(BILLING/COST CENTER #56201019)
As part of DPH’s ongoing emergency response to the COVID-19 pandemic, DPH staff
will continue to collect SARS-CoV-2 viral RNA tests. From the time period of July 1, 2020
through September 30, 2020 approximately 5,200 tests were submitted.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Page 7 of 7
SCOPE OF WORK
GROUP II
DEPARTMENT OF BEHAVIORAL HEALTH
LABORATORY SERVICES FOR FACILITIES THAT OPERATE
MONDAY THROUGH FRIDAY, 8:00 A.M. TO 5:00 P.M.
Please note that Billing/Cost Center numbers listed at the end of each program below are for
internal use only. DBH facilities and programs that require Contractor’s services include, but are
not limited, to the following:
1. Metro Outpatient Services, 4441 E. Kings Canyon Road, Fresno, CA 93702, phone (559)
600-4099, fax (559) 600-9135. (BILLING/COST CENTER # 56302920)
Metro Services provides culturally appropriate therapeutic outpatient and rehabilitative
group services to seriously and persistently mentally ill and homeless mentally ill
consumers. Staff provides medication administration and education, monitor medication
levels for consumers and perform physical and mental health assessments.
2. Older Adult Mental Health Clinic, 2025 E. Dakota Ave., Fresno, CA 93726, phone (559)
600-5755, fax (559) 229-2982. (BILLING/COST CENTER # 56304610)
3. Pathways to Recovery, Building 320, 515 S. Cedar Avenue, Fresno, CA 93702, phone
(559) 600-6068, fax (559) 600-6090. (BILLING/COST CENTER # 56302093 and
56302096)
Pathways to Recovery offers a three-track program that provides outpatient substance
abuse treatment services for pregnant and parenting women, mental health services for
CalWORKs clients and co-occurring services for clients with co-existing mental health
and substance abuse challenges.
4. COVID-19 Testing, locations listed on Page 5, phone (559) 600-9180. (BILLING/COST
CENTER #56301019)
As part of DBH’s ongoing emergency response to the COVID-19 pandemic, DBH
contracted health and treatment facility staff will collect approximately 2,000 SARS-CoV-2
viral RNA tests from July 1, 2020 through June 30, 2021.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
EXHIBIT B
Fresno County
Patient Service Centers
(PSC’s)
The most up-to date PCS locations can be found on the below link
https://appointment.questdiagnostics.com/patient/confirmation
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
N Bethel9th Street
Sanger
Jensen Ave
Walgreens
UnitedHealthCenter
9th Street
E Jensen Ave
WalmartSupercenter
Dollar Tree
SangerPavillions
2
Kearney Blvd
Whitesbridge
Belmont 145
180
KFC
DelNorteMadera AveVinelandKerman
21 3Sanger
2675 Jensen Ave, Suite B
Sanger, CA 93657
Phone: (559) 876-6494
Fax: (559) 876-6530
Selma
1122 E. Rose Ave., Suite 2
Selma, CA 93662
Phone: (559) 891-1358 Hours:
Fax: (559) 891-8718 *M-F 7-11:30/12:30-4
Kerman
177 S. Madera Ave
Kerman, CA 93630
Phone: (559) 846-7353 Hours:
Fax: (559) 846-8898 *M-F 8-12:30, 1-4:30
Redwood Ln.Dockery Ave.Country Club LaneEvergreen St.
SelmaCommunityHospital
E. Rose Ave.3
Selma
Hours:
*M-F 8-12:30, 1-4:30
UDS Hours:
8:30-11:00/12:00-2:00 *M-F 7-11, 12-4
Hours:
*M-F
7:00-4:00
Hours:
*M-F 6:30-3:30
*M-F 6:30-11:00/12:00-3:30
UDS Hours:
UDS Hours:
9:00-11:00/12:30-2:00
UDS Hours:
9:00-3:00
UDS Hours:
9:00-2:00
9:00-2:00
Reedley
Sanger
5
99
Almond
Golden
State
Madera
Community
Hospital
Madera
198
Phelps
Coalinga
Hospital
4
Coalinga
4 5
7 Chowchilla
1104 Ventura Ave
Chowchilla, CA 93610
Phone: (559) 665-7286 Hours:
Fax: (559) 665-7864 *M-F 7:00-11:30/12:30-3:30
Madera
1000 E. Almond #101
Madera, CA 93637
Phone: (559) 662-8993 Hours:
Fax: (559) 662-8995 *M-F 7:30-5
Coalinga
1165 E. Phelps Ave, Suite 107
Coalinga, CA 93210
Phone: (559) 934-1531
Hours:
Fax: (559) 934-1642
*M-F 7:00-11:30/12:30-4:00
41
Victoria
Lane
Elderberry
House
Oakhurst
Community
Urgent Care
49
6
Oakhurst
6 Oakhurst
48677 Victoria Lane
Oakhurst, CA 93644
Phone: (559) 683-0909
Hours:
Fax: (559) 658-7075
*M-F 7:00-4:00
341 Trinity Avenue
363 E. Almond, Suite 107 Hours:
*M-F 7:30-4:30
8 Reedley
1104 Ventura Ave
Reedley, CA 95654
Phone: (559) 637-9530
Hours:
Fax: (559) 637-9549
*M-F 7:00-11:00/12:00-4:00
789 N. Reed Avenue
Chowchilla
UDS Hours:
8:30-11:00/12:00-2:30
DSCS
1
7
8
UDS Hours:
9:00-3:00
9:00-3:00
UDS Hours:
Quest Diagnostics
Because it’s more that just a blood test.
It’s about your health
Fresno & Madera Counties
Patient Service Center (PSC) Directory
*Hours subject to change
DSCS Indicates Drug Screen Collection Site
See reverse for Quest Diagnostics
Patient Service Center Checklist
To find additional Quest Diagnostics
Patient Service Centers in your area please
log onto www.questdiagnostics.com
or call 800-377-8448.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Quest Diagnostics
Because it’s more than just a blood test.
It’s about your health.
Fresno and Clovis
Patient Service Center (PSC) Directory
See reverse for Quest Diagnostics Patient
Service Center Checklist
To find additional Quest Diagnostics Patient
Service Centers in your area please log
onto www.questdiagnostics.com or call
800-377-8448.
DSCS Indicates Drug Screen Collection Site
*Hours subject to change
7035 N. West Ave., Suite 107
Fresno, CA 93711
Phone: (559) 431-4382
Fax: (559) 431-5893
Hours:Hours: *M-F 6:30-3:30
6307 N. Fresno St., Suite 101
Fresno, CA 93710
Phone: (559) 432-4789
Fax: (559) 432-5336
Hours:Hours:
*M-F 7:00-4:00
4182 N. First Street, Suite 103
Fresno, CA 93726
Phone: (559) 230-0992
Fax: (559) 225-2982
Hours:Hours:
*M-F: 6:30-4:30
Sat. 7:00-12:00
Clovis - VonsClovis - Vons
1650 Herndon Avenue
Phone: 559-299-3157
Fax: 559-325-6535
Hours:Hours:
*M-F: 7:00-11:00/
12:00-4:00
(Appointments ONLY
until 12:30. Walk-ins
welcome AFTER 12:30)
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit C - DPH Schedule of Fees
SCHEDULE OF FEES
DEPARTMENT OF PUBLIC HEALTH
TEST Estimated UNIT TOTAL
NAME Annual Usage PRICE
1.Amphetamine conf (GC/MS)28 108.73$ 3,044.44$
2.Cannabinoid conf (GC/MS)30 35.00$ 1,050.00$
3.Cocaine conf (GC/MS)28 25.00$ 700.00$
4.Opiates conf (GC/MS)22 108.73$ 2,392.06$
5.Phencyclidine (PCP) conf (GC/MS)11 35.00$ 385.00$
6.Ethanol conf (GC/MS)22 108.73$ 2,392.06$
7.RPR (screening)633 6.00$ 3,798.00$
8.Direct Bilirubin (CPT Code = 82248)98 2.92$ 286.16$
9.Total Bilirubin (CPT Code = 82247)1 2.92$ 2.92$
10.Complete Urinalysis (CPT Code = 81000)420 4.25$ 1,785.00$
11.General Bacterial Culture 198 22.00$ 4,356.00$
12.Glucose 15 2.92$ 43.80$
13.Gonorrhea Culture 244 25.00$ 6,100.00$
14.Gram Stain 151 6.00$ 906.00$
15.Lipid Panel 33 9.28$ 306.24$
16.Liver Function Panel (CPT Code = 80061)83 3.84$ 318.72$
17.Magnesium 550 7.50$ 4,125.00$
18.Metabolic Panel (CPT Code= 80048) 141 4.00$ 564.00$
19.Mycobacterial Acid Fast Smear 905 50.00$ 45,250.00$
20.Mycobacterial Culture 905 35.00$ 31,675.00$
21.Phosphorus 17 2.92$ 49.64$
22.SDA for Gonorrhea 2310 25.00$ 57,750.00$
23.SDA for Chlamydia 2376 25.00$ 59,400.00$
24.Sed Rate (ESR) Westergren 14 7.03$ 98.42$
25.Stool Culture 42 20.00$ 840.00$
26.T-3, Total (CPT Code = 84480)1 29.54$ 29.54$
27.T-4 (Thyroxine), Total 9 16.95$ 152.55$
28.TPPA (confirmation)29 10.00$ 290.00$
29.TSH 220 8.32$ 1,830.40$
30.Uric Acid 110 3.10$ 341.00$
31.Urinalysis (Micro only)(CPT Code = 81002)2 5.00$ 10.00$
32.Urinalysis (w/o Micro)(CPT Code = 81015)22 1.96$ 43.12$
33.Urine Culture 432 11.00$ 4,752.00$
34.VDRL (CSF only)1 27.40$ 27.40$
35.CBC with Differential 44 5.00$ 220.00$
36.Cocciodioial Serology Panel 6 160.08$ 960.48$
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit C - DPH Schedule of Fees
TEST Estimated UNIT TOTAL
NAME Annual Usage PRICE
37.Comprehensive Metabolic Panel* (CPT 12 5.00$ 60.00$
Code = 80053; *different from Metabolic
Panel
38.Hemoglobin A1C Immunoassay 193 10.00$ 1,930.00$
39.Hemogram (BC w/platelet count)117 2.60$ 304.20$
40.Hepatitis A Antibody, IgM 34 8.00$ 272.00$
41.Hepatitis B Core Antibody 56 11.40$ 638.40$
42.Hepatitis B Surface Antibody 133 10.00$ 1,330.00$
43.Hepatitis B Surface Antigen 61 7.00$ 427.00$
44.Hepatitis C (Anti-HCV)79 88.00$ 6,952.00$
45.Herpes Simplex Virus, Type I and II, IgG 47 20.85$ 979.95$
46.Herpes Simplex Virus, Type I and II, IgM 47 50.00$ 2,350.00$
47.HIV 1 and HIV 2 Antibody (HIV Serology)44 18.00$ 792.00$
48.HIV 1 Western Blot 13 245.00$ 3,185.00$
49.HIV-1 RNA, QUAL, Real Time PCR (Viral Load Tests)132 300.00$ 39,600.00$
50.HIV Screen Only 550 70.00$ 38,500.00$
51.Lymphocyte Subset Panel 229 63.95$ 14,644.55$
52.PAP, SurePath Focal Point 134 30.00$ 4,020.00$
53.PAP, Thin Layer Prep 15 35.00$ 525.00$
54.Prostate-specific Antigen 77 15.00$ 1,155.00$
55.Prothrombin Time 33 8.00$ 264.00$
56.Renal Functional Panel (CPT Code = 80069)193 4.34$ 837.62$
57.STS (Rapid Plasma Reagin) Qual 12 5.20$ 62.40$
58.Thyroid Stimulating Hormone (3rd Generation)22 8.30$ 182.60$
59.T-Lymphocyte Helper/CD 131 30.75$ 4,028.25$
60.Toxoplasma Gondii Antibody IgG 77 12.04$ 927.08$
61.HIV-1/2 Antigens and Antibodies, 605 18.00$ 10,890.00$
Fourth Generation, with Reflexes, CPT 91431
62.HIV-1/2 Antibody Differentiation, CPT 91432 121 18.00$ 2,178.00$
63.SARS-CoV-2 RNA (COVID-19) Qualitative 1740 69.00$ 120,060.00$
TOTAL 493,370.00$
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Attachment D - DBH Schedule of Fees
SCHEDULE OF FEES
DEPARTMENT OF BEHAVIORAL HEALTH
TEST ESTIMATED UNIT TOTAL
NAME ANNUAL USAGE PRICE
1.Acute Hepatitis Panel 10 $45.76 $457.60
2.Alcohol (Ethanol) Urine 3 $50.00 $150.00
3.Alcohol, Ethyl (B)3 $52.00 $156.00
4.Amitriptyline 10 $46.80 $468.00
5.Amphetamine Conf by GC/MS, Urine 83 $40.00 $3,320.00
6.Basic Metabolic Panel 17 $4.00 $68.00
7.Barbiturates by GC/MS Urine 7 $78.00 $546.00
8.Benzodiazepines Conf (GC/MS) Urine 17 $108.73 $1,848.41
9.Blood drawing 1287 $8.00 $10,296.00
10.Carbamazinepine (Tegretol)17 $8.32 $141.44
11.CBC (Includes Diff/Plt)2750 $5.00 $13,750.00
12.CBC (RBC, H/H, Indices, WBC, Plt)110 $3.70 $407.00
13.Cholesterol Direct LDL 11 $2.08 $22.88
14.Clozapine 220 $30.00 $6,600.00
15.Comprehensive Metabolic Panel 798 $5.00 $3,990.00
16.Culture, Urine, Routine 11 $11.00 $121.00
17.Drug Abuse Panel 9, Serum 22 $130.00 $2,860.00
18.Drug Screen with Alcohol 22 $5.00 $110.00
19.Drug Test, General Toxicology , (B)39 $150.00 $5,850.00
20.Drug Test, General Toxicology , (SP)3 $150.00 $450.00
21.EIA 10 20 $54.59 $1,091.80
22.EIA 10 + Alcohol 20 $55.00 $1,100.00
23.EIA 7 + Alcohol w/ GC/MS 673 $55.00 $37,015.00
24.EIA 7 + Alcohol w/o Rflx 23 $53.35 $1,227.05
25.Ferritin 3 $26.00 $78.00
26.GGT 7 $15.60 $109.20
27.Glucose 28 $2.92 $81.76
28.Glucose, plasma 20 $2.94 $58.80
29.HCG, Total QL 26 $6.00 $156.00
30.HCG, Total QN 10 $14.56 $145.60
31.Hemoglobin A1C Immunoassay 550 $10.00 $5,500.00
32.Hep B Surface Ag w/Reflex Confirm 17 $7.00 $119.00
33.Hepatic Panel Acute w/ Ref 3 $45.76 $137.28
34.Hepatic Function Panel 13 $3.84 $49.92
35.Hepatitis B Surface AB, Qual 7 $26.00 $182.00
36.Hepatitis C 17 $11.44 $194.48
37.HIV AB, HIV 1/2, EIA, with Reflex 17 $18.00 $306.00
38.Iron and IBC w/o Reflex 3 $15.00 $45.00
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Attachment D - DBH Schedule of Fees
39. Lipid Panel with Reflex to Direct LDL 72 $9.28 $668.16
40. Lipid Profile 506 $9.28 $4,695.68
41. Lithium 83 $10.00 $830.00
42. Magnesium, Serum 20 $7.50 $150.00
43. Marijuana Metabolite, Quant, Urine 96 $35.00 $3,360.00
44. Nortriptyline 11 $29.99 $329.89
45. Olanzapine 55 $74.00 $4,070.00
46. Opiates, Confirmation by GC/MS, UR 30 $35.00 $1,050.00
47. Phenytoin (Dilantin) 2 $10.40 $20.80
48. Potassium, Serum 2 $2.92 $5.84
49. Pregnancy Test, Urine 17 $10.00 $170.00
50. Prolactin 39 $6.76 $263.64
51. Prostate Specific Antigen (PSA) 7 $15.00 $105.00
52. Renal Function Panel 3 $4.34 $13.02
53. Risperidone 11 $95.68 $1,052.48
54. RPR/Reflex TPPA 86 $5.20 $447.20
55. SARS-CoV-2 RNA (COVID-19) Qualitative 5200 $69.00 $358,800.00
56. STAT Charge 22 $30.00 $660.00
57. STS Titer + T. Pallidum-PA Reflex 10 $5.21 $52.10
58. T3 Total (Triiodothyronine) 3 $29.54 $88.62
59. T3 Uptake 17 $10.40 $176.80
60. T3, Free 3 $52.00 $156.00
61. T4 (Thyroxine) 3 $16.95 $50.85
62. T4, Free 26 $8.00 $208.00
63. Triglycerides 17 $4.68 $79.56
64. TSH 495 $8.32 $4,118.40
65. TSH Reflex to Free T4 17 $8.32 $141.44
66. Urinalysis C+S, If IND 13 $4.25 $55.25
67. Urinalysis Macroscopic 3 $1.96 $5.88
68. Urinalysis Microscopic 7 $2.30 $16.10
69. Urinalysis, Complete 3 $4.25 $12.75
70. Urinalysis, Macro w/Reflex to Micro 23 $1.96 $45.08
71. Valproic Acid 193 $15.60 $3,010.80
72. Vitamin B-12 and Folate 61 $10.00 $610.00
73. Vitamin D, 25-hydroxy, LC/MS/MS 39 $50.96 $1,987.44
74. Phlebotomy Fee/ hourly rate $25.00
$486,716.00
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit E - State Mental Health Requirements Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business
and Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all
State of California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates
of pay or other forms of compensation, use of facilities, and other terms
and conditions of employment.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit E
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C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further
funds, until CONTRACTOR can show clear and convincing evidence to
the satisfaction of COUNTY that funds provided under this Agreement
were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY’s Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted,
complied with the non-discrimination program requirements. (Gov. Code§ 12990
(a-f) and CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: CONTRACTOR will comply
with the requirements of the Drug-Free Workplace Act of 1990 and will provide a
drug-free workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is
prohibited and specifying actions to be taken against employees for
violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
c. Every employee who works on this Agreement will:
1) receive a copy of the company's drug-free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit E
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CONTRACTOR may be ineligible for award of any future State agreements if the
department determines that any of the following has occurred: the
CONTRACTOR has made false certification, or violated the certification by failing
to carry out the requirements as noted above. (Gov. Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR
certifies that no more than one (1) final unappealable finding of contempt of court
by a Federal court has been issued against CONTRACTOR within the
immediately preceding two (2) year period because of CONTRACTOR’s failure to
comply with an order of a Federal court, which orders CONTRACTOR to comply
with an order of the National Labor Relations Board. (Pub. Contract Code
§10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will
comply with the requirements of Section 6072 of the Business and Professions
Code, effective January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number
of hours of pro bono legal services during each year of the contract equal to the
lessor of 30 multiplied by the number of full time attorneys in the firm’s offices in
the State, with the number of hours prorated on an actual day basis for any
contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state
contract for legal services, and may be taken into account when determining the
award of future contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not
an expatriate corporation or subsidiary of an expatriate corporation within the
meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to
contract with the State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All CONTRACTORS contracting for the procurement or laundering of
apparel, garments or corresponding accessories, or the procurement of
equipment, materials, or supplies, other than procurement related to a
public works contract, declare under penalty of perjury that no apparel,
garments or corresponding accessories, equipment, materials, or
supplies furnished to the state pursuant to the contract have been
laundered or produced in whole or in part by sweatshop labor, forced
labor, convict labor, indentured labor under penal sanction, abusive forms
of child labor or exploitation of children in sweatshop labor, or with the
benefit of sweatshop labor, forced labor, convict labor, indentured labor
under penal sanction, abusive forms of child labor or exploitation of
children in sweatshop labor. CONTRACTOR further declares under
penalty of perjury that they adhere to the Sweatfree Code of Conduct as
set forth on the California Department of Industrial Relations website
located at www.dir.ca.gov, and Public Contract Code Section 6108.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit E
Page 4 of 6
b. CONTRACTOR agrees to cooperate fully in providing reasonable access
to the CONTRACTOR’s records, documents, agents or employees, or
premises if reasonably required by authorized officials of the contracting
agency, the Department of Industrial Relations, or the Department of
Justice to determine the contractor’s compliance with the requirements
under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following
provisions regarding current or former state employees. If CONTRACTOR has
any questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or
has a financial interest and which is sponsored or funded by any state
agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent contractor with any state agency to provide goods or
services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he
or she engaged in any of the negotiations, transactions, planning,
arrangements or any part of the decision-making process relevant to the
contract while employed in any capacity by any state agency.
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a
contract with any state agency if he or she was employed by that state
agency in a policy-making position in the same general subject area as
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit E
Page 5 of 6
the proposed contract within the twelve (12) month period prior to his or
her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not
receive payment other than payment of each meeting of the board or
commission, payment for preparatory time and payment for per diem. (Pub.
Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be
aware of the provisions which require every employer to be insured against
liability for Worker's Compensation or to undertake self-insurance in accordance
with the provisions, and CONTRACTOR affirms to comply with such provisions
before commencing the performance of the work of this Agreement. (Labor Code
Section 3700)
3. AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that
it complies with the Americans with Disabilities Act (ADA) of 1990, which
prohibits discrimination on the basis of disability, as well as all applicable
regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
CONTRACTOR’s name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior to approval
of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently
qualified to do business in California in order to ensure that all obligations
due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit.
Although there are some statutory exceptions to taxation, rarely will a
corporate contractor performing within the state not be subject to the
franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do
business in California. Agencies will determine whether a corporation is
in good standing by calling the Office of the Secretary of State.
6. RESOLUTION: A county, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local
governing body, which by law has authority to enter into an agreement,
authorizing execution of the agreement.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit E
Page 6 of 6
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
CONTRACTOR shall not be: (1) in violation of any order or resolution not
subject to review promulgated by the State Air Resources Board or an air
pollution control district; (2) subject to cease and desist order not subject to
review issued pursuant to Section 13301 of the Water Code for violation of waste
discharge requirements or discharge prohibitions; or (3) finally determined to be
in violation of provisions of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9. INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General,
and their designees may, at any time, inspect and audit any records or
documents of CONTRACTOR or its subcontractors, and may, at any time,
inspect the premises, physical facilities, and equipment where Medicaid-related
activities or work is conducted. The right to audit under this section exists for ten
(10) years from the final date of the contract period or from the date of
completion of any audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must
confirm the identity and determine the exclusion status of CONTRACTOR, any
subcontractor, as well as any person with an ownership or control interest, or
who is an agent or managing employee of CONTRACTOR through routine
checks of Federal databases. This includes the Social Security Administration's
Death Master File, the National Plan and Provider Enumeration System
(NPPES), the List of Excluded Individuals/Entities (LEIE), the System for Award
Management (SAM), and any other databases as the State or Secretary may
prescribe. These databases must be consulted upon contracting and no less
frequently than monthly thereafter. If the State finds a party that is excluded, it
must promptly notify the CONTRACTOR and take action consistent with §
438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under
this part is not located outside of the United States and that no claims paid by a
CONTRACTOR to a network provider, out-of-network provider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Page 1 of 2
Page 1 of 2
EXHIBIT F
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”), members
of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must disclose any
self-dealing transactions that they are a party to while providing goods, performing services, or both
for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest .”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self -dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the Corporation has the transaction;
and
b. The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4) Describe in detail why the self -dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self -dealing transaction
described in Sections (3) and (4).
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Page 2 of 2
Page 2 of 2
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: Date:
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit G
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I.Identifying Information
Name of entity D/B/A
Address (number, street) City State ZIP code
CLIA number Taxpayer ID number (EIN) Telephone number
( )
II.Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses of individuals or corporations under “Remarks” on page 2. Identify each item number to be continued.
A.Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
B.Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX? ...................................................................................... ❒ ❒
C.Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution’s, organization’s, or
agency’s fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ........... ❒ ❒
III.A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under “Remarks” on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under “Remarks.”
NAME ADDRESS EIN
B.Type of entity:❒Sole proprietorship ❒Partnership ❒Corporation
❒Unincorporated Associations ❒Other (specify)
C.If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under “Remarks.”
D.Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers. .......................................................................................................... ❒ ❒
NAME ADDRESS PROVIDER NUMBER
Unilab Corporation Quest Diagnostics
8401 Fallbrook Avenue West Hills CA 91304
71-0897031
X
X
X
Quest Diagnostics Incorporated 500 Plaza Drive, Secaucus, NJ 07094 16-1387862
X
See attached list - Annex B
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit G
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit G
YES NO
IV.A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C.Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V.Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
If yes, give date of change in operations.
VI.Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
B.If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative (typed) Title
Signature Date
Remarks
X
X
X
X
X
X
See attached list - Annex B
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
VP & GM - West Region
7/21/2021 | 12:17 PM PDT
Patrick Plewman
83932.1
ANNEX A
Quest Diagnostics Incorporated
500 Plaza Drive, Secaucus, NJ 070941
Directors and Officers
Directors
Vicky B. Gregg
Wright L. Lassiter, III
Timothy L. Main
Denise M. Morrison
Gary M. Pfeiffer
Timothy M. Ring
Stephen H. Rusckowski
Helen I. Torley
Gail R. Wilensky, Ph.D.
Officers
Stephen H. Rusckowski – Chairman, CEO and President
James E. Davis – EVP, General Diagnostics
Mark J. Guinan – EVP and CFO
Catherine T. Doherty – SVP and Group Executive, Clinical Franchise Solutions & Marketing
Carrie E. Eglinton Manner – SVP, Advanced Diagnostics
Michael E. Prevoznik – SVP and General Counsel
Sandip R. Patel – Vice President and Treasurer
William J. O’Shaughnessy, Jr., Secretary
1 All directors and officers located at this address.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
1
83060.1
ANNEX B
QUEST DIAGNOSTICS INCORPORATED (DE)1
(INCORPORATED ON DECEMBER 12, 1990 IN DELAWARE; EIN: 16-1387862)
SUBSIDIARIES, JOINT VENTURES AND AFFILIATES
COMPANY REGISTERED ALTERNATE NAME
100% Quest Diagnostics Holdings Incorporated (DE)
100% Quest Diagnostics Clinical Laboratories, Inc. (DE) Advanced Toxicology Network
Smithkline Beecham Clinical
Laboratories
Quest Diagnostics
Solstas Lab Partners Group
Solstas Lab Partners
100% LabOne, LLC (MO) Quest Diagnostics
LabOne, LLC of Kansas
100% ExamOne World Wide, Inc. (PA)
100% ExamOne LLC (DE)
100% ExamOne World Wide of NJ, Inc. (NJ)
51% DGXWMT JV, LLC (DE) Health Check by Quest Diagnostics
100% Quest HealthConnect, LLC (CA)
100% Quest Diagnostics Health & Wellness, LLC (DE)
100% LabOne of Ohio, Inc. (DE) Quest Diagnostics
LabOne
51% Diagnostic Laboratory of Oklahoma LLC (OK)
100% Mid America Clinical Laboratories, LLC (IN)
49% Sonora Quest Laboratories LLC (AZ)
100% Quest Diagnostics Incorporated (MD)
100% Quest Diagnostics Infectious Disease, Inc. (DE)
100% Quest Diagnostics LLC (IL) Quest Diagnostics LLC
100% Quest Diagnostics LLC (MA) Quest Diagnostics LLC
Quest Diagnostics of Connecticut
LLC
81.1% Quest Diagnostics Massachusetts LLC (MA)
100% Quest Diagnostics LLC (CT)
100% Quest Diagnostics Nichols Institute (CA) Nichols Institute
100% Quest Diagnostics of Pennsylvania Inc. (DE)
51% Quest Diagnostics Venture LLC (PA)
52.97% Associated Clinical Laboratories, L.P. (PA)
1 Registered Alternate Name: QDI Delaware Incorporated
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
2
83060.1
COMPANY REGISTERED ALTERNATE NAME
100% Quest Diagnostics TB, LLC (DE)
100 % Quest Diagnostics Ventures LLC (DE)
100% Athena Diagnostics, Inc. (DE)
100% American Medical Laboratories, Incorporated (DE)
100% Quest Diagnostics Nichols Institute, Inc. (VA) Nichols Institute
100% Quest Diagnostics Incorporated (NV) Quest Diagnostics Incorporated
of Nevada
Quest Diagnostics
100% Blueprint Genetics Inc. (DE)
100% Clearpoint Diagnostic Laboratories, LLC (TX)
100% Cleveland HeartLab, Inc. (DE) Cleveland Heartlab Services,
Inc.
100% Med Fusion, LLC (TX) med fusion
med fusion clin-trials
med fusion clin-labs
100% Nomad Massachusetts, Inc. (MA)
100% Reprosource Fertility Diagnostics, Inc. (MA)
100% Unilab Corporation (DE) Quest Diagnostics
100% AmeriPath, Inc. (DE)
100% AmeriPath Cincinnati, Inc. (OH) Richfield Laboratory of
Dermatopathology
100% AmeriPath Cleveland, Inc. (OH) AmeriPath GI Institute
Dermpath Diagnostics
100% AmeriPath Consolidated Labs, Inc. (FL)
100% AmeriPath Florida, LLC (DE) AmeriPath Central Florida
AmeriPath Northeast Florida
AmeriPath Southwest Florida
Bay Area Dermatopathology
Dermpath Diagnostics
Dermpath Diagnostics Bay Area
Institute for
Immunofluorescence
Institute for Podiatric
Pathology
100% AmeriPath Hospital Services Florida, LLC (DE)
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
3
83060.1
COMPANY REGISTERED ALTERNATE NAME
100% AmeriPath Kentucky, Inc. (KY)
100% AmeriPath Lubbock 5.01(A) Corporation (TX) Arlington Pathology Associates
Dermpath Diagnostics Texas
North Arlington Pathology
Associates
Pathology Associates of Texas
100% AmeriPath New York, LLC (DE) AmeriPath East
AmeriPath Gastrointestinal
Diagnostics
AmeriPath Northeast
Dermpath Diagnostics
Dermpath Diagnostics
NE-Braintree
Ackerman Academy of
Dermatopathology
Dermpath Diagnostics
New York
100% AmeriPath Texas Inc. (DE)
100% AmeriPath Tucson, Inc. (AZ) AmeriPath Arizona
100% Consolidated DermPath, Inc. (DE)
100% DFW 5.01(a) Corporation (TX) AmeriPath North Texas
AmeriPath Dallas
AmeriPath DFW 5.01(a)
Corporation
100% Diagnostic Pathology Services, Inc. (OK) AmeriPath Oklahoma
100% Kailash B. Sharma, M.D., Inc. (GA)
100% Nuclear Medicine and Pathology Associates (GA)
100% Institute for Dermatopathology, Inc. (PA) AmeriPath Mid Atlantic
Dermpath Diagnostics
The Dermatopathology
Laboratory
100% Ocmulgee Medical Pathology Association, Inc. (GA) AmeriPath Georgia
Gastrointestinal Diagnostics
Dermpath Diagnostics
100% Specialty Laboratories, Inc. (CA) Quest Diagnostics Nichols
Institute of Valencia, Inc.
ADDITIONAL ENTITIES CONSOLIDATED FOR ACCOUNTING PURPOSES
AmeriPath Indianapolis, PC (IN) AmeriPath Indianapolis, PSC
Dermpath Diagnostics
Colorado Pathology Consultants, P.C. (CO) AmeriPath Colorado
Dermpath Diagnostics
Dermatopathology of Wisconsin, S.C. (WI) AmeriPath Great Lakes
Hoffman, M.D., Associated Pathologists, Chartered (NV) Associated Pathologists,
Chartered
AmeriPath Nevada
Kilpatrick Pathology, P.A. (NC)
PhenoPath Laboratories, PLLC (WA)
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
Exhibit H Page 1 of 2
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Exhibit H
Page 2 of 2
(c) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)
Quest DiagnosticsPatrick Plewman, VP & GM, West Region
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
7/21/2021 | 12:17 PM PDT
EXHIBIT I
Customer IT Security Audit Standard
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Customer IT Security Audit Standard
Document Name: ITA-STD-CA
Effective Date: 12/31/2019
Owner: Information Technology Audits
Quest Diagnostics Incorporated ITA-STD-CA
CONFIDENTIAL – For Internal Use Only Page 1 of 3
Note: This standard is for internal use and applies to Employees representing our external customers who have
submitted requests to conduct audits of Quest Diagnostics IT systems or facilities. The word ‘audit’, as used in this
standard, also includes surveys, assessments, questionnaires and similar documents.
General
ITA-CA-GEN-01 Requests for Customer Information Security Audits must be sent to the appropriate
Information Technology Audits or Manager, in writing with 30 days notice.
ITA-CA-GEN-02 Audit requests must be accompanied by the questionnaire and/or checklist that will be
used in the audit, IT Audit Request form and a current Non-Disclosure Agreement.
ITA-CA-GEN-03
Requests for Customer Information Security Audits must be approved by the Managing
Director of the sponsoring Business. If approved, some or all of the provisions within this
standard may apply.
ITA-CA-GEN-04
Information Technology Audit or Authorized Quest Diagnostics work force member will
manage the requests for all IT related information. If there are requests for non-IT
information, such as personnel or physical security of our facilities, those requests must be
made to the appropriate functional groups by the business sponsor.
Audit Scope
ITA-CA-AS-01
The scope of the Customer Information Security Audits will be subject to the approval of
Quest Diagnostics Information Technology Audit or Authorized Quest Diagnostics work
force member, based on the customer’s business relationship with Quest Diagnostics and
other factors. The scope may be limited to:
Survey/questionnaire only
Interviews or conference calls with Quest Diagnostics IT employees
Hands-on review of documentation, and
Physical inspection of Quest Diagnostics IT facilities.
ITA-CA-AS-02 Information requested by Customers must be restricted and specifically related to the
Customer’s business relationship with Quest Diagnostics.
ITA-CA-AS-03
Customer audits that will require formal interviews and/or an onsite visit to a Quest
Diagnostics facility or Data Center must include an agenda detailing the target areas in
scope for the assessment and discussions.
Customer Audit Team
ITA-CA-AT-01
Members of the Customer Audit Team may include employees of the Customer and
independent consultants or auditors retained by the Customer, but may not include
representatives of vendors offering products or services related to the audit process.
ITA-CA-AT-02 Quest Diagnostics Information Technology reserves the right to make recommendations
on Customer Audit Team composition based on potential conflicts of interest.
Response Scope
ITA-CA-RS-01
Quest Diagnostics will not provide sensitive Company information or information it
considers important to the security and integrity of the network. Examples of the type of
information that will not be provided are: customer information, patient information,
personal or professional employee information, IT hardware and software licenses or
contracts, network diagrams with address information, firewall or other network device
configuration data, application and/or network vulnerability assessments or penetration
testing results, audit reports, IT facility blueprints, maintenance records and business
records.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Customer IT Security Audit Standard
Document Name: ITA-STD-CA
Effective Date: 12/31/2019
Owner: Information Technology Audits
Quest Diagnostics Incorporated ITA-STD-CA
CONFIDENTIAL – For Internal Use Only Page 2 of 3
ITA-CA-RS-02
Audit responses will represent conditions and practices of Quest Diagnostics at a given
point in time against its own security policies and technical standards. Changes in
technology, process, policy or organization may alter the IT environment and possibly
render portions of audit responses obsolete.
Interviews / Conference Calls
ITA-CA-ICC-01 Interviews and conference calls must be scheduled at a mutually agreeable time.
ITA-CA-ICC-02 Interviews and conference calls may not be video or audio recorded without prior written
consent.
ITA-CA-ICC-03
Interviews will take place in a Quest Diagnostics conference room, as opposed to a
workforce member’s office or work area or via a conference call or Quest Diagnostics
online web conferencing application.
ITA-CA-ICC-04 Information Technology Audits or authorized Quest Diagnostics workforce resource will
determine who represents the IT functions at the meeting.
Hands-on Review of Documentation
ITA-CA-HRD-01 No physical documents or electronic media belonging to Quest Diagnostics may be
removed from a Quest Diagnostics facility.
ITA-CA-HRD-02 Documents to be reviewed must be requested at the time the audit is scheduled.
ITA-CA-HRD-03 Quest Diagnostics may edit documents prior to viewing to remove confidential or sensitive
information.
ITA-CA-HRD-04 No pictures, photocopies or other facsimile may be taken of Quest Diagnostics
documentation.
ITA-CA-HRD-05 Documents must be reviewed in the presence of Information Technology Audits and/or an
authorized Quest Diagnostics workforce member.
Physical Inspection of IT Facilities
ITA-CA-PI-01 All visitors to Quest Diagnostics facilities must be escorted at all times by an authorized
Quest Diagnostics workforce member or a member of the Data Center Management Team.
ITA-CA-PI-02 All visitors to Quest Diagnostics facilities must comply with Corporate and local business
unit physical security policy / procedure.
ITA-CA-PI-03 Physical inspections of Quest Diagnostics facilities will be scheduled at a mutually
agreeable time.
ITA-CA-PI-04 No still or motion pictures, or audio recordings may be made at any Quest Diagnostics
facilities without prior written consent.
Network Access by Audit Personnel
ITA-CA-NA-01
In accordance with Quest Diagnostics security policy, access to Quest Diagnostics’
network by visitors will not be permitted under any circumstance. Attaching any non-
Quest Diagnostics asset to Company network, and visitor use of Company computing
assets are both prohibited.
ITA-CA-NA-02
Auditors may be permitted to view information pertinent to the audit displayed at a
workstation or via an online web conferencing tool under the exclusive control of an
authorized Quest Diagnostics workforce member and under the observation of Information
Technology Audits.
ITA-CA-NA-03 No scanning, analysis, auditing or other information gathering software or hardware
provided by auditors will be deployed on the Quest Diagnostics network.
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F
Customer IT Security Audit Standard
Document Name: ITA-STD-CA
Effective Date: 12/31/2019
Owner: Information Technology Audits
Quest Diagnostics Incorporated ITA-STD-CA
CONFIDENTIAL – For Internal Use Only Page 3 of 3
ITA-CA-NA-04
No customer initiated penetration testing and/or exploitation of any portion of Quest
Diagnostics’ network will be permitted as part of a Customer audit or Customer Security
Evaluation.
Non-Disclosure and Confidentiality
ITA-CA-NDC-01
Appropriate non-disclosure and/or confidentiality agreements must be signed by
authorized representatives of Customers conducting Information Security Audits prior to
the commencement of any auditing activity.
Audit Report Review
ITA-CA-ARR-01
In order to have the opportunity to identify and correct any potential errors or
misunderstandings, Quest Diagnostics requests to review the Customer’s audit report prior
to its publication.
ITA-CA-ARR-02
Quest Diagnostics will determine whether observations made during a customer’s audit
will be remediated. Observations/recommendations that are not in line with Quest
Diagnostics’ own security policies, technical standards, business or IT strategy, may be
treated as suggestions and documented as such
ITA-CA-ARR-03 Quest Diagnostics reserves the right to have a post-audit discussion with the client and
auditor to come to agreement on actions.
Glossary
Term Definition
Related Documents
Document Title Description
IT Audit Request Form
Revisions
Version Date Revision Submitted by:
2.0 05/22/2007 Ellen Robinson
3.0 12/5/2008 Terri Cetera
4.0 08/05/2011 Added ITA-CA-AS-02 & 03 plus other minor edits Terri Cetera
4.0 12/15/2018 Reviewed, no changes Terri Cetera
4.0 12/15/2019 Reviewed, no changes Terri Cetera
Effective this date, this standard shall be referenced in replacement of all previous revisions.
NAME Alaa A Matahen
TITLE Manager, IT Security
SIGNATURE Alaa A Matahen
DATE 12/31/2019
DocuSign Envelope ID: 51BD6252-C0BD-4C31-8889-A8582783223F