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HomeMy WebLinkAboutAgreement A-19-292 Master Agmt. for OT and PT Services.pdf Agreement No. 19-292 1 MASTER AGREEMENT 2 3 THIS MASTER AGREEMENT ("Agreement") is made and entered into this 18th day of June of 4 2019, by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California, 5 hereinafter referred to as "COUNTY", and each contractor (CONTRACTOR) listed in Exhibit A, attached 6 hereto and by this reference incorporated herein, collectively hereinafter referred to as "CONTRACTORS", 7 and such additional CONTRACTORS as may, from time to time during the term of this Agreement, be 8 added by COUNTY. COUNTY and each CONTRACTOR may be referred to as a "Party" or collectively as 9 "Parties" to this Agreement. 10 WITNESSETH: 11 WHEREAS, COUNTY, through its Department of Public Health (DPH) California Children's 12 Services (CCS) - Medical Therapy Program (MTP), is in need of Occupational Therapy (OT) and Physical 13 Therapy (PT) services to be performed by qualified Occupational Therapists and Physical Therapists 14 licensed by the State of California; and 15 WHEREAS, COUNTY DPH CCS-MTP is mandated by the California State Law to provide 16 prescribed OT and PT services for children, ranging from birth to 21 years old, with handicapping 17 conditions, generally due to neurological, musculoskeletal or other medical disorders, such as but not 18 limited to, cerebral palsy and spina bifida; and 19 WHEREAS, COUNTY issued Request for Statement of Qualifications No. 19-059 (RFSQ) soliciting 20 proposals from qualified CONTRACTORS to provide onsite Occupational Therapy (OT) and Physical 21 Therapy (PT) contracted services to the children, ranging from birth to 21 years of age, enrolled in 22 COUNTY's California Children's Services (CCS) Medical Therapy Program (MTP) at MTP operated 23 Medical Therapy Units (MTUs) located at three (3) local school sites in Fresno County; and 24 WHEREAS, CONTRACTORS, are willing to provide experienced and qualified staff who can 25 perform Occupational and /or Physical Therapy services to COUNTY's DPH CCS— MTP's Medical 26 Therapy Units (MTUs) pursuant to the terms and conditions of this Agreement; 27 NOW, THEREFORE, in consideration of the mutual covenants, terms and conditions herein 28 contained, the Parties hereto agree as follows: -1- 1 1. OBLIGATIONS OF THE CONTRACTOR 2 A. CONTRACTORS shall provide the COUNTY-DPH CCS-MTP's required 3 Occupational and Physical Therapy services in accordance with the scope of work, requirements, terms 4 and conditions of RFSQ No. 19-059 attached hereto as Exhibit B; and each CONTRACTOR's submitted 5 proposal, identified as Exhibits C-1 and C-2, attached hereto and by this reference incorporated herein. 6 CONTRACTORS agree to provide only qualified and State licensed Occupational Therapists and 7 Physical Therapists to fulfill all responsibilities identified in the Scope of Work section identified in Exhibit 8 B. 9 B. CONTRACTORS warrant that they possess all licenses and certifications required 10 by local, State of California and/or Federal laws and regulations for the conduct of their business and 11 shall operate their business in accordance with all applicable laws and regulations. CONTRACTORS 12 shall further warrant that all of its personnel performing services under this Agreement shall be licensed 13 and certified where required, to lawfully perform their duties and shall maintain such licensure and 14 certifications identified in the Comply/Non-Comply section of Exhibit B attached hereto and by this 15 reference incorporated herein, throughout the term of this Agreement. 16 C. CONTRACTORS shall submit copies of all licenses, certifications and applicable 17 medical clearances described in Comply/Not-Comply section of Exhibit B, prior to commencement of 18 work or services. County DPH CCS-MTP's Rehabilitative Therapy Manager or designee shall review 19 and approve all submitted licenses, certifications and applicable clearances, and will initiate an order to 20 work if approved, in accordance with Exhibit B. 21 D. CONTRACTORS will ensure that CONTRACTOR'S Therapy staff will perform 22 assigned duties in accordance with the highest scientific, professional and ethical standards of their 23 profession and at all times will act within the policies, rules and regulations of the COUNTY, the State of 24 California Department of Health Care Services and local statutes and administrative regulations relating 25 to health. 26 E. CONTRACTORS shall provide licensed and qualified Occupational and/or 27 Physical Therapists to perform services onsite at the COUNTY's Medical Therapy Units located within 28 COUNTY jurisdiction, 3 to 5 days per week, up to 8 hours per day, not to exceed nine thousand twenty- -2- 1 five (9,025) service hours annually, at times and dates mutually agreeable to both CONTRACTORS and 2 COUNTY. COUNTY'S CCS-MTP operates Medical Therapy Units (MTUs) located at three (3) local 3 school sites namely: 4 5 MTU LOCATION 6 Garfield MTU 1345 N. Peach Ave. Clovis 7 Ginsburg MTU 67 E. Ashlan Avenue, Fresno 8 Storey MTU 2444 S. Peach Avenue, Fresno 9 10 F. When a CONTRACTOR's assignee is selected, the service assignment shall 11 remain in effect unless CONTRACTOR terminates service, or assignee fails to perform or comply with 12 the requirements identified in the Scope of Work included in Exhibit B. 13 G. In the event CONTRACTOR's Therapy staff must discontinue or terminate its 14 service at the assigned CCS-MTU location, CONTRACTORS shall provide COUNTY CCS-MTP's 15 Rehabilitative Therapy Manager or designee at least two (2) work weeks notification of Therapy staff's 16 discontinuation of service. This notification will allow the COUNTY to conduct necessary review and 17 selection of qualified Therapy services in accordance with the selection process in Exhibit D and prevent 18 disruption of mandated services to COUNTY CCS-MTP enrolled clients. 19 H. CONTRACTORS agree that the Agreement does not constitute a guarantee or 20 promise that any CONTRACTOR shall provide certain amount of work or services to COUNTY under 21 the terms of this Agreement. This Agreement does not constitute a guarantee or promise that the total 22 fee or any fee will be received by any CONTRACTOR. 23 2. OBLIGATIONS OF THE COUNTY 24 A. COUNTY CCS —MTP's Rehabilitative Therapy Manager or designee, at time of 25 need, shall submit request through written or electronic notification to CONTRACTORS listed in Exhibit 26 A for qualified and licensed Occupational Therapy and/or Physical Therapy staff. 27 B. COUNTY shall conduct a review and selection process specified in Exhibit D to 28 determine selection of CONTRACTOR based on two priority factors at the time services are needed at -3- 1 the CCS-MTUs. Availability of qualified staffing to provide the services and cost will be the primary 2 considerations in the selection process. 3 C. COUNTY CCS-MTP's Rehabilitative Therapy Manager or designee shall review 4 and approve all of CONTRACTORS' submitted licenses, certifications and applicable clearances as 5 identified in the Comply/Not Comply section of Exhibit B. Upon approval, COUNTY CCS-MTP's 6 Rehabilitative Therapy Manager shall notify CONTRACTOR and provide assignment of MTU location, 7 work schedule and program's onboarding process necessary to initiate the commencement of 8 CONTRACTORS' service. 9 D. COUNTY does not guarantee or promise any certain amount of work or service 10 will be granted to CONTRACTORS under the terms and conditions of this Agreement. This Agreement 11 does not constitute a guarantee or promise that a total fee or any fee will be received by any 12 CONTRACTOR. 13 3. TERM 14 The term of this Agreement shall be for a period of three (3) years, commencing on July 1, 15 2019 through and including June 30, 2022. This Agreement may be extended for two (2) additional 16 consecutive twelve (12) month periods upon written approval of both parties no later than thirty(30) days 17 prior to the first day of the next twelve (12) month extension period. The COUNTY DPH Director or his or 18 her designee is authorized to execute such written approval on behalf of COUNTY based on 19 CONTRACTOR'S satisfactory performance. 20 4. TERMINATION 21 A. Non-Allocation of Funds -The terms of this Agreement, and the services to be 22 provided hereunder, are contingent on the approval of funds by the appropriating government agency. 23 Should sufficient funds not be allocated, the services provided may be modified, or this Agreement 24 terminated, at any time by giving the CONTRACTORS thirty (30) days advance written notice. 25 B. Breach of Contract- The COUNTY may immediately suspend or terminate this 26 Agreement in whole or in part, where in the determination of the COUNTY there is: 27 1) An illegal or improper use of funds; 28 2) A failure to comply with any term of this Agreement; -4- 1 3) A substantially incorrect or incomplete report submitted to the COUNTY; 2 4) Improperly performed service. 3 In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any 4 breach of this Agreement or any default which may then exist on the part of the CONTRACTORS. Neither 5 shall such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or 6 default. The COUNTY shall have the right to demand of the CONTRACTORS the repayment to the 7 COUNTY of any funds disbursed to the CONTRACTORS under this Agreement, which in the judgment of 8 the COUNTY were not expended in accordance with the terms of this Agreement. The CONTRACTORS 9 shall promptly refund any such funds upon demand. 10 C. Without Cause - Under circumstances other than those set forth above, this 11 Agreement may be terminated by COUNTY upon the giving of thirty (30) days advance written notice of an 12 intention to terminate to CONTRACTORS. 13 5. COMPENSATION/INVOICING 14 A. COUNTY agrees to pay CONTRACTORS for services satisfactorily performed 15 hereunder and CONTRACTORS agree to receive compensation at the hourly rates and other allowable 16 expense as deemed applicable, in accordance with each CONTRACTOR'S proposal submitted under 17 Request for Statement Qualification (RFSQ) No. 19-059. 18 B. COUNTY agrees to pay CONTRACTORS and CONTRACTORS agrees to receive 19 compensation according to the rates as identified in Exhibit E or proration thereof for the actual service 20 hours rendered. CONTRACTORS shall submit monthly invoices to the County of Fresno, Department of 21 Public Health, CCS, P.O. Box 11867, Fresno, CA 93775, Attention: MTP, Rehabilitative Therapy 22 Manager. Invoices shall include Name of Therapist, service type, service location and dates, contract 23 number, and number of service hours provided. In no event shall services performed under this 24 Agreement be in excess of Eight Hundred Fifty Seven Thousand Three Hundred Seventy-Five and 25 No/100 Dollars ($857,375.00)for each twelve (12) month period of this Agreement. It is understood that 26 all expenses incidental to CONTRACTORS performance of services except otherwise specified under 27 this Agreement shall be borne by CONTRACTORS. 28 -5- 1 6. INDEPENDENT CONTRACTOR 2 In performance of the work, duties and obligations assumed by CONTRACTORS under this 3 Agreement, it is mutually understood and agreed that CONTRACTORS, including any and all of the 4 CONTRACTORS' officers, agents, and employees will at all times be acting and performing as an 5 independent contractor, and shall act in an independent capacity and not as an officer, agent, servant, 6 employee,joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right 7 to control or supervise or direct the manner or method by which CONTRACTORS shall perform its work 8 and function. However, COUNTY shall retain the right to administer this Agreement so as to verify that 9 CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof. 10 CONTRACTORS and COUNTY shall comply with all applicable provisions of law and the 11 rules and regulations, if any, of governmental authorities having jurisdiction over matters the subject 12 thereof. 13 Because of its status as an independent contractor, CONTRACTORS shall have absolutely 14 no right to employment rights and benefits available to COUNTY employees. CONTRACTORS shall be 15 solely liable and responsible for providing to, or on behalf of, its employees all legally-required employee 16 benefits. In addition, CONTRACTORS shall be solely responsible and save COUNTY harmless from all 17 matters relating to payment of CONTRACTORS' employees, including compliance with Social Security 18 withholding and all other regulations governing such matters. It is acknowledged that during the term of this 19 Agreement, CONTRACTOR may be providing services to others unrelated to the COUNTY or to this 20 Agreement. 21 7. MODIFICATION 22 Any matters of this Agreement may be modified from time to time by the written consent of 23 all the parties without, in any way, affecting the remainder. Any modifications, made pursuant to the above 24 provisions, shall be effective as to the CONTRACTORS identified in the written modification, and shall not 25 alter or affect the existing Master Agreement between COUNTY, and the remaining CONTRACTORS. 26 8. NON-ASSIGNMENT 27 Neither party shall assign, transfer or sub-contract this Agreement nor their rights or duties 28 under this Agreement without the prior written consent of the other party. -6- 1 9. HOLD HARMLESS 2 CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY'S request, 3 defend the COUNTY, its officers, agents, and employees from any and all costs and expenses (including 4 attorney's fees and costs), damages, liabilities, claims, and losses occurring or resulting to COUNTY in 5 connection with the performance, or failure to perform, by CONTRACTORS, its officers, agents, or 6 employees under this Agreement, and from any and all costs and expenses (including attorney's fees and 7 costs), damages, liabilities, claims, and losses occurring or resulting to any person, firm, or corporation who 8 may be injured or damaged by the performance, or failure to perform, of CONTRACTORS, its officers, 9 agents, or employees under this Agreement. 10 10. INSURANCE 11 Without limiting the COUNTY's right to obtain indemnification from CONTRACTORS or 12 any third parties, CONTRACTORS, at its sole expense, shall maintain in full force and effect, the 13 following insurance policies throughout the term of the Agreement: 14 A. Commercial General Liability 15 Commercial General Liability Insurance with limits of not less than Two Million Dollars 16 ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00). This 17 policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including 18 completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal 19 liability or any other liability insurance deemed necessary because of the nature of this contract. 20 B. Automobile Liability 21 Comprehensive Automobile Liability Insurance with limits of not less than One Million Dollars 22 ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should include any auto 23 used in connection with this Agreement. 24 C. Professional Liability 25 If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W., 26 M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One Million 27 Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate. 28 -7- 1 D. Worker's Compensation 2 A policy of Worker's Compensation insurance as may be required by the California Labor 3 Code. 4 E. Molestation 5 Sexual abuse/molestation liability insurance with limits of not less than One Million Dollars 6 ($1,000,000.00) per occurrence. Two Million Dollars ($2,000,000.00) annual aggregate. This policy shall 7 be issued on a per occurrence basis. 8 E. Cyber Liability 9 Cyber Liability Insurance, with limits not less than Two Million Dollars ($2,000,000) per 10 occurrence or claim, Two Million Dollars ($2,000,000) aggregate. Coverage shall be sufficiently broad to 11 respond to the duties and obligations as is undertaken by CONTRACTORS in this Agreement and shall 12 include, but not be limited to, claims involving infringement of intellectual property, including but not limited 13 to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, 14 damage to or destruction of electronic information, release of private information, alteration of electronic 15 information, extortion and network security. The policy shall provide coverage for breach response costs as 16 well as regulatory fines and penalties as well as credit monitoring expenses with limits sufficient to respond 17 to these obligations. 18 Additional Requirements Relating to Insurance 19 CONTRACTORS shall obtain endorsements to the Commercial General Liability insurance 20 naming the County of Fresno, its officers, agents, and employees, individually and collectively, as additional 21 insured, but only insofar as the operations under this Agreement are concerned. Such coverage for 22 additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained 23 by COUNTY, its officers, agents and employees shall be excess only and not contributing with insurance 24 provided under CONTRACTORS' policies herein. This insurance shall not be cancelled or changed without 25 a minimum of thirty (30) days advance written notice given to COUNTY. 26 Within Thirty (30) days from the date CONTRACTOR signs and executes this Agreement, 27 CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the 28 foregoing policies, as required herein, to the County of Fresno, Department of Public Health, P.O. Box -8- 1 11867, Fresno, CA 93775, Attention: Contracts Section —6th Floor, stating that such insurance coverage 2 have been obtained and are in full force; that the County of Fresno, its officers, agents and employees will 3 not be responsible for any premiums on the policies; that such Commercial General Liability insurance 4 names the County of Fresno, its officers, agents and employees, individually and collectively, as additional 5 insured, but only insofar as the operations under this Agreement are concerned; that such coverage for 6 additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained 7 by COUNTY, its officers, agents and employees, shall be excess only and not contributing with insurance 8 provided under CONTRACTORS' policies herein; and that this insurance shall not be cancelled or changed 9 without a minimum of thirty (30) days advance, written notice given to COUNTY. 10 In the event CONTRACTORS fail to keep in effect at all times insurance coverage as herein 11 provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this 12 Agreement upon the occurrence of such event. 13 All policies shall be issued by admitted insurers licensed to do business in the State of 14 California, and such insurance shall be purchased from companies possessing a current A.M. Best, Inc. 15 rating of A FSC VI or better. 16 11. AUDITS AND INSPECTIONS 17 The CONTRACTOR shall at any time during business hours, and as often as the COUNTY 18 may deem necessary, make available to the COUNTY for examination all of its records and data with 19 respect to the matters covered by this Agreement. The CONTRACTOR shall, upon request by the 20 COUNTY, permit the COUNTY to audit and inspect all of such records and data necessary to ensure 21 CONTRACTOR'S compliance with the terms of this Agreement. 22 If this Agreement exceeds ten thousand dollars ($10,000.00), CONTRACTOR shall be 23 subject to the examination and audit of the Auditor General for a period of three (3) years after final 24 payment under contract(Government Code Section 8546.7). 25 12. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT 26 A. The parties to this Agreement shall be in strict conformance with all applicable 27 Federal and State of California laws and regulations, including but not limited to Sections 5328, 10850, and 28 14100.2 et seq. of the Welfare and Institutions Code, Sections 2.1 and 431.300 et seq. of Title 42, Code of -9- 1 Federal Regulations (CFR), Section 56 et seq. of the California Civil Code and the Health Insurance 2 Portability and Accountability Act (HIPAA), including but not limited to Section 1320 D et seq. of Title 42, 3 United States Code (USC) and its implementing regulations, including, but not limited to Title 45, CFR, 4 Sections 142, 160, 162, and 164, The Health Information Technology for Economic and Clinical Health Act 5 (HITECH) regarding the confidentiality and security of patient information, and the Genetic Information 6 Nondiscrimination Act (GINA) of 2008 regarding the confidentiality of genetic information. 7 Except as otherwise provided in this Agreement, CONTRACTORS, as a Business 8 Associate of COUNTY, may use or disclose Protected Health Information (PHI) to perform functions, 9 activities or services for or on behalf of COUNTY, as specified in this Agreement, provided that such use 10 or disclosure shall not violate the Health Insurance Portability and Accountability Act (HIPAA), USC 1320d 11 et seq. The uses and disclosures of PHI may not be more expansive than those applicable to COUNTY, 12 as the "Covered Entity" under the HIPAA Privacy Rule (45 CFR 164.500 et seq.), except as authorized for 13 management, administrative or legal responsibilities of the Business Associate. 14 B. CONTRACTORS, including its subcontractors and employees, shall protect, from 15 unauthorized access, use, or disclosure of names and other identifying information, including genetic 16 information, concerning persons receiving services pursuant to this Agreement, except where permitted in 17 order to carry out data aggregation purposes for health care operations [45 CFR Sections 164.504 (e)(2)(i), 18 164.504 (3)(2)(ii)(A), and 164.504 (e)(4)(i)] This pertains to any and all persons receiving services pursuant 19 to a COUNTY funded program. This requirement applies to electronic PHI. CONTRACTORS shall not use 20 such identifying information or genetic information for any purpose other than carrying out 21 CONTRACTORS' obligations under this Agreement. 22 C. CONTRACTORS, including its subcontractors and employees, shall not disclose 23 any such identifying information or genetic information to any person or entity, except as otherwise 24 specifically permitted by this Agreement, authorized by Subpart E of 45 CFR Part 164 or other law, required 25 by the Secretary, or authorized by the client/patient in writing. In using or disclosing PHI that is permitted by 26 this Agreement or authorized by law, CONTRACTORS shall make reasonable efforts to limit PHI to the 27 minimum necessary to accomplish intended purpose of use, disclosure or request. 28 D. For purposes of the above sections, identifying information shall include, but not be -10- 1 limited to name, identifying number, symbol, or other identifying particular assigned to the individual, such 2 as finger or voice print, or photograph. 3 E. For purposes of the above sections, genetic information shall include genetic tests of 4 family members of an individual or individual, manifestation of disease or disorder of family members of an 5 individual, or any request for or receipt of, genetic services by individual or family members. Family 6 member means a dependent or any person who is first, second, third, or fourth degree relative. 7 F. CONTRACTORS shall provide access, at the request of COUNTY, and in the 8 time and manner designated by COUNTY, to PHI in a designated record set (as defined in 45 CFR 9 Section 164.501), to an individual or to COUNTY in order to meet the requirements of 45 CFR Section 10 164.524 regarding access by individuals to their PHI. With respect to individual requests, access shall 11 be provided within thirty (30) days from request. Access may be extended if CONTRACTORS cannot 12 provide access and provides individual with the reasons for the delay and the date when access may be 13 granted. PHI shall be provided in the form and format requested by the individual or COUNTY. 14 CONTRACTORS shall make any amendment(s) to PHI in a designated record set 15 at the request of COUNTY or individual, and in the time and manner designated by COUNTY in 16 accordance with 45 CFR Section 164.526. 17 CONTRACTORS shall provide to COUNTY or to an individual, in a time and 18 manner designated by COUNTY, information collected in accordance with 45 CFR Section 164.528, to 19 permit COUNTY to respond to a request by the individual for an accounting of disclosures of PHI in 20 accordance with 45 CFR Section 164.528. 21 G. CONTRACTORS shall report to COUNTY, in writing, any knowledge or reasonable 22 belief that there has been unauthorized access, viewing, use, disclosure, security incident, or breach of 23 unsecured PHI not permitted by this Agreement of which it becomes aware, immediately and without 24 reasonable delay and in no case later than two (2) business days of discovery. Immediate notification shall 25 be made to COUNTY's Information Security Officer and Privacy Officer and COUNTY's DPH HIPAA 26 Representative, within two (2) business days of discovery. The notification shall include, to the extent 27 possible, the identification of each individual whose unsecured PHI has been, or is reasonably believed to 28 have been, accessed, acquired, used, disclosed, or breached. CONTRACTORS shall take prompt -11- 1 corrective action to cure any deficiencies and any action pertaining to such unauthorized disclosure 2 required by applicable Federal and State Laws and regulations. CONTRACTORS shall investigate such 3 breach and is responsible for all notifications required by law and regulation or deemed necessary by 4 COUNTY and shall provide a written report of the investigation and reporting required to COUNTY's 5 Information Security Officer and Privacy Officer and COUNTY's DPH HIPAA Representative. This written 6 investigation and description of any reporting necessary shall be postmarked within the thirty (30)working 7 days of the discovery of the breach to the addresses below: 8 County of Fresno County of Fresno County of Fresno Dept. of Public Health Dept. of Public Health Information Technology Services 9 HIPAA Representative Privacy Officer Information Security Officer 10 (559) 600-6439 (559) 600-6405 (559) 600-5800 P.O. Box 11867 P.O. Box 11867 333 W. Pontiac Way 11 Fresno, CA 93775 Fresno, CA 93775 Clovis, CA 93612 12 H. CONTRACTORS shall make its internal practices, books, and records relating to the 13 use and disclosure of PHI received from COUNTY, or created or received by the CONTRACTORS on 14 behalf of COUNTY, in compliance with HIPAA's Privacy Rule, including, but not limited to the requirements 15 set forth in Title 45, CFR, Sections 160 and 164. CONTRACTORS shall make its internal practices, books, 16 and records relating to the use and disclosure of PHI received from COUNTY, or created or received by the 17 CONTRACTORS on behalf of COUNTY, available to the United States Department of Health and Human 18 Services (Secretary) upon demand. 19 CONTRACTORS shall cooperate with the compliance and investigation reviews 20 conducted by the Secretary. PHI access to the Secretary must be provided during the CONTRACTORS' 21 normal business hours, however, upon exigent circumstances access at any time must be granted. Upon 22 the Secretary's compliance or investigation review, if PHI is unavailable to CONTRACTORS and in 23 possession of a Subcontractors, it must certify efforts to obtain the information to the Secretary. 24 I. Safeguards 25 CONTRACTORS shall implement administrative, physical, and technical safeguards 26 as required by the HIPAA Security Rule, Subpart C of 45 CFR 164, that reasonably and appropriately 27 protect the confidentiality, integrity, and availability of PHI, including electronic PHI, that it creates, 28 -12- 1 receives, maintains or transmits on behalf of COUNTY and to prevent unauthorized access, viewing, use, 2 disclosure, or breach of PHI other than as provided for by this Agreement. CONTRACTORS shall conduct 3 an accurate and thorough assessment of the potential risks and vulnerabilities to the confidential, integrity 4 and availability of electronic PHI. CONTRACTORS shall develop and maintain a written information 5 privacy and security program that includes administrative, technical and physical safeguards appropriate to 6 the size and complexity of CONTRACTORS' operations and the nature and scope of its activities. Upon 7 COUNTY's request, CONTRACTORS shall provide COUNTY with information concerning such 8 safeguards. 9 CONTRACTORS shall implement strong access controls and other security 10 safeguards and precautions in order to restrict logical and physical access to confidential, personal (e.g., 11 PHI) or sensitive data to authorized users only. Said safeguards and precautions shall include the 12 following administrative and technical password controls for all systems used to process or store 13 confidential, personal, or sensitive data: 14 1. Passwords must not be: 15 a. Shared or written down where they are accessible or recognizable 16 by anyone else; such as taped to computer screens, stored under keyboards, or visible in a work area; 17 b. A dictionary word; or 18 C. Stored in clear text 19 2. Passwords must be: 20 a. Eight (8) characters or more in length; 21 b. Changed every ninety (90) days; 22 C. Changed immediately if revealed or compromised; and 23 d. Composed of characters from at least three (3) of the following four 24 (4) groups from the standard keyboard: 25 1) Upper case letters (A-Z); 26 2) Lowercase letters (a-z); 27 3) Arabic numerals (0 through 9); and 28 4) Non-alphanumeric characters (punctuation symbols). -13- 1 CONTRACTORS shall implement the following security controls on each 2 workstation or portable computing device (e.g., laptop computer) containing confidential, 3 personal, or sensitive data: 4 1. Network-based firewall and/or personal firewall; 5 2. Continuously updated anti-virus software; and 6 3. Patch management process including installation of all operating 7 system/software vendor security patches. 8 CONTRACTORS shall utilize a commercial encryption solution that has received 9 FIPS 140-2 validation to encrypt all confidential, personal, or sensitive data stored on portable 10 electronic media (including, but not limited to, compact disks and thumb drives) and on portable 11 computing devices (including, but not limited to, laptop and notebook computers). 12 CONTRACTORS shall not transmit confidential, personal, or sensitive data via e- 13 mail or other internet transport protocol unless the data is encrypted by a solution that has been 14 validated by the National Institute of Standards and Technology (NIST) as conforming to the Advanced 15 Encryption Standard (AES) Algorithm. CONTRACTORA must apply appropriate sanctions against its 16 employees who fail to comply with these safeguards. CONTRACTORS must adopt procedures for 17 terminating access to PHI when employment of employee ends. 18 J. Mitigation of Harmful Effects 19 CONTRACTORS shall mitigate, to the extent practicable, any harmful effect that 20 is suspected or known to CONTRACTORS of an unauthorized access, viewing, use, disclosure, or 21 breach of PHI by CONTRACTOR or its subcontractors in violation of the requirements of these 22 provisions. CONTRACTOR must document suspected or known harmful effects and the outcome. 23 K. CONTRACTORS' Subcontractors 24 CONTRACTORS shall ensure that any of its contractors, including 25 subcontractors, if applicable, to whom CONTRACTORS provides PHI received from or created or 26 received by CONTRACTORS on behalf of COUNTY, agree to the same restrictions, safeguards, and 27 conditions that apply to CONTRACTORS with respect to such PHI and to incorporate, when applicable, 28 the relevant provisions of these provisions into each subcontract or sub-award to such agents or -14- 1 subcontractors.. 2 L. Employee Training and Discipline 3 CONTRACTORS shall train and use reasonable measures to ensure compliance 4 with the requirements of these provisions by employees who assist in the performance of functions or 5 activities on behalf of COUNTY under this Agreement and use or disclose PHI and discipline such 6 employees who intentionally violate any provisions of these provisions, including termination of 7 employment. 8 M. Termination for Cause 9 Upon COUNTY's knowledge of a material breach of these provisions by 10 CONTRACTOR, COUNTY shall either: 11 1. Provide an opportunity for CONTRACTORS to cure the breach or end the 12 violation and terminate this Agreement if CONTRACTORS does not cure the breach or end the 13 violation within the time specified by COUNTY; or 14 2. Immediately terminate this Agreement if CONTRACTORS has breached a 15 material term of these provisions and cure is not possible. 16 3. If neither cure nor termination is feasible, the COUNTY's Privacy Officer 17 shall report the violation to the Secretary of the U.S. Department of Health and Human Services. 18 N. Judicial or Administrative Proceedings 19 COUNTY may terminate this Agreement in accordance with the terms and 20 conditions of this Agreement as written hereinabove, if: (1) CONTRACTOR(S) is found guilty in a 21 criminal proceeding for a violation of the HIPAA Privacy or Security Laws or the HITECH Act; or (2) a 22 finding or stipulation that the CONTRACTORS have violated a privacy or security standard or 23 requirement of the HITECH Act, HIPAA or other security or privacy laws in an administrative or civil 24 proceeding in which the CONTRACTOR is a party. 25 O. Effect of Termination 26 Upon termination or expiration of this Agreement for any reason, 27 CONTRACTORS shall return or destroy all PHI received from COUNTY (or created or received by 28 CONTRACTORS on behalf of COUNTY) that CONTRACTORS still maintains in any form, and shall -15- 1 retain no copies of such PHI. If return or destruction of PHI is not feasible, it shall continue to extend 2 the protections of these provisions to such information, and limit further use of such PHI to those 3 purposes that make the return or destruction of such PHI infeasible. This provision shall apply to PHI 4 that is in the possession of subcontractors or agents, if applicable, of CONTRACTORS. If 5 CONTRACTORS destroys the PHI data, a certification of date and time of destruction shall be provided 6 to the COUNTY by CONTRACTORS. 7 P. Disclaimer 8 COUNTY makes no warranty or representation that compliance by 9 CONTRACTORS with these provisions, the HITECH Act, HIPAA or the HIPAA regulations will be 10 adequate or satisfactory for CONTRACTOR's own purposes or that any information in 11 CONTRACTORS' possession or control, or transmitted or received by CONTRACTORS, is or will be 12 secure from unauthorized access, viewing, use, disclosure, or breach. CONTRACTORS are solely 13 responsible for all decisions made by CONTRACTORS regarding the safeguarding of PHI. 14 Q. Amendment 15 The parties acknowledge that Federal and State laws relating to electronic data 16 security and privacy are rapidly evolving and that amendment of these provisions may be required to 17 provide for procedures to ensure compliance with such developments. The parties specifically agree to 18 take such action as is necessary to amend this agreement in order to implement the standards and 19 requirements of HIPAA, the HIPAA regulations, the HITECH Act and other applicable laws relating to 20 the security or privacy of PHI. COUNTY may terminate this Agreement upon thirty (30) days written 21 notice in the event that CONTRACTOR does not enter into an amendment providing assurances 22 regarding the safeguarding of PHI that COUNTY in its sole discretion, deems sufficient to satisfy the 23 standards and requirements of HIPAA, the HIPAA regulations and the HITECH Act. 24 R. No Third-Party Beneficiaries 25 Nothing express or implied in the terms and conditions of these provisions is 26 intended to confer, nor shall anything herein confer, upon any person other than COUNTY or 27 CONTRACTORS and their respective successors or assignees, any rights, remedies, obligations or 28 liabilities whatsoever. -16- 1 S. Interpretation 2 The terms and conditions in these provisions shall be interpreted as broadly as 3 necessary to implement and comply with HIPAA, the HIPAA regulations and applicable State laws. The 4 parties agree that any ambiguity in the terms and conditions of these provisions shall be resolved in 5 favor of a meaning that complies and is consistent with HIPAA and the HIPAA regulations. 6 T. Regulatory References 7 A reference in the terms and conditions of these provisions to a section in the 8 HIPAA regulations means the section as in effect or as amended. 9 U. Survival 10 The respective rights and obligations of CONTRACTORS as stated in this Section 11 shall survive the termination or expiration of this Agreement. 12 V. No Waiver of Obligations 13 No change, waiver or discharge of any liability or obligation hereunder on any one 14 or more occasions shall be deemed a waiver of performance of any continuing or other obligation, or 15 shall prohibit enforcement of any obligation on any other occasion. 16 13. NON-DISCRIMINATION 17 During the performance of this Agreement, CONTTRACTORS shall not unlawfully 18 discriminate against any employee or applicant for employment, or recipient of services, because of race, 19 religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, 20 genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, 21 military status or veteran status pursuant to all applicable State of California and Federal statutes and 22 regulation. 23 14. NOTICES 24 The persons and their addresses having authority to give and receive notices under this 25 Agreement include the following: 26 N 27 N 28 W -17- 1 COUNTY CONTRACTORS Director, COUNTY OF FRESNO SEE Attachment A 2 Department of Public Health P.O. Box 11867 3 Fresno, CA 93775 4 All notices between the COUNTY and CONTRACTORS provided for or permitted under this 5 Agreement must be in writing and delivered either by personal service, by first-class United States mail, by 6 an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by 7 personal service is effective upon service to the recipient. A notice delivered by first-class United States 8 mail is effective three COUNTY business days after deposit in the United States mail, postage prepaid, 9 addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one 10 COUNTY business day after deposit with the overnight commercial courier service, delivery fees prepaid, 11 with delivery instructions given for next day delivery, addressed to the recipient. A notice delivered by 12 telephonic facsimile is effective when transmission to the recipient is completed (but, if such transmission is 13 completed outside of COUNTY business hours, then such delivery shall be deemed to be effective at the 14 next beginning of a COUNTY business day), provided that the sender maintains a machine record of the 15 completed transmission. For all claims arising out of or related to this Agreement, nothing in this section 16 establishes, waives, or modifies any claims presentation requirements or procedures provided by law, 17 including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government Code, 18 beginning with section 810). 19 15. ADDITION AND DELETION OF CONTRACTORS 20 The Director of the Department of Public Health reserves the right at any time during this 21 Agreement to add and delete CONTRACTORS to those listed in Exhibit A, all subject to County Counsel 22 approval as to legal form and County Auditor-Controller/Treasurer-Tax Collector approval as to accounting 23 form. It is understood any such additions and deletions will not affect compensation paid to any other 24 CONTRACTOR, and therefore such additions and deletions may be made by COUNTY without notice to or 25 approval of the CONTRACTORS under this Agreement. Any such CONTRACTOR added must qualify 26 according to the terms of RFSQ No. 19-059. CONTRACTOR also agrees that inclusion on Exhibit A does 27 not constitute a guarantee or promise that any CONTRACTOR shall provide any certain amount of work or 28 services to COUNTY under this Agreement. Each CONTRACTOR understands that any such additions will -18- 1 not affect their compensation. These provisions apply to the termination of any CONTRACTOR listed in 2 Exhibit A. By executing a signature page, each CONTRACTOR becomes a signatory to this Agreement, 3 and agrees that it is party to this Agreement with the COUNTY and is bound by its terms. 4 16. GOVERNING LAW 5 Venue for any action arising out of or related to this Agreement shall only be in Fresno 6 County, California. 7 The rights and obligations of the parties and all interpretation and performance of this 8 Agreement shall be governed in all respects by the laws of the State of California. 9 17. DISCLOSURE OF SELF-DEALING TRANSACTIONS 10 This provision is only applicable if the CONTRACTOR is operating as a corporation (a 11 for-profit or non-profit corporation) or if during the term of the agreement, the CONTRACTOR changes 12 its status to operate as a corporation. 13 Members of the CONTRACTORS' Board of Directors shall disclose any self-dealing 14 transactions that they are a party to while CONTRACTORS are providing goods or performing services 15 under this agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR 16 is a party and in which one or more of its directors has a material financial interest. Members of the 17 Board of Directors shall disclose any self-dealing transactions that they are a party to by completing and 18 signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit F and incorporated 19 herein by reference, and submitting it to the COUNTY prior to commencing with the self-dealing 20 transaction or immediately thereafter. 21 18. SEVERABILITY 22 The positions of this Agreement are severable. The invalidity or unenforceability of any 23 one provision in the Agreement shall not affect the other provisions. 24 19. ENTIRE AGREEMENT 25 This Agreement, including all Exhibits, constitutes the entire agreement between the 26 CONTRACTORS and COUNTY with respect to the subject matter hereof and supersedes all previous 27 Agreement negotiations, proposals, commitments, writings, advertisements, publications, and 28 understanding of any nature whatsoever unless expressly included in this Agreement. -19- 1 IN WITNESS WHEREOF,the parties hereto have executed this Agreement as of the day and year first 2 hereinabove written. 3 CONTRACTOR: COUNTY OF FRESNO: 4 See attached Contractor Signature Pages 5 6 �r 7 `f CCU Nathan Magsig, Chairman of the Board of 8 Supervisors of the County of Fresno 9 10 ATTEST: Bernice E. Seidel 11 Clerk of the Board of Supervisors 12 County of Fresno, State of California 13 By: 14 Deputy 15 16 17 18 19 20 FOR ACCOUNTING USE ONLY: 21 ORG No.56201601 22 AccoUNT No.:7295 FUND:0001 23 SUBCLASS: 10000 24 25 26 27 28 -20- 1 Aureoment for Occupatior)al Therapy_and_E'livs+cal Therapy Services with the County of I'Enn-o 2 CONTRACTOR SIGNATURE PAGE a 6 Print Name: R t-M. 7 Tits 0 w o c r ................. 7...._..._�_�..._..__._._......_.______r. �_�_..r._ -----------•---- of 0 !By;� • }'•r► 11 Print Name: 12 Title: D►rt c h r 13 Date ;ld Q Id 01 q 14 IF-1 all Address for Noti'. j: C r C c 16 E-Mail N520,0 Goalact Pers n's NajMg; - 11 Clijaii NoUce Gulilacl Person's Title: A c C o,/1 18 rl 49 Company Name, 20 Mailing Address: I 21 It y, ,''Mite CisIt� 1 a f►n�� 1 F L 336��7 22 State in Whicb the Cumuany Originally Registered r` 23mac=os�asans�asoasa�taen=n=-- 24 C�,►ntact Telephone Number j -;61 - 1 7( 5 25 Contact Fax Number; 26 27 28 -21- 1 Agreement for Occupational Therapy and Physical Therapy Services with the County of Fresno 2 CONTRACTOR SIGNATURE PAGE 3 4 5 By.. 6 Print Name: i2 4 7 Title: C 8 Date: 114ay :)`7, 2-01 �1 9 ---------------------------------------------------------------------------------------------------------------------- 10 By. 11 Print Name: 12 Title: 13 Date: 14 ------------------------------------------------------------------- ----------------------------------------------------------- ------- 15 E-Mail Address for Notices: J O hn 6),3�'} ��y• Cvr i 16 E-Mail Notice Contact Person's Name: 17 Email Notice Contact Person's Title: �' F() 18 ----------------------------------------------------------------------------------------------------------------------------------- 19 Company Name: 60,0&,'e 11 20 Mailing Address: j Orj Sh��' Avk' 21 City. State & Zip Code: rr-QSo O, C19 ! 3 -71t 22 State in Which the Company Originally Registered: C�k)110/'h l Gl 23 ------------------------------------------------------------------- ------------------------------------------------------------------- 24 Contact Telephone Number: ��VI) aa`6 — 9/Cl 0 25 Contact Fax Number: C 5 5 cl D 3 SS y 2 u v 26 Ce ( z5r5`l) qO-7 7`7'7 '7 27 28 -22- 1 2 Agreement for Occupational Therapy and Physical Therapy Services with the County of Fresno 3 CONTRACTOR SIGNATURE PAGE 4 5 6 7 Print Name: 8 Title: 9 Date: 10 ---------------------------------------------------------------------------------------------------------------------- 11 Bv.- 12 Print Name: 13 Title: 14 Date: 15 ------------------------------------------------------------------- ------------------------------------------------------------------- 16 E-Mail Address for Notices: 17 E-Mail Notice Contact Person's Name: 18 Email Notice Contact Person's Title: 19 ------------------------------------------------------------------- ------------------------------------------------------------------- 20 Company Name: 21 Mailing Address: 22 City, State & Zip Code: 23 State in Which the Company Originally Registered: 24 ------------------------------------------------------------------- ------------------------------------------------------------------- 25 Contact Telephone Number: 26 Contact Fax Number: 27 28 -23- 1 2 EXHIBIT A 3 PARTICIPATING CONTRACTORS 4 CONTRACTOR ADDRESS RECEIVE AND SEND NOTICES 5 Cell Staff, LLC 1715 N. Westshore Blvd. Mac Lomax, Vice President 6 Suite 410, Recruit@cellstaff.com 7 Tampa, FL 33607 (855)561-1715 8 Goodfellow 2505 W. Shaw Ave. John Goodfellow, CEO 9 Occupational Suite 101, John@gftherapy.com 10 Therapy, Inc. Fresno, CA 93711 (559)228-9100 opt 2 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -24- EXHIBIT B COUNTY FRESNO $ r o� �a REQUEST FOR STATEMENT OF QUALIFICATIONS NUMBER: 19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES Issue Date: March 11, 2019 Closing Date: MARCH 28, 2019 AT 2:00 P.M. All Questions and Responses must be electronically submitted on the Bid Page on Public Purchase. For assistance, contact Heather Stevens at Phone (559) 600-7110. BIDDER TO COMPLETE Undersigned agrees to furnish the commodity or service stipulated in the attached at the prices and terms state in this RFSO. Bid must be siened and dated by an authorized officer or emnlovee. COMPANY CONTACT PERSON ADDRESS CITY STATE ZIP CODE TELEPHONE NUMBER E-MAIL ADDRESS AUTHORIZED SIGNATURE PRINT NAME TITLE G:\Public\RFSQ\FY2018-19\l9-059 Occupational and Physical1herapy Serv4ces\19-059 Occupational and Physical Therapy Services.doc Statement of Qualifications No. 19-059 Page 2 TABLE OF CONTENTS PAGE KEYDATES .................................................................................................................... 3 OVERVIEW.....................................................................................................................3 BACKGROUND...............................................................................................................3 PROJECT........................................................................................................................4 SCOPEOF WORK..........................................................................................................4 COMPLY/NOT COMPLY.................................................................................................5 SUBMITTAL ....................................................................................................................6 CONTRACTTERM .........................................................................................................6 INSURANCE REQUIREMENTS .....................................................................................7 APPEALS........................................................................................................................8 G:\PUBUC\RFSQ\FY2018-19\19-059 OCCUPATIONAL AND PHYSICALTHERAPYSERVICES\19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 3 KEY DATES RFSQ Issue Date: March 11, 2019 Written Questions for RFSQ Due: March 15, 2019 at 11:00 A.M. Questions must be submitted on the Bid Page. RFSQ Closing Date: March 28, 2019 at 2:00 P.M. Statement of Qualifications must be electronically submitted on the Bid Page on Public Purchase. OVERVIEW It is the intent of the County to engage several contractors under a master agreement to provide the professional services described herein. The County of Fresno, Department of Public Health (DPH) Children's Medical Services Division —California Children's Services Program is soliciting the services of a contractor(s)who can provide Occupational Therapy(OT)AND Physical Therapy(PT)services for children enrolled in California Children's Services (CCS) Medical Therapy Program (MTP). The CCS MTP is mandated by the California State Law to provide prescribed OT and PT services for children, ranging from birth to 21 years old, with handicapping conditions, generally due to neurological, musculoskeletal or other medical disorders, such as but not limited to, cerebral palsy and spina bifida. The MTP operates Medical Therapy Units (MTUs) located at three (3) local school sites in Fresno County. Each MTU is equipped to conduct the necessary special needs pediatric OT and PT services onsite. BACKGROUND There are currently 769 children receiving both OT and PT services at the three (3) MTUs. The Department has had a continuous recruitment for five (5)vacant licensed Occupational and Physical Therapist positions, but has not been successful in filling all. To meet the increasing medical therapy demands for Fresno County CCS MTP eligible children and address the difficulty of recruiting qualified OT and PT personnel, contracted services have been established since 2012. The OT and PT services provided by a current contractor enables CCS MTP to provide the necessary services to qualified MTP clients in Fresno County. The contractor's annual cost based on FY 2017-18 services was approximately$845,000.00. While CCS MTP has two (2)full time OTs and four(4)full time PTs, the contractor provides four(4) OTs, ultimately leaving 87 children currently on the PT waitlist. Additional OT and PT resources are needed to meet the demands of increasing numbers of CCS MTP eligible children in Fresno County. Should the County be unable to procure continued contracted OT and PT services, the number of waitlisted children will be upwards of 522 for OT services and 87 for PT services. The Request for Statement of Qualifications seeks the continuation of contracted OT and PT services, and if possible from multiple local providers. It is the intent of the County to engage several contractors under a master agreement to provide the professional services described herein. CCS MTP's goal is to provide timely and effective OT and PT services needed by every CCS MTP qualified child in Fresno County. G:APUBUC\RFSQAFY2018-19\19-059 OCCUPATIONAL AND PHYSICALTI IERAPY SERVICES\19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 4 PROJECT Request for Statement of Qualifications to provide Occupational therapy(OT)and Physical therapy(PT) contracted services to the children (ranging from birth to 21 years of age)enrolled in County of Fresno's California Children's Services (CCS) Medical Therapy Program (MTP). The MTP operated Medical Therapy Units (MTUs) located at three (3) local school sites namely: MTU LOCATION Garfield MTU 1345 N. Peach Ave. Clovis Ginsburg MTU 67 E. Ashlan Avenue, Fresno Storey MTU 2444 S. Peach Avenue, Fresno The County anticipates a three (3)year base master services agreement, with the option to extend for two (2) additional twelve (12) month periods, emanating from this RFSQ. The County will determine which contractor to utilize based on two priority factors. The first factor is which contractor will provide the required services at the lowest rate. The second factor is contractor OT/PT staff availability. SCOPE OF WORK The Contractor shall provide licensed OT and/or PT services onsite at the three (3) MTUs located within Fresno County, 3 to 5 days per week, up to 8 hours per day, not to exceed nine thousand twenty-five (9,025) service hours annually. The following responsibilities include but may not be limited to: A. Conduct OT and/or PT tasks in accordance with State and County regulations and guidelines B. Evaluate, plan, schedule and provide treatment to assigned and scheduled clients C. Complete required documentations accurately and in a timely manner, in accordance with State and County regulations and guidelines D. Communicate appropriate information to physicians, other MTP team members, parents, clients' teachers and other agencies as needed to implement client treatment services E. Attend and participate in medical therapy case conferences F. Fabricate, modifies and applies splints as prescribed G. Coordinates, teaches, supervises and develops functional exercises to provide corrective therapy H. May conduct home visits to assess the needs for the prescribed durable medical equipment(DME) and assess the environment for completing functional tasks and/or environmental barriers I. Assess and order DME and orthotics as prescribed J. Provide instructional training to clients, family members and caregivers regarding home exercise programs and equipment needs G:APUBUC\RFSQAFY2018-19\19-059 OCCUPATIONAL AND PHYSICALTI IERAPY SERVICES\19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 5 COMPLY/NOT COMPLY Compliance and understanding of the specification is to be noted by marking "COMPLY" on the line provided to the right of the specification. Non-compliance is to be indicated by marking "NOT COMPLY" on the line. A detailed statement explaining why they fail to meet the stated specification or requirement must accompany all non-compliant items. Failure to mark this page could result in your statement of qualifications being non-responsive. BIDDER TO COMPLETE THE FOLLOWING: COMPLY/ NOT COMPLY 1. Contractor shall provide State licensed Occupational and/or Physical Therapists with a minimum of three (3) years documented experience; or if less than three(3) years' experience, written approval from the CCS Rehabilitative Therapy Manager and the CCS Division Manager must be requested and obtained prior to placement. 2. Contractor's OT and PT staff shall be CCS Paneled 3. Contractor's OT and PT staff shall maintain all licenses,credentials, board regulations, and/or certifications. 4. Contractor's OT and PT staff shall maintain Cardiopulmonary Resuscitation (CPR) certification. 5. Contractor's OT and PT staff shall be HIPAA trained annually. 6. Contractor's OT and PT staff shall abide by all of County's confidentiality requirements. 7. Contractor's OT and PT staff shall provide own transportation for off site visits such as home visits and meetings at MTUs. 8. Contractor's OT and PT staff shall maintain applicable annual medical clearance (i.e. updated required vaccinations, annual Tuberculosis skin test, etc.), as required per OSHA training regulations. See links for additional information: a. Aerosol Transmissible Diseases -https://www.dir.ca.gov/title8/5199.html b. Blood Borne Pathogen - https://www.dir.ca.gov/title8/5193.html 9. Contractor must maintain offices locally(within Fresno County)to ensure OT and PT services can be provided at each of the CCS MTPs within a consistently timely and reliable manner 10. Contractor must meet County's minimum insurance and indemnification requirements, as provided in this RFSQ. 11. Contractor must provide and clearly identify service rates per staff position. G:AP1UBUC\RFSQAFY2018-19\19-059 OCCUPATIONAL AND PHYSICALTI IERAPY SERVICES\19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 6 SUBMITTAL A. The submittal will enable the County Department to appraise the general competence and qualifications of the responding firms. Please provide the listed information in the following sequence: 1. Firm name, address and phone number 2. Type of organization (sole-proprietorship, partnership, orcorporation) 3. Firm principals who will be responsible for the project, and their educational background, credentials, training and experience 4. Key personnel (including proposed sub-contractors, if applicable)who will work on the project with their educational background, credentials, training and experience on comparable projects 5. List of current staff, including job classification 6. Firm qualifications, including licenses 7. List current projects or commitments for similar services in progress 8. List the name and phone number of at least three (3) relevant client references B. Required Qualifications: 1. Contractor shall provide a copy of the OT's valid license as an Occupational Therapist with the State of California— Department of Consumer Affairs, California Board of Occupational Therapy 2. Contractor shall provide a copy of the PT's valid license as a Physical Therapist with the State of California— Department of Consumer Affairs, Physical Therapy Board of California 3. Contractor shall provide a copy of the current CPR certification and proof of HIPAA training certificate for each OT and PT staffs. 4. Contractor shall provide a copy of the current medical clearances for each OT and PT staff. 5. Contractor shall provide proof of local office establishment. CONTRACT TERM It is the County's intent to contract with the successful bidder(s)for a term of three (3) years. Agreement may be renewed for a potential of two (2)one (1) year periods, based on the mutual written consent of all parties. Total fees paid to the each contractor will be dependent upon the bid provided by contractor. No guarantee is made that the total fee or any fee will be received by the contractor. G:APUBUC\RFSQAFY2018-19\19-059 OCCUPATIONAL AND PHYSICALTI IERAPY SERVICES\19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 7 INSURANCE REQUIREMENTS INSURANCE: Without limiting the County's right to obtain indemnification from Contractor or any 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 coverage including completed operations, product liability, contractual liability, Explosion-Col lapse- Underground, fire legal liability or any other liability insurance deemed necessary because of the nature of the 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 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. This coverage shall be issued on a per claim basis. Contractor agrees that it shall maintain, at its sole expense, in full force and effect for a period of three 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 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. F. Cyber Liability: -Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is undertaken by CONTRACTOR in this agreement and shall include, but not be limited to, claims involving infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of electronic information, release of private information, alteration of electronic information, extortion and network security. The policy shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations. Additional Requirements Relating to Insurance: Contractor shall obtain endorsements to the Commercial General Liability insurance naming 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's policies herein. This insurance shall not be cancelled or changed without a minimum of thirty(30)days advance written notice given to County. G:APUBUC\RFSQAFY2018-19\19-059 OCCUPATIONAL AND PHYSICALTI IERAPY SERVICES\19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 8 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 executes this Agreement, Contractor shall provide certificates of insurance and endorsement as stated above for all of the foregoing policies, as required herein, to the County of Fresno, Department of Public Health, Attn: Susan Stasikonis, 1221 Fulton Street, Fresno, CA 93721, 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 names 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's 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. All policies shall be with admitted insurers licensed to do business in the State of California. Insurance purchased shall be purchased from companies possessing a current A.M. Best, Inc. rating of A FSC VII or better. APPEALS Appeals must be submitted in writing within seven (7) working days after notification of proposed recommendations for award. A"Notice of Award" is not an indication of County's acceptance of an offer made in response to this RFQ. Appeals shall be submitted to County of Fresno Purchasing, 4525 E. Hamilton Avenue 2nd Floor, Fresno, California 93702-4599 and in Word format to gcornuelle(aD_FresnoCountyCA.gov. Appeals should address only areas regarding RFQ contradictions, procurement errors, proposal rating discrepancies, legality of procurement context, conflict of interest, and inappropriate or unfair competitive procurement grievance regarding the RFQ process. Purchasing will provide a written response to the complainant within seven (7)working days unless the complainant is notified more time is required. If the appealing bidder is not satisfied with the decision of Purchasing, bidder shall have the right to appeal to the County Administrative Office within seven (7) working days after Purchasing's notification; if the appealing bidder is not satisfied with CAO's decision, the final appeal is with the Board of Supervisors. Please contact Purchasing if the appeal will be going to the Board of Supervisors. G:APUBUC\RFSQAFY2018-19\19-059 OCCUPATIONAL AND PHYSICALTHERAPYSERMCES\19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERMCES.DOC G 0 V LL Q cell staff Cn J J W 1715 N Westshore Blvd Suite 410, Tampa FL 33607 Ph: (855) 561-1715 11 Fax: (813) 433-5159 11 Bids@cellstaff.com EXHIBIT C-1 Proposal Prepared for: COtj O 1$56 O FRCS Department of Public Health RFSQ Number: 19-059 Occupational and Physical Therapy Services Opening: March 28th, 2019 at 2:00 p.m. Pacific Time Ce I I stal Table of Contents Section Title Page # Table of Contents 1 Section A. General Competence and Qualifications: 2 - 20 1. Firm name, address and phone number 2 2. Type of organization 2 3. Firm principals who will be responsible for the project 3 - 5 4. Key personnel who will work on the project 4 - 5 5. List of current staff, including job qualifications 6 - 8 6. Firm Qualifications, including licenses 9 - 18 7. List current projects or commitments for similar services in progress 19 - 20 8. List the name and phone number of at least three (3) client references 19 - 20 Section B. Required Qualifications: 21 - 22 1. Contractor shall provide a copy of the OT's valid license as an 21 Occupational Therapist with the State of California - Department of Consumer Affairs, California Board of Occupational Therapy 2. Contractor shall provide a copy of the PT's valid license as a Physical 21 Therapist with the State of California - Department of Consumer Affairs, Physical Therapy Board of California 3. Contractor shall provide a copy of the current CPR certification and 21 proof of HIPAA training certificate for each OT and PT staffs. 4. Contractor shall provide a copy of the current medical clearances for 22 each OT and PT staff. S. Contractor shall provide proof of local office establishment. 22 Section C. Service Cost Rates: 23 Signed IFB 19-059 Packet 24+ "It's All About The Experience" Page 11 ;0 Ce I I stal Section A: General Competence and Qualifications A. The submittal will enable the County Department to appraise the general competence and qualifications of the responding firms. Please provide the listed information in the following sequence: 1. Firm name, address and phone number: Cell Staff, LLC 1715 N Westshore Blvd, Suite 410,Tampa, FL 33607 Toll-Free Phone Number: (855) 561-1715 Additional Relevant Contact Information: Proposal and Contracts: - Grant Hargis (primary) or Rami Isa (secondary) at Staffing Requests: - Paul Zushma (primary) or Mac Lomax(secondary) at Recruit@cellstaff.com Billing/Invoicing: - Grant Hargis (primary) or Ashley Raynor (secondary) at Invoice@cellstaff.com Other Relevant Contact Information: - General Fax is (813)433-5159 - General Email is Recruit@cellstaff.com - Website is www.cellstaff.com 2. Type of organization(sole-proprietorship,partnership,or corporation): Cell Staff is a limited liability company partnership (LLC-P) organized under the laws of Florida. 3. Firm principals who will be responsible for the project, and their educational background, credentials, training and experience Please see pages 3,4 and 5. 4. Key personnel (including proposed sub-contractors, if applicable) who will work on the project with their educational background, credentials, training and experience on comparableprojects Please see pages 4 and 5. "It's All About The Experience" Page 12 0. Cell Stal Firm Principals/Key Personnel Project Manager-Mac Lomax,VP of Government Services Cell Staff s Project Manager for the County of Fresno,Department of Public Health(hereafter the COF, DPH)will be Mac Lomax,Vice President of Government Services who has over 12 years of experience working within the healthcare staffing industry. Mac launched his career by servicing behavioral health facilities, correctional institutions, and special education departments across Northern California. Over the past 12 years Mac has overseen the successful completion of numerous competitively bid contracts for healthcare staffing at various Federal, state, county and municipal agencies. Mac is a firm believer in consistent communication, regular performance evaluations, and on-site visits to ensure Cell Staff is exceeding the COF,DPH's expectations for project implementation execution. All other Cell Staff personnel will be held accountable to Mac for the successful project implementation with the COF, DPH. Mac holds a bachelor's degree in communications, which has helped him excel in interpersonal communication with his clients and bring projects to fruition. Assistant Project Manager-Rami Isa,VP of Business Development Rami Isa serves as Vice President of Business Development for Cell Staff. Rami's primary responsibility is building long-lasting partnerships throughout the healthcare industry with our clients. Rami has served as a tremendous resource for his clients by filling niche positions when urgent staffing needs have arisen,including behavioral healthcare. Over the past 15 years, Rami has provided healthcare staffing services to a variety of clients, including: various state and county departments of behavioral health, state hospitals, departments of corrections, state developmental centers, special education departments, and numerous other behavioral healthcare settings. Rami will assist Mac in ensuring all the COF, DPH's needs are being addressed,that all positions are being filled in a timely manner, and that the healthcare professionals on site are exceeding expectations. Rami holds a bachelor's degree in electrical engineering, which has given him an analytical and mathematical advantage over the course of his career. Recruitment-Dan Gutierrez,VP of Operations Cell Staffs company operations, recruitment, and training is overseen by Dan Gutierrez, Vice President of Operations. Dan has 18 years of government healthcare experience,which has included behavioral health institutions and correctional departments.Dan is supported by a team of recruiters who have multiple years of experience recruiting and onboarding qualified healthcare providers within a variety of federal, state, and county public organizations. Every new Cell Staff employee completes a 3-month recruitment, compliance,and customer service training period,which ensures each team member fully comprehends all aspects of Cell staffs core values, recruitment methods, applicant tracking systems, client resource management systems, qualifications for each profession/specialty,and client-specific credentialing processes.Dan has an impeccable track record of providing quality placements that adhere to Joint Commission,institutional,contractual,legal and ethical standards. Dan will be responsible for his recruitment team and their commitment to filling all vacant positions with qualified candidates who have backgrounds and experience related to their specific positions at the COF, DPH. While serving in the United States Navy, Dan obtained his bachelor's degree in healthcare administration.After returning to civilian life,Dan went on to obtain his master's degree in business administration. "It's All About The Experience" Page 13 Cell Staff California Team Experience: Mac, Dan and Rami are all California Natives. Although they now focus on healthcare staffing on a National level, each has deep insights into the State of California and understand the differences in the various local healthcare staffing markets. Mac started his career working in North California,specifically as a Recruiter in a local San Francisco office. Mac then moved on to manage his own office in Oakland California. Mac then managed the entire State of Arizona before also taking over the entire Government Services Division. Mac also assisted Dan at this time by providing leadership and management support to the various local California branches for multiple years. Rami has successfully run offices in the Sacramento, Los Angeles, Orange County, and San Diego, in addition to remotely serving the In-land Empire and all of Central California which included the City/County of Fresno. Rami went on to handle all outside sales and regional account management for all of California,Nevada and Arizona. Dan began his healthcare staffing career working in San Diego, working with numerous public and private clients. Dan then moved to the San Bernardino office and managed local office. Dan then returned to San Diego and began to develop local office for another company,quickly expanding their presence to local markets in Los Angeles, San Diego, Orange County, Sacramento, Phoenix and Los Vegas. Before long,Dan was managing the company's entire California and Southwest markets. Non-Principal Key Personnel Billing and Contractual Compliance-Grant Hargis,Director of Operations All contractual compliance is overseen by Mr. Grant Hargis, Director of Operations. Grant is responsible for outlining Cell Staffs contractual requirements for each client/project and ensuring all members of the Cell Staffs team are knowledgeable on these specific contractual obligations.This is including but not limited to scope of services for each profession, client-specific operating procedures and training,invoicing,and candidate minimum qualifications(both general and position specific). In addition, Grant will also assist Dan and his recruitment team in confirming that all new candidates submitted and nursing professionals currently working,remain current and up to date on all their credentials, in order to maintain contractual compliance. Grant holds a bachelor's degree in justice studies which has helped immensely when reading over lengthy contracts and comprehending complex client work-flow processes. Dedicated Account Manager-Paul Zushma Paul started as a Recruiter with Cell Staff over 3 years ago and quickly established himself as a top performer on the Recruitment Team. Once Paul had proven himself as an accomplished Recruiter and demonstrated the ability to create and maintain strong relationships with his healthcare professionals working in the field, Cell Staff promoted Paul into an Account Management position, allowing him to foster relationships on the client development side of the business. Paul yet again proved his worth,providing quick turnaround time on placements for staffing needs and providing exceptional customer service. Additionally, his experience and incites as a Recruiter allow him to effectively mentor the Recruiters working on his needs and expedite the placement process. Paul's experience also allows him to double-down and help his clients by quickly finding healthcare professionals to meet their urgent staffing needs. Paul holds a bachelor's degree in entrepreneurship, which coupled with his unparalleled work ethic, has result in a dynamic and creative approach to solving problem for his clients and his healthcare professionals. "It's All About The Experience" Page 14 Cell Staff Cell Staff Government Se:tikes Mac Lomax VP-Government Son-ims Rami lsa Dan Gutierrez t'P Busums Do-elopmont __ VP-Businoss Operations Paul Zusluna Clinical Liaison Grant Hargis L Acco::rat Managers Based on Profession Director of Operations Eric Parker Contract Team Recruitment Manager I Contract Specialists Healthcare Recruitment Team Compliance Team Professionals Per Your Request Professional RecruitersI Compliance Coordinators "It's All About The Experience" Page 15 0. Cell Stal 5. List of current staff, including job classification Cell Staff recruits individuals specifically for each project. Cell Staff has previously had OT and PT professionals working in the area, and they will be a few of many potential candidates that will be contacted upon award. If awarded, Cell Staff will implement a local, regional and Statewide recruitment campaign to hire the occupational and physical therapists necessary to fill the five (5) current vacancies at the California Children's Services (CCS) Medical Therapy Program (MTP). Based on RSFQ 19-059, Cell Staff will be responsible for providing 4 OT's and 1 PT for approximately 9,025 combined hours per year. Although Cell Staff does not have PT and OT staff currently on stand-by locally in Fresno, we have historically had excellent success in placing PT and OT candidates in a wide variety of setting,including pediatric and educational based settings. Please keep in mind, most vendors with local staff already have them assigned to other clients or their own clinics. With that said, the local vendors will either need to hire new staff to replace the current employees that are moved to the COG, DPH or else they will be recruiting new staff. Cell Staff will pre-screen and vet all PT and OT candidates to ensure they meet or exceed the required qualifications listed throughout RFSQ 19-059 and can successfully implement the scope of work: SCOPE OF WORK The Contractor shall provide licensed OT and/or PT services onsite at the three (3) MTUs located within Fresno County, 3 to 5 days per week, up to 8 hours per day, not to exceed nine thousand twenty-five (9,025) service hours annually. The following responsibilities include but may not be limited to: A. Conduct OT and/or PT tasks in accordance with State and County regulations and guidelines B. Evaluate, plan, schedule and provide treatment to assigned and scheduled clients C. Complete required documentations accurately and in a timely manner, in accordance with State and County regulations and guidelines D. Communicate appropriate information to physicians, other MTP team members, parents, clients' teachers and other agencies as needed to implement client treatment services E. Attend and participate in medical therapy case conferences F. Fabricate, modifies and applies splints as prescribed G. Coordinates,teaches, supervises and develops functional exercises to provide corrective therapy H. May conduct home visits to assess the needs for the prescribed durable medical equipment (DME)and assess the environment for completing functional tasks and/or environmental barriers 1. Assess and order DME and orthotics as prescribed J. Provide instructional training to clients, family members and caregivers regarding home exercise programs and equipment needs "It's All About The Experience" Page 16 0, Cell Staff Cell Staff would like to summarize our general recruitment model for identifying,screening, credentialing,and placing qualified PT's and OT's at the COF, DPH.This method will be adjusted to meet the position specific requirements,such as the specifications found using the link below,in addition to any general requirements the COF,DPH might have (Ex: California Live-scan). http://agency.governmentjobs.com/fresnoca/default.cfm?action=agencyspecs 1) Cell Staff identifies PT/OT candidates (existing Cell Staff employees or new recruit)who have the education, licensure, experience, skillsets and personal characteristics to perform the scope of work for their profession as required by the COF, DPH. After an initial vetting process by Cell Staffs Recruitment Team, each candidates' application packages will be submitted to the designated COF, DPH representative for review.These application packages would include: • Resume outlining relevant years' experience (minimum 1 year is standard practice) • Verified clinical references and/or performance reviews • Skills checklists and/or relevant training certificates • Copy of current California and/or National Professional License • Online license verification through the designated Board(s) • Any additional documents requested by the COF,DPH After review of each candidates' application package, the COF, DPH representative can either move forward with an interview and/or request to view additional candidates' application packages. Once the COF, DPH selects a candidate for a position, an offer letter will be presented to the candidate by Cell Staff for a position at the COF, DPH facility. 2) Once a PT or OT candidate has accepted the offer letter, Cell Staff will perform our full credentialing process to complete the candidate's compliance profile and hiring process. In the event of existing employees, the credentials on file will be reviewed to ensure they are current and meet the specifications of the COF, DPH contract and specific job requirements. Our credentialing process will be tailored to meet all the COF, DPH requirements,which can include but not limited to: • Completion of W-4 and I-9 accompanied by two forms of valid governmentlD • Signed new hire packet application and job description • 10-panel urine drug screen per section • 80%+ Passing scores on assigned professional competency testing • Education verification with candidate's applicable school(s) • Any additional reference checks to verify clinical experience and previous performance • Physician's evaluation of health confirming ability to perform job duties • Negative PPD/Mantoux or TST Screening within the last 12 Months (1 or 2 Step). In the event a candidate tests positive for TB,a negative chest x-ray is acceptable • Current BLS/CPR certificate • HIPAA Training Certificate and signed HIPPA Privacy Agreement • Other Annual Medical Clearance: Blood Borne Pathogens and Aerosol Transmissible Diseases • Cell Staff thorough background screenings process to can include: - 7-year State&County background check&social security number trace byHirease - Federal E-Verify verification of employment eligibility - Federal SAM,OIG, EPLS, OFAS and National Sex Offender Registry name check (included Medicare/Medicaid fraud check) - California Live-scan and/or FBI/DOJ Fingerprint Background Check "It's All About The Experience" Page 17 0. Cell Stal 3) Once a candidate's vetting/hiring process is complete,Cell Staff will submit the documents to the designated COF, DPH representative for review and filing. • If approved to, move onto step 4. • If denied, correct deficiencies (i.e.new BLS certificate) and resubmit forapproval. 4) Once a PT or OT is approved to start by the COF, DPH, Cell Staff will arrange the necessary orientations, trainings, and any other pending requirements to ensure our employee feels comfortable performing all requested administrative and clinical duties in line with COF, DPH policies and procedures. 5) Cell Staff s employee performs the requested services as outlined in the RFSQ. 6) Cell Staff and the COF, DPH review each employee's performance after 30 days, 90 days, and annually thereafter, to ensure all patients' needs are being addressed and the quality of care is meeting the expectation of the COF, DPH Staff. Cell Staff will provide regular feedback to our employees to promote continuous improvement in quality of care while working onsite. Please note,any healthcare professionals working at the COF,DPH will be employees (w2)of Cell Staff.Nurse Practitioners may be given the option to become 1099 contractors,which is standard practice for mid-levels and locum tenens,unless it is expressly forbidden by the COF,DPH. employeeF Cell Staff& facility evaluate performance F Cell Staff I k,11 Staffing Solution F Cell Staff I . . . - provides requested k L services A "It's All About The Experience" Page 18 0. Cell Stal 6. Firm qualifications, including licenses History: Cell Staff was established in Tampa, Florida on January 281h, 2014 with the mission provide supplemental healthcare staffing services to facilities across the United States. In response to the ever-growing public/government healthcare sector, Cell Staff specializes in healthcare staffing for Federal, state, and local government entities. Specifically, Cell Staff focuses on providing nursing, therapy/allied, behavioral healthcare and locum tenens to government agencies in the behavioral healthcare, correctional healthcare,and school-based settings. Mission: Are you Ready for a Fresh Start? We Can Help! Cell Staff provides nationwide employment opportunities for healthcare professionals, specifically on government service contracts. Cell Staff prides itself on being staffing visionaries.We seek the most gifted candidates in the healthcare field. Whether that describes you or the employee you're looking for,Cell Staff has you covered. Vision: It's All About the Experience. Whether it's your first day or first (or tenth) year with us, each client and employee will find their individual needs met with the Cell Staff personal touch. We know that no two people are alike and we will create a tailored experience to match your needs.Cell Staff might not be the biggest healthcare staffing company in the industry(yet) but we certainly pride ourselves on being the best! Our reputation for seeking only the best and most forward-thinking candidates is unmatched in the staffing industry. We attract incredible talent and build lasting relationships because we think we're pretty incredible ourselves. Reset Your Expectations of what a staffing company should be,with Cell Staff! Connect with us today to experience the difference. Core Values: Build Open and Honest Relationships Create a Team Environment with Family Spirit Be Passionate and Relentless Embrace and Drive Change Show Humility andAccountability Experience: Cell Staff brings more than 50 years of combined management experience within the healthcare staffing industry and we pride ourselves on our customer service, recruitment resources, staffing technology, national reputation and (above all) the ability to provide exceptional healthcare professionals to our clients. Cell Staffs executive team was assembled to bring the most knowledgeable and innovative healthcare staffing leaders together.Cell Staffs management team has partnered with wide range of government facilities nationwide such as: Federal and State Department of Veterans Affairs; Federal, State and County Department of Corrections; Department of Defense; Departments of Public Health; Indian Health Services; and various other government/public organizations. However, Cell Staffs strategic areas of focus remains our partnerships with government agencies providing behavioral healthcare and related services. "It's All About The Experience" Page 19 ;0 Ce I I stal Current or Previous Clients in California or with similar requested services: `!9 Fresno Veterans Home,California Dept.Veterans Affairs County of Fresno, Behavioral Health Department 5 Butte County Behavioral Health Department Los Angeles Unified School District Management Solutions (CDCR and CA-DSH) 5 Wisconsin School for the Deaf Wisconsin School for the Blind and Visually Impaired Providence Public Schools 5 Arkansas Health Center,Arkansas Dept Human Services Central State Hospital,Georgia Dept Behavioral Health and Developmental Disabilities Philosophy&Culture: Cell Staffs vision statement, "It's All About The Experience," summarizes our business philosophy and culture. As the tagline suggests, Cell Staff considers itself to be a customer services company. Although this term is thrown around loosely in today's business world,Cell Staffs executive team has envisioned a culture that strives to exceed this ideal by creating a team environment with a family spirit. Each and every employee, assignment, client and project is different. That being said,we feel every experience should be tailored to fit the needs of that particular individual or organization. Creating a tailored experience with a personal touch for everyone we partner with is what sets us apart from our competition.Additionally, building open and honest relationships in all facets of our business is how we foster both professional and personal relationships and create long-lasting, mutually beneficial partnerships. This philosophy applies not only to our clients receiving staff, but also to the healthcare professionals we employ to provide these services. Retention of quality healthcare professionals is key not only to our long-term success,but also in maintaining continuity of care and excellent customer satisfaction. Each healthcare provider's experience begins with a connection to one of our recruiters,is tailored during the recruitment/hiring process and continues to develop as an active employee of Cell Staff.Just as our account executives build both personal and professional relationships with our clients, our recruiters do the same for our healthcare professionals.As long as each and every Cell Staff employee remains passionate and relentless about their endeavors and continues to show humility and accountability for their actions, success and customer satisfaction will follow. It's a simple formula that we've perfected. Innovation: Cell Staff prides itself on being a technology-based company.Embracing and driving change is critical to the success of any business in today's technology-centered world. Cell Staff uses the latest in staffing software, social media, web integration, and recruitment techniques to stay ahead of the curve. For Cell Staff,this includes using recruitment technology that allows our company to reach a broader pool of candidates. Phones calls, referrals, and conferences are still effective means of contacting talented healthcare professionals. However, search engine optimization, online databases/leads systems, streamlined web-based job postings to multiple forums, and effective use of social media, is critical to reaching the growing millennial presence in the workforce, specifically within the growing healthcare field. "It's All About The Experience" Page 110 0, Ce I I stal Recruitment Resources In addition to our proprietary candidate database and extensive network of healthcare professionals, Cell Staff also utilizes the following to identify and recruit new healthcare professionals specifically for the positions requested by our clients. Online: • CellStaff.com-Job postings that stream live to our website from Talent Rover (described below) or via direct entry. From there our RSS feed pushes these job postings out to many of the forums listed below • Work4 Lab Solutions - Allows us to use Facebook and Linkedin to identify healthcare professionals by profession within a geographic area.Additionally,this system also pushes out our job postings on automated schedules to Facebook, Linkedin,and Twitter. • Indeed-Pay-per-click job postings,and profile database search • CareerBuilder-Job postings and resume database search • Craigslist-Job postings • Jobs-2-Careers-Job postings that stream live to hundreds of job boards • Allied/Nursing Travel Career-Therapist&nursing candidate lead generator,resume database search,and job postings that are fed directly from ourwebsite. • Allied/Nursing VIP-Therapist and nursing candidate lead generator and job postings • I Hire Therapy&I Hire Nursing-Job postings and resume database search • Health Jobs Nationwide-Job postings and resume database search • Staff DNA-Healthcare candidate lead generator • LinkedIn Recruiter-Job posting and candidate resume search Traditional: • Call Lists-Both from purchased lists and generated from our extensive internal database Conferences/Exhibits: • National Conferences for Healthcare Professions • College/University Job Fairs for students entering the healthcare field • Hosting Pub Nights and Social Events for Various Healthcare Professionals "It's All About The Experience" Page 111 0. Cell Stal Employee Benefits to Attract and Retain our Healthcare Professionals Standard Benefits: 0 Social Security Contribution • Federal and State Tax Withholding based on employee's W4 and applicable state's tax withholding form(s) 0 General,Automobile,Workers Compensation, Professional,and Umbrella Liability insurance through our Insurance Providers 0 Weekly Pay via Direct Deposit 0 Basic Life/AD&D Insurance of$25,000.00 through the Hartford All Cell Staff employees are eligible to elect to receive the following benefits based on their tailored compensation package. Benefits are effective on 1st day of employment! 0 Individual/Family Medical Insurance, 50%Cell Staff Contribution,through Blue Cross 0 In Individual/Family Dental Insurance through Lincoln 0 Individual/Family Vision Insurance through Lincoln 0 Pet Insurance through Healthy Paws 0 Supplemental Life (up to $150,000.00) and AD&D for Employees and/or Dependents through Hartford 0 Supplemental Life and AD&D for Dependents (up to$150,000.00) 0 Voluntary Short-Term Disability,Critical Illness and Accident Policies through the Hartford 0 Continuing Education and/or Training Reimbursement 0 Clinical Mentorship/Liaisons for certain healthcare professions 0 Professional Licensure and/or Certification Reimbursement • Paid Holidays/Vacation/Sick Time (within client's contractual guidelines) 0 Wellness Program with Discounted Membership to 10,000 Gym locations Nationwide 0 401K Retirement Plan 0 Travel, Lodging,and Meal stipends within GSA and IRS guidelines Complimentary Continuing Education: • Local In-Service Training - Cell Staff offers group or individual classes through third parties such as the American Red Cross, American Health and Safety Institute, and American Heart Association. Class examples include BLS certification,CPI,SAMA,etcetera but classes do vary depending on geographic location and time ofyear. • Client Internal Programs or Additional Requests - Cell Staff also encourages our employees to participate in all in-house training sessions offered by our clients. Cell Staff also encourage auxiliary training offered by third parties for software systems or equipment used by our clients. • Mentorship/Clinical Liaisons-Offered for certain professions,our mentors and clinical liaisons are available to address clinical questions and offer guidance to our healthcare professionals. • ContinuingEducation.com and Cell Staff E-University - Cell Staff has partnered with Allied Health Media's nationally accredited e-learning platform to create the Cell Staff Institute. The Cell Staff Institute will allow our healthcare professionals to log on remotely through our website and complete certified continuing education units (CEU's) at their leisure online. "It's All About The Experience" Page 112 Alex Padilla Caiifornia Secretary of State Business Search - Entity Detail The California Business Search is updated daily and reflects work processed through Wednesday.March 27,2019 Please refer to document Processing Times for the received dates of filings currently being processed The data provided is not a complete or certified record of an entity Not all images are available online 201413210183 CELL STAFF, LLC Registration Date: 05/07/2014 Jurisdiction: FLORIDA Entity Type: FOREIGN Status: ACTIVE Agent for Service of Process: CORPORATION SERVICE COMPANY WHICH WILL DO BUSINESS IN CALIFORNIA AS CSC - LAWYERS INCORPORATING SERVICE, (C1592199) To find the most current California registered Corporate Agent for Service of Process address and authorized employeeis) information,click the link above and then select the most current 1505 Certificate. Entity Address,. 1715 N.WESTSHORE BOULEVARD,SUITE 410 TAMPA FL 33607 Entity Mailing Address: 1715 N WESTSHORE BOULEVARD,SUITE 410 TAMPA FL 33607 LLC Management ' A Statement of Information is due EVERY EVEN-NUMBERED year beginning five months before and through the end of May Document Type jt File Date j PDF SI-COMPLETE 11/14/2018 SI-COMPLETE 04/28/2016 REGISTRATION 05/07/2014 Indicates the information is not contained in the California Secretary of State's database. Note:If the agent for service of process is a corporation,the address of the agent may be requested by ordering a status report • For information on checking or reserving a name,refer to Name Availability. • If the image is not available online,for information on ordering a copy refer to Information Requests. • For information on ordering certificates,status reports.certified copies of documents and copies of documents not currently available in the Business Search or to request a more extensive search for records, refer to Information fLUU2211 • For help with searching an entity name,refer to Search Tips. • For descriptions of the various fields and status types, refer to Frequently Asked Questions "It's All About The Experience" Page 113 0, Cell Staff State of Florida Department of State I certify from the records of this office that CELL STAFF, LLC is a limited liability company organized under the laws of the State of Florida, filed on January 28,2014. The document number of this limited liability company is L 14000014839. 1 fitrther certify that said limited liability company has paid all fees due this office through December 31.2019,that its most recent annual report was filed on March 20,2019, and that its status is active. Given under nq hand and the Great Seal of the State of Florida at Tallahassee,the Capital,this the Twentieth diq of March,2019 t�ire Secretary of State Tracking Number:4181249127C'C To authenticate this certiliicateMsit the follouing site.enter this number,and then follow the instructions displayed. hltps://services.sunbiz.org/Filings/C'erliricaleOiSlatus/C'ertiricateAu thentication "It's All About The Experience" Page 114 0. Cell Stal Insurance Cell Staff has provided a copy of our COI below for your records. Cell Staff would like to request that the COF, DPH accept our excess liability policy to meet the following limits below. Cell Staff does carry cyber liability insurance although it is not specifically listed on the COI below. Evidence will be furnished upon request. 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 coverage including completed operations, product liability, contractual liability, Explosion-Collapse-Underground, fire legal liability or any other liability insurance deemed necessary because of the nature of the contract. E. Molestation: - Sexual abuse /molestation liability 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. F. Cyber Liability: - Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is undertaken by CONTRACTOR in this agreement and shall include, but not be limited to, claims involving infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of electronic information, release of private information, alteration of electronic information, extortion and network security. The policy shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations. "It's All About The Experience" Page 115 Cell Staff ncoRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM`Do1YYYY1 1011112018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER- IMPORTANT, If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED.subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER CONTACT NAME! Kim Tran Arthur J.Gallagher&Co. PHONE F Insurance Brokers of CA-LIC 4 0726293 Juc No, i•818.539 8618 Arc Not:818,539.8718 505 N Brand Blvd,Suite 600 E MAR s• Kim TranJIlaJg com Glendale CA 91203 WSURERi AFFORDING COVERAGE 4 HAKE INSURER A:Illinois Union Insurance Company 27960 _ _ INSURED CELLSTA-01 INSURER B:Old Republic Insurance Company 24147 Cell Staff,LLC 815 Colorado Blvd.,Suite 4400 INSURER C.- Los Angeles,CA 90041 INSURER or INSURER E: _ INSURER F COVERAGES CERTIFICATE NUMBER:1830e99539 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMSEFF - L TYPE OF INSURANCE lA1NSID I wv R� POLICY NUMBER MM DDYrYYYV M OCY EXP 1 LIMITS A X COMMERCIAL GENERAL LIABILITY ULPG27171SM-005 lt,2WO17 5128rP01e EACHOCCURRENCE 151,20l.000 X CLAIMSAIADE a OCCUR P�RAEA1 SEIIAGE S�Ee-ft CeI S31)0.000 RIED EXP,Any ono Peoan) $10,000 PERSONAL 6 ADV INJURY S I,00D.000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $3,OOD.ODO X POlICY�IECT 7 Lac PRODUCTS-COh1PIOP AGG SI.OD0.000 OTHEW. 5 A AUTOMOIILELIAVILITY ML➢G2717188"05 1112VZO17 8128WI9 COMOINED CINGLE LIMI 5 (EA awdenti _ ANY AUTO BODILY INJURY Me,U rsom 5 OWNED SCHEDULED BODILY INJURY IPwacck"h 5 AUTOS ONLY AUTOS X MIRED X NON-OWNED PROPERTY DAMAGE - AUTOS ONLY AUTOS ONLY IPar accldaM) Subllmll Each OCC(Ago1.000,000 A UMBRELLA LIAR OCCUR 11LG27111698-005 1115=17 512wols EACI OCCURRENCE II4.000,000_ X EXCESS UAB X CLAIML114AADE ,AGGREGATE 54,00D,000 DIED X RETENTION li S B WORKERS COMPENSATION MWC3139l N)0 61112016 611120t9 X PER 0 H- AND EM/LOYERS'LIABILITY STATUTE ER ANYPROPRIETORiPARTfIER,EXECUnVE YIN EL EACH ACCIDENT S I.000,000 OFFICERRAEMFREXCLuoew NIA -- - } (Mandatory in NM) E L.DISEASE•EA EMPLOYEEI S 1.DOD.DDo d yS6 JeSUID9 Under DESCRIPTION OF OPERATIONS beloH E,L DISEASE•POLICY LIMI 5 1000.000 A P(0leaelonal LND1111Y MLPG2 7 1 7 1 866-005 itr=017 606=19 Per Claim $1Ao0.001) RNfo Date-0226/2 14 Agglegale S].000.000 -W--Made tone DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remares Scnedwe,may De anacned it more epace U required) Excess Liability retroactive date 21282D14 for the first SIM Limit Excess Liability retroactive date 7/12/2016 for the next S31M Lirnit Abuse and Molestation under General Liability with S1,000,000 Aggregate Sublimit subject to SIDK Deductible Abuse&Molestation Liability retroactive date.022812014,Claims-FDim Made Policy-Crime Policy Term:6/12018 to 6/1/2019 See Attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Coverage AU1HOPI2ED REP ESENTATIVE f-L, ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD "It's All About The Experience" Page 116 Cell St Jai AGENCY CUSTOMER ID:CELLSTA-01 LOC#: ACQRO" ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY NAMEDINSURED Arthur J Gallagher&Co Cell Staff,LLC 815 Colorado Blvd.,Suite s400 POLICY NUMBER Los Angeles,CA 90041 CARRIER NAIC COCE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Policy#:72BDDHG7366 Carrier Hartford Fire Insurance Company Employee theft.Limit$100,000,Deducbble-.S1,000 Policy:Directors&Officers Liability Policy#:8241-8428 Policy Tenn:6/1/2018-6/1/2019 Carrier.Federal Insurance Company Per Claim S2.000.000.Aggregate:$2.000.000,Retentlon:SO Evidence of Coverane ACORD 101 (2008/01) , 2008 ACORD CORPORATION, All rights reserved The ACORD name and logo are registered marks of ACORD "It's All About The Experience" Page 117 Cell Sta ,aco�zo� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlVYYVI 6)1/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsements. PRODUCER CONTACT NAME: Kim Tran Arthur J.Gallagher&Co. PHONE FAX Insurance Broker of CA.Inc.LIC#0726293 Ale wa Ezt:818.539.8618 AC. No):818.539A617 505 N Brand Blvd,Suite 600 EDDR%ss: kim trannajg.com Glendale CA 91203 INSURERS AFFORDING COVERAGE NAIC A INSURER A:Old Republic Insurance Company 24147 INSURED CEUSTA-01 INSURER B: Cell Staff,LLC. 815 Colorado Blvd..Suite#400 INSURER C. Los Angeles,CA 90041 INSURER D: INSURER It: INSURER F: COVERAGES CERTIFICATE NUMBER:1891710650 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSUFANCEADOL SUBR� POLICY EPF POLICY EXP OMITS LTR I POLICY NUMBER /D I MID Y V COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DA 'O OR _ J CLAIMS•MADE _ OCCUR PREN11W LEaENT OtWnMca•� 3 _ MED EXP IAny_anaparsanl S PERSONAL a AD'✓INJURY S GEN L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE _ S POLICY u JECOT- LOC P_ROCUCTS-COMP/OP AGO S OTHER S AUTOMOBILE LIABILITY COMBtN 0 SINGLE LIA11T S atlem ANY AUTO BODILY INJURY(Per persdnl S OWNED r—�I SCHEDULEDAUTO AUTOS BODILY INJURY I Pot acddeap 3 — MIRED ONLY II-1 NON-OWNED HIRED AUTOSONLY PROPER DAMAGES ' AUTOS OTILY AUTOS ONLY LPer_aecalegtl`_ __ S UMBRELLA UAS OCCUR EACH OCCURRENCE 3 EXCELS LIAR CLAIMS-MADE AGGREGATE 5 DEO RETENTIONS 5 WORKERS COMPENSATION MVJC31391100 &12018 W12019 X STA E ERH- ANO EMPLOYERS'LIABILITY y I N 4NYPROPRIETOR�PARTNERIEXECUTIVE E.L.EACH ACCIDENT 51,000,000 OF FICER'MEAIBEREXCWDEO'+ WA (Mandatory In NMI E.L DISEASE•EA ENIPLOYE 5 1.000 Ono III. r yyea.descnba uMer 0 SCRIPT( N OF OPERATION bae v E.L.DISEASE-POLICY LIMIT S 1,000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Addttlonal Remarks Schedule,may be attached U more space Is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Coverage AUTHOrtrtRREDREP ESENTATIVE tc.1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD "It's All About The Experience" Page 118 0, Ce I I stal 7. List current projects or commitments for similar services in progress See below under refences in section 8. Cell Staff does not currently have any or projects or commitments that would impede our ability to perform under this project. 8. List the name and phone number of at least three (3) relevantclient references California References: Fresno Veterans Home, California Department of Veterans Affairs:August 2014- Present 2811 W California Ave, Fresno,CA 93706592 Robert Domrese, Director of Restorative Care/ (559) 493-4427 /robert.domrese@calvet.ca.gov Provided Physical Therapy and Occupational Therapy staffing services. Butte County Behavioral Health Department: June 2015 - Present 3217 Cohasset Road,Chico, CA 95973 Christine Zaveson, Nurse Manager/Ph: (530) 891-2954/czaveson@buttecounty.net Provide Registered Nurses, Licensed Vocational Nurses,and Recreational Therapy Services Management Solution, LLC which manages all staffing for the California Department of Corrections and Rehabilitation and the California State Hospitals: May 2017 - Present Deidre Blair-Saldana, Operations Lead/ (855) 502-3600 x 103 /deidre@vmssolution.com Provide Registered Nurses and Registered Dietitian staffing services. Other Physical and Occupational Therapy References: Wisconsin School for the Deaf: September 2014- Present 309 W Walworth Ave, Delavan,WI 53115-1099 Biran Lievens, Principal/ (262) 378-0114/brian.lievens@wsd.k12.wi.us Provide Physical Therapy,Occupational Therapy,and Speech Language Pathology staffing services. Wisconsin School for the Blind and Visually Impaired: September 2014- Present 1700 West State Street,Janesville,WI, 53546-5344 Pete Dally, Director/ (608) 758-4925 /pete.dally@wcbvi.k12.wi.us Provide Physical Therapy,Occupational Therapy,Speech Language Pathology,and Music Therapy staffing services. Providence Public School District: September 2016- Present 797 Westminster Street,Providence, RI 02903 Katherine Swart, Program Admin./ (401) 456-9100 ext 11337 /Katherine.swart@Rpsd.org_ Provide Physical Therapy,Occupational Therapy,and Speech Language Pathology staffing services. Arkansas Health Center,Arkansas Department of Human Services:July 2014- Present 6701 U.S. 67, Benton,AR 72015 Dr. Megan Edwards, Clinical Director/Ph: (501) 860-0534/megan.edwards@dhs.arkansas.gov Provide Physical Therapy,Occupational Therapy,and Speech Language Pathology staffing services. "It's All About The Experience" Page 119 0, Cell Stal Georgia Department of Behavioral Health and Developmental Disabilities, Central State Hospital 620 Broad Street, Milledgeville GA 31062 Sarah"Kay" Brooks, Director of Nursing/ (478) 445-4960 /sarah.brooks@dbadd.ga.gov Provide Physical Therapy staffing services. "It's All About The Experience" Page 120 0. Cell Stal B. Required Qualifications: 1. Contractor shall provide a copy of the OT's valid license as an Occupational Therapist with the State of California - Department of Consumer Affairs, California Board of Occupational Therapy All occupational therapist candidate will submit a copy of their California OT license to Cell Staff during our internal compliance process. Cell Staff will then verify their professional OT license online with the California - Department of Consumer Affairs, California Board of Occupational Therapy. If the license is free of any restrictions, Cell Staff will then move forward with the recruitment, vetting and placement process. The COF, DPH will receive a copy of the original license and license verification with the compliance/credential packet submitted along with each candidate. 2. Contractor shall provide a copy of the PT's valid license as a Physical Therapist with the State of California -Department of Consumer Affairs, Physical Therapy Board of California All physical therapist candidates will submit a copy of their California PT license to Cell Staff during our internal compliance process. Cell Staff will then verify their professional PT license online with the California - Department of Consumer Affairs, California Board of Physical Therapy. If the license is free of any restrictions, Cell Staff will then move forward with the recruitment, vetting and placement process. The COF, DPH will receive a copy of the original license and license verification with the compliance/credential packet submitted along with each candidate. 3. Contractor shall provide a copy of the current CPR certification and proof of HIPAA training certificate for each OT and PTstaffs. Copies of each candidate's CPR certification and proof of HIPAA training will be furnished to Cell Staff during the vetting process. If either is expired or missing, Cell Staff will assist each candidate in enrolling in the needed program. Cell Staff would need clarification from the County as to which CPR classes for healthcare professionals are acceptable, examples include American Heart Association (AHA), American Red Cross (ACR), American Health and Safety Institute (AHSA), among others. Additionally, Cell Staff can provide online HIPAA training with our internal software from API or we can enroll them in 3rd party HIPAA training either online or in-person. Cell Staff will also ensure that each candidate attend the County's internal HIPAA training if that is your preference. Many of our clients prefer that the candidates participate in their internal HIPAA training classes as part of orientation. Current and valid CPR certification and HIPAA training will be furnished to the COF, DPH in each candidates compliance/credentialing packet. "It's All About The Experience" Page 121 0. Cell Stal 4. Contractor shall provide a copy of the current medical clearances for each OT and PT staff. Cell Staff will include current medical clearances for each OT and PT staff in their compliance/credentialing packet. Typically, items include pre-employment physical, TB/PPD or Chest X-ray, Immunization Records or TITERS, or any other requested medical clearance documents. 5. Contractor shall provide proof of local office establishment. Cell Staff requests that the COF, DPH waive this requirement for Cell Staff. Cell Staff has successfully placed healthcare professional in over 30 States, including many healthcare professionals in California. Additionally, Cell Staff successfully provided the Fresno Veterans Home with supplemental Physical and Occupational Therapy Services for multiple years and can be verified by our reference. Cell Staff also recently received a contract to provide recruitment of temporary healthcare staff to the County of Fresno, Department of Behavioral Health and have our first behavioral healthcare candidate interviewing for a position on March 29th, 2019. Our organization feels that our success in staffing physical and occupational therapists Nationally, across California, and specifically within the City/County of Fresno had proven our ability to services our clients from the Tampa, FL office. In the event the COF, DPH chooses to award to multiple vendors, Cell Staff would prove to be an excellent resource in the event the local vendors are unable to provide the necessary number of PT or OT professionals, especially if they are local therapy clinics and not nationwide recruitment/staffing agencies. "It's All About The Experience" Page 122 Cell Staff Service Cost Rates: Physical Therapist (PT): $90.00 per hour Physical Therapy Assistant (PTA): $62.00 per hour Occupational Therapist (OT, OTR, OTR/L): $90.00 per hour Occupational Therapy Assistant (COTA): $62.00 per hour "It's All About The Experience" Page 123 COUNTY OF FRESNO co� REQUEST FOR STATEMENT OF QUALIFICATIONS NUMBER: 19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES Issue Date: March 11, 2019 Closing Date: MARCH 28, 2019 AT 2:00 P.M. All Questions and Responses must be electronically submitted on the Bid Page on Public Purchase. For assistance, contact Heather Stevens at Phone (559) 600-7110. BIDDER TO COMPLETE Undersigned agrees tofu rnish the commodity orservicestipulated in the attached atthe prices and terms state in this RFSQ. Bid must be signed and dated by an authorized officer or employee. Cell Staff COMPANY Proposal, Contracts and Billing contact is Grant Hargis/ Staffing requests contact is Paul Zushma CONTACT PERSON 1715 N Westshore Blvd, Suite 410 ADDRESS Tampa FL 33607 ITY STATE ZIP CODE - - - - 1 G:IPubIic1RFSQIFY 201819119-059 Occupational and Physical Therapy Services119.059 Occupational and Physical Therapy Services.doc Statement of Qualifications No. 19-059 Page 2 TABLE OF CONTENTS PAGE KEYDATES..........................................................................................................................3 OVERVIEW .....................................................................................................................3 BACKGROUND....................................................................................................................3 PROJECT........................................................................................................................4 SCOPEOF WORK ..........................................................................................................4 COMPLY/NOT COMPLY................................................................................................ 5 SUBMITIAL .................................................................................................................... 6 CONTRACTTERM......................................................................................................... 6 INSURANCE REQUIREMENTS..................................................................................... 7 APPEALS............................................................................................................................. 8 G:IPUBLICIRFSO\FY2018-19\19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES\19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 3 KEY DATES RFSQ Issue Date: March 11, 2019 Written Questions for RFSQ Due: March 18, 2019 at 1:00 P.M. Questions must be submitted on the Bid Page. RFSQ Closing Date: March 28, 2019 at 2:00 P.M. Statement of Qualifications must be electronically submitted on the Bid Page on Public Purchase. OVERVIEW It is the intent of the County to engage several contractors under a master agreement to provide the professional services described herein. The County of Fresno, Department of Public Health (DPH) Children's Medical Services Division - California Children's Services Program is soliciting the services of a contractor(s)who can provide Occupational Therapy (OT)AND Physical Therapy (PT) services for children enrolled in California Children's Services (CCS) Medical Therapy Program (MTP). The CCS MTP is mandated by the California State Law to provide prescribed OT and PT services for children, ranging from birth to 21 years old, with handicapping conditions, generally due to neurological, musculoskeletal or other medical disorders, such as but not limited to, cerebral palsy and spina bifida. The MTP operates Medical Therapy Units (MTUs) located at three (3) local school sites in Fresno County. Each MTU is equipped to conduct the necessary special needs pediatric OT and PT services onsite. BACKGROUND There are currently 769 children receiving both OT and PT services at the three (3) MTUs. The Department has had a continuous recruitment for five (5)vacant licensed Occupational and Physical Therapist positions, but has not been successful in filling all. To meet the increasing medical therapy demands for Fresno County CCS MTP eligible children and address the difficulty of recruiting qualified OT and PT personnel, contracted services have been established since 2012. The OT and PT services provided by a current contractor enables CCS MTP to provide the necessary services to qualified MTP clients in Fresno County. The contractor's annual cost based on FY 2017-18 services was approximately$845,000.00. While CCS MTP has two (2)full time OTs and four(4)full time PTs, the contractor provides four(4) OTs, ultimately leaving 87 children currently on the PT waitlist. Additional OT and PT resources are needed to meet the demands of increasing numbers of CCS MTP eligible children in Fresno County. Should the County be unable to procure continued contracted OT and PT services, the number of waitlisted children will be upwards of 522 for OT services and 87 for PT services. The Request for Statement of Qualifications seeks the continuation of contracted OT and PT services, and if possible from multiple local providers. It is the intent of the County to engage several contractors under a master agreement to provide the professional services described herein. CCS MTP's goal is to provide timely and effective OT and PT services needed by every CCS MTP qualified qhild in Fresno County. G:IPUBLICIRFSQIFY 2018-19119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 4 PROJECT Request for Statement of Qualifications to provide Occupational therapy (OT) and Physical therapy (PT) contracted services to the children (ranging from birth to 21 years of age)enrolled in County of Fresno's California Children's Services (CCS) Medical Therapy Program (MTP). The MTP operated Medical Therapy Units (MTUs) located at three (3) local school sites namely: MTU LOCATION Garfield MTU 1345 N. Peach Ave., Clovis Ginsbura MTU 67 E. Ashlan Avenue Fresno Storev MTU 2444 S. Peach Avenue, Fresno The County anticipates a three (3)year base master services agreement, with the option to extend for two (2) additional twelve (12) month periods, emanating from this RFSQ. The County will determine which contractor to utilize based on two priority factors. The first factor is which contractor will provide the required services at the lowest rate. The second factor is contractor OT/PT staff availability. SCOPE OF WORK The Contractor shall provide licensed OT and/or PT services onsite at the three (3) MTUs located within Fresno County, 3 to 5 days per week, up to 8 hours per day, not to exceed nine thousand twenty-five (9,025) service hours annually. The following responsibilities include but may not be limited to: A. Conduct OT and/or PT tasks in accordance with State and County regulations and guidelines B. Evaluate, plan, schedule and provide treatment to assigned and scheduled clients C. Complete required documentations accurately and in a timely manner, in accordance with State and County regulations and guidelines D. Communicate appropriate information to physicians, other MTP team members, parents, clients' teachers and other agencies as needed to implement client treatment services E. Attend and participate in medical therapy case conferences F. Fabricate, modifies and applies splints as prescribed G. Coordinates, teaches, supervises and develops functional exercises to provide corrective therapy H. May conduct home visits to assess the needs for the prescribed durable medical equipment (DME) and assess the environment for completing functional tasks and/or environmental barriers I. Assess and order DIME and orthotics as prescribed J. Provide instructional training to clients, family members and caregivers regarding home exercise programs and equipment needs G:IPUBLICIRFSQIFY 2018-19119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 5 COMPLY/NOT COMPLY Compliance and understanding of the specification is to be noted by marking "COMPLY" on the line provided to the right of the specification. Non-compliance is to be indicated by marking "NOT COMPLY" on the line. A detailed statement explaining why they fail to meet the stated specification or requirement must accompany all non-compliant items. Failure to mark this page could result in your statement of qualifications being non-responsive. BIDDER TO COMPLETE THE FOLLOWING: COMPLY/ NOT COMPLY 1. Contractor shall provide State licensed Occupational and/or Physical Therapists with a minimum of three(3)years documented experience; or if less than three(3) years'experience, written approval from the CCS Rehabilitative Therapy Manager and the CCS Division Manager must be requested and obtained prior to placement. COMPLY 2. Contractor's OT and PT staff shall be CCS Paneled COMPLY 3. Contractor's OT and PT staff shall maintain all licenses, credentials, board regulations, and/or certifications. COMPLY 4. Contractor's OT and PT staff shall maintain Cardiopulmonary Resuscitation (CPR) certification. COMPLY 5. Contractor's OT and PT staff shall be HIPAA trained annually. COMPLY 6. Contractor's OT and PT staff shall abide by all of County's confidentiality requirements. COMPLY 7. Contractor's OT and PT staff shall provide own transportation for off site visits COMPLY such as home visits and meetings at MTUs. 8. Contractor's OT and PT staff shall maintain applicable annual medical clearance (i.e. updated required vaccinations, annual Tuberculosis skin test, etc.), as required per OSHA training regulations. See links for additional information: a. Aerosol Transmissible Diseases-https://www.dir.ca.gov/tttle8/5199.html COMPLY b. Blood Borne Pathogen-https://www.dir.ca.gov/title8/5193.htrnl COMPLY 9. Contractor must maintain offices locally(within Fresno County)to ensure OT and PT services can be provided at each of the CCS MTPs within a consistently timely NOT COMPLY and reliable manner Waiver requested based on experier 10. Contractor must meet County's minimum insurance and indemnification NOTCOMPLY requirements, as provided inthis RFSO. Excess liability policy can be used to meet limit 11. Contractor must provide and clearly identify service rates per staff position. COMPLY G:IPUBLICIRFSWY 2018-19119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES119--059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 6 SUBMITTAL A. The submittal will enable the County Department to appraise the general competence and qualifications of the responding firms. Please provide the listed information in the following sequence: 1. Firm name, address and phone number 2. Type of organization (sole-proprietorship, partnership, or corporation) 3. Firm principals who will be responsible for the project, and their educational background, credentials, training and experience 4. Key personnel (including proposed sub-contractors, if applicable)who will work on the project wilh their educational background, credentials, training and experience on comparable projects 5. List of current staff, including job classification 6. Firm qualifications, including licenses 7. List current projects or commitments for similar services in progress 8. List the name and phone number of at least"three (3) relevant client references B. Required Qualifications: 1. Contractor shall provide a copy of the OT's valid license as an Occupational Therapist with the State of California - Department of Consumer Affairs, California Board of Occupational Therapy 2. Contractor shall provide a copy of the PT's valid license as a Physical Therapist with the State of California - Department of Consumer Affairs, Physical Therapy Board of California 3. Contractor shall provide a copy of the current CPR certification and proof of HIPAA training certificate for each OT and PT staffs. 4. Contractor shall provide a copy of the current medical clearances for each OT and PT staff. 5. Contractor shall provide proof of local office establishment. CONTRACT TERM It is the County's intent to contract with the successful bidder(s)for a term of three (3)years. Agreement may be renewed for a potential of two (2) one (1) year periods, based on the mutual written consent of all parties. Total fees paid to the each contractor will be dependent upon the bid provided by contractor. No guarantee is made that the total fee or any fee will be received by the contractor. G:IPUBLICIRFSWY 2018-19119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 7 INSURANCE REQUIREMENTS INSURANCE: Without limiting the County's right to obtain indemnification from Contractor or any 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 coverage including completed operations, product liability, contractual liability, Explosion-Collapse- Underground, fire legal liability or any other liability insurance deemed necessary because of the nature of the 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 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. This coverage shall be issued on a per claim basis. Contractor agrees that it shall maintain, at its sole expense, in full force and effect for a period of three 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 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. F. Cyber Liability: - Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is undertaken by CONTRACTOR in this agreement and shall include, but not be limited to, claims involving infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of electronic information, release of private information, alteration of electronic information, extortion and network security. The policy shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations. Additional Requirements Relating to Insurance: Contractor shall obtain endorsements to the Commercial General Liability insurance naming 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's policies herein. This insurance shall not be cancelled or changed without a minimum of thirty(30)days advance written notice given to County. G:IPUBLICIRFSQIFY 2018-19119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Statement of Qualifications No. 19-059 Page 8 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 executes this Agreement, Contractor shall provide certificates of insurance and endorsement as stated above for all of the foregoing policies, as required herein, to the County of Fresno, Department of Public Health, Attn: Susan Stasikonis, 1221 Fulton Street, Fresno, CA 93721, 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 names the County of Fresno, its officers, agents and employees, individually and collectively, as additional insured, but only insofar as the operations un der 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's policies herein; and that Ihis 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. All policies shall be with admitted insurers licensed to do business in the State of California. Insurance purchased shall be purchased from companies possessing a current AM. Best, Inc. rating of A FSC VII or better. APPEALS Appeals must be submitted in writing within seven (7)working days after notification of proposed recommendations for award. A"Notice of Award" is not an indication of County's acceptance of an offer made in response to this RFQ. Appeals shall be submitted to County of Fresno Purchasing, 4525 E. Hamilton Avenue 2nd Floor, Fresno, California 93702-4599 and in Word format to gcornuelle(a-)FresnoCountvCA.aov. Appeals should address only areas regarding RFQ contradictions, procurement errors, proposal rating discrepancies, legality of procurement context, conflict of interest, and inappropriate or unfair competitive procurement grievance regarding the RFQ process. Purchasing will provide a written response to the complainant within seven (7)working days unless the complainant is notified more time is required. If the appealing bidder is not satisfied with the decision of Purchasing, bidder shall have the right to appeal to the County Administrative Office within seven (7) working days after Purchasing's notification; if the appealing bidder is not satisfied with CAO's decision, the final appeal is with the Board of Supervisors. Please contact Purchasing if the appeal will be going to the Board of Supervisors. G:IPUBLICIRFSQIFY 2018-19119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC Exhibit C-2 COUNTY OF FRESNO co O� s6 O AREc�� REQUEST FOR STATEMENT OF QUALIFICATIONS NUMBER: 19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES Issue Date: March 11, 2019 Closing Date: MARCH 28, 2019 AT 2:00 P.M. All Questions and Responses must be electronically submitted on the Bid Page on Public Purchase. For assistance, contact Heather Stevens at Phone (559) 600-7110. BIDDER TO COMPLETE Undersigned agrees to furnish the commodity or service stipulated in the attached at the prices and terms state in this RFSQ. Bid must be signed and dated by an authorized officer or employee. Goodfellow Occupational Therapy Inc. COMPANY John Goodfellow CONTACT PERSON 2505 W. Shaw Ave., Suite 101 ADDRESS Fresno --- --- - ___— _- — - -- CA _ - 93711 CITY STATE ZIP CODE ( ) 559 - 228-9100 option 2 john@gftherapy.com - TELEPHONE N MBER E-MAIL ADDRESS UUTHORI ED SIGNATURE John Goodfellow, OTD, OTR/L CEO _ PRINT NAME TITLE G:1PublibRFSWY 2018-19119-059 Occupational and Physical Therapy Services119-059 Occupational and Physical Therapy Services.doc Statement of Qualifications No. 19-059 Page 5 COMPLY/NOT COMPLY Compliance and understanding of the specification is to be noted by marking "COMPLY" on the line provided to the right of the specification. Non-compliance is to be indicated by marking "NOT COMPLY" on the line. A detailed statement explaining why they fail to meet the stated specification or requirement must accompany all non-compliant items. Failure to mark this page could result in your statement of qualifications being non-responsive. BIDDER TO COMPLETE THE FOLLOWING: COMPLY/ NOT COMPLY 1. Contractor shall provide State licensed Occupational and/or Physical Therapists with a minimum of three(3)years documented experience; or if less than three(3) years' experience, written approval from the CCS Rehabilitative Therapy Manager and the CCS Division Manager must be requested and obtained prior to placement. Comply 2. Contractor's OT and PT staff shall be CCS Paneled Comply / 1 pending 3. Contractor's OT and PT staff shall maintain all licenses, credentials, board regulations, and/or certifications. Comply 4. Contractor's OT and PT staff shall maintain Cardiopulmonary Resuscitation (CPR) certification. Comply/ 3 pending 5. Contractor's OT and PT staff shall be HIPAA trained annually. Comply 6. Contractor's OT and PT staff shall abide by all of County's confidentiality requirements. Comply 7. Contractor's OT and PT staff shall provide own transportation for off site visits such as home visits and meetings at MTUs. Comply 8. Contractor's OT and PT staff shall maintain applicable annual medical clearance (i.e. updated required vaccinations, annual Tuberculosis skin test, etc.), as required per OSHA training regulations. See links for additional information: a. Aerosol Transmissible Diseases-https://www.dir.ca.gov/title8/5199.html Comply b. Blood Borne Pathogen - https://www.dir.ca.gov/title8/5193.htmi Comply 9. Contractor must maintain offices locally(within Fresno County)to ensure OT and PT services can be provided at each of the CCS MTPs within a consistently timely and reliable manner Comply 10. Contractor must meet County's minimum insurance and indemnification requirements, as provided in this RFSQ. Comply 11. Contractor must provide and clearly identify service rates per staff position. Comply Item 2 Explanation: Georgeta Paulino, Joyce Werth, Karen Jhutti have all been paneled. 1 employee Kelsey Puliafico pending. If placed at MTU and less than 1 year of experience on a CCS Unit, the therapist is not able to be paneled until therapist has been 1 year on CCS unit, then therapist may apply to be paneled. Item 4 Explanation: Georgeta Paulino, Karen Jhutti, and Kelsey Puliafico attending class April 2019. G:IPUBLI0RFSQIFY 2018-19119-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICESl19-059 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES.DOC �;''�;� MAIN OFFICE: • GOODFELLOW 2505 West Shaw Avenue OCCUPATIONAL Building A Fresno, CA 93711 THERAPY T: 559-228-9100 F. 559-432-8055 Statement of Qualifications Number: 19-059 Occupational and Physical Therapy Services Bid and Contract Term Contractor: Goodfellow Occupational Therapy, Inc. Local Contact Persons: John Goodfellow, OTD, OTR/L Susanna Ortiz, MBA Chief Executive Officer Chief Operating Officer Phone Numbers: (559) 228-9100 (559) 228-9100 x 502 Billing Address: Goodfellow Occupational Therapy, Inc. 2505 W. Shaw Ave., Building A Fresno, CA 93711 Bid Due Date: March 28, 2019 Contract Term: If this bid is accepted by Fresno County, contractor will agrees to a term of three (3) years. Agreement may be renewed for a potential of two (2) and (1) year periods, based on the mutual written consent of all parties. Bid: Hourly Rate: $95.00 per hour, per therapist. Maximum Hours Per Day: 8 hours, per therapist. Maximum Work Days Per Year: 220 days, per therapist. Number of Therapist: Up to 5 occupational therapist and /or physical therapist. Maximum Number of Hours: Not to exceed nine thousand twenty-five (9,025) service hours. Maximum Proposed Amount per Year: $836,000.00 Maximum Proposed Amount per 3 Year Period: $2,508,000.00 Prepared�bb - 6a- ,P,-o-'%, 0T,� John Goodfellow, OTD, OTR/L CEO www.goodfellowtherapy.com • Email: GOTlnfo@gftherapy.com id, MAIN OFFICE E: OW 2505 West Shaw Avenue VA OCCUPATIONAL Building A Fresno, CA 93711 ' THERAPY T 559-228-9100 A F. 559-432-8055 Statement of Qualifications Number: 19-059 Occupational and Physical Therapy Services SUBMITTAL A.1 Firm name, address, and phone number: Goodfellow Occupational Therapy Attn: John Goodfellow 2505 W. Shaw Ave., Suite 101 Fresno, CA 93710 Business Phone: 559-228-9100 Cell Phone: 559-907-7777 A.2 Type of Organization: Corporation A.3 Firm principals who will be responsible for the project, and their educational backgrounds: CEO: John Goodfellow, OTD, OTR/L; Occupational Therapist Registered/ Licensed; Samuel Merritt University; Master of Occupational Therapy; Graduation: December 1997 COO: Susanna Ortiz, MBA; Master of Business Administration; California State University Fresno; Graduation-MBA Graduation: May 2003 A.4 Key personal who will work on the project with their educational background, credentials, training and experience on comparable projects: Occupational Therapists: Joyce Werth, OTR/L; San Jose State University; Bachelor of Science in Occupational Therapy: Graduation Date: May 1989 Karen Jhutti, OTR/L; St. Augustine University; Master of Occupational Therapy; Graduation Date: April 2015 Georgata Paulino OTR/L; Touro University Nevada; Master of Science Occupational Therapy; Graduation Date: May 2011. Kelsey Puliafico, OTR/L; Touro University Nevada; Master of Science Occupational Therapy; Graduation Date: July 2016 www.goodfellowtherapy.com • Email: GOTinfo@gftherapy.com Goodfellow Occupational Therapy 2 A.5 List of Current staff, including job classification: See items A.3 and A.4 Additional Staff to fulfill contract: Rosie Fernandez: Accounts Administrator; California State University Fresno, Bachelor of Science Public Health; Graduation Date: December 2016. Physical Therapist available upon request of MTU Manager. A.6 Firm Qualifications: Business License City of Fresno; Tax Account No: 72850 S-Corporation Registered with State of California: Corporate Identification Number: 3973647 A.7 List current projects or commitments of similar services in progress: Fresno County: CCS Fresno Madera County: CCS Madera Merced County: CCS Merced We also provide occupational therapy and speech therapy services to school districts in Fresno, Tulare, Monterey, Santa Clara, and Kern Counties. A.8 List the name and phone number of at least 3 relevant client references. Belinda Meyer; Fresno County Office of Education; Special Education Program Manager; Phone: 559-265-3048 Rebecca Gilbert; Madera County California Children Services; PT/OT Medical Therapy Unit Supervisor; Phone: 559-662-4815 Karen Schoettler; Merced County California Children Services; Medical Therapy Unit Supervising Therapist; Phone: 559-706-2725 Required Qualifications B.I Contractor shall provide copy of the OT's valid license as an Occupational Therapist with the State of California—Department of Consumer Affairs, California Board of Occupational Therapy. SEE ATTACHED LICENSE VERIFICATIONS B.2 Contractor shall provide copy of the PT's valid license as an Occupational Therapist with the State of California—Department of Consumer Affairs, Physical Therapy Board of California. Will provide as Fresno CCS request this position to be filled. Goodfellow Occupational Therapy 3 B.3 Contractor shall provide a copy of the current CPR certification and proof of HIPPA training for each OT and PT staffs: SEE ATTACHED CPR and HIPPA BA Contractor will provide a copy of current medical clearances for each OT and PT staffs: TB and Immunization Records are Attached B.5 Contractor shall provide proof of local office establishment: SEE ATTACHED: Business License with address listed on business license. Articles of Incopration. Background Information: Goodfellow Occupational Therapy has contracted with Fresno County CCS since November 2012, initially providing occupational therapy up to 4 days per month. Starting in June 2015, after a contract was agreed upon, this agency began to provide up to 5 OT/ PT professionals based on the need as determined by the CCS Rehabilitative Therapy Manager. Currently, the CCS Rehabilitative Therapy Manager has requested that our agency provide Fresno County CCS with 4 occupational therapists. At this time, the CCS Rehabilitative Therapy Manager has not requested a physical therapist from our agency. In the past, we have shown the ability to provide Fresno County CCS with a full-time and part-time contract physical therapy positions. If a physical therapist is requested by the CCS Rehabilitative Therapy Manager our agency does have the ability to fulfill this need. Prepared b , John Goodfellow, OTD, OTR/L CEO Attachments: 1. Fingerprints for CEO and each Employee. 2. Proof of Panel a. Included for Georgeta Paulino b. Included for Karen Jhutti c. Included for John Goodfellow (copy from CCS website_ d. Joyce Werth (listed on CCS website) e. Pending for Kelsey Puliafico 3. Certificate of Liability Insurance a. This will be updated to meet terms of contract, if bid is accepted Sun Java System Communications. -.Npress - Pleasc View Frame 1 I'age I of I From PI.FASE DO NOT REPLY OR SEND MAIL'fO THIS ADDRESS<AppprocessoisystemC(e..doj.ca.guv'> p Sent Tuesday,August 4,2009 9:23 pm 'ro al3948(_t)smss.doj.ca.gov SubJecl AI'1':FBI-GOODFELLOW,JOHN-CADOJ(.2009o80;1210358_07:592003) STATE OF C:ALIFORNIA DEPART�MLNT OF JUSTICE Bureau of Criminal Information and Analysis 11.0.Box 903417 Sacramento, CA 9,1203-4170 DATE:08/04/2009 C'ACTGOODFLW OCUPTNI..'I'l IRPY 2505 W SHAW AVE BL.DG A FRGSNO CA 93711 Rli:FINGERPRINTS SCJBMIT'I'ED'rO THE 1.,131 APP ORI: AC'877 APP NAME: JOHN E GOODFELLOW APPTYPE: CONTRA CTT3M11LOYI-T. APP TITLE: OWNEWTHE RA VI ST APP SERVICE RE( UESTED:CA/FBl/ OC'A: SID: A032063278 DOB: ���7 SSN: CDL: KIT OATI: DATI:SL'BMI'l7lil): 08/04/2009 SCN if: APP ADDRESS: 2854 F FREMONT AVF.FRI.SNU CA 93710 fps. Based upon a fingerprint search ofrecords contained io the Federal Rurcau or Investigation files,there is no oul-of=sta(c or lWoral criminal history infonnation on ilic above nnmcd individual that meets dissemination criteria pursuant to California law. Muclronic Response Code: 13948 E-mail Address: A 1394V@i SMSS,DOJ.CA.G0V littps://secuf-email.doi.ea.gov/fi-ame,html'?&Sectu-ity=false&lang=en&POPLIpLeveI=undefined 1/11/2019 Sun Java System Communications Express - Ylease view Prame l rage i 01 1 From CADOJ- PLEASE DO NOT REPLY OR SEND MAIL TO THIS ADDRESS <cadoj@doj.ca,gov> p Sent Wednesday, March 25, 2015 5:42 pm To al3948@smss,doj.ca.gov Subject APP: FBI -WERTH, JOYCE -CADOJ (,20150325171738_20:467023.) STATE OF CALIFORNIA DEPARTMENT OF JUSTICE Bureau of Criminal Information and Analysis P.O. Box 903417 Sacramento, CA 94203-4170 DATE: 03/25/2015 CACTGOODFLW OCUPTNL THRPY 2505 W SHAW AVE BLDG A FRESNO CA 93711 RE: FINGERPRINTS SUBMITTED TO THE FBI APP ORI: AC877 APP NAME: JOYCE A WERTH APP TYPE: CONTRACT EMPLOYEE APP TITLE: THERAPIST/AIDE APP SERVICE REQUESTED: CA/FBI/ OCA: SID: Afi2AW426 DOB: $$ SSN: CDL: ATI: B084WEJ862 OATI: DATE SUBMITTED: 03/25/2015 SCN#: APP ADDRESS: 1476 E STUART AVE FRESNO CA 93710 Based upon a fingerprint search of records contained in the Federal Bureau of Investigation files,there is no out-of-state or federal criminal history information on the above named individual that meets dissemination criteria pursuant to California law. Electronic Response Code: 13948 E-mail Address: A13948@SMSS.DOJ.CA.GOV l-4+rn./Inon„rcma;l rin; PvPI=llnriPfln 4/1)1/1)nl5 DEPARTMENT OF JUSTICE sµ••.y STATE OF CALIGOFM A &CIA WI tl Y (a1W GV=I,row,01=11) '�. REQUEST FOR LIVE SCAN SERVICE Applicant Submission AC 877 Employment OR (Code."4WiDoi) AUtli Applicant ype Therapist/Aide/Admin Type of Licen a Ica o ermill OR Worilking TlUe ao a.r.der+•n"10r4d by rid,ua wtI mse..eW"d Contributing Agency Information: Goodfellow Occupational Therapy 13948 Agency Authorized to Receive Criminal Reoi In"ation 91 o e ve Till, :1-1,;s ass fine y 2505 W. Shaw Ave., Bldg.A Susanna Ortiz Street Address or P.O.Box Contact Name(mandatory for all school submissions) Fresno CA 93711 559 228-9100 icy Late Zile contact I a ep one Ni Applicant Information: PU Lt A �t O ICELSE`{ ix Lest Name rs Name �nma Other Name Suffix (AKAorAlias) Last First Sex Male ZFemale �f_A� B ateo Driver's t1 105 I105 �1 vlti �WvJn Billing eight eg9V Tit — Eye Color air o}� I'� or— Number 150,140 M =} �h , Agency Billing Number) N �-bra Misc. Place of Birth(State or Country) oo a ecur wrin er Number p i1 (Omer Idendficadon Number) Home 2 o01 -7 E Y l nlln Qrw' t ycsn® (A 13-72-0 Address Street Address or P.O.Box city State ZIP Code Your Number: Level of Service: DOJ ❑x FBI OCA Number(Agency Idenlitying Number) If re-submission, list original ATI number: Original Number (Must provide proof of rejection) Employer(Additional response for agencies specified by statute): Smp over Name 'Mail Code(five g t a assign y 0 2505 W Shalw Nc, etm' -- A Street Address or Ox fy ll 0 Cft- City State ZIP Code Telephone Number(optional) Live Scan Transaction Completed By: L � nrr in inil! Na"of Operator Date Tranorr g Agency LSID ATI Number Amount Collectedlgll Ied ORIGINAL-Uve Scan Operator SECOND COPY-Applicant THIRD COPY(if nHd d).Requesting AUency STATE OF CALIFORNIA DEPARTMENT OF JUSTICE d SCII 8010 (odg.4/01;rev.6/09) REQUEST FOR LIVE SCAN SERVICE `----,-(pplicant Submission AC 877 Employment 0RI (Code assigned by DOJ) Authorized pp icanType Therapist/Aide Type of License/Certification/PermitWorking Title Maximum 30 characters•If assigned by DOJ,use exact UUe assigned Contributing Agency Information: Goodfellow Occupational Therapy 13948 Agency Authorized to Receive Criminal Record Information Mail Coe(five-digit code assigned y 2505 W. Shaw Ave., Bldg. A Susanna Ortiz Street Address or P.O.Box Contact Name(mandatory for all school submissions) Fresno CA 93711-3334 (559) 228-9100 City toe ode Contact Telephone Number Applicant Information: Last Name First Name Middle Initial TU Mx Other Name (AKA or Alias) Last First Suffix Sex Male Female �4 �1 �XX ate o Irt Driver's License Number (l'{ Billing l Height V Ve-lg t Eye Color— air Color Number 150340 �t Agency Billing umber) _I�. P'BE(PPBA$P�BB Misc. ...-'lace of Birth(State or Country) Social Security Number Number (Other Identification Number) Home ! �1 (.t'li'`; iC ��)r I;. yl`_ Address Street Address or P.O.Box City State ZIP Code Your Number: Level of Service: DOJ ❑x FBI OCA Number(Agency Idenllfying Number) If re-submission, list original ATI number: Original Number (Must provide proof of rejection) Employer(Additional response for agencies specified by statute): Employer Name Mail Code(five digit code assigned y DOJ Street Address or P.O.Box City State ZIP Code Telephone Number(optional) Live Scan Transaction Completed By:. 1me of bperafok Date T- UPS Transrnitting Agency LSID ATI Number Amount Collected/Billed ORIGINAL-Live Scan Operator SECOND COPY-Applicant THIRD COPY(if needed)-Requesting Agency STATE OF CALIFORNIA DEPARTMENT OF JVST rC B C lA 6016 Qe6 �• {«4p,0412001;r*y,012011) REQUEST FOR LIVE SCAN SERVICE Applicant 5ubmission AC 877 Employment ORI Cede udpned by DOJ) Authorized pp ican ype IYpe oil Icensee er ifcaflon rml Ing I e MaxfmumJOuursden•Mu�pwObyDOJ•usewalUsueged contributing Agency Information; Goodfellow Occupational Therapy 13954 Agency Authorized to Receive Criminal Record Information Mail Code we a assign y 2505 W, Shaw Ave„ Bldg, A Susanna Ortiz Street Address or P.O,Box Contact Name(mandatory for all school submissions) Fresno CA 93711 (559) 228-9100 a e code Contact on a ep one Number Applicant Information, Las Ndme First Name IMiddle nrbal u ix Other Name (AKA or Alias) Last First $ Suffix a e Sex Male Female �n BB Ices a"mD1er� t " �J�,for Billing eIg L f'' �n elg t ye color p���arr/]o-o�7r Number 150340 E&AN 1 GA i0kaBaF ififB g Misc, Gency DaN Number) Place of BHIh-(State or Country) Social Security Number Number Q�� + (Other ldeNfcation Number) 23 L — �l" �_ Home 'iI � . Address Street Address or P.O.Box City State ZIP Code Your Number. Level of Service: DOJ 0 FBI OCA Nurnber(Agemy LdenbtyN Number) If re-submission, list original ATI number; (Must provide proof of refection) Original Number Employer(Additional response for agencies specified by statute): Employer ame aI o e(rive Iglt code assigned y Street Address orBox City State ZIP Code Telephone Number(optional) vtr Scan Transaction Cgmpleted 6y :_-- i of�t)perator c ;}1yY�4a s Date �}ij�.r�, r, r���r� 1�1'r�i3�n;���:y SID •> r t ATI Number° Amo nt ColledCd/Billed ORIGINAL,.live Scan Operator SECOND COPY•Applicant THIRD COPY(If needed)-Requesting Agency 03/25/2019 15:41 5593271911 CLOVIS MTU PAGE 02/02 Ch.ildren's Medical Services Page 1 of a t'61',vnw Homc Of ITome DITCS 0-vani.:lion ;:aav�n.•riinenur n,lu):fy miu Atonduc. 1".201 a 1.cu tx P 11 Children's ,Medical Services _ Manuat- I Contaee Us I Bulletins I =nQ I Help I Logout Car lnq for CkI Id,4n with Sproul Medioal Needs... Current Lnq,4pd In U!;Rr:Georgeta Paltlino,OTR(Occupational Therapist Home Referral Program ME05 I I ReolstratFon I t}Ilgib1lRy I I coverage 1 I RopprtF I Administration My we0 Moweagra(l) Page Tracking Modules IagtlirY (Non PMF Provider)-PAULINO,GEORGETA M PROVIDER DETAILS Provider Name: PAULINO.GEORGETA M Provider 10; CHDP ProvldarID: Provider Type; OCCUPATIONAL THERAPIST Phone Nvmher. (559)327-1910 Extension; Emall: County: FRESNO Data Added: OS/2212018 Application Date: Lest PMF Activity; 11812212015 SSN; FEI No: License No: OT 12185 License Data; Llcentta Expiration Date! 05/3112018 Reject Reason: Group; Out of state: IN STATE Paneled PROVIDER STATUS Stalus Effective Date ACTIVE 08/22rz018 CMS PANELING INFORMATION Provider Type Specialty)Sub-epeclalty Ettective Onto Termination Date Panel Status Occupational Therapist Occupe tOnel Therapy 0812212016 Psnelod El ADORESS INFORMATION Ei 0 k Back to Too of Page Conaluan,of Use I Privacy Poil y I Inlanlel EVIarar Settings lbr CM2 Browser is connected to OMSA01 PV Version:150 Deployment Dets:02122/2019 Copyright 0 2019 State of CeNrorrile. Children's Medical Services Page 1 of 1 �. rll•,n::w I Lan; );h l Ilr ru rr ;)I ll.: �Irpau aull�r.r 1c�51011 IifuCQl1I Ifs Ut1.aU aiin \Innaa),Sl;�l•Gh�� 7(Il•I�lU�;�!.'P•I Chlildren's Medical Services MdIWBlS CbntectUs I eulletlns FAQ ! Help I Loguut Caring for Childran will,Spscidl Avdlcal Needs . Current LOgq¢d Ir U5er Karen Jhutti(0ttupational Therapist) Home Reterral Program ratoL ; 1 I I R091iU.ltlOh I EIIUlbility ( I COVOragO I I Reports I Administration My Web Messages(+) Page 7ractclnp MOOtlICi Inquiry (Non PMF Provider) ]HUTTI, KAREN PROVIDER DETAILS Provider Name: JHUTTI,KAREN Provider ID: CHDP Provider ID: Provider Type: OCCUPATIONA'_THERAPIST Phone Number: Extension: Emall: County: FRESNO Date Added: Oa/2212C15 Application Date: Laet PMF Activity: 00/22/2018 SSN: FEI No: License No: OT 15368 License Date: License Expiration Date: 1 113 0/7 01 7 Rejact Reason: Group: Out of State: IN STATE Paneled PROVIDER STATUS Status Effective Date ACTIVE 0 8122/20 1 6 CMS PANELING INFORMATION Provider Type Specialty I Sub-specialty Effective Date Termination Date Panel Status i Oecupatonei Therapist Occupational Therapy 0809/,2016 Paneled El ADDRESS INFORMATION [sack Back to Top of Psoe Conditions al Usti I Pr vary Poucy I Inlarrol Explorer bonitos ror CME Browser is connected to OMSA01 PV Version:150 Deployment Dale:02/22/2019 Copyright II5 2019 State of California. TO/TO 39Vd n1W A3dO1S 99Z9E9ZG99 bT:89 GTOZ/9Z/Ea N 0 0 0 0 0 0 nG) 0 a -� a a v 0 0 0 0 N 0 0 d N ° CL> > 0Nf Ul (D N c 0 c o 0 � m 0 ' m m s m < C- m D r • c v v v D O (n O O cn n N N a 0 ((DD 0 cni _ c m c c 0 m N 0 N ODi N w m m mco m' o0i = � s N m Ni m m �• N N N N N N N N � c nO U 0 nO 3 c a 0 m 0 0 _ _ c m c c N 0 N N N + o toto o o. o. n. s D w a mcu CD' 'D 0 =r =r < m m m m v d v 0 0 to 0 0 0 0 O N O CDN N N _ A (0Z, - _ N � N N N N N (G O (p Cl O_ O O O co O (O O O O O c0 (D N O O N (D 0 r a w • N i CD A O O .p 1 V I GOODOCC-01 RH LQUIN ACORN" DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/29/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#OE02096 CONTACT NAME DiBuduo&DeFendis Insurance Brokers,LLC A PHONE,Ext: 559 432-0222 jnlc,No):(559)431-7941 P.O.Box 5479 (A/C, L Fresno,CA 93755-5479 ADDRE INSURER S AFFORDING COVERAGE NAIC M INSURER A:Berkley Insurance Company INSURED INSURER B:Security National Insurance Company-19879 Goodfellow Occupational Therapy,Inc. INSURER C: __ ___ 2505 W.Shaw Ave.,Building A INSURER D: Fresno,CA 93711 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRIDNYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 MISCLAIMS-MADE �OCCUR X HH58525680 12/08/2017 12/08/2018 DAMAGE TO RENTED $ 500,000 MED EXP(Any one n $ 10,000 PERSONAL 6 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3,000,000 X POLICY El jPE LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: Sexual Abuse 11000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000,000 IxANY AUTO HHS8525680 12/08/2017 12/08/2018 BODILY INJURY(Per person) S _ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY p BOODILY INJURY Per accident $ _ AUTOS ONLY X AUJ ONLY Peracadent AMAGE $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE 11000,000 X EXCESS LIAB CLAIMS-MADE HHS8525680 12108/2017 12/08/2018 AGGREGATE $ 1,000,000 DIED I I RETENTION$ B WORKERS COMPENSATION X I PER OTH- ANDEMPLOYERS'LIABILITY SWC1200588 07/01/2018'07/01/2019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y� NIA E.L.EACH ACCIDENT $ FICER/MEMgT)EXCLUDED? 1,000,000 andatory In NH) E.L.DISEASE•EA EMPLOYE $ _ Tins descr be under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A Professional Liab HHS8525680 12/08/2017 12/08/2018 Each Claim 1,000,000 A Professional Liab HHS8525680 12/08/2017 12/08/2018 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If mores ace is required) Certificate holder is included as an Additional Insured with respect to General Liability per attached CG8391 0515. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE County Of Fresno,Dept.Of Public Health THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y P ACCORDANCE WITH THE POLICY PROVISIONS. California Children Services P O Box 11867 Fresno,CA 93775 AUTHORIZED REPRESENTATIVE I I A4� ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD (4) Liability assumed under any"insured 11. Notice To Company contract" for the ownership, maintenance, If you report an"occurrence"or offense to or use of aircraft,watercraft, or"autos";or your Workers' Compensation insurer (5) "Bodily injury"or"property damage" which later becomes a claim under this arising out of the operation of any of the Coverage Part, failure to report such equipment listed in Paragraph f. (2)or f, "occurrence"or offense to us at the time of (3) of Section V- Definitions, Paragraph the"occurrence"or offense will not be 12., "Mobile Equipment"; or considered a violation of the Duties In (6) An aircraft you do not own that is: The Event Of Occurrence, Offense, (a) Hired,chartered, or loaned with a Claim Or Suit Condition, if you notify us crew; and as soon as practicable when you become aware that the"occurrence"or offense has (b) Not owned in whole or in part by any become a liability claim. insured. J. AUTOMATIC COVERAGE FOR SPECIAL (7) This insurance does not apply, under EVENTS Paragraph g.(1) and g.(2) above, if the 1. You are automatically covered for all"special insured has any other insurance for"bodily events"which you organize, promote, injury'or"property damage"which would administer, sponsor, or conduct during the also apply to loss covered under this term of this policy. provision, whether the other insurance is primary, excess, contingent, or on any 2. Section V-Definitions is amended to add other basis. the following paragraph: (8) This insurance is excess, under 23. "Special Event"means any event: Paragraph g. (6) above, over any other a. The purpose of which is to raise funds insurance,whether the other insurance is for you; or primary, excess, contingent or on any b. To recognize the accomplishments of other basis. your organization, your"employees," I. BROADENED COMMERCIAL GENERAL or your volunteer workers; or LIABILITY CONDITIONS c. Which you, or an individual or 1. Paragraph 2. Duties in The Event Of organization with whom you have Occurrence, Offense, Claims Or Suit under entered into a contract or agreement. Section IV-Commercial General Liability organize, promote, administer, Conditions is amended to add the following sponsor, or conduct for the purposes provision: described in Paragraphs a. or b, e. Your obligation to notify us as soon as above; and practicable of an"occurrence,"or offense d. Which takes place on premises owned under Paragraph 2.a.above, or a claim or by you, or on premises while rented or .,suit" or offense under Paragraphs 2.a., leased to you or to that organization 2.b., and 2.c above, is satisfied if you described in Paragraph c. above. send us written notice as soon as K. AUTOMATIC ADDITIONAL INSURED(S) practicable after any of your"executive The following provisions are added to Section II- officers,"directors, partners, insurance Who Is An Insured: managers,or legal representatives becomes aware of, or should have 4, Automatic Additional Insured(s) become aware of, such"occurrence," a. Additional Insureds-Athletic Activity offense, claim or"suit." Participants 2. The following provisions are added to Section (1) This policy is amended to include as IV-Commercial General Liability an insured any person(s)[hereinafter Conditions: called Additional insured(s)) 10. Liberalization representing you while participating in If we adopt any revision that would amateur athletic activities that you broaden the coverage under this coverage sponsor. However, no such person is part without additional premium within 30 an insured for: days prior to or during the policy period, (a) "Medical expenses" under the broadened coverage will immediately Coverage C Medical Payments apply to this coverage part. (b) "Bodily Injury" to: Page 4 of 8 Includes copyrighted material of Insurance Services CG 83 91 05 15 Office, Inc. used with its permission. (i) A co-participant, your (ii) Which takes place after you volunteer worker or your cease to be a tenant in that ''employee"while participating premises. in amateur athletic activities (c) With respect to architects, that you sponsor; or engineers, or surveyors, coverage (ii) You, or any partner or does not apply to"Bodily Injury," member, (if you are a "Property Damage,""Personal partnership orjoint venture), Injury,"or"Advertising Injury" or any member(if you are a arising out of the rendering or the limited liability company); or failure to render any professional (c) "Property damage"to property services by or for you including: owned by, occupied or used by, (i) The preparing, approving, or rented to , in the care, custody, or failing to approve or prepare control of,or over which physical maps, drawings, opinions, control is being exercised for any reports, surveys, change purpose by: orders, designs or (i) A co-participant, your specifications; and volunteer worker, or your (ii) Supervisory, inspection, or "employee"; or engineering services. (ii) You, or any partner or (d) Coverage provided herein shall be member, (if you are a considered excess over any other partnership or joint venture), valid and collectible insurance or any member(if you are a available to the Additional Insured limited liability company). whether that other insurance is b. Additional Insured—Contractual primary, excess, contingent, or on Obligations any other basis unless a written (1) This policy is amended to include as contractual arrangement an insured any person or organization specifically requires this insurance (hereinafter called Additional Insured) to be primary. that you are required by a written (e) In the event that you are engaged "insured contract"; to include as an in the manufacture or assembly of insured, subject to all of the following any goods or products for the provisions: benefit or at the direction of (a) Coverage is limited to liability another party, pursuant to a arising out of: contract or agreement with that party, this paragraph (e). does (i) Your ongoing operations not extend coverage to that party performed for such Additional as an Additional Insured. Insured; or Coverage for such a party will be (ii) Such Additional Insured's extended only by a specific financial control of you; or endorsement issued by us and (iii) The maintenance, operation naming such party. or use by you of equipment c. Additional Insured—Funding Sources leased to you by such (1) This policy is amended to include as Additional Insured; or an insured any Funding Source (iv) A permit issued to you by a (hereinafter called Additional Insured) state or political subdivision. which requires you in a written (b) Coverage does not apply to any contract to name such Additional "occurrence"or offense: Insured but only with respect to (i) Which took place before the liability arising out of your premises or execution of, or subsequent to "your work"for such Additional Insured, and only to the extent set the completion or expiration of, the written "insured forth as follows: contract"; or CG 83 91 05 15 Includes copyrighted material of Insurance Services Page 5 of 8 Office, Inc. used with its permission. (a) The Limits of Insurance applicable (2) With respect to the insurance afforded to the Additional Insured are the the Additional Insured identified in lesser of those specified in the Paragraph d. (1) immediately above, written contract or agreement or in the following additional provisions the Declarations for this policy and apply: subject to all the terms, conditions The (a) This insurance applies only to and exclusions for this policy. liability arising out of the Limits of Insurance applicable to ownership, maintenance,or use of the Additional Insured are that portion of the premises inclusive of, and not in addition to, leased to you; the Limits of Insurance shown in (b) The Limits of Insurance applicable the Declarations. to the Additional Insured are the (b) The coverage provided to the lesser of those specified in the Additional Insured is not greater written contract or agreement or in than that customarily provided by the Declarations for this policy and the policy forms specified in and subject to all this policy's terms, required by the contract. conditions, and exclusions. The (c) In no event shall the coverages or Limits of Insurance applicable to Limits of Insurance in this the Additional Insured are Coverage Form be increased by inclusive of, not in addition to, the such contract. Limits of Insurance shown in the (d) Coverage provided herein shall be Declarations. considered excess over any other (c) In no event shall the coverages or valid and collectible insurance Limits of Insurance in this available to the Additional Insured Coverage Part be increased by whether that other insurance is such contract or agreement. primary, excess,contingent, or on (d) Coverage provided herein shall be any other basis unless a written considered excess over any other contractual arrangement valid and collectible insurance specifically requires this insurance available to the Additional Insured to be primary. whether that other insurance is d. Additional Insured—Manager or Lessor primary, excess, contingent,or on of Premises any other basis unless a written (1) This policy is amended to include as contractual arrangement an insured any person or organization specifically requires this insurance (hereinafter called Additional Insured) to be primary. from whom you lease or rent your (3) This insurance does not apply to: premises and which requires you to (a) Any"occurrence"or offense which add such person or organization as an takes place after you cease to be Additional Insured in this policy under a tenant in the premises covered (a) A written contract;or by this endorsement;or (b) An oral agreement or contract (b) Structural alterations, new where a Certificate of Insurance construction, or demolition has been issued showing that operations performed by or on person or organization as an behalf of the Additional Insured. Additional Insured; e. Additional Insured—Owner, Manager, but only if the written or oral Operator or Lessor of"Special Events" agreement is an"insured Premises contract'; (1) This policy is amended to include as (i) Currently in effect or to an insured any person or organization become effective during the (hereinafter called Additional Insured) term of this policy; and from whom you lease, rent or occupy (ii) Executed prior to the"bodily the premises upon which a "special injury,""property damage," event"is held, sponsored or "personal injury", or conducted by you, or on your behalf, "advertising injury." under: Page 6 of 8 Includes copyrighted material of Insurance Services CG 83 91 05 15 Office, Inc. used with its permission. (a) A written contract; or (3) This insurance does not apply to: (b) An oral agreement or contract (a) Any"occurrence"or offense which where a Certificate of Insurance takes place after you cease to be has been issued showing that a tenant, licensee or occupant in person or organization as an the premises covered by this Additional Insured; but only if the endorsement; or written or oral agreement is an (b) Any acts or"occurrences"caused "insured contract," by or attributable to the owner, (i) Currently in effect or to manager, operator, or lessor of become effective during the the premises upon which the term of this policy; and 'special event" is held. (i I) Executed prior to the"bodily f. Additional Insured—Supervisors or injury,""property damage," Higher in Rank "personal injury,"or (1) This policy is amended to include as "advertising injury." insured any"employees" (hereinafter (2) With respect to the insurance afforded called Additional Insured), designated the Additional Insured identified in as supervisor or higher in rank,who Paragraph e. (1)of this endorsement, are authorized by you to exercise the following additional provisions direct or indirect supervision and apply: control over"employees"and the (a) This insurance applies only to manner in which work is performed, liability arising out of the use of but only for acts within the scope of that portion of the premises while their employment by you or while leased or rented to you for the performing duties related to the specific"special event'; conduct of your business. However, (b) The Limits of Insurance applicable none of these"employees"designated to the Additional Insured are the as supervisor or higher in rank, is an lesser of those specified in the insured for: contract or agreement pertaining (a) "Bodily injury"or"personal injury": to the use of the premises or in (i) To you, to your partners or the Declarations for this policy and members (if you are a subject to all of this policy's terms, partnership or joint venture). conditions, and exclusions. The or to your members (if you are Limits of Insurance applicable to a limited liability company); the Additional Insured are (i i) For which there is any inclusive of, not in addition to, the obligation to share damages Limits of Insurance shown in the with or repay someone else Declarations. who must pay damages (c) In no event shall the coverage or because of the injury Limits of Insurance in this described in paragraph (a)(i) Coverage Form be increased by above; or such contract or agreement. (iii) Arising out of his or her (d) Coverage provided herein shall be providing or failing to provide considered excess over any other professional health care valid and collectible insurance services. available to the Additional Insured (b) "Personal Injury": whether that other insurance is primary, excess, contingent, or on (i) the course a co-"employer"while in t any other basis unless a written th , or his or her contractual arrangement employment, specifically requires this insurance (ii) To the spouse, child, parent, to be primary. brother or sister of that co- "employee"as a consequence of Paragraph (b)(1) above; CG 83 91 05 15 Includes copyrighted material of Insurance Services Page 7 of 8 Office, Inc. used with its permission. (III) For which there is any restitution, penalties, and formula obligation to share damages damages added to"actual with or repay someone else damages"and any other who must pay damages enhanced damages. because of the injury (4) All other terms and conditions of this described in Paragraph (b) (i) Coverage Part which are not or (b) (ii) above. inconsistent with this Paragraph h. (c) "Property damage"to property: apply to coverage extended to the (i) Owned, occupied or used by; above referenced Additional Insureds or REGARDLESS OF WHETHER OR (i i) Rented to, in the care, NOT A COPY OF THIS COVERAGE custody, or control of, or over PART AND/OR ITS which physical control is being ENDORSEMENTS ARE DELIVERED exercised for any purpose by TO AN ADDITIONAL INSURED. you, any of your"employees," L. BLANKET WAIVER OF SUBROGATION any partner, or member(if you Paragraph 8. under Section IV— Commercial are a partnership orjoint General Liability Conditions is deleted and venture), or any member(if replaced with the following: you are a limited liability 8. Transfer of Rights Of Recovery Against company). Others To Us And Blanket Waiver Of g. Additional Insured—LIMITATIONS Subrogation (1) The persons, entities, or organizations a. If an insured has rights to recover all or to which coverage is extended under part of any payment we have made under Paragraphs a. (Athletic Activity this Coverage Part, those rights are Participants), b. (Contractual transferred to us. The insured must do Obligations), c. (Funding Sources), d. nothing after loss to impair them. At our (Managers or Lessors of Premises), request, the insured will bring "suit"or and e. (Owner, Manager, Operator, or transfer those rights to us and help us Lessor of"Special Events" Premises) enforce them. are Additional Insureds, but only: b. If required by written "insured contract," (a) With respect to each Additional we waive any right of recovery we may Insured's vicarious liability for have against any person or organization "actual damages"solely caused because of payments we make for injury by you or by"your work"that is or damage arising out of your ongoing ongoing for such Additional operations or"your work"done under a Insured's supervision of"your contract for that person or organization work"; and and included in the"products-completed (b) If the Additional Insured did not operations hazard." cause or contribute to the M. PRIORITY OF APPLICATION FOR MULTIPLE "occurrence"or act resulting in INSUREDS liability. Section III—Limits Of Insurance is amended to (2) If an endorsement is attached to this add the following paragraph: policy and specifically names a person 8. In the event a claim or"suit" is brought against or organization as an Additional more than one insured,due to"bodily injury" Insured, then the coverage extended or"property damage"from the same under this paragraph 4. AUTOMATIC "occurrence," or"personal injury,"or ADDITIONAL INSURED(S)does not "advertising injury,"from the same offense,we apply to that person, entity, or will apply the Limits of Insurance in the organization. following order: (3) The following is added to Section V— a. You; Definitions: b, Your"executive officers,"directors, 24. ''Actual Damages" is to have its "employees,"and usual and customary legal c. Any other insureds in any order that we meaning and excludes without limitation, punitive damages, choose. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Page 8 of 8 Includes copyrighted material of Insurance Services CG 83 91 05 15 Office, Inc. used with its permission. Required Qualifications Attachments for: B.1 3/25/2019 DCA-Search Details BOARD OF OCCUPATIONAL THERAPY LICENSING DETAILS FOR: 2598 NAME: GOODFELLOW, JOHN EDWARD LICENSETYPE: OCCUPATIONAL THERAPIST PRIMARY STATUS: C U R R E N T ADDRESS NOT DISCLOSED ISSUANCE DATE OCTOBER 8 , 2002 EXPIRATION DATE NOVEMBER 30, 2020 CURRENT DATE / TIME MARCH 25, 2019 3 :01 :41 PM https://search.dca.ca.gov/details/7101/OT/2598/fl f3f84f55b49a943d3670af99eb94aa 1 1 3/25/2019 DCA-Search Details BOARD OF OCCUPATIONAL THERAPY LICENSING DETAILS FOR: 4583 NAME: WERTH, JOYCE WILHELM LICENSETYPE: OCCUPATIONAL THERAPIST PRIMARY STATUS: C U R R E N T ADDRESS NOT DISCLOSED ISSUANCE DATE DECEMBER 13 , 2002 EXPIRATION DATE FEBRUARY 28, 2021 CURRENT DATE /TIME MARCH 25, 2019 3:01 :08 PM https://search.dca.ca.pov/details[7101/OT/4583/8cOf892f3983cbf3007845f06a58467a 1 1 3/25/2019 DCA-Search Details BOAR® OF OCCUPATIONAL THERAPY LICENSING DETAILS FOR: 15368 NAME: JHUTTI , KAREN KAUR LICENSE TYPE: OCCUPATIONAL THERAPIST PRIMARY STATUS: C U R R E N T ADDRESS NOT DISCLOSED ISSUANCE DATE JUNE 23 , 2015 EXPIRATION DATE NOVEMBER 30, 2019 CURRENT DATE / TIME MARCH 25, 2019 https://search.dca.ca.gov/details/7101/OT/15368/370df8e9580ee8cb8d89e2dcO3ee5888 3/25/2019 DCA-Search Details BOAR® OF OCCUPATIONAL. THERAPY LICENSING DETAILS FOR: 16960 NAME: PULIAFICO, KELSEY JANE LICENSETYPE: OCCUPATIONAL THERAPIST PRIMARY STATUS: C U R R E N T PREVIOUS NAMES: PUALIFICO , KELSEY JANE ADDRESS NOT DISCLOSED ISSUANCE DATE DECEMBER 10, 2016 EXPIRATION DATE APRIL 30 , 2019 CURRENT DATE / TIME MARCH 25, 2019 3:00: 15 PM https://search.dca.ca.gov/details/7101/OT/16960/b75462369946e343e2f3ee5a89384918 3/25/2019 DCA-Search Details BARD OF OCCUPATIONAL. THERAPY LICENSING DETAILS FOR: 12185 NAME: PAULINO, GEORGETA M LICENSETYPE: OCCUPATIONAL THERAPIST PRIMARY STATUS: C U R R E N T ADDRESS NOT DISCLOSED ISSUANCE DATE SEPTEMBER 26 , 2011 EXPIRATION DATE MAY 31 , 2020 CURRENT DATE / TIME MARCH 25, 2019 2 : 59:08 PM https://search.dca.ca.gov/details/7101/OT/12185/7cb39bb4bac5ffef75ab82db5a857afe 1'1 Required Qualifications Attachments for: B.3 BASIC LIFE SUPPORT BASIC LIFE SUPPORT__.- BLS Training �Wiv :tfxt vr=ft d��ftft-'Tp American Center Name NIHE 8A 10297 Heart r" Provider ro As 3ociatione In o Fairfield,CA 94534 800-773-8895 RCEI. � Heart LiNc �. HERE John Goodfellow Course ai on HeartlinkCPR.net 559-779-0174 The above Individual has successfully completed the cognitive and Instructor Inst.ID# skills evaluations in accordance with the curriculum of the American Name Richard Haahr 02112276719 Heart Association Basic Life Support(CPR and AED)Program. -- 2017 08 2019 Holder's 06 04 /_.. ...._.. � Signature Issue Date Recommended Renewal Date ®2015 American Heart Association Tampering with this card will alter Its appearance. 15.1805 This card contains unique security features to protect against forgery, _.__.._.._..._._._.._._..._.._....__ ._....._........._....._...._..._._.._....._....r..__..._..._....._...... 15-1805 11/15 Werth � ASIC LIFft 5Vrrwn i r .. v ■ i - + � it BLS American Training Superior Life Support Inc. Heart Center Name Provider "Assoclavono Training CA20619 Joyce Werth Center ID The above individual has successfully completed the cogriltNe.and skills TC Address 25128 Avenue Tibbitts,STE 150 �1 t evaluations In accordance with the curriculum of the American,Heart Valencia CA 91355 USA Association Basic Life Support(CPR and AED)Program., TC Phone (661)607 0344 x K (•- \n `\ G! Instructor Yi Issue Date Recommended Renewal pate_ Name Kathy Haahr 1/8/2018 0112,020 To view or vedry authenuolty,students and employer. Instructor ID 02160936711 t should scan this OR code with their moblie deyica'or�w� GM . t go to w.heartorg'opdmycards,- ®2016 American Heart Association 15-0001 3/16 F61 ''' >:i t(� V"r., ` < a=V'•m..i �``<,v V :.ra. \j .,ny o : ,, �► :::d- .s: v .. :V`.; V?.ar. r* ` ==V ` •a'v�❑ O n 1 n O �`/iy' �5.�:> i+^✓y"%:�� =ts y,,:� .rr�\+�V'r�• a;Z" .� R`�.�...1. j_,.... �y�� t��wh'n �tiY��'��`++r"v'�V Oj ,j fJG F J [ ITI ® ,. OD ^ � 1 Co �_ CD i U 4 A oOEMCFO i. Zi ¢ +b . C� . �.. F f; � � r QRZ aml 46 o r ,'", O Q cn N ,� Mom• '�j• _ � � r b t Ua f W CA W C ' E CL cr •V C � � � � � as MOW oo MEN 0 cr uu �� �` . p 'r ro ti C p 4 UR �� }t' rift CD n o n o C'D cr Zil n v r...+ . r-r• OMWOo . b < H ill t� .a f t Required Qualifications Attachments for: B.4 INTISAS SULTAN MD INC. INTISAB SULTAN FWD. LIC#:A76962•DEA C.B§7269803 2256 DOCKERY AVE,STE#A SELMA,CA 93662-3874 Tel:559-891-0100 a Fax:559-891-9000 Bij§ B B Name. Date.dre . a.uat ❑1-24 ❑25.50- 51-7 rBW& $❑75.100 ❑101-150 ❑151 and over 1) Units Refills 0-1-2-3-4-5 $ ❑Do not substitute 1-24:21-55 ❑51-74 Quantity:Co ' ❑75 100 ❑1051 and over 2) Units_—Refil -2-3 4-5❑Do not substit P� Quantity:❑1-24 ❑2550 ❑51 74 co � ❑75-100 ❑101-150 ❑151 and over A;ut 41 3) Units._Refills 0-1-2-3-4-5 Do not substitute 1 Presc.'Apli Is VOID if a ps bed Is not noted ❑1 ❑2 133 SCRIPT#1225 0tder•1 ' 1 ® UNIVERSITY OF ST. AUGUSTINE �p . DEPARTMENT OF CLINICAL EDUCATION CONFIDENTIAL STUDENT MEDICAL RECORD FORM Declaration: This is a confidential medical form consisting of two parts: Part A (Physical Examination) and Part B (Statement of Good Health). Please have your physician transcribe ALL ITEMS ON THIS FORM, with vaccination records, then complete and sign this form within 15 days before or after Orientation. It is mandatory that the Clinical Education office maintains a cony of these records in your file, and thus must be provided by the student upon request. Clinical Education will only accept COPIES of this form that has been transcribed by your physician. PART B - STATEMENT OF GOOD HEALTH'i Patient Name: $ '$ Birth Date: Medical Insurance Carrier: - M_ _ 'cv\ VACCINATIONS: Date Result (a) Hepatitis B(completed series and positive HbsAb(Antibody to Hepatitis B surface antigen)laboratory blood test or student can sign decline wan er after discussion with doctor of the risks of HepB) *Decline Waiver requires a negative HbsAg(Hepatitis B surface antigen)blood test. BFdBAB • Received 11 injection • Received 2ud injection ImWaEft • Received 31 injection nwlu • Titer(To be completed following the series) 1 (b) MMR(Measles Mumps Rubella) • Documentation of 2 immunizations after one year of age • Or immunity established by laboratory blood test Lk wo, a • Or born before 1957 � $ $ © BBB (c) Two-Step PPD Mantoux Annual 1 Step 8 _pBBBB 2"Step OR • Chest X-Ray one time for positive PPD(or under MD orders) • Note:x-ray report valid for 2-years OR • Quantiferon TB Test B (d) Tdan: (within 10 years) C /25/IJ >5� _ BBBBBBBBB (e) Varicella Titer L\\A-\rj I find the above named patient to be in good health and free of communicable disease(s). I find the above named patient to be in good health and free of communicable disease(s). Facility Name Physician(Liefrised MD,DO,NP or PA)Name(Please Print) �ss�� �gi-o�orJ Facility's Phone Number Physician(Liceflge—d D,DO,NP or PA)Signature V\515—lu\ A 2,014 UPIN# D to Signed 700 1K7NDY POTNT DRIvE,SAN MARCOS,CA 92069-WEBSITE:nww.usa.edu Page 1 of 1 rggA D s rh f5�V$f_ jeII �� 9m IMMUNIZATION RECORD Comprobante de immunizacwn Y,°�Fvdi4s�s'� DATE DATE NEXT VACCINE GIVEN DOCTOR OFFICE OR CLINIC DOSE DUE vacuna fecha de medico o clinioa pr6xarne vacunaci6n vacUna KAISER MR# mbimmmM PRINTED: 09/09/2015 Name mm?hre JY MIIlYlY1r'YlV MM Birthdate Sex lecha,le nocrrniernn mmmmm ceo F Allergies alerKiav Vaccine Reactions reacciones a to vanuur RETAIN THIS DOCUMENT — CONSERVE ESTE DOCUNENTO DATE DATE NEXT VACCINE GIVEN DOCTOR OFFICE OR CLINIC DOSE DUE vacuna fecha de medico o clinica pr6xxm vacunaci6n vacuna INFLUENZA 10/26/2009 INF H1141-09 STANDARD DOSE INF H1111-09 Kaiser PeZmariente jQ5/15/2009 MR w,iP Kaiser Permanente TDAP TD 09/18/2009 TDAP (ADACEL) Tr'h kaiser Permanente arents: our child must meet Caijformas rmmurnzauon regmrements to be emoli ed m school and child care.Keep this Record as proof of immunization Pad,a: Sv rri6n de be tvmpor con las requi.vlos de vacurws par asisrar o la escuela y a In TS SKIN TESTS' Pruebas de Is Tuberculosis ma'de"a Mwierr a esra Cam robwrm to necesiwrw. DT Td = Dip I ena,tHano Type' Date given Given by Date read Read by m ndur Impression DTa P/rdap =Diphreria,te(anus,peaussis(whooping cough)(difteria,terano,y los forino) DTP =Diphiena,tetanus,pertussis(whoopingcough)[diReria,tetano,ylosforino) PPD OS 13 2009 OS 15 2009 00 NEG HEPA =Hepatitis A HEPH =Hepatitis 8 PPD HIH =HIH Meninpis(Haemophilius inluemae type H)(meningitis Hib) HFV =Human pa tlloma virus(vins del papiloma humus) PPD INFv =Influenra�la gnpa) �IENINCOCOCCAL=Mcoingococcel vaccine(vacuna mcningococia) 'A chest x-ray may be indicated if skin test is posluve =Measles,mumps,rubella(swampion,papras rubeola) 'If required for school entry,must teNjamoux unle s exoe u n Kpmed by local health de ru em PNEUtc =Pneumococcae vaccine[pnewnococica) CHEST X-RAY Filin date: I Interprelation:))normal()abnomaI POL10 =Poliomielins[poliomielins) [Radiografla)Person is freed mm'un-ca)1e tuberculosis(h•cs()no RV Rot.,irus(rotavuus) (Necessary if skin test positive.) 2v =V'ancella(chickenpox)(varicela) SignaturQ/Agency P(q,ai.aji(�.,nta 'Med-kcal Group, Inc. ArjUn..'r Mr.-DiC-NE 2011 Ear'; Novembe-23, 2018 M m.tmmmm MS iBBBBRB Clovis 1-6277 DeaABBBBBB, mmmmm PAk (JIl KEE C, KAN MD A!" ST 44-,M?3-- idwcaten pose'-t-1-i.rlpi') ip,t and ros'diastir,ni silhouatta j?(1-k,,jyj,!j nc.',17�)j Jin)jjs. A.io focal consolidation.pleural effusion or j,.c;t?y iaenitl"&(.l 17),3 b,: 'V x'S("'.�Ssly intact The Permanente Medical Group, Inc. OBSTETRICS AND GYNECOLOGY 2071 East Herndon Clovis CA 93611-6101 Dept: 559-448-4555 Main: 559-324-5100 VISIT VERIFICATION Date:November 22, 2013 I�dr1�bA��i�Q�IR � �lui1't�IdlYlivi�aiM1�111✓�1�IMMM n SIGNATURE AND TITLE 1 � AMANDA DEWNE REEVE MD 1 hereby authorize the Kaiser Permanente Medical Care Program to verify to my employer/school, upon request, the information contained on this form. SIGNATURE OF PATIENT OR RESPONSIBLE PERSON RELATIONSHIP TO PATIENT The Permanente Medical Group, Inc. ADULT MEDICINE 2071 East Herndon Clovis CA 93611-6101 Dept: 559-448-4555 Main: 559-324-5100 November 26, 2013 MM46fMV&ff4MMMM MMMVNMIl KfM To Whom It May Concern, BjM8BBBB8BR had a chest x-ray done for TB clearance. TB evaluation ** FINDINGS ** : Comparison: 08/11/2011 Technique: PA view of the chest was obtained. Heart size is normal with no increased vascularity or mediastinal widening. No focal infiltrate, effusion or discrete lung nodule . Osseous structures are unremarkable . ** IMPRESSION ** : No radiographic evidence of an acute infectious process . The chest x-ray is negative. Sincerely, ELECTRONI LY SIGNED BY OUSSAINT STREAT. a� TOUS T MACEO STR T MD /01 / 0 AN JOAQUINVALLEY REHABILITATION HOSPITAL Tuberculosis Screening Name: M?644 Mlgate: 4 ✓ I 1 Position: a� Department: I PCJS This is to certify by the undersigned employee: Vry I am consenting to tuberculin skin test using Tuberculin Purified Protein Derivatives (PPD) 0.1 ml. intradermal. I have not had a live virus vaccine such as MMR, Polio, or influenza or had a viral infection (illness with a high fever) in the past 4 —5 weeks. I am not receiving coritco steroids or immunosuppressive agent. I have never had a positive skin test. I am not pregnant nor a nursing mother at this time. I have never received BCG/not a contraindication. Signature: BB B B_ BBBBBB'BBffYBBBBBB'BBBBB19BBBB If the results were positive, the follow-up chest x-ray was done on: SOL.# 1MM EXP. S PPD Tuberculin skin test was in'stered on the arm on 7 ,� f by: ` rn Employee Health Nurse Test was read on: l by , R.N. RESULTS: Negative less than 4mm Doubtful induration 5—9 mm or erythema greater than 10mm—(retesting may be indicated) Positive induration of 10mm or more FOLLOW UP XMorhidity renort to he filed on new TB converters onlv. r N_ v � N i� N N p 'tti � � 0 � N tci M o N �a• K r � o o C4 N co «�. NO� N ct) a N O < r+tg Q � }< l .Aa 117 � to r' � d � N � .••10 o E d it �' �y �`► m � 'R 'a cb O- s Uo yTirl 10 �,gyp, � �^q .1 1 '.Y t, h•. ,Y� `�, t t h,• i� .tyy� PPD (POCT) Results Normal Status: Final result (Collected: 11/12/2018 08:00) Component Results Component Collected - Lab PPD 11/12/2018 08 :00 Unknown Neq Encounter View Encounter Additional Information Specimen Date Specimen Time Specimen Specimen Taken Taken Received Date Received Time Result Date Result Time Nov 12, 2018 0800 Nov 14, 2018 0812 View SmartLink Info POCT PPD PNA(Order#205223117) on 11/14/18 Order Report Order Details 8` J BBB#QSBBBBBBBUBBBBBB) c 7 N (/� 70•G O O'O 2 (n , oc mD ; nc � c � ' a �. ° 0ti ® 7 3 a o d D mN n � B 6 c g�^ c ep4gn m CD "R�\ b va 3 I{I �. C CO o B B - B \ ® a > $ m O i o$ N. r� ` ;B f,, 8 i �` 'v �ml C: B s " 1' ;.s 9' e B CL Q Q r ❑ m � � � o f 1 Z rrt o o Ll �BBBI "� BBB BBBBBBBBBBBBB Name Sex Birthdate VACCINE DATE DOCTOR OFFICE OR CLINIC DATE NEXT GIVEN DOSE DUE VOCUno (echo cle mr?dico a chnica proximo vocunocidn vocuna I I 2 POLIO 3 i 1 4i P ;1 tt1g1; ❑ Td DTP i,IPa, ❑ DT Td ,P i)V D1Cr10 i Div I Tetanus 3 ❑ Td Perlussis ❑ DT (Whooping ❑ DTP Cough) 4 ❑ Td ❑ DT difteria ❑ DTP t6tano 5 ❑ Td y ❑ DT tos ferino ❑ DTP ❑ Td ❑ DT MMR �Q � I Measles, Mo Ps, R soramprt paperos, 1 I- I0LP s m i&alemon 1 I CCU' Hib Meningitis PM 298(1/88) "Z-18! � 87 Required Qualifications Attachments for: B.5 i i - r ot ` $ 1F .3�� d ;,{ _ }Y a •,Ri t• �4 ,3a. o, fro '�"= ' `5i�. � ,,}t, Laa. ' � L :� tom+ �r� t y}�I Yam, � .,r. _:�•ks � S. =P r CITY OF FRESNO BUSINESS TAX CERTIFICATE EXPIRES: 03/31/2019 Business Name: GOODFELLOW*" __J�A JNAL THERAPY SERVICES Location: 2505 W SHAW AvE f A Contact/Owner. Tax Account No.: 72850 This tax certificate may be accepted as valid up to thirty(30)days after the expiration date above If appropriate tax returns have been filed and business tax paid before the due date.This tax oerticate must be avadale for inspection by any auttwrized City of Fresno esrptoj� BusrFe,��',,.a,do a fixed kxat o t or are located oeA of the city s`4a carry this Tax Cecbi xca?e wtde cwxkx"t wig m the City This * t e rc r 3ssiness has a Tax Certificate nittt�-be City of Fresno_R does nct ent€�e Uae hc(der A carry on i ussr'�art6,i�s iin a n �—6 win Q r! zj acc&-die provision to d-)e Fresno Auscapai Code- G IFELL(4h'OCCLIPATK)MAL Tt£RAPY SERVICES 25C6 fit'Sfl"I AVE X A cW-ShID-CA 93711-3334 �r Lim C AY Cor&oier t. - fi , ' +� t 3973647 ARTICLES OF INCORPORATION Sea FILE® OF eta GOODFELLOW OCCUPATIONAL THERAPY,INC. State of Caiifomia JAN 01 2017 0, 1. NAME I cc, The name of the corporation is GOODFELLOW OCCUPATIONAL THERAPY, INC. II. PURPOSE The purpose of the corporation is to engage in the profession of occupational therapy and any other lawful activities (other than the banking or trust company business) not prohibited to a corporation engaging in such profession by applicable laws and regulations. III. AGENT FOR SERVICE OF PROCESS The name and address in this state of the corporation's initial agent for service of process are: John E. Goodfellow 2505 West Shaw Avenue,Building A Fresno, California 93711 IV, CORPORATE ADDRESSES The initial street and mailing address of the corporation is; 2505 West Shaw Avenue,Building A,Fresno,California 93711. V. STOCK The corporation is authorized to issue only one (1)class of shares, which shall be designated"common shares,"having a total number of five hundred thousand(500,000)shares. DOWLINGJAARON 3973647 VI. NO PREFERENCES,PRIVILEGES,RESTRICTIONS No distinction shall exist between the shares of the corporation or the holders thereof. VII. LIMITATION ON DIRECTOR LIABILITY The liability of the directors of the corporation for monetary damages shall be eliminated to the fullest extent permissible under California law. VIII. INDEMNIFICATION OF AGENTS The corporation is authorized to provide indemnification of agents (as defined in Section 317 of the California Corporations Code) through bylaw provisions, agreements with agents, vote of shareholders or disinterested directors or otherwise, in excess of the indemnification otherwise permitted by Section 317 of the California Corporations Code,subject only to the applicable limits set forth in Section 204 of the California Corporations Code with respect to actions for breach of duty to the corporation and its shareholders. IX. PROFESSIONAL CORPORATION This corporation is a professional corporation within the meaning of Part 4 of Division 3 of Title 1 of the California Corporations Code. X. FILING DATE The undersigned hereby requests that these Articles of Incorporation be filed January 1,2017. EXECUTION IN WITNESS WHEREOF, the undersigned, who is the incorporator of this corporation,has executed these Articles of Incorporation on� I/.v ,2016. NATHAN W.POWELL, Incorporator 018133-000000-02085751.DOC-1 DOW LING I AARON 2 EXHIBIT D OT AND/OR PT CONTRACTOR STAFFING ASSIGNMENT PROCESS COMMENCEMENT OF SERVICE ASSIGNMENT 1. At least two (2) work weeks or ten (10) working days prior to the effectivity of Master Agreement, CCS-MTP Rehabilitative Therapy Manager (RTM) or designee will notify Contractors of the number of OT and/or PT staff needed by the program at a specified start date of service. 2. Contractors will be given five (5) working days to submit a list of available licensed OT and/or PT for the RTM or designee's evaluation. The qualification of OT and/or PT staff is based on the list of compliance requirements identified in the RFSQ No. 19-059. 3. In order to prevent disruption of Medical Therapy service to CCS enrolled clients, selection criteria of qualified OT and/or PT staff from Contractors shall be based on: a. Availability of qualified staff at the required date of service b. Price, if all Contractors have available and equally qualified staff 4. After selection, RTM or designee will notify the Contractor who best meets all the County's requirements. Notification shall include the names of selected Therapy staff, Start Date of Service and Medical Therapy Unit (MTU) location assignment. 5. Upon receipt of County's notification of Therapy staff selection, Contractor shall provide a confirmation of assignment within 24 business hours. Non confirmation will allow the County's RTM to select the next qualified and available Contractor. 6. After a qualified Therapy staff is confirmed acceptable and available, RTM will send a notification to all Contractors stating the required Therapy staff service requirement has been fulfilled. DISCONTINUATION OR TERMINATION OF SERVICE ASSIGNMENT 1. Contractor shall provide at least two (2) work week notification to the County through CCS-MTP's RTM or designee, stating the discontinuation of Contractor's Therapy staff (s). 2. County shall follow the review and selection process as per the Commencement of Service Assignment section above, items no. 2 through 6. 3. In the event, Contractor provided less than two (2) work week notification of discontinuation of Therapy service(s), County's time to process the evaluation and selection of replacement Therapy services shall be reduced accordingly. EXHIBIT E SERVICE RATES CONTRACTOR SERVICE RATE Cell Staff, Inc. OT: $90.00/1-Ir PT: $90.00/1-Ir Goodfellow Occupational OT: $95.00/1-Ir Therapy, Inc. PT: $95.00/1-Ir NOTES: OT: Occupational Therapist PT: Physical Therapist 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). Page 1 of 2 Exhibit F (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: Page 2 of 2