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HomeMy WebLinkAboutA-15-030 DPH Misc. Docs.pdf CONTRACT STATUS FORM ti co�,�, O� 56 O DATE: December 01, 2023 RECEIVE REST DIVISION(S): Emergency Services FEB 21 202 (Lead Division listed first) CONTRACTOR: Community Regional Medical Center DEPARTMENT OF PUBLIC HEALTH CONTRACTS SECTION SERVICES: Designation as a Level I Trauma Center CONTRACT TERM: 12/1/14 to 6/30/24 E ADDITIONAL INFO: Evergreen Agreement-Please Review ORGANIZATION #(s): 56201695 CONTRACT AMOUNT: $0.00 Contract#: A-15-030 StatefVendor#: Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:March 1, 2024 ❑ Extend contract through: , 20 With no changes in terms or conditions. With the following change(s): © Evergreen: Continue contract through: (�1 0 20 Z . ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: G l/ 7i(,��Z Program Supervisor/Staff Analyst: Date: Division Manager: Date: Submit to: DPH Contracts - Stop#147 - Brix Building, 6th Floor- Phone #: 600-7090 ti CO U� CONTRACT STATUS FORM O� 456 0 DATE: December 01, 2022 FREs� DIVISION(S): Emergency Medical Services (Lead Division listed first) RECEIVED CONTRACTOR: Community Regional Medical Center FEB 01 2023 SERVICES: Designation as a Level I Trauma Center DEPARDlMQ Tipi omc fS ION CONTRACT TERM: 12/1/14 to 6/30/23 E ADDITIONAL INFO: Evergreen Agreement-Please Review ORGANIZATION #(s): 56201695 CONTRACT AMOUNT: $0.00 Contract#: A-15-030 State/Vendor#: Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:March 1, 2023 Extend contract through: , 20 11 With no changes in terms or conditions. With the following change(s): 0 Evergreen: Continue contract through: ���� , 20 ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by. Program Supervisor/Staff Analyst: Date: 17i Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 CO U� CONTRACT STATUS FORM O 9 O DATE: December 01, 2021 RECEIVED DIVISION(S): Emergency Medical Services DEC 07 202 (Lead Division listed first) g DEPARTMENT OF SECTION LTH CONTRACTOR: CommunityRegional Medical Center SERVICES: Designation as a Level I Trauma Center CONTRACT TERM: 12/1/14 to 6/30/22 E ADDITIONAL INFO: Evergreen Agreement-Please Review ORGANIZATION #(s): 56201695 CONTRACT AMOUNT: $0.00 Contract#: A-15-030 State/Vendor#: Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:March 1, 2022 Extend contract through: , 20 ❑ With no changes in terms or conditions. ❑ With the following change(s): Evergreen: Continue contract through: ��/ip , 20 Z 5 ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Supervisor/Staff A lyst: Date: IZ 7 �L Division Manager: Date: 1 L/ 7 /l t1 Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 CONTRACT STATUS FORM ti coU� RECEIVED o g o DATE: December 01, 2020 JAN 14 2021 E5�' DIVISION(S): Emergency Medical Services DEPARTMENT OF PUBLIC HEALTH (Lead Division listed first) CONTRACTS SECTION CONTRACTOR: Community Regional Medical Center SERVICES: Designation as a Level I Trauma Center CONTRACT TERM: 12/1/14 to 6/30/21 E ADDITIONAL INFO: Evergreen Agreement-Please Review ORGANIZATION #(s): 56201695 CONTRACT AMOUNT: $0.00 Contract#: A-15-030 State/Vendor#: Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:March 1, 2021 Extend contract through: , 20 ❑ With no changes in terms or conditions. ❑ With the following change(s): Evergreen: Continue contract through: , 20 ZZ ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Supervisor/Staff A lyst: Date: Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 COUP CWNTRACT STATUS FOiddfig 0 O� g6 O DATE: December 02, 2019 RECEIVED DIVISION(S): Emergency Medical Services f`l 2 (Lead Division listed first) 3 2020 CONTRACTOR: Community Regional Medical Cer ARTMENTOFPUBUC CONTRACTS SECTIUry SERVICES: Designation as a Level I Trauma Center CURRENT PERIOD: 12/1/14 to 6/30/20 E Auto-renewal: hrough: (If not the kmarked above, contract will terminate ENTIRE TERM: 12/1/14 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201695 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Evergreen Agreement-Please Review Contract#: A-15-030 State/Vendor#: Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:March 1, 2020 Renew contract through: , 20 With no changes in terms or conditions. ❑ With the following change(s): ❑ Evergreen: Continue contract through: 20 Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by.- Program Supervisor/Staff Anqlv.At: Date: / Division Manager: Date: 0/2,-T! zo Z-0 Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 co CONTRACT STATUS FORTVI O es6 O DATE: November 29, 2018 1: DIVISION(S): Emergency Medical Services RECEIVED (Lead Division listed first) CONTRACTOR: Community Regional Medical Center DEC 0 6 2018 DEPARTMENT OF PUBLIC HEAL H SERVICES: Designation as a Level I Trauma Center CONTRACTS SECTION CURRENT PERIOD: 12/1/14 to 6/30/2019 E Auto-renewal: ❑ through: (If not checkmarked above,contract will terminate ENTIRE TERM: 12/1/14 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201695 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Contract#: A-15-030 State/Vendor M Lead Dept: Other Dept(s): Complete the information below and return to DPH Contracts by:March 1, 2019 Renew contract through: , 20 ❑ With no changes in terms or conditions. ❑ With the following change(s): Evergreen: Continue contract through: 20 ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Supervisor/St Analyst Date: i-L_4 y / ►� Division Manager: Z Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 CO U� CONTRACT STATUS FORM Ah DATE: December 01, 2017 RECEIVED Est' DIVISION(S): Emergency Medical Services ,iAN 2 3 2013 (Lead Division listed first) CONTRACTOR: Community Regional Medical CenWARTMENT OF PUBLIC H Ele CONTRACTS SECTION SERVICES: Designation as a Level I Trauma Center CURRENT PERIOD: 12/1/14 to 6/30/2018 E Auto-renewal: O through: (if not checkmarked above,contract will terminate ENTIRE TERM: 12/1/14 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201695 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Contract#: A-15-030 State/Vendor#: Lead Dept: Other Dept(s): Complete the information below and return to DPH Contracts by:March 1, 2018 Renew contract through: , 20 With no changes in terms or conditions. With the following change(s): Evergreen: Continue contract through: 20 Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: , Program Supervisor/Staff al st: Date: ►L 4�h Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 ,w UP C"NTRACT STATUS F01 .CO O� 56 O DATE: November 20, 2015 R E`i C Lt y EI �;:. FxES� l__0 DIVISION(S): Emergency Medical Services j 1 7 1) (Lead Division listed first) CONTRACTOR: Community Regional Medical Center SERVICES: Designation as a Level I Trauma Center CURRENT PERIOD: 12/1/15 to 6/30/16 Auto-renewal: through: (If not the rked above,contract will terminate ENTIRE TERM: 12/1/14 to 6/30/18 at the end of the current period.) t ORGANIZATION #(s): 56201695 CONTRACT AMOUNT $0.00 ADDITIONAL INFO: Contract#: A-15-030 State/Vendor#: Lead Dept: Other Dept(s): Complete the information below and return to DPH Contracts by:March 1, 2016 Renew contract through: With no changes in terms or conditions. With the following change(s): Evergreen: Continue contract through: 20 Cancel contract effective: , 20 Additional) Information (e.g., anticipated effective date/term, contract extension, etc.): 1 (,I 1a I 1, l_C /T -1.., /S h-�T/ GL CST J G l Dlii �i/fi✓car h2-i✓ !1'a r'�- -rv�-- '1 a Approved by: Program Supervisor/Staff An st: Date: Division Manager: Date: o Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 147 i co County of Fresno DEPARTMENT OF PUBLIC HEALTH ESQ David Luchini, Director Dr. Rais Vohra, Interim Health Officer September 6, 2024 Rachel VanNoy, Trauma Manager Community Regional Medical Center 2823 Fresno Street Fresno, CA 93721 Agreement: 15-030 Dear Contractor, The County of Fresno, Department of Public Health has not received current verification of your insurance requirements in accordance with the "Insurance" Section of the Agreement between the County of Fresno and your agency. For your reference the insurance requirements are listed on pages 9-11 of the enclosed Agreement. Please send us an original insurance certificate(s) verifying that your insurance is in compliance for the current period of the Agreement at your earliest possible convenience but no later than thirty (30) days from the date of this letter. Please forward a copy of the certificate(s) to dphcontractsP-fresnocountyca.gov or mail the original to: County of Fresno, Department of Public Health P.O. Box 11867 Fresno, CA 93775 ATTN: Contracts Section — 6th Floor If you have any questions, please contact me at (559) 600-7090. cerely, Roberta Bynum Senior Staff Analyst RB: Iw Promotion,preservation and protection of the community's health 1221 Fulton Street/P. 0. Box 11867, Fresno,CA 93775 (559)600-3200 0 FAX(559)600-7687 The County of Fresno is an Equal Employment Opportunity Employer www.co.fresno.ca.us ❑ www.fcdph.org c cot,,t.� low County of Fresno o� s6 o DEPARTMENT OF PUBLIC HEALTH FRESH November 8, 2019 Rachel VanNoy. Trauma Manager Community Regional Medical Center 2823 Fresno Street Fresno, CA 93721 Agreement: A-15-030 Dear Contractor, The County of Fresno, Department of Public Health has not received current verification of your insurance requirements in accordance with the "Insurance" Section of the Agreement between the County of Fresno and your agency. Please send us an original insurance certificate(s) verifying that your insurance is in compliance for the current period of the Agreement at your earliest possible convenience but no later than thirty (30) days from the date of this letter. Please forward a copy of the certificate to dphcontracts(a)fresnocountyca.gov or mail the original to: County of Fresno, Department of Public Health P.O. Box 11867 Fresno, CA 93775 ATTN: Contracts Section — 6t" Floor If you have any questions, please contact me at (559) 600-7090. Sincerely, R berta Bynum Senior Staff Analyst RB: Iw Promotion,preservation and protection of the community's health 1221 Fulton Street/P. O. Box 11867, Fresno,CA 93775 (559)600-3200 • FAX(559)600-7687 The County of Fresno is an Equal Employment Opportunity Employer www.co.fresno.ca.us . www.fcdQh.org 1(�f COUP County of Fresno DEPARTMENT OF PUBLIC HEALTH ESQ David Pomaville, Director Dr. Sara Goldgraben, Health Officer October 10, 2018 Lynn Bennink, RN, Trauma Manager Community Regional Medical Center 2823 Fresno Street Fresno, CA 93721 Dear Contractor, The County of Fresno, Department of Public Health has not received current verification of your insurance requirements in accordance with the "Insurance" Section of the Agreement between the County of Fresno and your agency. Please send us an original insurance certificate(s) verifying that your insurance is in compliance for the current period of the Agreement at your earliest possible convenience but no later than thirty (30) days from the date of this letter. Please forward a copy of the certificate to dphcontracts cafresnocountyca.gov or mail the original to: County of Fresno, Department of Public Health P.O. Box 11867 Fresno, CA 93775 ATTN: Contracts Section — 6th Floor If you have any questions, please contact me at (559) 600-7090. Sincerely, Ro erta Bynum Senior Staff Analyst RB: Iw Promotion,preservation and protection of the community's health 1221 Fulton Street, Fresno Ca. 93721/13. 0. Box 11867, Fresno,CA 93775 (559)600-3330 • FAX(559)455-4705 The County of Fresno is an Equal Employment Opportunity Employer www.co.fresno.ca.us • www.fcd hh..org COtj� 0 County of Fresno O� o DEPARTMENT OF PUBLIC HEALTH p�E6� David Pomaville, Director Dr. Ken Bird, Health Officer July 11, 2017 Lynn Bennink, R.N., Trauma Manager Community Regional Medical Center 2823 Fresno Street Fresno, CA 93721 Dear Contractor, The County of Fresno, Department of Public Health has not received current verification of your insurance requirements in accordance with the "Insurance" Section of the Agreement between the County of Fresno and your agency. Please send us an original insurance certificate(s) verifying that your insurance is in compliance for the period of the Agreement at your earliest possible convenience but no later than thirty (30) days from the date of this letter. Please fax a copy of the certificate to (559) 600-7687 Attn: Contracts and mail the original to: County of Fresno, Department of Public Health P.O. Box 11867 Fresno, CA 93775 ATTN: Contracts Section — 6th Floor If you have any questions, please contact me at (559) 600-7090. Si cere , Trs` oberta Bynum Senior Staff Analyst RB: Iw Promotion,preservation and protection of the community's health 1221 Fulton Mall/P. O. Box 11867, Fresno, CA 93775 (559)600-3200 • FAX(559)600-7687 The County of Fresno is an Equal Opportunity Employer www.co.fresno.ca.us • www.fcdph.org 4co County of Fresno DEPARTMENT OF PUBLIC HEALTH DES DAVID POMAVILLE, DIRECTOR July 28, 2015 Tim Joslin, President & CEO Community Regional Medical Center 2823 Fresno Street Fresno, CA 93721 Dear Contractor, The County of Fresno, Department of Public Health has not received current verification of your insurance requirements in accordance with the "Insurance" Section of the Agreement between the County of Fresno and your agency. Please send us an original insurance certificate(s) verifying that your insurance is in compliance for the period of the Agreement at your earliest possible convenience but no later than thirty (30) days from the date of this letter. Please fax a copy of the certificate to (559) 600-7687 Attn: Contracts and mail the original to: Roberta Bynum, Senior Staff Analyst County of Fresno, Department of Public Health Contracts Section — 6th Floor P.O. Box 11867 Fresno, CA 93775 If you have any questions, please contact me at (559) 600-7090. Sincerely, Roberta Bynum Senior Staff Analyst RB:Iw Promotion,preservation and protection of the community's health 1221 Fulton Mall/P. O. Box 11867, Fresno, CA 93775 (559)600-3200 • FAX(559) 600-7687 Equal Employment Opportunity • Affirmative Action • Disabled Employer www.co.fresno.ca.us • www.fcdph.org co v`r u s County of Fresno Ofi 56 O DEPARTMENT OF PUBLIC HEALTH ESQ DAVID POMAVILLE, DIRECTOR January 23, 2015 Lynn Bennink, R.N. Trauma Manager Community Regional Medical Center 2823 Fresno. Street Fresno, CA 93721 Dear Ms. Bennink, Enclosed is a fully-executed Agreement between the County of Fresno and Community Regional Medical Center for the provision of designation as a Level I Trauma Center. This Agreement is effective December 1, 2014 through June 30, 2018 with the provision for possible extensions. Please retain this copy for your files. Sincerely, Julie Williams Staff Analyst Enclosure Dedicated to Public Health 1221 Fulton Mall/ P.O. Box 11867, Fresno, California 93775/(559)600-3200/FAX(559)600-7687 Equal Employment Opportunity • Affirmative Action • Disabled Employer www.fcdph.org