HomeMy WebLinkAboutA-05-401 DPH Misc. Docs.pdf CONTRACT STATUS FORM ti CO
RECEIVED o eg6 0
DATE: December 02, 2024 Es�
DEC 19 2024
DIVISION(S): Emergency Services
(Lead Division listed first) 11PAR pNTRgOF SECTION ALT
CONTRACTOR: Saint Agnes Medical Center
SERVICES: Voice Print Access to County's EMS Communications
CONTRACT TERM: 8/30/05 to 6/30/25 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
Contract#: A-05-401 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:March 1, 2025
Extend contract through: , 20
❑ With no changes in terms or conditions.
❑ With the following change(s):
Evergreen: Continue contract through: Wi6 , 20 ,
❑ Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by. l Z/r Z
Program Supervisor/Staff Analyst: Date: $� 1
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090
CONTRACT STATUS FO E IVED coU�
DATE: December 01, 2023 FEB 212024 �'RE
DEPWIMN RAoTSSELI
CT
DIVISION(S): Emergency Services
(Lead Division listed first)
CONTRACTOR: Saint Agnes Medical Center
SERVICES: Voice Print Access to County's EMS Communications
CONTRACT TERM: 8/30/05 to 6/30/24 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
Contract#: A-05-401 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:March 9, 2024
❑ Extend 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 Analyst: Date: Z/1�//2�{
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
ti CO U�
CONTRACT STATUS FORM
RECuo o 60
DATE: December 01, 2022 FEB U 2023 ORES)
DIVISION(S): Emergency Medical Services �pp,RTMENTOFPUBtC�'`F't'
(Lead Division listed first) CONTRACTS SEG1,kU'k)
CONTRACTOR: Saint Agnes Medical Center
SERVICES: Voice Print Access to County's EMS Communications
CONTRACT TERM: 8/30/05 to 6/30/23 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
Contract#: A-05-401 StateNendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:March 1. 2023
Extend contract through: , 20
With no changes in terms or conditions.
With the following change(s):
n Evergreen: Continue contract through: 117k- 20 .
❑ Cancel contract effective: , 20
❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
Program Supervisor/Staff Analyst: Date: 17VW
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
CONTRACT STATUS FORM coU�
�--
DATE: December 01, 2021 RECEIVED FuEs�
DIVISION(S): Emergency Medical Services
DEC 0? 20
(Lead Division listed first) DEPARTMENT OF PUBLIC H LTH
CONTRACTOR: Saint Agnes Medical Center
CONTRACTS SECTI
SERVICES: Voice Print Access to County's EMS Communications
CONTRACT TERM: 8/30/05 to 6/30/22 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
Contract#: A-05-401 State/Vendor#: N/A
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: 20 ,
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
Program Supervisor/Staff t: Date:
Division Manager: Date: 1Z/7/21
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090
CONTRACT STATUS FORM w co�,��
DATE: December 01, 2020 RECEIVEDFRE
DIVISION(S): Emergency Medical Services .1AN 14 2021
(Lead Division listed first) DEPARTMENT OF PUBLIC HEA H
CONTRACTOR: Saint Agnes Medical Center
CONTRACTS SECTION
SERVICES: Voice Print Access to County's EMS Communications
CONTRACT TERM: 8/30/05 to 6/30/21 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
Contract#: A-05-401 State/Vendor#: N/A
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
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
Program Supervisor/Staff Ana t: Date:
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
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CWNTRACT STATUS FOWtd
DATE: December 02, 2019
DIVISION(S): Emergency Medical Services RECEIVED
(Lead Division listed first)
CONTRACTOR: Saint Agnes Medical Center JUN Z 3 2020
DEPARTMENT OF PUBLIC HEALTH
SERVICES: Voice Print Access to County's EMS Communications CONTRACTS SECTION
CURRENT PERIOD: 8/30/05 to 6/30/20 E Auto-renewo:_Erlthrough:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
ADDITIONAL INFO: Evergreen Agreement-Please Review
Contract#: A-05-401 State/Vendor#: N/A
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 An lyst: Date:
Division Manager: Date: lP`T- 4",PU
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
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C6NTRACT STATUS FORM fp
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DATE: November 29, 2018BS�
RECEIVED
DIVISION(S): Emergency Medical Services
(Lead Division listed first) DEC 0 6 2018
CONTRACTOR: Saint Agnes Medical Center DEPARTMENT OF PUBLIC HEALT
CONTRACTS SECTION
SERVICES: Voice Print Access to County's EMS Communications
CURRENT PERIOD: 8/30/05 to 6/30/2019 E Auto-renewal: ❑ through:
(if not checkmarked above,contract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
ADDITIONAL INFO:
Contract#: A-05-401 State/Vendor#: N/A
Lead Dept: DPH 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/Sta n y t: Of Date: 1 LO 4 I ��
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
��ti co �
CUNTRACT STATUS FOI&
RECEIVE o g,, o
DATE: December 01, 2017 FRE`3
JAN 2 3 2018
DIVISION(S): Emergency Medical Services DEPARTMENT OF PUBLIC HE T
(Lead Division listed first) CONTRACTS SECTIO
CONTRACTOR: Saint Agnes Medical Center
SERVICES: Voice Print Access to County's EMS Communications
CURRENT PERIOD: 7/1/17 to 6/30/2018 E Auto-renewal: ❑ through:
(if not checkmarked above,contract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
ADDITIONAL INFO:
Contract#: A-05-401 State/Vendor#: N/A
Lead Dept: DPH 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. f
Program Supervisor/Staff na Date: 3-
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
O NTRACT STATUS FOAU
co
DATE: November 28, 2016 FRESH
DIVISION(S): Emergency Medical Services
(Lead Division listed first)
CONTRACTOR: Saint Agnes Medical Center
SERVICES: Voice Print Access to County's EMS Communications
CURRENT PERIOD: 7/1/16 to 6/30/17 E Auto-renewal: ❑ through:
(If not checl -� ntract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at tm==nt period.)
ORGANIZATION #(s): 56201693 DFr. 0 5 2016
CONTRACT AMOUNT $208.00
DEPARTMENT OF PUBLIC HEALT
ADDITIONAL INFO: CONTRACTS SECTION
Contract#: A-05-401 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:March 1, 2017
)Rf 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: /94f
Program Supervisor/Sta Analyst: Date: t 'l `c
Division Manager: Date: /�
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
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MNTRACT STATUS FOR"
O 1 56 O
DATE: November 20, 2015
�
DIVISION(S): Emergency Medical Services REGEvEi
(Lead Division listed first) E: j 7 2015
CONTRACTOR: Saint Agnes Medical Center JEPARTMENTOF PUBLIC HEALk!
i� rtr� r= c710L
SERVICES: Voice Print Access to County's EMS Communications
CURRENT PERIOD: 7/1/15 to 6/30/16 E Auto-renewal: ❑ through:
(if not checkmarked above,contract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT $208.00
ADDITIONAL INFO:
Contract#: A-05-401 StateNendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:March 1, 2016
enew contract through: �20 , 20 (7
A�rwith no changes in terms or conditions.
With the following change(s):
❑ Evergreen: Continue contract through: 20
Cancel contract effective: 120
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Pro ram Supervisor/Staff Analyst: Date:
I-on Manager: h Date: 'e,
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
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C(' gTRACT STATUS FORM
O� 56 O
DATE: December 01, 2014 RE �'RE`'�
RECEIVED
DIVISION(S): Emergency Medical Services JAN 14 2015
(Lead Division listed first)
CONTRACTOR: Saint Agnes Medical Center DEPARTMENT OF PUBLIC HEALTH
CONTRACTS SECTION
SERVICES: Voice Print Access to County's EMS Communications
CURRENT PERIOD: 7/1/14 to 6/30/15 E Auto-renewalZmarked
rough:
(If not chabove,contract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
ADDITIONAL INFO:
Contract#: A-05-401 State/Vendor M N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by: March 1, 2015
enew contract through: Z,30 -, 20
ith 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 A lyst: Date:
Division Manager: - Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
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CCRTRACT STATUS FORM
('7 O� 656 O
DATE: December-1 , 2013
DIVISION(S): Emergency Medical Services
(Lead Division listed first)
CONTRACTOR: Saint Agnes Medical Center
SERVICES: Voice Print Access to County's EMS Communications
CURRENT PERIOD: 7/1/13 to 6/30/14 E Auto-renewal: 0 through:
(if not checkmarked above,contract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
ADDITIONAL INFO:
Contract#: A-05-401 StateNendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by: March 2014
HECE
Renew contract through: 40 J sue- 30 , 20 l� IVED
DEC 19 2013
With no changes in terms or conditions. DEPARTMENT OFPIIBUCHEALTH
❑ With the following change(s): CONTRACTS SECTION
❑ Evergreen: Continue contract through: 20
Cancel contract effective: , 20
❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
Program Supervisor/Sta nal Date:
Division Manager: Date: / /3
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
COUP
C6wiTRACT STATUS 0
Off` 60
DATE: December 03, 20125�
DIVISION(S): Emergency Medical Services
(Lead Division listed first)
CONTRACTOR: Saint Agnes Medical Center
SERVICES: Voice Print Access to County's EMS Communications
CURRENT PERIOD: 7/1/12 to 6/30/13 E Auto-renewal: ❑ through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
ADDITIONAL INFO:
Contract#: A-05-401 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by: March 1, 2013
Renew contract through:
❑ With no changes in terms or conditions.
❑ With the following change(s):
Evergreen: Continue contract through: G�3 , 20 /,
Cancel contract effective: , 20
❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
Program Superviso tall Analys - Date:
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090
CO U�
CUNTRACT STATUS FOffM
O� 56 O
DATE: December$�2011 FRESH
DIVISION(S): Emergency Medical Services
(Lead Division listed first)
CONTRACTOR: Saint Agnes Medical Center
SERVICES: Voice Print Access to County's EMS Communications
CURRENT PERIOD: 7/1/11 to 6/30/12 E Auto-renewal: O through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
ADDITIONAL INFO:
Contract#: A-05-401 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete.the information below and return to DPH Contracts by: March 1, 2012
❑ Renew contract through: , 20
❑ With no changes in terms or conditions.
❑ With the following change(s):
Evergreen: Continue contract through:.-.-_ -3 20 / 3
Cancel contract effective: , 20
❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Supervis Staff A�na�t-
�— Date: ,
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 445-7090
MW qw CO tj�
CONTRACT STATUS FORM
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DATE: December 01, 2010 FRESH
DIVISION(S): Emergency Medical Services
(Lead Division listed first)
CONTRACTOR: Saint Agnes Medical Center
SERVICES: Voice Print Access to County's EMS Communications
CURRENT PERIOD: 7/1/10 to 6/30/11 E Auto-renewal: E through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
ADDITIONAL INFO:
Contract#: A-05-401 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
0ompI106-t[e4i formation below and return to DPH Contracts by: March 1, 2t;11
Renew contract through: , 20_
With no changes in terms or conditions.
With the following change(s):
ZEvergreen: Continue contract through: L-3 � , 20
❑ Cancel contract effective: , 20
1-1 Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Supervisor Staff Analyst: — Date:
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 445-7090
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CONTRACT STATUS FO
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DATE: November 24, 2009 RECEIVED ES
DIVISION(S): Emergency Medical Services JAN 2 '
(Lead Division listed first) DEPARTMENT OF P UPLIc HLALTH
CONTRACTOR: Saint Agnes Medical Center CONTRACTS SECTION
SERVICES: Voice Print Access to County's EMS Communications
CURRENT PERIOD: 7/1/09 to 6/30/10 E Auto-renewal: through:
(If not chXed above,contract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
ADDITIONAL INFO:
Contract#: A-05-401 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by: March 1, 2010
P_-P new contract through: _, 20
L?"l-th 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 An Date:
Division Manager: Date: l
. Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 445-7090
coU�,��.
Contract Renewal/Termination Form
O 856 O
DATE: December 01, 2008 FRESH
DIVISION(S): Emergency Medical Services
(Lead Division listed first)
CONTRACTOR: Saint Agnes Medical Center RECEIVED
JAN 0 6 2009
SERVICES: Voice Print Access to County's EMS Comm ,DEPA MENT F,U?LBEALTii
CONTRACTS ECTION
CURRENT PERIOD: 7/1/08 to 6/30/09 E Auto-renewal: through:
(If not check rked above,contract will terminate
ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00
ADDITIONAL INFO:
Contract#: A-05-401 StateNendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by: March 1. 2009
Renew contract through: , 20/Ell-
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 nalyst: Date:
�`,qivision Manager: Date:
M
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 445-7090
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Contract Renewal/Termination Form
' t
O 1856 O
DATE: November 21, 2007 FxEs�
TO: Emergency Medical Services RECEIVED
BAN
2
CONTRACTOR: Saint Agnes Medical Center OEP,gR�FNTpFCpG20�
NTRACTSSECT%ON nc4zrhl
SERVICES: Voice Print Access to County's EMS Communications
CURRENT TERM: 7/1/07 to 6/30/08 E Auto-renewal: ❑ Through:
FULL TERM: 8/30/2005 to Evergreen
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00 LEAD DEPT: DCH State/Vendor#: N/A
ADDITIONAL INFO: Contract#: A-05-401
Please complete and return this form to DCH Contracts by: March 1, 2008
Renew contract through: , 20
With no changes in terms or conditions.
Amend with the following change(s):
Evergreen: Continue contract through: �U�Jlf 30 720
Cancel contract effective: , 20
❑ Additional Information:
Submitted by:
Print Name: ce� ty NGff Title:
Signature: Date: 17— 7 Phone #: S:�_33?57
Approved by:
Division Manager Initial: Staff Analyst Initial:
Department Head: ___ Date:
Submit to: DCH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 445-7090
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Contract Renewal/Termination Form fp
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DATE: December 01, 2006 FREc��
TO: Emergency Medical Services
RECEIVED
CONTRACTOR: Saint Agnes Medical Center
APR 05 al
SERVICES: Voice Print Access to County's EMS CommunicaticMWTMENTOFCUMMUNITVHEALTH
CONTRACTS SECTION
CURRENT TERM: 8/30/06 to 6/30/07 E Auto-renewal: -- Through:
FULL TERM: 8/30/2005 to Evergreen
ORGANIZATION #(s): 56201693
CONTRACT AMOUNT: $208.00 LEAD DEPT: DCH State/Vendor#: N/A
ADDITIONAL INFO: Contract #: A-05-401
Please complete and return this form to DCH Contracts by: March 1, 2007
Renew contract through: 62 —_Fbr(!5)9> , 20
With no changes in terms or conditions.
With the following changes:
Cancel contract effective: , 20
Additional Information:
Approved by:
Print Name: � �{� Gy�G Division Manager Initial:,
Signature: Staff Analyst Initial:
Title: Date: ZPhone #: .5--3387
Department Head �� `� 7i7 Date:
DCH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 445-7090
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County of Fresno
�
O� s6 O DEPARTMENT OF PUBLIC HEALTH
FREC3 DAVID POMAVILLE, DIRECTOR
July 28, 2015
Nancy Hollingsworth, Chief Operationg Officer
Saint Agnes Medical Center
1303 E. Herndon Ave.
Fresno, CA 93720
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