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HomeMy WebLinkAboutA-05-402 DPH Misc. Docs.pdf :5e� qW or COUP CONTRACT STATUS FORM I ' RECEIVED o� 8y6 0 DATE: December 02, 2024 DEC 18 2024 F ES DIVISION(S): Emergency Services DEPARTMENT OF PUBLIC HEALTCONTRACTS SECTION (Lead Division listed first) CONTRACTOR: Valley Children's Hospital 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: $0.00 Contract#: A-05-402 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 1-1 With no changes in terms or conditions. FT With the following change(s): T(Evergreen: Continue contract through: �pr J , 20 ❑ Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Supervisor/Staff Analyst: Date: �Z�(f���y Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 co CONTRACT STATUS FORM 19 RECEIVED 856 O DATE: December 01, 2023 FRE`') DIVISION(S): Emergency Services FEB 21 2 (Lead Division listed first) DEPARTMENT OF PU LIC T CONTRACTS S C N CONTRACTOR: Valley Children's Hospital 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: $0.00 Contract#: A-05-402 State/Vendor#: N/A 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: 6/36 20 z Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by. Program Supervisor/Staff Analyst: ww Date: Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 4- CO CONTRACT STATUS FORM RERUN 0 56 0 DATE: December 01, 2022 FEB p 1 2023 DI I;ON(S:first) Emergency Medical Services Wool K c ) CONTRACTOR: Valley Children's Hospital 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: $0.00 Contract#: A-05-402 State/Vendor#: 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): Evergreen: Continue contract through: 6/;d , 20 _, Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by. J/� Program Supervisor/Staff Analyst: Date: Il6�zZ Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 CONTRACT STATUS FORM ��ti co�,� O� 56 O DATE: December 01, 2021 FRESH DIVISION(S): Emergency Medical Services RECEIVED (Lead Division listed first) oEC U 7 2O CONTRACTOR: Valley Children's Hospital DEPARTMENT OF PUBLIC ALTFI CONTRACTS SECTION 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: $0.00 Contract#: A-05-402 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: �� /jo , 20 Z3 Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by. Program Supervisor/Staff al t: Date: 17,/ 7 /lf Division Manager: Date: 1 Z/ 7 /b I Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 CONTRACT STATUS FORM ti coU� O� 56 O DATE: December 01, 2020 RECEIVEDES� DIVISION(S): Emergency Medical Services JAN 14 2021 (Lead Division listed first) CONTRACTOR: Valley Children's Hospital DEPARTMENT OF PUBLIC H ALTki 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: $0.00 Contract#: A-05-402 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: ❑ With no changes in terms or conditions. ❑ With the following change(s): Evergreen: Continue contract through: , 20-2 �-- ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by. Program Supervisor/Staff An st: Date: Division Manager: Date: / Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 CO U� CWNTRACT STATUS FOWM A O� s6 O DATE: December 02, 2019 FuES5 DIVISION(S): Emergency Medical Services (Lead Division listed first) RECEIVED CONTRACTOR: Valley Children's Hospital JuN 2 3 zozo SERVICES: Voice Print Access to County's EMS Communic ip, ENT OFPOBLICH CONTRACTS SECTION CURRENT PERIOD: 8/30/05 to 6/30/20 E Auto-renewal�hrough: (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: $0.00 ADDITIONAL INFO: Evergreen Agreement-Please Review Contract#: A-05-402 StateNendor#: 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 alyst: Date: Division Manager: Date: (� L3 2vLv Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 _ _ co CONTRACT STATUS FORM O� 56 O DATE: November 29, 2018 RECEIVED DIVISION(S): Emergency Medical Services DEC 0 6 2018 (Lead Division listed first) DEPARTMENT OF PUBLIC HEALT CONTRACTOR: Valley Children's Hospital 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: $0.00 ADDITIONAL INFO: Contract#: A-05-402 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 nal st: Date: i Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 CO U� CtYNTRACT STATUS FORM DATE: December 01, 2017 FxES� DIVISION(S): Emergency Medical Services RECEIVED (Lead Division listed first) JAN 2 3 2018 CONTRACTOR: Valley Children's Hospital DEPARTMENT OF PUBLIC N ETH SERVICES: Voice Print Access to County's EMS dMWcafions CURRENT PERIOD: 8/30/05 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: $0.00 ADDITIONAL INFO: Contract#: A-05-402 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: Program Supervisor/St A Date: L , -.:L Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 COUP CC TTRACT STATUS FORM ti O� s6 O DATE: November 28, 2016 FRESH DIVISION(S): Emergency Medical Services (Lead Division listed first) CONTRACTOR: Children's Hospital Central California SERVICES: Voice Print Access to County's EMS Communications CURRENT PERIOD: 7/1/16 to 6/30/17 E Auto-renewal: �� throu h: (If not checkmark� v KQ will terminate ENTIRE TERM: 8/30/2005 to Evergreen at the en a current period.) ORGANIZATION #(s): 56201693 DEC 0 5 2016 CONTRACT AMOUNT $0.00 DEPARTMENT Of PUBLIC HE ADDITIONAL INFO: CONTRACTS SECTIO NI Contract#: A-05-402 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:March 1, 2017 )6Renew contract through: 4L-3 0 , 20 /VV 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.): A roved by: P' ram Supervisor/Sta Anal st: Date: — i ion Manager: Date: Z Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 ��ti CUNTRACT STATUS FO co o� 560 DATE: November 20, 2015 � DIVISION(S): Emergency Medical Services 7 (Lead Division listed first) CONTRACTOR: Children's Hospital Central California:'- 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 $0.00 ADDITIONAL INFO: Contract#: A-05-402 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:March 1, 2016 Renew contract through: /v / 3� , 20 ;24ith 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.): f c Approved by: /j, Program Supervisor/Staff 4 Date: S\ Manager: Date: /7 �I —gon �/ Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 coti� CONTRACT STATUS FORM �0 O e56 O DATE: December 04, 2014 ESp DIVISION(S): Emergency Medical Services (Lead Division listed first) CONTRACTOR: Children's Hospital Central California SERVICES: Voice Print Access to County's EMS Communications CURRENT PERIOD: 7/1/14 to 6/30/15 E Auto-renewal: through: 10 (If not the marked above,contra will terminate ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201693 RECEIVED CONTRACT AMOUNT: $0.00 JAN 14 2015 ADDITIONAL INFO: DEPARTMENT OF PUBLIC HEALTH Contract#: A-05-402 State/Vendor#: N/A CONTRACTS SECTION Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by: March 1, 2015 Renew contract through: 4e' 3G' , 20 With no changes in terms or conditions. ❑ With the following change(s): Evergreen: Continue contract through: 20 1-1 Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): j'Approved by: ,Grogram Supervisor/Staff AiLt Date: A-,,, Division Manager: 4 Date: Z /cam Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 M co CONTRACT STATUS FORM DATE: December, 2013 DIVISION(S): Emergency Medical Services (Lead Division listed first) CONTRACTOR: Children's Hospital Central California SERVICES: Voice Print Access to County's EMS Communications CURRENT PERIOD: 7/1/13 to 6/30/14 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: $0.00 ADDITIONAL INFO: Contract#: A-05-402 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): 7 Complete the information below and return to DPH Contracts by: March'#'2014....,a� _ Renew contract through: c�U,3e ;T,70 20��' RECEIVED P-V ith no changes in terms or conditions. DEC 19 2013 DEPAMENTQFPUBLI HEALTH ❑ With the following change(s): L N RA TS E 1`ION Evergreen: Continue contract through: 20 ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): I pproved by. V\Program Supervisor/S An I Date: Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 CO CONTRACT STATUS FOM 0 856 0 DATE: December 03, 2012 FxES� DIVISION(S): Emergency Medical Services (Lead Division listed first) CONTRACTOR: Children's Hospital Central California SERVICES: Voice Print Access to County's EMS Communications CURRENT PERIOD: 7/1/12 to 6/30/13 E Auto-renewal: ❑ through: (If not checkmart(ed above,contract will terminate ENTIRE TERM: 8/30/2005 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201693 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Contract#: A-05-402 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: 20 ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by. Program Superviso tall Anal s -- Date: s > Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 CO U� CUNTRACT STATUS FOB >10 O 856 O DATE: December, 2011 DIVISION(S): Emergency Medical Services (Lead Division listed first) CONTRACTOR: Children's Hospital Central California SERVICES: Voice Print Access to County's EMS Communications CURRENT PERIOD: 7/1/11 to 6/30/12 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: $0.00 ADDITIONAL INFO: Contract#: A-05-402 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: , 20 Cancel contract effective: , 20 ❑ 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 - CpU CONTRACT STATUS FORM DATE: December 01, 2010 s� DIVISION(S): Emergency Medical Services (Lead Division listed first) CONTRACTOR: Children's Hospital Central California SERVICES: Voice Print Access to County's EMS Communications CURRENT PERIOD: 7/1/10 to 6/30/11 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-05-402 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contrac+s by: March 1, 2011 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 Superviso tall Analys : --- � - �•�-�+ Date: Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 445-7090 r COUP CONTRACT STATUS FO�Ii 0 1856 O DATE: November 24, 2009 RECEIVED FRESZ' DIVISION(S): Emergency Medical Services ,JA 2 tS °sl (Lead Division listed first) DEPAP,7,1ENT �PUBLIC HEALTH CONTRACTOR: Children's Hospital Central CaliforMiA RACTS 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 ch kmarked 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-05-402 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by: March 1, 2010 Renew contract through: , 20 � 'Jith 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: ,11rogram Supervisor/Staff naly A Date: Division Manager: f Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 445-7090 co Contract Renewal/Termination Form O� 56 O DATE: December 01, 2008 FREc�� DIVISION(S): Emergency Medical Services RECEIVED (Lead Division listed first) JAN 0 6 NOCONTRACTOR: Children's Hospital Central California DEPACONT,ACOTS SECTION HEALTH SERVICES: Voice Print Access to County's EMS Communica ions CURRENT PERIOD: 7/1/08 to 6/30/09 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-05-402 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by: March 1, 2009 r Renew contract through: , 20 /E],"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 st: MDate: Division Manager: /2� Date: ,7 Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 445-7090 coU Contract Renewal/Termination Form I I r O 1856 O DATE: November 21, 2007 REG,E� FREc�� TO: Emergency Medical Services QED OEPARTM AN 2 ?OG� CONTRACTOR: Children's Hospital Central California CONRO�CS F�TONytA(Tf 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-05-402 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: JQN-e 30 20�. ❑ Cancel contract effective: , 20 ❑ Additional Information: Submitted by: Print Name: � ` L NCtt Title: �ly �� Signature: Date: �Z �� Phone Approved by: Division Manager Initial: Staff Analyst Initial: Department Head: ` �� �- Date: Submit to: DCH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 445-7090 �y co Contract Renewal/Termination Form O� s6 O DATE: December 01, 2006 RECEIVED Es� TO: Emergency Medical Services APR 0 5 2V CONTRACTOR: Children's Hospital Central California DEPARTMENT OF COMMUNITY HEALTH CONTRACTS SECTION SERVICES: Voice Print Access to County's EMS Communications CURRENT TERM: 8/30/06 to 6/30/07 E Auto-renewal: r-1 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-05-402 Please complete and return this form to DCH Contracts by: March 1, 2007 Renew contract through: 6/30Za 8 , 20 With no changes in terms or conditions. ❑ With the following changes: ❑ Cancel contract effective: , 20 ❑ Additional Information: Approved by: Print Name: ► �- '`� Division Manager Initial: Signature: \ Staff Analyst Initial: Title: Date: /ZZI_-7 OG Phone #: � g7 Department Head: `�'�y1 Date: DCH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 445-7090