HomeMy WebLinkAbout25D - AGMT - SEXUAL ASSAULT EXAMSREQUEST FOR
COUNCIL ACTION
CITY COUNCIL MEETING DATE:
JANUARY 15, 2019
TITLE:
APPROVE AND AGREEMENT WITH
THE UNIVERSITY OF CALIFORNIA,
IRVINE (UCI) TO PROVIDE SEXUAL
ASSAULT VICTIM EXAMS AND
EVIDENCE COLLECTION SERVICES
TO THE POLICE DEPARTMENT
(STRATEGIC PLAN GOAL NO. 1, 1D)
�SY —
CITY MANAGER
RECOMMENDED ACTION
CLERK OF COUNCIL USE ONLY:
•;• k
❑ As Recommended
❑ As Amended
❑ Ordinance on 15' Reading
❑ Ordinance on 2ntl Reading
❑ Implementing Resolution
❑ Set Public Hearing For
CONTINUED TO
FILE NUMBER
Authorize the City Manager and Clerk of the Council to execute an initial three-year agreement
with the University of California, Irvine (UCI) for the period of July 1, 2018 through June 30, 2021,
to provide sexual assault victim examinations and evidence collection for the Police Department,
in the amount of $61,200 (including a $3,900 contingency), subject to non -substantive changes
approved by the City Manager and City Attorney. The agreement also includes one (1) two-year
renewal option exercisable in writing by the City Manager and the City Attorney, in the amount of
$28,600 (including a $2,600 contingency). The total not to exceed agreement amount for the
three-year base agreement and two-year renewal option, if exercised, will not exceed $89,800.
The Police Department uses the services of the County's Child Abuse Services Team (CAST)
facility to conduct sexual assault examinations and evidence collection for juvenile victims of
sexual assault and associated suspects. The UCI medical staff assigned to the CAST facility are
trained to perform medical exams on abused children, and collect evidence needed for court.
UCI is also the lead agency that handles the agreements and billing for CAST.
The Child Abuse Response Team facility is an all -in -one facility that provides a variety of
services for child abuse investigations. The medical exams are performed at the facility in
conjunction with a forensic interview to minimize any added stress or trauma to the victim. The
Child Abuse Response Team facility is the only facility in Orange County that provides a safe,
child -friendly environment for the victims requiring a forensic interview and a medical exam. A
Deputy District Attorney is onsite to provide guidance and address any legal issues. A specially
trained Social Worker conducts the forensic interview and every law enforcement agency in the
County uses CAST, as it is the standard response for child abuse investigations.
25D-1
Agreement with University of California, Irvine (UCI)
January 15, 2019
Page 2
The costs for the services are $800 per "acute" victim examination, and $650 per "non-acute"
victim examination. The agreement (Exhibit 1) will include $13,000 per fiscal year, a $3,900
contingency, and $18,300 for services provided since January 1, 2017, for a total not to exceed
agreement amount of $61,200 for the initial three-year term. The services performed since
January 1, 2017 were provided under an MOU between UCI and the Police Department. This
MOU will be replaced by the proposed agreement, which is a better mechanism for coordinating
these services for the Police Department and more consistent with the City's purchasing
guidelines. The agreement also includes one (1) two-year renewal option exercisable in writing
by the City Manager and the City Attorney, in the amount of $28,600 (including a $2,600
contingency). The total not to exceed agreement amount for the three-year base agreement and
two-year renewal option, if exercised, will not exceed $89,800.
STRATEGIC PLAN ALIGNMENT
This item's approval allows the City to meet its 5 -Year Strategic Plan Goals; specifically, it
supports Goal #1 — Community Safety, Objective #1 (modernize the Community Policing
Philosophy to improve customer service, crime prevention, and traffic/pedestrian safety),
Strategy 'D' (establish and implement a plan to partner with community service organizations and
other community groups to conduct awareness, intervention, and prevention of child abuse,
domestic violence and driving under the influence of alcohol and/or drugs).
FISCAL IMPACT
Funds in the amount of $32,600 are available in the FY 2018-19 Criminal Investigations Division
— Contract Services account (no. 01114435 62300) and will be included in proposed budgets for
future years as follows:
Three -Year Base Agreement
FY 2018-19
$32,600
FY 2019-20
$14,300
FY 2020-21
$14,300
Subtotal
$61,200
Two -Year Renewal Ontion
FY 2021-22 $14,300
FY 2022-23 $14,300
Subtotal $28,600
David Vale
Police
Santa Ana Police Department
APPROVED AS TO FUNDS AND ACCOUNT:
/1 @&Urno
Kathryn Downs, CPA v t (tso
Executive Director
Finance and Management Services Agency
Exhibit: 1. Agreement with University of California, Irvine (UCI)
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AGREEMENT FOR EVIDENCE COLLECTION SERVICES
FOR CHILD ABUSE VICTIMS
THIS AGREEMENT ("Agreement") is made and entered into this 15th dayiof January, 2019 by and
between The Regents of the University of California, as described in Article IX, Section 9 of the
California Constitution, on behalf of University of California, Irvine School of Medicine, Department
of Pediatrics ("UCP'), and the City of Santa Ana, a charter city and municipal corporation organized
and existing under the Constitution and laws of the State of California on behalf of Santa Ana Police
Department ("City" or "SAPD").
RECITALS
A. UCI and Orange County Social Services Agency (SSA) have entered into an agreement for
Provision of Child Abuse Medical Services effective January 1, 2017 through June 30, 2021
("Master Agreement").
B. In connection with the Master Agreement, the City desires to retain 'UCI for the collection of
forensic evidence with respect to victims of child abuse.
C. UCI represents that UCI is able and willing to provide such services to the City.
D. UCI represents that services performed by UCI under this Agreement will be performed in
compliance with such standards as may reasonably be expected from a professional in the field
of collection of forensic evidence with respect to victims of child abuse.
E. UCI and City agree and understand that this Agreement is intended to replace and supersede
the January 1, 2017, memorandum of understanding ("MOU") entered into by the Parties, and
attached hereto as Exhibit A. The MOU will be terminated upon the effective date of this
Agreement, provided, however, that the MOU will continue to be recognized for services
provided by UCI to the City prior to the effective date of this Agreement. All invoices for
services performed prior to the date hereof under the MOU shall be due and payable pursuant
to the compensation terms as set forth in the MOU.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms
and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
UCI will closely coordinate the following services with the Santa Ana Police Department ("SAPD")
in relation to the following areas:
• Attorney General Requirements
• California Governor's Office of Emergency Services (Cal OES) Grant Requirements;
• Department of Justice Grant Requirements
• Utilizing CAST to reduce the trauma to the child
UCI agrees to provide the following services (collectively, the "Services") to SAPD:
a. Examination. UCI agrees to provide approved forensic -medical exams on child abuse
victims for the gathering of evidence for use in the criminal justice system. Examinations
25D-3
will be conducted at the County of Orange CAST facility. Exam shall include digital
imaging of injuries and physical findings. Forensic examinations will be conducted by
medical personnel who are competent in the use of the equipment and the interpretation of
the findings. An exam may include the following services:
i. Initial Evaluation
ii. Evidence Collection (for Acute exams)
iii. Written Report
iv. Consultation
v. STI Testing
vi. Lab Analysis
vii. Follow Up Exams
b. Types of Exams:
"Non -Acute Exam" as used herein shall mean an exam any time after an incident without
the collection of forensic evidence.
"Acute Exam" as used herein shall mean an exam up to 10 days after incident, with
potential for forensic evidence collection at discretion of examiner.
c. Evidence. All evidence collected during the examination will be relinquished by UCI
medical staff to Santa Ana PD personnel at the conclusion of that examination. Digital
photographs will be available upon request to SAPD investigators.
d. Reports. UCI shall provide their findings in a report. City and UCI shall confer and
mutually agree on formatting and scheduling of deadline for receipt of reports from the
UCI. Final reports, and any documents or attachments, provided as part of the report will
become the property of the City.
2. COMPENSATION
a. City agrees to pay, and UCI agrees to accept payment for services at a rate of $650.00 per
"Non-acute exam" and a rate of $800.00 per "acute exam". The total sum to be expended
under the initial term of this Agreement shall not exceed $611200.' This amount shall
include a base annual amount of $13,000 during the term of this Agreement; a 10%
contingency in the amount of -$3,900; and $18,300 to compensate UCI for services
performed as detailed in Recital E and will be paid pursuant to the terms in Exhibit A.
b. If the two-year renewal option in Section 3 below is exercised, the City agrees to pay, and
UCI agrees to accept payment for services at a rate of $650.00 per'Non-acute exam" and
a rate of $800.00 per "acute exam". The total sum to be expended under this two-year
renewal option shall not exceed $28,600. This amount shall include a base annual amount
of $13,000 and a 10% contingency ($2,600).
c. Effective July 1, 2018, payment by City shall be made within 45 days (forty-five) days
following receipt of proper invoice evidencing work performed, subject to City accounting
procedures. Payment will not be remitted for work that fails to meet the standards of
performance set forth in the Recitals as may reasonably be expected by City.
25D-4
3. TERM
This Agreement shall be deemed to have commenced on July 1, 2018 and will terminate on
June 30, 2021, with the option for the City to grant up to a one (1) two (2) year renewal, exercisable
by a writing by the City Manager and the City Attorney, unless terminated earlier in accordance with
Section 13, below.
4. INDEPENDENT CONTRACTOR
UCI shall, during the entire term of this Agreement, be construed to be an independent
contractor and not an employee of the City. This Agreement is not intended nor shall it be construed
to create an employer-employee relationship, a joint venture relationship, or to allow the City to
exercise discretion or control over the professional manner in which UCI performs the services which
are the subject matter of this Agreement; however, the services to be provided by UCI shall be provided
in a manner consistent with all applicable standards and regulations governing such services. UCI shall
pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes
relating to employees and shall be responsible for all applicable withholding taxes.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, each party shall maintain
and shall require its subcontractors, if any, to obtain and maintain insurance as described below:
A. City at its respective sole cost and expense, shall insure or self -insure its activities in
connection with this Agreement and obtain, keep in force and maintain insurance as
follows:
i. Errors and Omissions:
(1) Each Occurrence $1,000,000
(2) General Aggregate $2,000,000
(3) Personal and Advertising Injury* $1,000,000
(4) General Aggregate $2,000,000
(Bodily Injury, Property Damage)
However, if such insurance is written on a "claims made" form, following
termination of the Agreement, coverage shall survive for a period of not less than
three years. Coverage shall provide for a retroactive date of placement prior to or
coinciding with the effective date of the Agreement.
ii. Comprehensive or Commercial Form General Liability Insurance (contractual
liability included) with limits as follows:
(1) Each Occurrence $1,000,000
(2) Products, Completed Operations Aggregate $3,000,000
(3) Personal and Advertising Injury* $1,000,000
(4) General Aggregate* $3,000,000
*(not applicable to comprehensive form)
However, if such insurance is written on a "claims made" form, following
termination of the Agreement, coverage shall survive for a period of not less than
25D-5
f�
three years. Coverage shall provide for a retroactive date of placement prior to or
coinciding with the effective date of the Agreement.
iii. Such other insurance in such amounts which from time to time may be reasonably
required by the mutual consent of both parties against other insurable hazards
relating to performance.
It is expressly understood, however, that the coverages required under paragraphs Ad.
and A.ii. shall not in any way limit the liability of either party. Such provision,
however, shall only apply in proportion to and to the extent of the negligent acts or
omissions of the other party, its officers, agents, employees. Each party upon execution
of this Agreement shall fumish the other party with Certificates of Insurance or other
evidence of compliance with all requirements. Certificates shall further provide for
thirty (3 0) calendar days advance written notice to the other party of any modifications,
change, or cancellation of any of the above insurance coverage.
UCI at its respective sole cost and expense, shall insure or self -insure its activities in
connection with this Agreement and obtain, keep in force and maintain insurance as
follows:
Professional Medical and Hospital Liability:
(1) Each Occurrence $1,000,000
(2) General Aggregate $3,000,000
(3) Personal and Advertising Injury* $1,000,000
(4) General Aggregate $3,000,000
(Bodily Injury, Property Damage)
However, if such insurance is written on a "claims made" form, following
termination of the Agreement, coverage shall survive for a period of not less than
three years. Coverage shall provide for a retroactive date of placement prior to or
coinciding with the effective date of the Agreement.
ii. Comprehensive or Commercial Form General Liability Insurance (contractual
liability included) with limits as follows:
(1) Each Occurrence $1,000,000
(2) Products, Completed Operations Aggregate $3,000,000
(3) Personal and Advertising Injury* $1,000,000
(4) General Aggregate* $3,000,000
*(not applicable to comprehensive form)
However, if such insurance is written on a claims made form, following termination
of the Agreement, coverage shall survive for a period of not less than three years.
Coverage shall provide for a retroactive date of placement prior to or coinciding
with the effective date of the Agreement.
iii. Workers' Compensation and Employers Liability Insurance in a form and as
required by California law.
25D-6
iv. Such other insurance in such amounts which from time to time may be reasonably
required by the mutual consent of both parties against other insurable hazards
relating to performance.
It should be expressly understood, however, that the coverages required under
paragraphs B.i., B.ii.. and B.iii.. hereof shall not in any way limit the liability of either
party. Such provision, however, shall only apply in proportion to and to the extent of
the negligent acts or omissions of the other party, its officers, agents, employees. Each
party upon execution of this Agreement shall furnish the other party with Certificates
of Insurance or other evidence of compliance with all requirements. Certificates shall
further provide for thirty (30) calendar days advance written notice to the other party
of any modifications, change, or cancellation of any of the above insurance coverage.
6. INDEMNIFICATION
UCI shall defend, indemnify and hold City, its trustees, officers, employees and agents
harmless from and against any and all liability, loss, expense (including reasonable attorneys' fees), or
claims for injury or damages arising out of the performance of this Agreement, but only in proportion
to and to the extent such liability, loss, expense, attorneys' fees, or claims for injury or damages are
caused by or result from the negligent or intentional acts or omissions of UCI, its officers, employees
or agents.
City shall defend, indemnify and hold UCI, its officers, employees an agents harmless from
and against any and all liability, loss, expense (including reasonable attorneys' fees), or claims for
injury or damages arising out of the performance of this Agreement, but only in proportion to and to
the extent such liability, loss expense, attorneys' fees, or claims for injury or damages are caused by
or result from the negligent or intentional acts or omissions of City, its trustees, officers, employees
or agents.
7. RECORDS
UCI shall keep records and invoices in connection with the work to be performed under this
Agreement. UCI shall maintain complete and accurate records with respect to the costs incurred under
this Agreement and any services, expenditures, and disbursements charged to the City for a minimum
period of three (3) years, or for any longer period required by law, from the date of final payment to
UCI under this Agreement. All such records and invoices shall be clearly identifiable. Upon at least
three (3) business days advance notice, UCI shall allow a representative of the City to examine, audit,
and make transcripts or copies of such records and any other documents created pursuant to this
Agreement during regular business hours. City shall reimburse UCI for copies at the rate of twenty-
five cents ($0.25) per page plus reasonable administrative costs. UCI shall allow inspection of all
work, data, documents, proceedings, and activities related to this Agreement for a period of three (3)
years from the date of final payment to UCI under this Agreement.
8. CONMENTIAMY
If UCI receives from the City information which due to the nature of such information is
reasonably understood to be confidential and/or proprietary, UCI agrees that it shall not use or disclose
such information except in the performance of this Agreement, and further agrees to exercise the same
degree of care it uses to protect its own information of like importance, but in no event less than
reasonable care. "Confidential Information" shall include all nonpublic information. Confidential
25D-7
information includes not only written information, but also information transferred orally, visually,
electronically, or by other means. Confidential information disclosed to either party by any subsidiary
and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use
and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available
sources; (b) is, through no fault of the UCI disclosed in a publicly available source; (c) is in rightful
possession of the UCI without an obligation of confidentiality; (d) is required to be disclosed by
operation of law; or (e) is independently developed by the UCI without reference to information
disclosed by the City. Notwithstanding the foregoing, City understands and agrees that UCI is a public
institution, subject to the provisions of the California Public Records Act, and Confidential Information
may be subject to disclosure thereunder. In the event UCI receives a request to produce this
Agreement, or identify any term, condition, or aspect of this Agreement, UCI will contact City to
advise of such release of information in accordance with applicable law.
9. CONFLICT OF INTEREST CLAUSE
UCI represents that it presently has no interests and shall not have interests, direct or indirect,
which would conflict in any manner with performance of services specified under this Agreement.
10. NON-DISCRIMINATION
UCI shall not discriminate because of race, color, creed, religion, sex, marital status, sexual
orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in
the recruitment, selection, training, utilization, promotion, termination or other employment related
activities. UCI affirms that it is an equal opportunity employer and shall comply with all applicable
federal, state and local laws and regulations.
11. ENTIRE AGREEMENT
This Agreement represents the entire understanding and agreement between the City and UCI with
respect to the subject matter hereof and supersedes any and all other agreements, arrangements, and
understandings, whether oral or written, between the parties relating to the subject matter hereof. No
representation, inducement, promise or agreement, whether oral or written, has been made by any
party, or anyone acting on behalf of any party, which is not embodied herein.
12. CONFLICTS; AMENDMENTS
In the event of a conflict between the terms of this Agreement and any attachments hereto, the
terms of this Agreement shall prevail. This Agreement may not be modified except by written
instrument signed by the City and by an authorized representative of UCI. The parties agree that any
amendment to this Agreement shall be made in writing and mutually agreed upon between the parties.
Neither party may not assign, transfer, delegate, or subcontract any interest herein without the
prior written consent of the other party and any such assignment, transfer, delegation or subcontract
without the other party's prior written consent shall be considered null and void. Nothing in this
Agreement shall be construed to limit the City's ability to have any of the services which are the subject
to this Agreement performed by City personnel.
25D-8
14. TERMINATION
This Agreement shall terminate upon the termination of the Master Agreement between UCI
and SSA. This Agreement may otherwise be terminated with or without cause at any time by either
party upon thirty (30) days prior written notice of termination. hi any event, UCI shall be entitled to
receive and the City shall pay UCI compensation for all services performed by UCI up to the date of
termination.
15. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or granted
by the provisions of this Agreement shall be effective unless it is in writing and signed by the party
waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall
be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any
waiver constitute a continuing waiver unless the writing so specifies.
16. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be
determined and governed by the laws of the State of California. Both parties further agree that Orange
County, California, shall be the venue for any action or proceeding that may be brought or arise out of,
in connection with or by reason of this Agreement.
17. PROFESSIONAL LICENSES
UCI shall, throughout the term of this Agreement, maintain all necessary licenses, permits,
approvals, waivers, and exemptions necessary for the provision of the services hereunder and required
by the laws and regulations of the United States, the State of California, the City of Santa Ana and all
other governmental agencies. UCI shall notify the City immediately and in writing of its inability to
obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be
cause for termination of this Agreement.
18. MISCELLANEOUS PROVISIONS
a. Each undersigned represents that its signature herein below has the power, authority
and right to bind their respective parties to each of the terms of this Agreement.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
19. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall
be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or
certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner
provided in this Section, to the following persons:
25D-9
To City:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax: 714- 647-6956
With courtesy copies to:
Chief of Police Sonia R. Carvalho
City of Santa Ana City Attorney
20 Civic Center Plaza (M-97) City of Santa Ana
P.O. Box 1988 20 Civic Center Plaza (M-29)
Santa Ana, California 92702 P.O. Box 1988
Fax: 714-245-8007 Santa Aha, California 92702
Fax: 714- 647-6515
To UCI:
UC Irvine Medical Center
Attn: Director of Contracting
333 City Boulevard West, Suite 200
Orange, CA 92868
A party may change its address by giving notice in writing to the other party. Thereafter, any
communication shall be addressed and transmitted to the new address. If sent by mail, communication
shall be effective or deemed to have been given three (3) days after it has been deposited in the United
States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent
by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after
the time set forth on the transmission report issued by the transmitting facsimile machine, addressed
as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or
City holidays shall be excluded.
(signature page to follow]
25D-10
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above written.
i I
ATTEST:
Maria D. Huizar
Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City tomey
By: 4K=—
Tamara ogosian
Assistant City Attorney
FOR APPROVAL:
DAVID VALENTIN
Chief of Police
CITY OF SANTA ANA
Raul Godinez II
City Manager
UCI:
Nasim Afsarmanesh, MD, MBA
UC Irvine Health
Chief Ambulatory Officer
25D-11
Exhibit A
MEMORANDUM OF UNDERSTANDING
THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
AS DESCRIBED IN ARTICLE IX, SECTION 9 OF THE CALIFORINA CONSTITUTION,
ON BEHALF OF
UNIVERSITY CALIFORNIA, IRVINE
DEPARTMENT OF PEDIATRICS
AND
THE SANTA ANA POLICE DEPARTMENT
This Memorandum of Understanding (MOU) dated January 1st, 2017 summarizes the terms of an
operational agreement between The Regents of the University of California, as described in Article IX,
Section 9 of the California Constitution on behalf of University of California, Irvine Department of
Pediatrics (UCI), Orange County Social Services Agency (SSA), the Child Abuse Services Team
(CAST), the Office of the District Attorney (DA), and Santa Ana Police Department, a law enforcement
agency ("SAPD'7
RECITALS
WHEREAS UCI and SSA have entered in to an Agreement for Provision of Child Abuse Services
("Agreement"), the term of the Operational Agreement is January 1, 2017 through June 30, 2021.
Notwithstanding the foregoing, this Operational Agreement shall terminate immediately upon termination
of the Agreement. UCI will closely coordinate the following services with SAPD in relation to the
following areas:
). Attorney General Grant Requirements;
2. California Governor's Office of Emergency Services (Cal OES) Grant Requirements;
3. Department of Justice Grant Requirements;
4. Utilizing CAST to reduce the trauma to the child;
All agencies believe that implementation of the CAST proposal will further this goal.
To that end, each agency agrees to participate in the program by coordinating and/or providing the
following services:
• Project staff being readily available to CAST for service provision through the attached
Agreement for the Child Abuse Medical Services Provider.
• Regularly scheduled meetings between indicated agencies to discuss strategies, time tables, and
implementation of mandated services.
• Specifically, services as described in the Agreement attached hereto and incorporated herein by
reference.
We, the undersigned, as authorized representatives of CAST, SSA, the DA, UCI, and SAPD do hereby
approve this Operational Agreement,
1. DEFINITIONS
3/27/2017
25D-12
"Non -Acute Exam" as used herein shall mean an exam any time after an incident without
the collection of forensic evidence.
"Acute Exam" as used herein shall mean an exam up to 10 days after incident, with
potential for forensic evidence collection at discretion of examiner.
2. TERM The term of this agreement will be from January 1, 2017 -June 30, 2021.
3. COMPENSATION
a. SAM will compensate UCI $650.00 per "Non- acute exam".
b. SAPD will compensate UCI $800.00 per "acute exam".
4. BMLING The CAST Office Coordinator will invoice SAPD after services have been rendered.
SAPD will remit payment within thirty (30) days fmmthe date on the invoice to the following
address:
UC Irvine Department of Pediatrics
Atm: Finances
333 City Blvd West, Suite 800
Orange, CA 92868
5. DESCRIPTION OF SERVICES
An exam may include the following services:
3/27/2017
I. Initial Evaluation
ii. Evidence Collection (for Acute exams)
iii. Written Report
Iv. Consultation
v. STITesting
vi. Lab Analysis
vii. Follow Up Exams
25D-13
Signatures below indicate acceptable of this agreement.
%. a,0�j- (a`Iz1)-4-
UC Irvine Health Date
Teresa Conk
Chief Strategy Officer &
Associate Vice Chancellor for Clinical Intearation
Santa Ane Police Department
James Schasbi, Acting Chief of Police
3/272017
25D-14
Date
Exhibit B
UCI CAST MEDICAL UNIT
401 THE CITY DRIVE
TEL714-935-8456 UC Irvine Health
it
FAx714-935-7796
INVOICE #:1115. 10.2.2017
BIU. TO
TERMS: PAYMENT DUE 30 DAYS FROM INVOICE DATE
SANTA ANA POLICE DEPARTMENT
MAKE CHECKS PAYABLE To: UC REGENTS
60 CHIC CENTER PIZ
1.
SANTA ANA, CA 92701
MAIL PAYMENTTO:
16-28196
UC IRVINE PEMATRICSATM: FINANCES DEPARTMENT
2.
333 Cm Sivn, WEST SURE 800
Non -Acute
ORANGE, CA 92868
25D-15
DATE OF EXAM
EXAM TYPE
POLICE DR #
AMOUNT
1.
1/18/2017
Non -Acute
16-28196
$650.06
2.
2108/2017
Non -Acute
17-03566
$650.00
3.
2/1012017
Non -Acute
17-03775
$650.00
4.
2/23/2017
Acute
17-04504
$800.00
5.
3/09/2017
Non -Acute
17-03941
$650.00
6.
3/23/2017
Non -Acute
17-07568
$650.00
7.
3/23/2017
ACUTE
17-07814
$800.00
8.
6/01/2017
NON-ACUTE
17-12906
$650.00
9.
7/07/2017
.ACUTE
17-18376
$800.00
TOTALAMOUNT DUE BY
11.1.2017
$6,300.00
25D-15
UPI CAST MEDICAL UNIT
401 THE CITY DRIVEy'r°2
TEL 714 t:J
FAx714-935-7796 UC Irvine Health
w; 3i
INVOICE: 1729
12.5 *2017
i
BILLTO
TERMS: PAYMENT DUE 90 DAYS FROM INVOICE DATE
SANTA ANA POLICE DEPARTMENT
MAKE CHECKS PAYABLE TD: UC REGENTS
60 CIVIC CENTER PWA
SANTA ANA, CA 92701.4060
MAILPAYMENTTO:
UC IRVINE PEDIATRICS ATTN: FINANCES DEPARTMENT
333 CITY BLVD, WEST SUITE 800
ORANGE, CA 92868
DATE OF EXAM
EXAM TYPE
POLICE NUMBER
AMOUNT
06/13/2017
Non -Acute
17-14954
$650.00
06/27/2017
Non -Acute
17-16397
$650.00
TOTALAMOUNT DUE BY
JANUARY 4, 2018
25D-16
$1300.00
UCI CAST MEDICAL UNIT
_
401 THE CITY DRIVE
UC Irvine Health
TEL 714-935-8456
_.
FAx714-935-7796
MAILPAYMENTTo:
INVOICE M 1717 10.23.2017
BILL TO
TERMS: PAYMENT DUE 30 DAYS FROM INVOICE DATE
SANTAANA POLICE DEPARTMENT
MAKE CHECKS PAYABLE To: UC REGENTS
60 CIVIC CENTER PIZ
1.
SANTA'ANA,CA92701-4060
MAILPAYMENTTo:
17-23751
UC IRVINE PEDIATPoCSATTN: FINANCES DEPARTMENT
2.
333 CITY BLVD, WEST SUITE 800
Non -Acute
ORANGE,CA 92868
25D-17
DATE OF ExAM
EXAM TYPE
POLICE DR #
'AMOUNT
1.
8/30/2017
Non -Acute
17-23751
$650.00
2.
8/31/2017
Non -Acute
17-23195 (Sibling 1)
$656.00
3.
8/31/2017
Non -Acute
17-23195 (Sibling 2)
$650.00
ToTALAMoUNT DUE By 11.22.2017
$1950.00
25D-17
25D-18