INVITATION FOR BID Notice to Prospective Bidders. IFB Number: TEMPORARY/RELIEF LVN SERVICES

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1 Page 1 of West Jayne Avenue, P. O. Box 5000, Coalinga, CA INVITATION FOR BID Notice to Prospective Bidders TEMPORARY/RELIEF LVN SERVICES April 3, 2013 You are invited to review and respond to this Invitation for Bid (IFB) Number , entitled,. The Department of State Hospitals Coalinga (DSH-C) is seeking bids for a contractor to provide for the Department of State Hospitals Coalinga patients. In submitting your bid, you must comply with the instructions found herein. Failure to comply with any of the requirements may result in rejection of your bid. By submitting a bid, your firm agrees to the terms and conditions stated in this IFB and your proposed contract. Note that all agreements entered into with the State of California will include by reference General Terms and Conditions and Contractor Certification Clauses that may be viewed and downloaded at Internet site This bid solicitation is published online in the California State Contracts Register, BidSync web site at To ensure receipt of any addenda that may be issued, and answers to questions posed, interested parties must register online at This contract will be awarded as a Multi-Provider Contract. Under the Multi-Provider contract, DSH-C can award multiple contracts in order of the lowest bidder for back-up services when such incidents arrive where the lowest responsible bidder cannot provide the services requested. The Department of State Hospitals - Coalinga will utilize a maximum of ten (10) contractors. In the opinion of the, this Invitation for Bid is complete and without need of explanation. However, if you have questions, or should you need any clarifying information, the contact person for this IFB is: Shelle O Brien Public Phone Number: (559) Fax Number: (559) Address: shelle.obrien@csh.dsh.ca.gov

2 TABLE OF CONTENTS Page 2 of 42 ITEM PAGE i. Cover Page 1 ii. Table of Contents 2 I. Description of Services 3 A. Description of Services 3 B. Contract Term 3 II. Bidder Minimum Qualifications 3 III. Bid Requirements and Information 3 A. Key Action Dates 3 B. Bidder Questions 4 C. Submission of Bids 4 D. Evaluation and Selection 5 E. Award and Protest 6 F. Disposition of Bids 6 G. Agreement Execution and Performance 6 IV. Preference and Incentive Programs 6 A. Small Business Preference 6 B. Other Preference Programs 7 C. Disabled Veteran Business Enterprise Program Incentive 7 D. Combining Preference and Incentive 8 V. Bid Evaluation 9 VI. Required Attachments 9 Attachment 1 Bid Submission Checklist 10 Attachment 2 Bidder Certification 11 Attachment 3 Minimum Qualification Response 12 Attachment 4 Bidder References 13 Attachment 5 Darfur Contracting Act Certification 14 Attachment 6 Bidder Rate Sheet 15 Attachment 7 Bidder Declaration (Form GSPD ) included by 16 web site reference: Attachment 8 - Payee Data Record (Std. 204) ) included by web site 16 reference: Attachment 9 Contractor Certification Clauses (CCC 307) 17 Attachment 10 Sample Contract 21 Sample Standard Agreement (Std. 213) 21 Exhibit A Scope of Work 22 Exhibit B Budget Detail and Payment Provisions 29 Exhibit D Special Terms and Conditions 31 Exhibit E Confidentiality and Information Security Provisions 37 Exhibit F Insurance Requirements 41

3 I. Description of Services and Contract Term Page 3 of 42 A. Description of Services Contractor shall provide all labor, tools, materials, equipment, non-consumable supplies, transportation, including travel and per diem, licenses, permits, certificates and every other item of expense necessary to provide the (DSH-C) with, under the direction of the Nurse Administrator of the. Please carefully review and consider the detailed Scope of Work located in Attachment 9, Sample Agreement, Exhibit A, Scope of Work (page 22), in order to complete your bid. B. Contract Term: The term of any contract resulting from this IFB is anticipated to be September 01, 2013 through August 31, DSH-C may modify the contract term and/or contract dollar amount during the term of the contract via a written amendment to the contract. The contract resulting from this IFB shall be of no force or effect until it is signed by both parties and approved. The Bidder(s) awarded this contract is advised not to commence performance until this contract award has been made, all approvals have been obtained, and the awarded contract has been fully executed. II. Bidder Minimum Qualifications A. Contractor must submit a copy of their license to do Business in the State of California. Contractor, at Contractor s own expense, shall maintain and possess such license, and any and all necessary license(s), permit(s), and certificate(s) required by law throughout the entire term of the contract. Such license(s) permits(s), and certificate(s) shall be in full force and effect prior to conducting any work required in connection with this contract. B. Contractors located within the State of California shall meet all terms and conditions for operating a business in the city/county in which the business is headquartered. Contractors which are corporations located within the State of California, shall submit a copy of the incorporation document/letter from the Secretary of State of California. Contractors located outside the State of California shall meet all terms and conditions for operating a business in the state, province, or country in which the contractor is headquartered, and shall submit an affidavit to show that the business is in good standing in that state, province, or country. C. Bidder must submit references (Attachment 4) with the bid package. If bidder has contracted with DSH-C within the last five years, DSH-C must be listed as one of the references. III. Bid Requirements and Information A. Key Action Dates: Event Date Time IFB available to prospective bidders 04/03/ :00 am Deadline for Submission of Questions 04/18/ :00 pm Final Date for Bid Submission 04/24/2013 4:00 pm Public Bid Opening 04/26/2013 9:00 am Proposed Start Date of Agreement 09/01/2013 8:00 am

4 B. Bidder Questions: Page 4 of Bidders should notify the DSH-C Contact Person immediately through BidSync ( if they need clarification about the services being sought or have questions about the IFB instructions or requirements. The level of detail that shall be provided, in response, is subject to the availability of DSH-C resources. Note: It is the responsibility of the bidder to check BidSync for questions and/or changes within the IFB as all questions, answers, and addenda will posted. DSH-C will not be held responsible for inaccurate bids due to vendor s oversight in reviewing any and all information via BidSync. 2. Verbal comments regarding this IFB are unofficial and are not binding on DSH-C unless later confirmed in writing as an official addendum. 3. Bidders that fail to report a known or suspected problem with the IFB or fail to seek clarification and/or correction of the IFB, submit a bid at their own risk. C. Submission of Bids: 1. All bids must be submitted under a sealed cover and received by DSH-C by the date and time shown in Section III, A Key Action Dates. The sealed cover must be plainly marked with the IFB number and title, must show your firm name and address, and must be marked DO NOT OPEN, as shown in the following example: IFB # (Bidder Agency Name & Address) DO NOT OPEN 2. Bids not submitted under a sealed cover shall be rejected. A minimum of one (1) original and one (1) copy of the bid must be submitted. 3. All bids shall include the documents identified in Section VI, Required Attachments, Attachment 1, Bid Submission Checklist (page 10). Bids not including the proper required attachments shall be deemed non-responsive. A non-responsive bid is one that does not meet the basic bid requirements. 4. All documents requiring a signature must bear an original signature of a person authorized to bind the bidding firm. 5. Mail Delivery, Hand Delivery, or Overnight Delivery of bids should be addressed to: U.S. Postal Deliveries: Hand Deliveries: (UPS, Express Mail, Federal Express) Procurement Services Attn: Shelle O Brien P. O. Box 5000 Coalinga, CA Procurement Services Attn: Shelle O Brien West Jayne Avenue Coalinga, CA 93210

5 Page 5 of Bids must be submitted for the performance of all the services described herein. Any deviation from the work specifications will not be considered and shall cause a bid to be rejected. 7. A bid shall be rejected if it is conditional or incomplete, or if it contains any alterations of form or other irregularities of any kind. The State may reject any or all bids and may waive an immaterial deviation in a bid. The State s waiver of an immaterial defect shall in no way modify the IFB document or excuse the bidder from full compliance with all requirements if awarded the agreement. 8. Costs for developing bids and anticipation of award of the agreement are entirely the responsibilities of the bidder and shall not be charged to the State of California. 9. An individual, who is authorized to bind the bidder contractually, shall sign the Bidder s Certification Sheet. The signature should indicate the title or position that the individual holds in the firm. An unsigned bid may be rejected. 10. A bidder may modify a bid, after its submission, by withdrawing their original bid and resubmitting a new bid prior to the bid submission deadline. Bidder modifications offered in any other manner, oral or written, will not be considered. 11. A bidder may withdraw their bid by submitting a written withdrawal request to the Department of State Hospitals - Coalinga Contract Office, signed by the bidder or an authorized agent. A bidder may thereafter submit a new bid prior to the bid submission deadline. Bids may not be withdrawn without cause, subsequent to bid submission deadline. 12. The awarding agency may modify the IFB, prior to the date fixed for submission of bids, by the issuance of an addendum to all parties who received a bid package. 13. The awarding agency reserves the right to reject all bids. The agency is not required to award an agreement. 14. Before submitting a response to this solicitation, bidders should review, correct all errors, and confirm compliance with the IFB requirements. 15. Where applicable, bidder must carefully examine work sites and specifications. Bidder shall investigate conditions, character, and quality of surface or subsurface materials or obstacles that might be encountered. No additions or increases to the agreement amount will be made due to a lack of careful examination of work sites and specifications. 16. The State does not accept alternate contract language from a prospective contractor. A bid with such language will be considered a counter proposal and will be rejected. The State s General Terms and Conditions (GTC) are not negotiable. 17. No oral understanding or agreement shall be binding on either party. D. Evaluation and Selection: 1. At the time of the bid opening, each bid will be checked for the presence or absence of required information in conformance with the submission requirements of this IFB. 2. The State will evaluate each bid to determine its responsiveness to the published requirements. 3. Bids that contain false or misleading statements, or which provide references that do not support an attribute or condition claimed by the bidder, may be rejected.

6 Page 6 of Award, if made, will be to a maximum of ten (10) contractors based upon the lowest responsive and responsible bids in accordance with Section V, Bid Evaluations. E. Award and Protest: 1. Whenever an agreement is awarded under a procedure that provides for competitive bidding, but the agreement is not to be awarded to the low bidder, the low bidder shall be notified by telegram, electronic facsimile transmission, overnight courier, or personal delivery five (5) working days prior to the award of the agreement. 2. Upon written request by any bidder, notice of the proposed award shall be posted in a public place in the office of the awarding agency at least five (5) working days prior to awarding the agreement. 3. If any bidder, prior to the award of agreement, files a written protest with the Department of General Services and The including the grounds that the (protesting) bidder is the lowest responsive responsible bidder, the agreement shall not be awarded until either the protest has been withdrawn or the Department of General Services has decided the matter. 4. Within five (5) days after filing the initial protest, the protesting bidder shall file with the Department of General Services and the awarding agency a detailed written statement specifying the grounds for the protest. A copy of the detailed written statement should be mailed to the awarding agency. It is suggested that any protest be submitted by certified or registered mail. The address for the Department of General Services is: F. Disposition of Bids: Department of General Services Office of Legal Services 707 Third Street, 7th Floor, Suite West Sacramento, CA Upon bid opening, all documents submitted in response to this IFB will become the property of the State of California, and will be regarded as public records under the California Public Records Act (Government Code Section 6250 et seq.) and subject to review by the public. G. Agreement Execution and Performance: 1. Performance shall start no later than on the expressed date set by the awarding agency and after all approvals have been obtained and the agreement is fully executed. Should Contractor fail to commence work at the agreed upon time, the awarding agency, upon five (5) days written notice to the Contractor, reserves the right to terminate the agreement. 2. All performance, under the agreement, shall be completed on or before the termination date of the agreement. 3. Contractor shall agree to all security provisions when the performance of work takes place on any State Hospital grounds.

7 IV. Preference and Incentive Programs A. Small Business Preference Page 7 of 42 In accordance with Government Code Section , et seq. and California Code of Regulations, Title 2, Section 1896, et seq., a five (5) percent preference will be granted to bidders properly certified as a California Small Business, Microbusiness, or Non-Small Business with a Small Business subcontracting for a minimum of 25% of the bid amount. A five (5) percent preference will be granted to bidders certified as a Non-Profit Veteran Service Agency in accordance with the Military and Veterans Code Section Applications must be on file at the office of Small Business and Disabled Veteran Business Enterprise Certification by 5:00 p.m. on bid opening day. EXAMPLE 1 Bidder Amount bid SB status Bidder A $50,000 No Bidder B $51,000 Yes COMPUTATION Preference Formula: low bid x 5% = equals the amount of the preference $50,000 x.05 = $2,500 Bidder B bid: $ 51,000 Minus preference $ 2,500 Adjusted amount (for evaluation only) $ 48,500 After the application of the Small Business Preference the Bidder B is the apparent low bidder. B. Other Preference Programs Additional preference programs exist for business enterprise zones and military base closure areas. For information regarding these programs: Target Area Contract Preference Act (TACPA), Local Agency Military Base Recovery Area (LAMBRA) Act, Enterprise Zone Act (EZA), For information regarding these programs, please see the following web site addresses: C. Disabled Veteran Business Enterprise Program Disabled Veteran Business Enterprise Program Incentive The State hereby waives the mandatory Disabled Veteran Business Enterprise (DVBE) participation requirement for this IFB; however, an incentive for bidders who include DVBE participation is available and encouraged. For evaluation purposes only, the State shall apply an incentive to bids that include California certified DVBE participation and confirmed by the State. The incentive amount will vary in conjunction with the percentage of DVBE participation in accordance with the following formula:

8 DVBE Incentive Participation of: Page 8 of 42 DVBE Incentive: 5% or Over 5% 4% to 4.99% Inclusive 4% 3% to 3.99% Inclusive 3% 2% to 2.99% Inclusive 2% 1% to 1.99% Inclusive 1% The net bid price of responsive bids with DVBE participation will be reduced (for evaluation purposes only) by the amount of DVBE incentive as applied to the lowest responsive net bid price. If the #1 ranked, responsive, responsible bid is a California certified small business, the only bidders eligible for the incentive will be other California certified small businesses. The incentive adjustment for awards based on low price cannot exceed 5% or $100,000.00, whichever is less, of the #1 ranked net bid price. When used in combination with a Small Business preference adjustment, the cumulative adjustment amount cannot exceed $100, Please note that a non-small business bidder with a DVBE Incentive preference may not displace a small business bidder [CA Code of Regulations, Title 2, (c)]. Information submitted by the bidder to claim the DVBE incentive will be verified by the State. Only the DVBEs who shall perform a commercially useful function relevant to the Scope of Work included in this IFB may be used to qualify the bidder for a DVBE incentive. For more information regarding the DVBE incentive, Commercially Useful Function definition, and how to find DVBEs, please view the following website: EXAMPLE 2 Bidder Amount Bid DVBE Status Bidder A $50,000 No Bidder B $51,000 No Bidder C $51,100 DVBE 3% Incentive Formula: low bid x 3% = equals the amount of the Incentive COMPUTATION $50,000 (low bid x.03 (DVBE) = $1,500 (incentive) Bidder C bid: $51,100 Minus Incentive 1,500 Adjusted amount $49,600 After the application of the DVBE Incentive, Bidder C is the apparent low bidder. D. Combining Preferences and Incentive For evaluation purposes only if a bidder is eligible for Preferences and Incentives, they are calculated separately and then subtracted from their actual bid. EXAMPLE 3 Bidder Amount Bid SB Status DVBE Status Bidder A $50,000 No No Bidder B $51,000 No No Bidder C $53,100 Yes DVBE 3%

9 Page 9 of 42 Calculations for Bidder C: Step 1 - SB Preference Formula: low bid x 5% = equals the amount of the preference $50,000 x.05 - $2,500 deduction Step 2 - Incentive Formula: low bid x 3% = equals the amount of the Incentive $50,000 (low bid x.03 (DVBE) = $1,500 deduction Step 3 - Combined SB Preference and DVBE Incentive $ 2,500 SB deduction + $ 1,500 DVBE deduction $ 4,000 Total Deduction Step 4 - Subtract preference amount from original bid to determine bid evaluation amount $ 53,100 - $ 4,000 $ 49,100 BASED ON THE CALCULATION BIDDER C IS THE LOW BIDDER V. BID EVALUATION THIS SECTION IS COMPLETED BY DSH FOR EVALUATION PURPOSES ONLY FOR EACH BID (These calculations do not change the amount of the bid.) SB Low Bid SB Preference and DVBE Incentive Calculations X.05% = $ 25, DVBE Incentive Low Bid Percentage of participation (3%) = $ 15, X Total Preference and Incentive Deduction $ 40, Final Calculation Actual Amount of Bid $ 500, Minus Preference and Incentive Deductions - $ 40, ADJUSTED BID EVALUATION AMOUNT $ 460, VI. Required Attachments Refer to the following pages for additional Required Attachments that are a required part of this solicitation.

10 ATTACHMENT 1 Bid Submission Checklist Page 10 of 42 Complete this checklist to confirm the items in your bid. For your bid to be considered responsive, Attachments 1 through 9 in this checklist must be submitted by the Bid Submittal Deadline indicated in this IFB. Include this checklist with your bid package. Contractor Name: Attachment Attachment 1 Attachment 2 Attachment 3 Attachment 4 Attachment 5 Attachment 6 Name of Attachment Bid Submission Checklist Bidder Certification Minimum Qualifications Response Bidder References Darfur Contracting Act Certification (only if applicable) Bidder Rate Sheet Attachment 7 Bidder Declaration (GSPD ) This form is not included in this IFB. Please obtain from the following web site: Attachment 8 Payee Data Record, Std. 204 This form is not included in this IFB. Please obtain from the following web site: Attachment 9 Contractor Certification Clauses, CCC-307 Other Attachments for your reference (do not submit with your bid) Attachment 10 Sample Contract

11 ATTACHMENT 2 Bidder Certification Page 11 of 42 The signature affixed hereon and dated certifies compliance with all the requirements of this bid document. The signature below authorizes the verification of this certification. An Unsigned Bidder Certification May Be Cause for Rejection Company Name Telephone Number Fax Number Address Name Title Original Signature Date

12 Page 12 of 42 ATTACHMENT 3 Minimum Qualification Response Minimum Qualification Contractor must submit a copy of their license to do Business in the State of California. Contractor, at Contractor s own expense, shall maintain and possess such license, and any and all necessary license(s), permit(s), and certificate(s) required by law throughout the entire term of the contract. Such license(s) permits(s), and certificate(s) shall be in full force and effect prior to conducting any work required in connection with this contract. Bidder Response Copy of Business License(s) Included? Yes No Contractors located within the State of California shall meet all terms and conditions for operating a business in the city/county in which the business is headquartered. Contractors which are corporations located within the State of California, shall submit a copy of the incorporation document/letter from the Secretary of State of California. Contractors located outside the State of California shall meet all terms and conditions for operating a business in the state, province, or country in which the contractor is headquartered, and shall submit an affidavit to show that the business is in good standing in that state, province, or country. Copy of incorporation document/letter from the Secretary of State of California included? Yes No Bidder must submit references (Attachment 4) with the bid package. If bidder has contracted with DSH-C within the last five years, DSH-C must be listed as one of the references. Copy of Bidder References included? Yes No

13 Page 13 of 42 ATTACHMENT 4 Bidder References Failure to complete and return this attachment with your bid will cause your bid to be rejected and deemed nonresponsive. List below three references for services performed within the last five years, which are similar to the scope of work to be performed in this contract. If bidder has contracted with DSH-C within the last five years, DSH-C must be listed as one of the references. Reference 1 Name of Company Address Contact person Telephone Address: Description of Work Reference 2 Name of Company Address Contact person Telephone Address: Description of Work Reference 3 Name of Company Address Contact person Telephone Address: Description of Work

14 ATTACHMENT 5 Darfur Contracting Act Certification Page 14 of 42 Public Contract Code Sections applies to any company that currently or within the previous three years has had business activities or other operations outside of the United States. For such a company to bid on or submit a proposal for a State of California contract, the company must certify that it is either a) not a scrutinized company; or b) a scrutinized company that has been granted permission by the Department of General Services to submit a proposal or bid. If your company has not, within the previous three years, had any business activities or other operations outside of the United States, you do not need to complete this form. OPTION #1 - CERTIFICATION If your company, within the previous three years, has had business activities or other operations outside of the United States, in order to be eligible to submit a bid or proposal, please insert your company name and Federal ID Number and complete the certification below. I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective proposer/bidder named below is not a scrutinized company per Public Contract Code 10476; and b) I am duly authorized to legally bind the prospective proposer/bidder named below. This certification is made under the laws of the State of California. Company/Vendor Name (Printed) Federal ID Number By (Authorized Signature) Printed Name and Title of Person Signing Date Executed Executed in the County and State of OPTION #2 WRITTEN PERMISSION FROM DGS Pursuant to Public Contract Code section 10477(b), the Director of the Department of General Services may permit a scrutinized company, on a case-by-case basis, to bid on or submit a proposal for a contract with a state agency for goods or services, if it is in the best interests of the state. If you are a scrutinized company that has obtained written permission from the DGS to submit a bid or proposal, complete the information below. We are a scrutinized company as defined in Public Contract Code Section 10476, but we have received written permission from the Department of General Services to submit a bid or proposal pursuant to Public Contract Code Section 10477(b). A copy of the written permission from DGS is included with our bid or proposal. Company/Vendor Name (Printed) Federal ID Number Initials of Submitter Printed Name and Title of Person Initialing

15 ATTACHMENT 6 Bidder Rate Sheet Page 15 of 42 THE BID CAP FOR THIS CONTRACT HAS BEEN SET AT $39.01 PER HOUR. ANY BID RECEIVED THAT EXCEEDS THE $39.01 PER HOUR CAP WILL BE REJECTED. HOWEVER, THE AWARD RANKING WILL BE BASED ON THE LOWEST RESPONSIVE AND RESPONSIBLE BIDDER. *Estimated Number of Hours X Hourly Rate X Estimated Number of Staff X Estimated Number of Months = Total Contract Dollar Amount 176 X $ X 10 X 24 = $ The amounts indicated above will be used solely for comparison of bids. The State makes no guarantee, expressed or implied, for actual number of service hours to be performed. However, the actual rates quoted above by the bidder shall be binding for the term of the Agreement. This contract will be awarded as a Multi-Provider Contract. Under the Multi-Provider contract, DSH-C can award multiple contracts in order of the lowest bidder, for back-up services when such incidents arrive where the lowest responsible bidder cannot provide the services requested. The Department of State Hospitals - Coalinga will utilize a maximum of ten (10) contractors. Contractor may offer a discount on invoices in order for the invoices to be paid within 30 (thirty) days of receipt. Discount offered must be at least one-half percent. Discount offered on invoices paid within 30 (thirty) days of receipt - % In the event of a tie, absent other determining factors, the lowest responsible bid with the highest discount shall prevail.

16 Page 16 of 42 ATTACHMENT 7 Bidder Declaration Form Form is located at the following web address: ATTACHMENT 8 Payee Data Record (Std. 204) Form is located at the following web address:

17 ATTACHMENT 9 Contractor Certification Clauses, CCC 307 Page 17 of 42 CERTIFICATION I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the prospective Contractor to the clause(s) listed below. This certification is made under the laws of the State of California. Contractor/Bidder Firm Name (Printed) Federal ID Number By (Authorized Signature) Printed Name and Title of Person Signing Date Executed Executed in the County of 1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code (a-f) and CCR, Title 2, Section 8103) (Not applicable to public entities.) 2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the requirements of the Drug- Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions: a. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations. b. Establish a Drug-Free Awareness Program to inform employees about: 1) the dangers of drug abuse in the workplace; 2) the person's or organization's policy of maintaining a drug-free workplace; 3) any available counseling, rehabilitation and employee assistance programs; and, 4) penalties that may be imposed upon employees for drug abuse violations. c. Every employee who works on the proposed Agreement will: 1) receive a copy of the company's drug-free workplace policy statement; and, 2) agree to abide by the terms of the company's statement as a condition of employment on the Agreement.

18 Page 18 of 42 Failure to comply with these requirements may result in suspension of payments under the Agreement or termination of the Agreement or both and Contractor may be ineligible for award of any future State agreements if the department determines that any of the following has occurred: the Contractor has made false certification, or violated the certification by failing to carry out the requirements as noted above. (Gov. Code 8350 et seq.) 3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that no more than one (1) final unappealable finding of contempt of court by a Federal court has been issued against Contractor within the immediately preceding two-year period because of Contractor's failure to comply with an order of a Federal court, which orders Contractor to comply with an order of the National Labor Relations Board. (Pub. Contract Code 10296) (Not applicable to public entities.) 4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO REQUIREMENT: Contractor hereby certifies that contractor will comply with the requirements of Section 6072 of the Business and Professions Code, effective January 1, Contractor agrees to make a good faith effort to provide a minimum number of hours of pro bono legal services during each year of the contract equal to the lesser of 30 multiplied by the number of full time attorneys in the firm s offices in the State, with the number of hours prorated on an actual day basis for any contract period of less than a full year or 10% of its contract with the State. Failure to make a good faith effort may be cause for non-renewal of a state contract for legal services, and may be taken into account when determining the award of future contracts with the State for legal services. 5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an expatriate corporation or subsidiary of an expatriate corporation within the meaning of Public Contract Code Section and , and is eligible to contract with the State of California. 6. SWEATFREE CODE OF CONDUCT: a. All Contractors contracting for the procurement or laundering of apparel, garments or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no apparel, garments or corresponding accessories, equipment, materials, or supplies furnished to the state pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor. The contractor further declares under penalty of perjury that they adhere to the Sweat Free Code of Conduct as set forth on the California Department of Industrial Relations website located at and Public Contract Code Section b. The contractor agrees to cooperate fully in providing reasonable access to the contractor s records, documents, agents or employees, or premises if reasonably required by authorized officials of the contracting agency, the Department of Industrial Relations, or the Department of Justice to determine the contractor s compliance with the requirements under paragraph (a). 7. DOMESTIC PARTNERS: For contracts over $100,000 executed or amended after January 1, 2007, the contractor certifies that contractor is in compliance with Public Contract Code section DOING BUSINESS WITH THE STATE OF CALIFORNIA The following laws apply to persons or entities doing business with the State of California.

19 Page 19 of CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions regarding current or former state employees. If Contractor has any questions on the status of any person rendering services or involved with the Agreement, the awarding agency must be contacted immediately for clarification. Current State Employees (Pub. Contract Code 10410): 1). No officer or employee shall engage in any employment, activity or enterprise from which the officer or employee receives compensation or has a financial interest and which is sponsored or funded by any state agency, unless the employment, activity or enterprise is required as a condition of regular state employment. 2). No officer or employee shall contract on his or her own behalf as an independent contractor with any state agency to provide goods or services. Former State Employees (Pub. Contract Code 10411): 1). For the two-year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision-making process relevant to the contract while employed in any capacity by any state agency. 2). For the twelve-month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy-making position in the same general subject area as the proposed contract within the 12-month period prior to his or her leaving state service. If Contractor violates any provisions of above paragraphs, such action by Contractor shall render this Agreement void. (Pub. Contract Code 10420) Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission, payment for preparatory time and payment for per diem. (Pub. Contract Code (e)) 2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and Contractor affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700) 3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C et seq.) 4. CONTRACTOR NAME CHANGE: An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment. 5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA: a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the contractor is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled.

20 Page 20 of 42 b. "Doing business" is defined in R&TC Section as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax. c. Both domestic and foreign corporations (those incorporated outside of California) must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State. 6. RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into an agreement, authorizing execution of the agreement. 7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall not be: (1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district; (2) subject to cease and desist order not subject to review issued pursuant to Section of the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3) finally determined to be in violation of provisions of federal law relating to air or water pollution. 8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity.

21 STATE OF CALIFORNIA STANDARD AGREEMENT STD 213 (Rev 06/03) Page 21 of 42 Attachment 10 Sample Contract AGREEMENT NUMBER REGISTRATION NUMBER 1. This Agreement is entered into between the State Agency and the Contractor named below: STATE AGENCY'S NAME Department of State Hospitals Coalinga CONTRACTOR'S NAME 2. The term of this agreement is 09/01/2013 through 08/31/2015 Or upon DGS Approval, whichever is later 3. The maximum amount of this Agreement $ 4. The parties agree to comply with the terms and conditions of the following exhibits which are by this reference made a part of the Agreement. Exhibit A Scope of Work 7 pages Exhibit B Budget Detail and Payment Provisions 2 pages Exhibit C* General Terms and Conditions GTC-610 Check mark one item below as Exhibit D: X Exhibit - D Special Terms and Conditions (Attached hereto as part of this agreement) 6 pages Exhibit - D* Special Terms and Conditions Exhibit E Confidentiality and Information Security Provisions 5 pages Exhibit F Insurance Requirements 2 pages Items shown with an Asterisk (*), are hereby incorporated by reference and made part of this agreement as if attached hereto. These documents can be viewed at IN WITNESS WHEREOF, this Agreement has been executed by the parties hereto. CONTRACTOR CONTRACTOR S NAME (if other than an individual, state whether a corporation, partnership, etc.) California Department of General Services Use Only BY (Authorized Signature) PRINTED NAME AND TITLE OF PERSON SIGNING DATE SIGNED(Do not type) ADDRESS AGENCY NAME STATE OF CALIFORNIA Department of State Hospitals Coalinga BY (Authorized Signature) PRINTED NAME AND TITLE OF PERSON SIGNING Kathryn Radtkey-Gaither, Chief Deputy Director ADDRESS th Street, Room 101, Sacramento, CA DATE SIGNED(Do not type) Exempt per:

22 EXHIBIT A SCOPE OF WORK Page 22 of (Name of Contractor), hereafter referred to as Contractor, agrees to provide to the Department of State Hospitals - Coalinga (DSH-C) Temporary/Relief Licensed Vocational Nurse services as described herein: Contractor agrees to provide the with Temporary/Relief Licensed Vocational Nurse services on an as-needed basis to assist the medical staff at the in providing the highest quality of medical care reasonable and consistent with available resources. To assure that appropriate evaluations and documentation meet the requirements and standards set forth by Licensing Title 22, The Joint Commission and the Department of Justice. 2. The services shall be performed at The, which is located at West Jayne Avenue, Coalinga, CA The services shall be provided on an as-needed basis, twenty-four (24) hours a day, seven (7) days a week, including holidays. On Call/Standby services may be required on an as-needed basis. 4. The project representatives during the term of this agreement will be: Section/Unit: Attention: Nurse Administrator Address: Phone: Fax: Direct all administrative inquiries to: Section/Unit: Central Nursing Services Attention: Address: Phone: Fax: Contractor: Section/Unit: Attention: Address: Phone: Fax: Contractor: Section/Unit: Attention: Address: Phone: Fax:

23 5. SPECIFICATIONS/DETAILED DESCRIPTION OF WORK Page 23 of 42 A. Contractor will provide Temporary/Relief Licensed Vocational Nurse Registry Services for individuals/patients in residence at DSH-C on an as needed basis. Services will be used to fill temporary civil service vacancies, DSH-C employee absences and temporary workload increases, or when appropriate staffing levels cannot be maintained with civil service staff. B. This agreement shall not be the primary means for DSH-C receiving this service. This agreement shall be used only when all other means have been exhausted. This includes, but is not limited to, civil service considerations as well as the use of other agreements. C. Contracted personnel shall work under the Nurse Administrator (NA) or designee. Contractor agrees that all referred personnel will be required to provide services to individuals in residence at DSH-C who are referred for treatment. Contractor shall provide services in accordance with DSH-C Standards of Care and National Standards of Care. 6. CONTRACTOR RESPONSIBILITIES A. Registry personnel referred by the Contractor must be able to perform the tasks associated with providing the above nursing services and assume full responsibility for services performed. B. Contractor agrees that all referred registry personnel will be required to render health services to any patient as needed. Registry staff will work under the clinical direction of the NA or designee in accordance with State laws and regulations and shall at all times comply with universal safety precautions and maintain DSH-C security measures and a safe work environment. C. Contractor agrees that all expenses associated with travel to and from the facility, lodging and all training expenses, such as Continuing Education for referred personnel, will be at the expense of the Contractor staff and will not be reimbursed by DSH-C. D. In the event that a Licensed Vocational Nurse assigned under this contract by the Contractor is subpoenaed to testify in a hospital related court matter, reimbursement will be made for travel and per diem equivalent to that of a Licensed Vocational Nurse employed in state service. E. Any and all services performed outside the scope of this agreement will be at the sole risk and expense of the Contractor. F. Contractor shall possess and maintain, throughout the term of this agreement, a current and valid license to do business in the State of California and shall obtain, at Contractor s expense, any and all necessary license(s), permit(s) and certificate(s) required by law for accomplishing any work required in connection with this Agreement. G. Contractor shall maintain current Curriculum Vitae and licenses on each Licensed Vocational Nurse assigned under this Agreement. Such records shall include the following: i. Name of person contacted and date ii. Name of previous paid employment as a Licensed Vocational Nurse iii. Length of employment and re-hire status iv. National Practitioners Data Bank information v. Department of Justice background check H. Contractor shall ensure that all licenses, permits, certifications and other requirements as outlined herein, are current and in effect at all times during the term of this Agreement. Contractor will

24 Page 24 of 42 provide current or renewed license and/or certification(s) to DSH-C no less than thirty (30) days prior to the expiration date, or replace the referred personnel. If, during the course of this Agreement, any of the required licenses and certifications as stated herein, are found to be inactive, revoked or not in compliance, DSH-C will immediately terminate referred personnel or this Agreement. I. Contractor is responsible for verifying through the appropriate licensing boards that no adverse actions have been taken by the State licensing authorities against any referred personnel assigned to DSH-C, and that all licenses are active and void of misconduct. DSH-C may, at its discretion, verify the current status of staff assigned. If, during the course of this Agreement, any of the licenses and requirements as stated herein are found to be inactive or not in compliance, DSH-C may immediately terminate this Agreement. J. Under the direction of the NA or designee, Contractor will provide services as permitted within the scope of practice for Licensed Vocational Nurse, including but not limited to the following: i. Perform care consistent with the scope of licensure and in accordance with the DSH-C facility policies and procedures. ii. Provide direct licensed nursing services, comprehensive evaluations, diagnosis and treatment, including administration of psychotropic medications. iii. Provide licensed nursing evaluations and care to individual patients housed in the Seclusion Room. iv. Review individual patients progress. v. Consult, as necessary, on unusual, complex or serious cases, and present such cases to appropriate clinical staff for advice. vi. Develop individual patient treatment plans and coordinate professional and para-professional services. vii. Provide and maintain adequate medical documentation for the individual patients medical record. viii. Provide follow-up services. ix. Attend and participate in staff meetings for the discussion of psychiatry and the mental condition of various individual patients and their final diagnosis and treatment. x. Maintain security of work area and work materials. K. Each Licensed Vocational Nurse assigned under this Agreement must have a current and valid license issued by the Medical Board of California, be Board Certified or Board Eligible in their specialty and maintain a current Cardiopulmonary Resuscitation (CPR) card. A copy of each Licensed Vocational Nurse s license, certifications and Curriculum Vitae must be provided when the Staffing Coordinator is requesting staffing services. L. Contractor must provide the State with proof of the required training, licensure and certification(s) for each of the referred personnel providing services under this Agreement. Services shall only be provided by the Licensed Vocational Nurse who meets these requirements. M. DSH-C shall approve, in advance, all referred personnel assigned to this Agreement. If any personnel provided by Contractor are unable to perform due to illness, resignation or factors beyond Contractor s control, Contractor shall submit qualifications of proposed substitute personnel to DSH-C for approval within twenty-four (24) hours of notification. Failure to do so may be cause for termination of this Agreement. N. Contractor shall be responsible to ensure that DSH-C Identification Badges and Personal Alarms provided to sub-contracted staff, be returned to the facility once a contracted staff is no longer

25 Page 25 of 42 working at DSH-C. Contractor will be invoiced/charged $5.00 for each Identification Badge and $ for each Personal Alarm not returned. O. Personnel referred through this Agreement must be proficient in the English language, be able to speak fluently, understand oral and written communications and write effectively. 7. REQUEST FOR SERVICES A. At the time of scheduling, DSH-C shall provide the Contractor with an estimate of the period of time the hospital anticipates the need for the services. This will be a good faith estimate based on the circumstances known to DSH-C at the time of the request. It is not a guarantee of business and is subject to change depending on DSH-C fluctuations in the patient population. B. Contractor acknowledges that the hospital may request services at any time, including weekends and holidays, if needed for emergency services. C. Contractor agrees to provide on-site services as arranged with the NA or designee on an asneeded basis, in accordance with the hospital s policies and procedures. D. Contractor shall have a locally based contact person with twenty-four (24) hour telephone availability. Telephone answering devices (i.e. message machines) are not acceptable. The initial contact will be by phone; however, DSH-C shall follow-up with a facsimile request. Failure to do so may be cause for termination of this Agreement. The Contractor shall respond to the hospital s request for services within two (2) hours of initial contact. E. Alternate work schedules/assignments are at the discretion of the NA or designee. F. Contractor will notify DSH-C at least twenty-four (24) hours in advance of scheduled services, if unable to provide services for reasons other than illness or immediately provide replacement staff to avoid a disruption of services. G. Contractor agrees to provide services Monday through Sunday (7-days a week), twenty-four (24) hours a day, on an as-needed basis, in accordance with DSH-C policies and procedures. DSH-C may request services at any time, including weekends and holidays if needed. Contractor will provide services within twenty-four (24) hours of notification by DSH-C. Compensation will be based on the hourly rate defined in Exhibit B, Budget Detail of this Agreement. H. Contractor must notify the State, in writing, of any changes of those personnel allowed access to State premises for the purpose of providing services under this Agreement. In addition, contractor must recover and return any State-issued identification card provided to Contractor s employee(s) upon their departure or termination. 8. FAILURE TO PERFORM A. Any personnel referred to DSH-C who fails to meet the minimum qualifications shall not be permitted to perform services. The Staffing Coordinator or designee shall state, in writing, the reason(s) the referred personnel does not meet minimum qualifications. DSH-C will not pay Contractor for any hours worked by a Licensed Vocational Nurse who does not meet the minimum qualifications. Contractor must have a bi-lingual (English/Spanish) speaking Licensed Vocational Nurse available when requested by the state hospital, at no additional charge. B. DSH-C shall routinely evaluate the work performance of the Contractor and/or Contractor s personnel assigned to DSH-C to determine if DSH-C standards and departmental policies and