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This is a Scope of Work and supporting exhibits for Agreement Number 25CS0054, a medical equipment maintenance, repair, and certification services contract with the California Department of Veterans Affairs (CalVet) for the Veterans Home of California - Chula Vista located at 700 E. Naples Court, Chula Vista, CA 91911. The contractor shall provide comprehensive maintenance, repair, and certification services for medical equipment including hospital beds, patient lifts, oxygen concentrators, nebulizers, infusion pumps, vital signs monitors, aspirators, scales, and various clinical diagnostic equipment. Services include annual preventive maintenance performed in July, unlimited repair requests with a 48-hour response time (same-day completion whenever possible, with a maximum of five working days unless parts must be ordered), equipment removal and repair services at off-site locations with a five-working-day limit, and provision of loan equipment at no additional cost for repairs exceeding five working days on vital equipment. The equipment inventory spans three main buildings (300, 700, and 1100) plus clinic and therapy areas, encompassing approximately 200 individual pieces of medical and biomedical equipment requiring maintenance and certification to meet Title 22, NFPA 99, and Joint Commission standards. Work shall be performed during standard business hours (8:00 a.m. to 4:00 p.m., Monday through Friday) unless prior written approval is obtained from the Contract Manager.

The contractor must be a certified Small Business (SB), Microbusiness (MB), or Disabled Veteran Business Enterprise (DVBE) as required by this solicitation. Pricing shall include an all-inclusive annual preventive maintenance and certification rate, an hourly rate for incidental repairs during normal business hours, and material reimbursement at actual cost plus 10% plus shipping and taxes, with invoices requiring proof of cost. All parts replaced shall remain property of CalVet unless authorized for "core" exchange. The contractor must employ or direct qualified, factory-trained biomedical or medical equipment technicians with either factory training certification or a minimum of three consecutive years' experience maintaining or repairing the specified equipment. Commercial general liability insurance of at least $1,000,000 combined single limit, workers' compensation insurance, and proof of all required state and local licenses and permits are mandatory. The contract includes compliance requirements with federal and state regulations including HIPAA, Title 22 California Code of Regulations, and examination and audit rights for the State Auditor for three years after final payment. The term of the agreement is not specified in the exhibits provided, though the rate sheet indicates rates are effective for the term including any extension through amendment.

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California Department of Veterans Affairs Agreement Number 25CS0054 Exhibit A - Scope of Work TBD

MEDICAL EQUIPMENT MAINTENANCE, REPAIR AND CERTIFICATION SERVICES

1. INTRODUCTION/SERVICES

A. Contractor shall provide services, as specified, to California Department of Veterans Affairs, (CalVet), Veterans Home of California – [Chula Vista] located at Veterans Home-Chula Vista, 700 E. Naples Court, Chula Vista, CA, 91911. Contractor shall provide all labor, materials, staff, transportation, license, permits and every other item of expense necessary, unless otherwise stated, to provide medical equipment, maintenance, repair and certification Services. Services shall be provided at CalVet, upon request and in compliance with terms of this Agreement.

B. All work shall be coordinated and approved by Contract Manager. Services shall be performed during standard business hours from 8:00 a.m. to 4:00 p.m., Monday through Friday unless otherwise specified.

No work is to be performed on weekends, State holidays or on an overtime basis unless prior approval is received in writing from the Contract Manager, prior to this work taking place. All services performed outside the scope of this Agreement or not approved by the Contract Manager, shall be at the sole risk and expense of the Contractor.

C. Contractors shall be able to perform the tasks associated with providing services under the scope of their license. Contractors shall provide services in accordance with federal and state laws and regulations and CalVet policies.

D. Contractor shall not be authorized to deliver or commence performance of services as described in the Agreement until written approval has been obtained from Contract Manager and the Contractor has received an executed Agreement from CalVet. Any delivery or performance of service commenced prior to the Contractor obtaining all written approvals shall be considered voluntary on the part of the Contractor.

2. EQUIPMENT

A. The following equipment is included in this Agreement as listed in Exhibit A-1, Equipment List.

B. CalVet reserves the right to add or delete similar equipment listed in Exhibit A-1, Equipment List. Additional equipment shall be serviced as specified herein at the rates indicated in Exhibit B-1, Rate Sheet.

Contractor shall be notified in writing by the Contract Manager of equipment that has been added and/or removed from the list.

3. MINIMUM QUALIFICATIONS

A. All service performed under this Agreement shall be performed by qualified service technicians in the employ or under the direction of the Contractor.

B. Contractor shall provide a service technician who is factory-trained on the equipment specified in this Agreement. Contractor shall provide CalVet with proof of the required training for each service technician providing services under this Agreement. Acceptable proof shall be a resume showing experience, training and factory school completion.

4. CONTRACTOR’S RESPONSIBILITIES

A. Contractor shall provide the following services:

1) ANNUAL MAINTENANCE SERVICES – All Preventative Maintenance shall include the following:

a) Contractor shall perform the annual service in July during the duration of this Agreement.

b) Repairs, documentation and testing to meet licensing, Title 22, National Fire Protection

Association NFPA 99 and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards. The equipment to be serviced by the contractor is listed in Exhibit A-1 Equipment List. This list may not be inclusive at the time of the scheduled work.

c) The Contractor shall provide services as described herein on a date and time of the Home’s choosing. There will be no scheduled work on State Holidays. Services shall be based upon the specific need of each piece of equipment, as recommended per the manufacturer’s specification and maintenance manuals.

d) Maintenance shall include regular inspection, lubrications, and necessary adjustments. Prior to any major repairs, the Contractor will give an estimate of repair costs including parts to the Contract Manager to determine whether or not the piece of equipment is economically repairable.

e) For approved repairs lasting more than five (5) working days, CalVet reserves the right to require the Contractor to provide loan equipment, as available, to CalVet at no additional cost. The equipment provided shall be the same or equivalent to the equipment being repaired. If loan equipment is requested, Contractor shall provide the equipment to CalVet within 24 hours of notification.

i. Requests by CalVet for loan equipment shall only be made for those pieces of equipment considered by CalVet to be vital to daily operations. Any loan equipment provided by the Contractor to CalVet under this provision shall remain in the possession of CalVet until such repair has been completed. If loan equipment is not available, Contractor shall provide to CalVet with a listing of known alternate equipment sources.

ii. CalVet shall be relieved of all risks of loss or damage during the entire time the loan equipment is in the possession of CalVet, except when loss or damage is due to fault or neglect of CalVet. All loan equipment will be returned to the Contractor in good condition subject to reasonable wear and tear, except for any loss or damage arising from circumstances beyond the control of CalVet.

f) After completion of service, the Contractor shall submit a complete a report to the Contractor Manager of the service provided, including any necessary repairs. Reports shall include:

i. Date of service

ii. Hourly rate

iii. Time in and time out

iv. Description of service provided, including replacement of any worn parts

v. Name and signature of service technician

vi. Location of equipment

vii. Equipment make, model and serial number

viii. Description of any noted deficiencies and suggested corrective action

ix. Total labor hours expended

x. Signature of Contract Manager certifying indicated services were performed

B. EQUIPMENT REPAIR SERVICES

1) There shall be no limit to the number of requests CalVet can make regarding equipment repair services. Contractor shall respond to and provide an unlimited number of visits for any repair services requested or necessary to keep the equipment fully operational during the terms of this contract.

Contractor shall respond to requests for repair services and perform required work within forty-eight

(48) hours of telephone notification from the Contract Manager.

2) Contractor shall make every attempt to complete repairs the same working day. Unless the repair requires parts that must be ordered, no repair may take longer than five (5) working days to complete.

When a delay in repair occurs due to parts that must be ordered, written notification shall be presented to the Contract Manager immediately.

3) For approved repairs lasting more than five (5) working days, CalVet reserves the right to require the Contractor to provide loan equipment, as available, to CalVet at no additional cost. The equipment provided shall be the same or equivalent to the equipment being repaired. If loan equipment is requested, Contractor shall provide the equipment to CalVet within 24 hours of notification.

i. Requests by CalVet for loan equipment shall only be made for those pieces of equipment considered by CalVet to be vital to daily operations. Any loan equipment provided by the Contractor to CalVet under this provision shall remain in the possession of CalVet until such repair has been completed. If loan equipment is not available, Contractor shall provide CalVet a listing of known alternate equipment sources.

ii. CalVet shall be relieved of all risks of loss or damage during the entire time the loan equipment is in the possession of the State, except when loss or damage is due to fault or neglect of the State.

All loan equipment will be returned to the Contractor in good condition subject to reasonable wear and tear, except for any loss or damage arising from circumstances beyond the control of CalVet.

4) After completion of service, the Contractor shall submit a complete report to the Contract Manger of the service provided, including any necessary repairs. Reports shall include:

i. Date of service

ii. Hourly rate

iii. Time in and time out

iv. Description of service provided, including replacement of any worn parts

v. Name and signature of service technician

vi. Location of equipment

vii. Equipment make, model and serial number

viii. Description of any noted deficiencies and suggested corrective action

ix. Total labor hours expended

x. Signature of State employee certifying indicated services were performed

5) Contractor shall provide repairs, as requested or necessary, to keep the equipment fully operational.

Repairs that are not provided during regularly scheduled maintenance visits or not covered by the guaranteed section of the Scope of Work, repairs shall be provided upon written request from the Contract Manager. Contractor shall respond to request for repair within two (2) hours of initial notification. Every effort shall be made to perform the repairs during normal business hours; State holiday and weekends excluded. CalVet shall, at its discretion, allow access to the Contractor during after-business hours as required to repair the equipment. Repairs performed outside of normal business hours shall be approved in advance in writing by the Contract Manager.

6) EQUIPMENT REMOVAL

1) Contractor shall endeavor to perform all services required under this Agreement on CalVet’s premises. In the event that equipment must be removed from CalVet’s premises for repair, prior approval from the Contract Manager shall be obtained. Contractor shall be responsible to pick-up and deliver from CalVet’s premises. Upon completion of repair, Contractor shall notify the CalVet to schedule a delivery date and time. Under no circumstances shall equipment removed from CalVet’s premises be kept by the Contractor for longer than five (5) working days, unless prior written permission has been obtained from the Contract Manager.

2) Before equipment may be removed from CalVet’s premises, the Contract Manager shall record the serial number(s) of the equipment being removed and inspect the equipment. Upon return of the equipment by the Contractor, the Contract Manager shall check the serial number(s) against those previously recorded and inspect the equipment for acceptability.

5. LICENSES, PERMITS, AND CERTIFICATION REQUIREMENTS

A. All service completed under this Agreement shall be performed by qualified medical or biomedical equipment technicians in the employ or under the direction of the Contractor. All technicians shall be either factory-trained on the equipment specified in this Agreement or have a minimum of three (3) consecutive years of experience in maintaining or repairing the equipment specified herein. Contractor shall provide CalVet with proof of the required training or experience for each technician providing services under this Agreement.

B. Contractor shall ensure all licenses, permits, and certification requirements are verified and current throughout the term of this Agreement.

6. PARTS REPLACEMENT

A. This Agreement shall include replacement of any part that becomes worn or inoperable, or that otherwise affects the equipment's operability in any way. A written estimate of the required part(s) shall be submitted to the CalVet Contract Manager and approved before replacement in all cases. Parts replaced under this Agreement shall be new, factory-manufactured, or exceeding Original Equipment Manual (OEM) specifications. Contractor should maintain an adequate supply and/or shall be able to obtain within a reasonable amount of time any necessary replacement parts to perform repairs and maintenance in a timely manner. Consumables and other supply items are hereby excluded.

B. When parts are needed, the Contractor shall be reimbursed for the actual cost of the parts plus 10%, plus actual shipping charges and taxes paid by the contractor to obtain the parts. Proof of cost, such as a copy of the actual invoice for the parts from the business from which it was purchased, shall be attached to the Contractor's invoice for reimbursement. All parts shall be paid within this Agreement. Calvet shall elect to purchase parts themselves as determined by the Contract Manager.

C. Any parts replaced shall remain the property of CalVet. The only exception is when the Contract Manager authorizes the Contractor to use the part(s) as a refund for “core” charges. If the Contractor is authorized to use the part for “core” exchange, the invoice shall reflect the reduced cost of the parts based on “core” exchange value.

D. CalVet assumes no responsibility and shall not reimburse the Contractor for parts ordered by the Contractor and/or labor if the part was installed prior to authorization by the Contract Manager. Contractor shall be responsible for the replacement of parts necessitated by the Contractor’s negligence at no expense to CalVet.

7. WORK AREA

A. While working on equipment, Contractor agrees to provide services with as little disruption to the State’s operations as possible. Contractor will ensure that the work area is kept clean and free of debris, as necessary, to maintain a safe working environment for residents and staff. All tools, equipment and other materials belonging to the Contractor will be removed from CalVet at the end of each working day. CalVet shall not be responsible for storage of any of the Contractor’s property.

8. WORKMANSHIP

A. All work provided by the Contractor shall conform to the latest requirements of Federal, State, City and

County regulations. This includes but is not limited to Titles 17, 19 and 22 of the California Code of Regulations. Contractor shall be responsible for compliance with all applicable laws, codes, rules and regulations on connection with work performed under this Agreement. Any services performed by the Contractor shall be inspected by CalVet after completion. CalVet shall be responsible for determining acceptability of the work performed and the operability of the equipment.

9. INDEPENDENT CONTRACTOR STATUS

A. Contractor shall be considered “Independent Contractor” in relation to CalVet and the State. Therefore, the

Contractor/Providers shall not be considered employee(s) of CalVet and shall not be entitled to any employee benefits from CalVet.

10. CONTACT INFORMATION

A. Contract Managers during the term of this Agreement shall be:

CalVet Representative/Contract Manager:

California Department of Veterans Affairs – Chula Vista

TBD

700 E. Naples Court Chula Vista CA 91911 Phone: TBD

1) CONTRACTOR Representative:

TBD

B. Contract Managers, addresses, and phone/fax numbers shall be changed by issuing a 20-day prior written notification and shall not require a formal amendment to this Agreement. The notifying party shall provide complete contact information for the replacement Contract Manager including, name, title, mailing address, phone/fax numbers, and email address. All other changes require a formal written amendment to this Agreement.

BLDG/UNIT ROOM DESCRIPTION MAKE MODEL SERIAL Preventative Maintenance (Annual or Semi-Annual)

Maintenance Date Maintenance ID Purchase Date Purchase Order State Property ID Comments

300 400 Pod Patient Lift Arjo Maxi Move 300366181 Annual 656764 300 400 Pod Vital Signs Monitor Welch Allyn 4400 1000091254020 Annual 670880 300 500 Pod Patient Lift Arjo Maxi Move 300366169 Annual 659042 300 500 Pod Vital Signs Monitor Welch Allyn 4400 1000089083920 Annual 670885 300 600 Pod Vital Signs Monitor Welch Allyn 4400 100089343920 Annual 670857 300 A314 Scale, Chair Doran DS8150 DS210100017 Annual 665848 300 A314 Patient Lift Arjo Sara Flex 300312730 Annual 670886 300 A318 O2 Concentrator Airsep New Life Intensity 10 CBB0122440060 Annual 4061 300 A318 O2 Concentrator Airsep New Life Intensity 10 CBB0124330118 Annual 4363 300 A318 Nebulizer Devibiss 4650D D7073118 Annual 12643 300 A318 Pump, Infusion Braun 637-202 133887 Annual 12948 300 A318 Pump, Infusion Braun Vista Basic 135442 Annual 12955 300 A318 Nebulizer Devibiss 4650D D7073090 Annual 618043 300 A318 Nebulizer Devibiss 3655D D2804369 Annual 649148 300 A318 Nebulizer Devibiss 3655D 0D1040883 Annual 649166 300 A318 Aspirator Vacu Tec 800 EV2 AJV127RP0258 Annual 656765 300 A318 Aspirator Vacu Tec 800 EV2 1120161 Annual 659047 300 A318 Nebulizer Devibiss 3655D D2636610 Annual 659049 300 A402 Hospital Bed Medline Alterra 1385 2016050380 Annual 612378 300 A402 Hospital Bed Joerns UCXTBED 50108688 Annual 670884 300 A402 Hospital Bed Joerns UCXTBED 9643095 Annual 677419 300 A403 Hospital Bed Hillrom Resident 27A0000Y94 Annual 502156 300 A403 Hospital Bed Joerns UCXTBED 214171 Annual 665845 300 A404 Hospital Bed Hillrom Resident 27A0000WZG Annual 507075 300 A404 Hospital Bed Medline Alterra 1385 080192 Annual 640733 300 A405 Hospital Bed Hillrom Resident 27A0000YAC Annual 502130 300 A405 Hospital Bed Joerns UCXTBED 50194818 Annual 612357 300 A405 Hospital Bed Hillrom Resident 27A0000XUU Annual 648846 300 A406 Nebulizer Devibiss 4650D D7073137 Annual 12626 300 A406 Hospital Bed Hillrom Resident 27A0000XWD Annual 502148 300 A406 O2 Concentrator Airsep New Life Elite 278570 Annual 505390 300 A406 Hospital Bed Invacare 00841447102663 Annual 670883 300 A407 Hospital Bed Joerns UCXTBED 10009439 Annual 612377 300 A407 Hospital Bed Joerns UCXTBED 1000478193 Annual 03026 300 A408 Hospital Bed Hillrom Resident 27A0000XV6 Annual 504543 300 A408 Hospital Bed Joerns UCXTBED 2017020212 Annual 618056 300 A408 Hospital Bed Medline Alterra 1385 Annual 649144 300 A409 Hospital Bed Hillrom Resident 27A0000YA2 Annual 502155 300 A409 Hospital Bed Invacare IHCS7 20FFT000612 Annual 03157 300 A410 Hospital Bed Joerns UCXTBED 50194815 Annual 612403 300 A410 Hospital Bed Hillrom Resident 27A0000XAQ Annual 659046 300 A411 Hospital Bed Hillrom Resident 27A0000Y8T Annual 505133 300 A411 Hospital Bed Joerns UCXTBED 27A0000XVS Annual 649146 300 A412 Hospital Bed Joerns UCXTBED 50194813 Annual 612368 300 A412 Hospital Bed Joerns UCXTBED Annual 612397 300 A502 Hospital Bed Hillrom Resident 27A0000XWE Annual 504514 300 A503 Hospital Bed Medline Alterra 1385 2017030028 Annual 612370 300 A503 Hospital Bed Invacare IHCS7 20DFT000659 Annual 03027 300 A504 Hospital Bed Hillrom Resident 27A0000WZ9 Annual 505197 300 A504 Hospital Bed Hillrom Resident 27A0000Y8E Annual 508643 300 A505 O2 Concentrator Airsep New Life Intensity 10 CBB0124330119 Annual 4364 300 A505 Hospital Bed Hillrom Resident 27A0000XAD Annual 507053 300 A506 Hospital Bed Hillrom Resident 27A0000WZJ Annual 408374 300 A506 Hospital Bed Hillrom Resident 27A0000YBE Annual 612373 300 A506 Nebulizer Devibiss 4650D D7073119 Annual 618077 300 A506 Nebulizer Devibiss Annual 665854 300 A506 O2 Concentrator Airsep New Life Elite Annual 670881 300 A507 Hospital Bed Hillrom Resident 27A0000YAD Annual 501412 300 A507 Hospital Bed Hillrom Resident 27A000XA7 Annual 612406 300 A507 Pump, Feeding Covidien Kangaroo C21362600 Annual 03158 300 A508 Hospital Bed Hillrom Resident 27A0000YAE Annual 502146 300 A508 Hospital Bed Joerns UCXTBED 1918555 Annual 612388 300 A508 Hospital Bed Invacare IHCS7 20DFT000545 Annual 03028 300 A509 O2 Concentrator Airsep New Life Elite CBB0122440086 Annual 4062 300 A509 Hospital Bed Hillrom Resident Annual 508652 300 A602 Hospital Bed Hillrom Resident 27A0000XAT Annual 507066 300 A602 Hospital Bed Hillrom Resident 27A0000WZF Annual 507070 300 A603 Hospital Bed Hillrom Resident 27A0000XA8 Annual 670861 300 A603 Hospital Bed Invacare IHCS7 20EFT000028 Annual 12665 300 A604 Hospital Bed Hillrom Resident 27A0000XAB Annual 505200 300 A604 Hospital Bed Medline Alterra 1385 4509167938 Annual 612394 300 A605 Hospital Bed Hillrom Resident 27A0000XVY Annual 508647

Chula Vista Veterans Home Biomedical Inventory

Maintenance Date Maintenance ID Purchase Date Purchase Order State Property ID Comments

300 A606 Hospital Bed Hillrom Resident 27A0000YBJ Annual 502108 300 A606 Hospital Bed Hillrom Resident 27A0000YBE Annual 648857 300 A607 Hospital Bed Medline Alterra 1385 Annual 612409 300 A607 Hospital Bed Hillrom Resident 27A0000WMP Annual 670856 300 A608 Hospital Bed Hillrom Resident 27A000Y98 Annual 502158 300 A608 Hospital Bed Hillrom Resident 27A0000WZW Annual 507054 300 A609 Hospital Bed Hillrom Resident 27A0000WM2 Annual 505201 300 A609 Hospital Bed Medline Alterra 1385 Annual 612381 300 A610 Hospital Bed Hillrom Resident 27A0000XVN Annual 501414 300 A610 Hospital Bed Hillrom Resident 27A0000XOK Annual 507064 300 A610 O2 Concentrator Airsep New Life Elite CBB0119120434 Annual 670887 300 A611 Hospital Bed Joerns UCXTBED Annual 665853 300 A612 Hospital Bed Hillrom Resident 27A0000XVP Annual 612371 300 A612 Hospital Bed Joerns UCXTBED 50194809 Annual 648855 300 A613 Hospital Bed Hillrom Resident 27A0000YA5 Annual 502159 300 A613 Hospital Bed Medline Alterra 1385 2017030029 Annual 618024 300 Crash Cart AED Philips Heart Start FRX B23H-00933 Annual 4255 300 Crash Cart Aspirator Vacu Tec 800 EV2 AJV127RP0553 Annual 12833 700 1000 Pod Patient Lift Arjo Sara Flex Annual 659043 700 1000 Pod Vital Signs Monitor Welch Allyn 4400 1000089363920 Annual 670871 700 800 Pod Patient Lift Arjo Sara Flex 300312728 Annual 12781 700 800 Pod Vital Signs Monitor Welch Allyn 4400 100094294420 Annual 670862 700 800 Pod Patient Lift Arjo Maxi Move 300366170 Annual 670870 700 900 Pod Vital Signs Monitor Welch Allyn 4400 100089293920 Annual 670869 700 900 Pod Patient Lift Arjo Maxi Move 300476229 Annual CV01232 700 A1002 Bed Hillrom Resident 27A0000WZX Annual 505191 700 A1002 Hospital Bed Hillrom Resident 27A0000XV4 Annual 508646 700 A1003 Pump, Feeding Covidien Kangaroo C22373635 Annual 3008 700 A1003 Hospital Bed Hillrom Resident 27A0000YBD Annual 501408 700 A1003 Hospital Bed Hillrom Resident 27A0000XAU Annual 649139 700 A1004 Hospital Bed Hillrom Resident 27A0000XV2 Annual 508641 700 A1004 Hospital Bed Hillrom Resident 27A0000XVT Annual 618023 700 A1006 Hospital Bed Hillrom Resident 27A0000XVD Annual 408293 700 A1006 Hospital Bed Hillrom Resident 27A0000YAH Annual 502152 700 A1007 Hospital Bed Hillrom Resident 27A0000XWT Annual 511566 700 A1007 O2 Concentrator Airsep New Life Elite CBB0119120436 Annual 656756 700 A1007 Hospital Bed Hillrom Resident 27A0000XOB Annual 665847 700 A1008 Hospital Bed Hillrom Resident 27A0000XWQ Annual 504546 700 A1008 Hospital Bed Medline Alterra 1385 4509074215 Annual 612360 700 A1008 Nebulizer Devibiss 3655D D2804374 Annual 636553 700 A1009 Hospital Bed Hillrom Resident 27A0000YB8 Annual 502157 700 A1009 Hospital Bed Hillrom Resident 27A0000XOF Annual 507055 700 A1009 Hospital Bed Floor Bed 1 Annual 648847 700 A1010 Aspirator Gomco 4005 20030619010 Annual 505382 700 A1010 Hospital Bed Hillrom Resident 27A0000YBG Annual 511565 700 A1010 Hospital Bed Medline Alterra 1385 4509167938 Annual 612393 700 A1010 Pump, Feeding Covidien Kangaroo C21366602 Annual 04207 700 A1011 Hospital Bed Hillrom Resident 27A0000Y8W Annual 502168 700 A1011 Hospital Bed Medline Alterra 1385 FCET2017080191 Annual 648843 700 A1012 Hospital Bed Joerns UCXTBED 6798846 Annual 612392 700 A1012 Nebulizer Devibiss 4650D D7073096 Annual 618037 700 A1012 Hospital Bed Joerns UCXTBED 1000523268 Annual 03163 700 A714 Patient Lift Arjo Maxi Move KMC-04691 Annual 504535 700 A718 O2 Concentrator Airsep New Life Elite CB00122440078 Annual 4065 700 A718 O2 Concentrator Airsep New Life Intensity 10 CBB0124330105 Annual 4366 700 A718 Nebulizer Devibiss 3655D D2813287 Annual 12307 700 A718 Pump, Infusion Braun 637-202 133889 Annual 12950 700 A718 Nebulizer Pulmoaide 4650D D7073120 Annual 649154 700 A718 Aspirator Vacu Tec 800 EV2 AJV127RP0594 Annual 04206 700 A726 Tub Rm Scale, Chair Health O Meter 594KL 594P90061 Annual 648841 700 A726 Tub Rm Scale, Chair Doran DS8150 DS210100002 Annual 670867 700 A802 Hospital Bed Medline Alterra 1385 4508386973 Annual 612359 700 A802 Hospital Bed Invacare IHCS7 20DFT000578 Annual 03161 700 A803 Hospital Bed Joerns UCXTBED 50194812 Annual 618022 700 A803 Aspirator Vacu Tec Annual 670874 700 A803 Hospital Bed Invacare IHCS7 20DFT000486 Annual 03159 700 A803 Pump, Feeding Covidien Kangaroo C23162582 Annual 03160 700 A804 Hospital Bed Hillrom Resident 27A00000XWF Annual 612358 700 A804 Hospital Bed Joerns UCXTBED 1918551 Annual 612407 700 A805 Hospital Bed Hillrom Resident 27A0000X0H Annual 502163 700 A805 Hospital Bed Joerns UCXTBED 1918550 Annual 612410 700 A806 Hospital Bed Hillrom Resident 27A0000XWV Annual 408281 700 A806 Hospital Bed Joerns UCXTBED 50194818 Annual 612413 700 A807 Hospital Bed Hillrom Resident 27A0000X0C Annual 502109 700 A807 Hospital Bed Joerns UCXTBED 217526006111687 Annual 648850

Maintenance Date Maintenance ID Purchase Date Purchase Order State Property ID Comments

700 A808 O2 Concentrator Airsep New Life Elite CBB0122440081 Annual 4067 700 A808 O2 Concentrator Airsep New Life Elite CBB0122440079 Annual 4069 700 A808 Hospital Bed Hillrom Resident Annual 508637 700 A808 Nebulizer Devibiss 4650D D7066706 Annual 649143 700 A808 Hospital Bed Hillrom Resident 27A0000YCA Annual 665843 700 A809 Hospital Bed Hillrom Resident 27A0000W2L Annual 505186 700 A809 Hospital Bed Medline Alterra 1385 Annual 649140 700 A810 Hospital Bed Hillrom Resident 27A0000XWX Annual 408274 700 A810 Hospital Bed Medline Alterra 1385 Annual 612401 700 A811 Hospital Bed Hillrom Resident 27A0000WZC Annual 504539 700 A811 Hospital Bed Medline Alterra 1385 4508383973 Annual 612395 700 A812 Nebulizer Medline Annual 665850 700 A812 Hospital Bed Invacare 72150 Annual 665855 700 A812 Hospital Bed Invacare IHCS7 20DFT000613 Annual 03042 700 A813 O2 Concentrator Airsep New Life Elite CBB0122440084 Annual 4066 700 A813 O2 Concentrator Airsep New Life Intensity 10 CBB0124330116 Annual 4367 700 A813 Nebulizer Devibiss 4650D D7073093 Annual 12647 700 A813 Hospital Bed Hillrom Resident 27A0000Y8K Annual 502170 700 A813 Hospital Bed Hillrom Resident 27A0000Y8Q Annual 505183 700 A902 Hospital Bed Hillrom Resident 27A0000XVK Annual 505188 700 A903 Hospital Bed Hillrom Resident 27A0000XAV Annual 505148 700 A903 Hospital Bed Hillrom Resident 270000WYZ Annual 612361 700 A904 Hospital Bed Joerns 1918553 Annual 618028 700 A904 Hospital Bed Invacare IHCS7 20EFT000067 Annual 03162 700 A905 Hospital Bed Joerns UCXTBED 50194817 Annual 618030 700 A905 Hospital Bed Hillrom Resident 27A0000XA9 Annual 670853 700 A906 Hospital Bed Hillrom Resident 27A0000YA7 Annual 502144 700 A906 Hospital Bed Hillrom Resident 27A0000X03 Annual 505192 700 A907 O2 Concentrator Airsep New Life Intensity 10 CBB0124330096 Annual 4365 700 A907 Hospital Bed Hillrom Resident 27A0000YA1 Annual 618026 700 A907 Hospital Bed Medline Alterra 1385 2017020197 Annual 618027 700 A908 O2 Concentrator Airsep New Life Elite CBB0122440080 Annual 4064 700 A908 Hospital Bed Hillrom Resident 27A0000WMN Annual 507077 700 A909 Hospital Bed Hillrom Resident 27A0000WZU Annual 504506 700 Crash Cart AED Philips Heart Start FRX B23H-00648 Annual 4254 700 Nurse Station Aspirator Roscoe ASP-HD ET181102377 Annual 665846 1100 1200 Pod Detecto Scale, W/C MV1A E11821-00909 Annual 03164 1100 A1114 Patient Lift Arjo Maxi Move 50112586 Annual 612461 1100 A1133 Pump, Feeding Covidien Kangaroo C4114464 Annual 612444 1100 A1202 Hospital Bed Hillrom Resident 27A0000X8P Annual 502128 1100 A1202 Hospital Bed Hillrom Resident 27A0000Y93 Annual 502169 1100 A1202 Hospital Bed Hillrom Resident 27A0000VEM Annual 665844 1100 A1203 Hospital Bed Hillrom Resident 27A0000YA6 Annual 502151 1100 A1203 Hospital Bed Hillrom Resident 28A0000WZT Annual 640724 1100 A1203 Hospital Bed Joerns UCXTBED 1000016590 Annual 670877 1100 A1204 Hospital Bed Hillrom Resident 27A0000XAS Annual 511522 1100 A1204 Hospital Bed Hillrom Resident 27A000XW7 Annual 612383 1100 A1205 Hospital Bed Hillrom Resident 27A0000XWK Annual 505154 1100 A1205 Hospital Bed Hillrom Resident 27A000Y8R Annual 612402 1100 A1206 Hospital Bed Hillrom Resident 27A0000XWM Annual 505203 1100 A1206 Hospital Bed Hillrom Resident 27A0000XVL Annual 507065 1100 A1207 Hospital Bed Hillrom Resident 27A0000WZ9 Annual 659048 1100 A1207 Hospital Bed Hillrom Resident 27A0000YAQ Annual 665852 1100 A1208 Hospital Bed Hillrom Resident 27A0000Y8G Annual 502167 1100 A1208 Patient Lift Arjo Maxi Move 300184322 Annual 618045 1100 A1208 Hospital Bed Hillrom Resident 27A0000YZ7 Annual 648851 1100 A1209 Hospital Bed Hillrom Resident 27A0000WMN Annual 507076 1100 A1209 Hospital Bed Hillrom Resident 27A0000XW9 Annual 665851 1100 A1210 Hospital Bed Hillrom Resident 27A0000XWU Annual 505185 1100 A1211 Hospital Bed Joerns UCXTBED 5019808 Annual 612375 1100 A1211 Hospital Bed Hillrom Resident 27A0000XWH Annual 618025 1100 A1212 Hospital Bed Hillrom Resident 27A0000YAA Annual 502149 1100 A1212 Hospital Bed Hillrom Resident 27A0000WZV Annual 612369 1100 A1213 Hospital Bed Hillrom Resident 27A0000XOD Annual 504540 1100 A1213 Hospital Bed Hillrom Resident 27A0000XUT Annual 505149 1100 A1302 Hospital Bed Hillrom Resident 27A0000Y8Y Annual 03047 1100 A1303 Hospital Bed Hillrom Resident 27A000Y9F Annual 502138 1100 A1303 Hospital Bed Hillrom Resident 27A0000XW0 Annual 505131 1100 A1303 Hospital Bed Joerns UCXTBED Annual 612364 1100 A1303 Hospital Bed Hillrom Resident 27A0000VER Annual 649149 1100 A1304 Nebulizer Devibiss D7113869 Annual 3071 1100 A1304 Aspirator Devibiss 7305P-D PD269104 Annual 9648 1100 A1305 Hospital Bed Hillrom Resident 27A0000Y9B Annual 504549 1100 A1306 Hospital Bed Hillrom Resident 27A0000XAE Annual 504516 1100 A1306 Hospital Bed Medline Alterra 1385 54117020001 Annual 612391

Maintenance Date Maintenance ID Purchase Date Purchase Order State Property ID Comments

1100 A1307 Patient Lift Arjo Maxi Move 300715050 Annual CV01137 1100 A1307 Patient Lift Arjo Maxi Move 300713738 Annual CV01138 1100 A1307 Patient Lift Arjo Maxi Move 300713736 Annual CV01139 1100 A1307 Patient Lift Arjo Maxi Move 300715048 Annual CV01140 1100 A1308 Hospital Bed Medline Alterra 1385 2016050238 Annual 612404 1100 A1309 Vital Signs Monitor Welch Allyn 4400 100004100425 Annual 3082 1100 A1309 Vital Signs Monitor Welch Allyn 4400 100005210425 Annual 3083 1100 A1309 Vital Signs Monitor Welch Allyn 4400 100006500525 Annual 3088 1100 A1309 Scale, Adult Detecto E17725-0017 Annual 3144 1100 A1309 Scale, Adult Detecto E17725-0042 Annual 3145 1100 A1309 Scale, Adult Detecto E17625-0043 Annual 3146 1100 A1309 Hospital Bed Hillrom Resident 27A0000XWW Annual 408269 1100 A1402 Hospital Bed Hillrom Resident 27A0000XWP Annual 408279 1100 A1402 Hospital Bed Hillrom Resident 27A0000WZK Annual 505184 1100 A1403 Hospital Bed Hillrom Resident 27A0000Y99 Annual 502107 1100 A1403 Hospital Bed Hillrom Resident 27A0000WZH Annual 504509 1100 A1404 Hospital Bed Hillrom Resident 27A0000XWN Annual 612363 1100 A1405 Hospital Bed Hillrom Resident 27A0000XWG Annual 648848 1100 A1406 Hospital Bed Hillrom Resident 27A0000Y78L Annual 502110 1100 A1406 Hospital Bed Hillrom Resident 27A0000YAB Annual 502147 1100 A1406 Hospital Bed Hillrom Resident 27A0000XWL Annual 648835 1100 A1407 Hospital Bed Hillrom Resident 27A0000Y92 Annual 407517 1100 A1407 Hospital Bed Hillrom Resident 27A0000XUY Annual 505202 1100 A1407 Hospital Bed Joerns UCXTBED Annual 649141 1100 A1407 Hospital Bed Hillrom Resident 27A0000X07 Annual 665841 1100 A1408 Hospital Bed Hillrom Resident 27A0000XVJ Annual 408309 1100 A1408 Hospital Bed Medline Alterra 1385 2017080188 Annual 649147 1100 A1409 Hospital Bed Hillrom Resident 27A0000WZZ Annual 511567 1100 A1409 Hospital Bed Joerns UCXTBED 1918554 Annual 612408 1100 A1410 Hospital Bed Hillrom Resident 27A0000XVI Annual 504553 1100 A1410 Hospital Bed Hillrom Resident 27A0000XVC Annual 649142 1100 A1411 Hospital Bed Hillrom Resident 27A0000XUS Annual 03165 1100 A1411 Hospital Bed Hillrom Resident 27A0000X02 Annual 03166 1100 A1412 Hospital Bed Hillrom Resident 27A0000X0J Annual 505189 1100 A1412 Hospital Bed Hillrom Resident 27A0000Y9V Annual 670863 1100 A318 O2 Concentrator Airsep New Life Intensity 10 CBB0124330107 Annual 4368 1100 A318 O2 Concentrator Airsep New Life Elite CBB0119510361 Annual 659060 1100 A406 O2 Concentrator Airsep New Life Elite CBB0119120437 Annual 3023 1100 A503 O2 Concentrator Airsep New Life Elite CBB0119510353 Annual 670868 1100 Crash Cart AED Philips Heart Start FRX B23H-01238 Annual 4253 1100 Nurse Station Aspirator Gomco 405 2000519029 Annual 407749 Bldg A Corridor A-181 AED Laerdal Heart Start FRX B23H-00641 Annual 4251 Bldg A Front Desk AED Philips Heart Start B23H-01232 Annual 4252 Bldg A Health Safety AED Philips Heart Start FRX B23H-00645 Annual 4256 Bldg A Health Safety AED Philips Heart Start FRX B23H-00845 Annual 4258 Bldg A Health Safety AED Philips Heart Start FRX B23H-01228 Annual 4260 Bldg B Member Help AED Philips Heart Start B22F-04615 Annual 12984 Bldg C 113 Vital Signs Monitor Hillrom 44WT 100000350125 Annual 4166 Bldg C 113 Vital Signs Monitor Hillrom 44WT 100000270125 Annual 4167 Bldg C 114 Scale, Adult Seca 7771821004 1310396 Annual 4293 Bldg C 114 Scale Seca Stand Up Manual Annual 501668 Bldg C 114 Scale, Adult Detecto 758C 0002-238 Annual 505272 Bldg C 114 Scale, Adult Accuro DB100 DB10000587 Annual 612418 Bldg C Member Help AED Philips Heart Start FRX B22K-03007 Annual 12719 Bldg D Member Help AED Philips Heart Start FR2 B16I-02007 Annual 636551 Bldg E Member Help AED Philips Heart Start FRX B16I-02289 Annual 636550 Bldg F Member Help AED Philips Heart Start B23H-00859 Annual 4259 Clinic 161 Scale, Adult Accuro DB100 DB10000586 Annual 620990 Clinic 161 Scale, Adult Welch Allyn 5002-XX U107237192677 Annual 659057 Clinic A165 Airway Clearance Sys Hillrom Vest 205 51-01502 Annual 9078 Clinic A165 EKG Welch Allyn CP100 10021368 Annual 11067 Clinic A165 Hyfrecator Conmed 7-900-115 01FGJ037 Annual 501653 Clinic A165 EKG Welch Allyn CP100 10008304 Annual 507031 Clinic A165 Microscope Unico G300 Annual 620992 Clinic A188 Refrigerator Magic Chef Midsize Annual 648859 Clinic Crash Cart Pulse Oximeter Nellcor Oximax N-65 607841096 Annual 7765 Clinic Ex Rm 1 Pulse Oximeter BCI Spectro 2 4040409 Annual 10609 Clinic Ex Rm 1 Light, Exam Welch Allyn 44100 Annual 407633 Clinic Ex Rm 1 Oto/Ophthalmoscope Welch Allyn 767 Annual 501649 Clinic Ex Rm 1 Table, Exam Midmark 222 V1332730 Annual 612347 Clinic Ex Rm 1 Vital Signs Monitor Welch Allyn 3400 100018651017 Annual 612352 Clinic Ex Rm 1 Scale, Adult Accuro DB100 DB10000579 Annual 620988 Clinic Ex Rm 1 Thermometer Covidien Genius 2 Annual 665859 Clinic Ex Rm 1 EKG Welch Allyn CP150 100008571121 Annual 665861

Maintenance Date Maintenance ID Purchase Date Purchase Order State Property ID Comments

Clinic Ex Rm 1 Blood Pressure Unit Baum Wall 06191338 Annual 04201 Clinic Ex Rm 1 Thermometer Covidien Genius 3 N20701544 Annual 04204 Clinic Ex Rm 2 Pulse Oximeter BCI Spectro 2/20 4110415 Annual 4280 Clinic Ex Rm 2 Table, Exam Midmark 307 GY001475 Annual 501632 Clinic Ex Rm 2 Oto/Ophthalmoscope Welch Allyn 767 Annual 505146 Clinic Ex Rm 2 Vital Signs Monitor Welch Allyn 3400 100000401312 Annual 612346 Clinic Ex Rm 2 EKG Hewlett Packard Pagewriter 300 US00200274 Annual 612355 Clinic Ex Rm 2 Thermometer Covidien Genius 2 N16630644 Annual 620983 Clinic Ex Rm 2 AED Philips Heart Start FRX B16I-02297 Annual 636552 Clinic Ex Rm 2 Bladder Scanner Cube-Scan MRC-900 P1350/CV01025 Annual 665860 Clinic Ex Rm 2 Doppler Pocket Dop Sonotrax Basic Annual 665862 Clinic Ex Rm 2 Blood Pressure Unit Baum Wall 06191340 Annual 04202 Clinic Ex Rm 3 Oto/Ophthalmoscope Welch Allyn 767 Annual 505266 Clinic Ex Rm 3 Table, Exam Midmark 307 GY001480 Annual 505268 Clinic Ex Rm 3 Vital Signs Monitor Welch Allyn 3400 100000621312 Annual 612350 Clinic Ex Rm 3 Thermometer Covidien Genius 2 N16617486 Annual 620984 Clinic Ex Rm 3 Blood Pressure Unit Baum Wall 06191339 Annual 04203 Clinic Ex Rm 3 Blood Pressure Unit Omron BP7350 202009043809V Annual 04205 Clinic Eye Exam Lensmeter Marco 101 41702 Annual 407580 Clinic Eye Exam Frame Warmer Sadler 179 Annual 501642 Clinic Eye Exam Chair, Eye Exam Topcon OC2200 22175 Annual 505269 Clinic Eye Exam Keratometer Reichert 12515 10856-00 Annual 507034 Clinic Eye Exam Vision Test System Lombart CS-IV Annual 507035 Clinic Eye Exam Slit Lamp Topcon PS-64A 426495 Annual 507036 Clinic Eye Exam Lensmeter Reichert 12084 17329-00 Annual 620986 Clinic Eye Exam Visual Field Unit Ziess Humphrey Matrix 800 Annual 620987 Clinic Lab Blood Pressure Unit Baum Standby 07115381 Annual 612348 Clinic Lab Blood Pressure Unit Baum Standby 07115360 Annual 620982 Clinic Lab Refrigerator Magic Chef Midsize Annual 648860 Clinic Office Pulse Oximeter BCI Spectro 2 Annual 665856 Connex Storage Pump, Feeding Covidien Kangaroo C13056683 Annual 11269 Connex Storage Pump, Infusion Braun Vista Annual 618053 Connex Storage Pump, Infusion Braun 637-202 77262 Annual 636554 Connex Storage Pump, Feeding Covidien Kangaroo C13066796 Annual 636555 Connex Storage Pump, Infusion Braun Vista Basic Annual 656767 Dental 163 Vital Signs Monitor Welch Allyn 3400 100018771017 Annual 620985 Dental 163 Thermometer Covidien Genius 2 Annual 685857 Dining Rm Middle Pillar AED Philips Heart Start FRX B23H-00564 Annual 4261 Dining Rm Middle Pillar Aspirator Gomco 405 2000519034 Annual 504582 Therapy A158 Bike, Stationary Scifit Sone 151-015517 Annual 881 Therapy A158 Massage Gun 53000 001-00 Annual 882 Therapy A158 Ultrasound Chattanooga Intelect 6975 Annual 501670 Therapy A158 E-Stim Unit Chattanooga Intelect 4048 Annual 501671 Therapy A158 Treadmill TRUE Gait Keeper Annual 504431 Therapy A158 Balance System Biodex Annual 504432 Therapy A158 Patient Lift Midland 4512E 2006376 Annual 504433 Therapy A158 Table, Hi/Lo Midland 22265B 28041B Annual 507045 Therapy A158 Bike, Stationary Scifit REX70000 990-007989 Annual 611681 Therapy A158 Paraffin Bath Whitehall PB-105 12041086 Annual 618010 Therapy A158 Hydrocollator Tropic M-2-TH T-3784 Annual 618014 Therapy A158 Freezer Chattanooga Midsize Annual 618015 Therapy A158 Pulse Oximeter Nonin 8500M 501408660 Annual 618016 Therapy A158 Muscle Tester Lafayette Ins. 01165 Annual 618017 Therapy A158 Dynamomter Jamar Pinch 50200056 Annual 618018 Therapy A158 Dynamomter Jamar Squeeze 10100422 Annual 618019 Therapy A158 Bike, Stationary Scifit Sone 151-009749 Annual 648858 Therapy A158 Blood Pressure Unit Match Mates Handheld 77681 Annual 659053 Therapy A158 Water Bath Nuohai Annual 659059 Therapy A158 Table, Hi/Lo Chattanooga ADP300 2608 Annual 670889 Therapy A158 Hand Cycle Cando Annual 03169 Therapy A158 Blood Pressure Unit Omron BP7150 202407017643V Annual 03170 Therapy A158 Omni Trainer HCI Fitness OT01B2003 Annual CV01244 Therapy A158 Parallel Bars Armedica AMTM703 97123 Annual CV01249 Therapy A158 Step One Scifit SONE 151-017691 Annual CV01260 Therapy A158 Ergonometer Scifit Pro 100-INT P1XERGW23310051 Annual CV01267

California Department of Veterans Affairs Exhibit B - Budget Detail and Payment Provisions

Agreement Number: 25CS0054

1. STANDARD BUDGET DETAIL AND PAYMENT PROVISIONS

A. Invoicing and Payment

1. For services satisfactorily rendered, and upon receipt and approval of the invoices, the State agrees to compensate the Contractor for services rendered in accordance with the rates in Exhibit B-1.

2. Invoices shall include the Agreement Number and shall be submitted in not more frequently than monthly in arrears to:

Original Invoice Approval Copy

Department of Veterans Affairs CalVet Accounting Office 1227 “O” Street Room 402 Sacramento, CA 95814

Veterans Home of California – Chula Vista Attn: Elenita Petrache 700 East Naples Court Chula Vista, CA 91911

B. Budget Contingency Clause

1. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further form and effect. In this event, the State shall have no liability to pay any funds whatsoever to Contractor or to furnish any other considerations under this Agreement and Contractor shall not be obligated to perform any provisions of this Agreement.

2. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State, or offer an Agreement amendment to Contractor to reflect the reduced amount.

C. Prompt Payment Clause

Payment will be made in accordance with, and within the time specified in, Government Code, Chapter 4.5, commencing with Section 927.

2. SPECIAL BUDGET DETAIL AND PAYMENT PROVISIONS

A. Submissions of Invoices/Claims

1. All invoices/claims must be completed thoroughly and legibly, with all applicable fields completed.

Invoices/claims that are submitted to the appropriate location but have been altered, or are inaccurate, or do not provide all necessary information will not be accepted and will be returned to the Contractor for correction.

2. Any changes to this provision relating to the invoice/claim submittal process, including but not limited to an address, form, or process change, shall be an administrative change managed through the appropriate designated CalVet office and shall not require a contract amendment.

3. Invoices/claims submitted shall include the following information in order to be considered complete and acceptable for processing, or the invoice/claim will be returned:

a) Contractor’s Company name exactly as it appears on the Payee Data Record (STD.204)

b) Contractor’s Company address, phone number and e-mail

c) Date of invoice/claim

d) Invoice/claim number

California Department of Veterans Affairs Exhibit B - Budget Detail and Payment Provisions

Agreement Number: 25CS0054

e) CalVet location where services were performed

f) Agreement Number

g) Date(s) of Service

h) Total dollar amount being billed

i) First and Last name of Contractor or Provider performing services, if applicable

j) Contractor’s or Provider’s Classification, whichever is applicable

k) When applicable, Contractors shall include the following information on the invoice/claim submitted for hourly reimbursement:

1. Hourly Rate

2. Time in and time out

3. Total hours worked

4. Any other information or documentation reasonably required to verify and substantiate the provision of services and the charges for such services.

California Department of Veterans Affairs Agreement Number: 25CS0054 Exhibit B-1, Rate Sheet TBD

RATE SHEET

The Contractor must be able to provide services listed below. Subcontractors may be used to comply with this requirement. Subcontractor Agreements may be used to comply with this requirement. Subcontractor(s) information must be identified on Bidder Declaration (GSPD-05-105). If additional Subcontractors are added during the term of the Agreement, an updated GSPD-05-105 must be submitted.

The rates listed below are in effect for the term of the Agreement, including any extension of the term through an amendment.

Description of Services Rate/Service

All-inclusive Annual Preventive Maintenance and Certification; includes all labor, tools and equipment

Incidental repairs - Normal business hours

(Monday-Friday 8:00am to 4:00pm)

$ an hr.

Description of Services Amount

MATERIAL REIMBURSEMENT $

California Department of Veterans Affairs Agreement Number:25CS0054 Exhibit D – Special Terms and Conditions TBD

1. EXCISE TAX

The State of California is exempt from Federal Excise Taxes, and no payment will be made for any taxes levied on employees' wages. The State will pay for any applicable State of California or local sales or use taxes on the services rendered or equipment or parts supplied pursuant to this Contract. California may pay any applicable sales or use tax imposed by another state.

2. STATUTORY AND REGULATORY PROVISIONS

A. This Contract shall be governed and construed in accordance with all applicable statutory and regulatory provisions including, but not limited to:

1) Title XVIII of the Federal Social Security Act

2) Title XIX of the Federal Social Security Act

3) Chapters 7 and 8 (commencing with Section 14000), Part 3, Division 9, Welfare and Institutions Code

4) Division 3, Title 22, California Code of Regulations (CCR)

5) Health and Safety Code Section 1340 et seq.

6) All applicable Federal provisions which regulate the administration of health care programs and budget revisions, as contained in the Code of Federal Regulations (CFR), Title 42, and Title 45, Part 74, Title 42 United States Code, Sections 1395 et seq. and 1396 et seq.

7) Sub-chapter 13 (commencing with Section 6800), Chapter 4, Part 1, Title 17, CCR; and

8) All other applicable laws and regulations.

B. Any provision of this Contract in conflict with the applicable laws and regulations is hereby amended to conform to the provisions of those laws and regulations. Such amendment of the Contract shall be effective on the effective date of the statutes or regulations necessitating it, and shall be binding on the parties even though the amendment may not have been reduced to writing and formally agreed upon and executed by the parties. If, due to amendment in laws of regulations, Contractor is unable or unwilling to comply with the provisions of the amendment(s), State or Contractor may terminate this Contract in accordance with the Termination provision of this Contract.

3. EXAMINATION AND AUDIT

A. Contractor shall allow the State and its related entities, the Comptroller General of the United States, Department of Justice (DOJ), and the Bureau of Medi-Cal Fraud, or their duly authorized representatives, to inspect or otherwise evaluate the quality, appropriateness, and timeliness of services performed under this Contract, and to inspect, evaluate, and audit any and all books, records, and facilities maintained by the Contractor and Subcontractors pertaining to services under this Contract at any time during normal business hours.

B. Contractor shall be subject to the examination and audit of the State Auditor for a period of three (3) years after final payment under this Contract in accordance with Government Code, Section 85467.7. The examination and audit shall be confined to those matters directly connected with the performance of the contract, including, but not limited to, the costs of administering the Contract.

C. Books and records include, but are not limited to, all physical records originated or prepared pursuant to the performance under this Contract, including working papers, reports, financial records, and books of account, Medical Records, prescriptions files, Subcontracts, and any other documentation pertaining to medical and non-medical services for residents of the Home. Upon request, at any time during the term of this Contract, the Contractor shall furnish any record or copy.

4. RESOLUTION OF DISPUTES

A. The Contractor may dispute and appeal a decision or action by the State arising out of the Interpretation or administration of this Contract. A written dispute notice shall be submitted to the Contract Manager within thirty (30) calendar days from the date the Contractor receives notice of the decision or action in dispute.

The Contractor’s dispute notice shall state the following, based on the most accurate information available to the Contractor:

1) That it is a dispute pursuant to this Section.

2) The date, nature, and circumstances of the conduct, which is the subject of dispute.

3) The names, telephone numbers, function, and activity of each contractor, subcontractor, State official, or employee involved in or knowledgeable about the conduct.

4) The identification of any documents and the substance of any oral communications involved in the conduct. Copies of all identified documents shall be attached.

5) The reason why the Contractor is disputing the conduct.

6) The cost impact to the Contractor directly attributable to the alleged conduct, if any.

7) The Contractor’s desired remedy.

B. The State and the Contractor agree to try to resolve all contractual issues by negotiation and mutual agreement at the Contract Manager level. The parties recognize that the implementation of this policy depends on open-mindedness, and the need for both sides to present adequate supporting information on matters in question. The Contract Manager, in a written decision stating the factual basis for the decision, will decide any disputes concerning performance of this Contract. Before issuance of the Contract Manager’s decision, informal discussions between the parties by the individuals who have not participated substantially in the matter in dispute will be considered by the parties in efforts to reach mutual agreement.

C. The Contract Manager will render a decision or request additional substantiating documentation from the

Contractor within thirty (30) days of receipt of the Contractor’s appeal. A copy of the decision will be provided to the Contractor. The decision shall be final and conclusive unless, within thirty (30) days from the date of the decision, the Contractor files a written appeal addressed to the Undersecretary, California Department of Veterans Affairs.

D. The Undersecretary’s decision shall be final and conclusive unless the decision is arbitrary, capricious, grossly erroneous or if any determination of fact is unsupported by substantiating evidence. The Undersecretary’s decision will be in writing and may encompass facts, interpretations of the Contract, and determination or application of law. The Contractor may, prior to the Undersecretary’s decision, present oral or documentary evidence, and arguments in support of the Contractor’s appeal. The decision will either:

1) Find in favor of the Contractor, in which case the Undersecretary may:

a) Countermand the earlier conduct which caused the Contractor to file a dispute; or

b) Reaffirm the conduct and, if there is a cost impact sufficient to constitute a change in obligations pursuant to the payment provisions, direct the State to comply with that Section.

2) Deny the Contractor’s dispute and, where necessary, direct the manner of future performance; or

3) Request…

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