HomeMy WebLinkAbout14-Fire Department
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CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION
From: Larry R. Pitzer, Fire Chief
Subject:
Authorization to submit a contract proposal for the
development and implementation of a Metropolitan
Medical Response System (MMRS) and accept
funding allocation in the amount of $400,000.
Dept: Fire
7~',""~ '~. J
Date: March 11,2002
MC/C Meeting Date:
April 1, 2002
Synopsis of Previous Council Action:
06/04/01
Resolution #2001-149 authorizing the City's participation in a terrorism domestic
preparedness training program and acceptance of an equipment and administrative grant
from the U.S. Department of Justice in the amount of $310,000.
RECOMMENDATION:
Adopt resolution.
Contact Person: Larrv Pitzer. Fire Chief
Phone: 384-5286
Supporting data attached: Staff Report. Resolution. & Proposal
Ward: Citywide
FUNDING REQUIREMENTS:
Amount:
$0
Source:
(ACCT. No)
(Acct. Description)
Finance:
Council Notes:
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,
Agenda Item No. /'1
STAFF REPORT
SUBJECT:
Authorization to submit a contract proposal for the development and implementation of a
Metropolitan Medical Response System (MMRS) and accept funding allocation in the
amount of $400,000.
BACKGROUND:
As a follow-up to the City's implementation of the United States (U.S.) Department of
Justice's Terrorism Domestic Preparedness Program, the U.S. Department of Health and
Human Services (DHHS) is offering each participating city an opportunity to enter into
fixed price contracts for disaster medical response development. The contracts require
each city to formulate an implementation plan tailored to its existing system and needs.
The plan includes equipment, supply, pharmaceutical, and training requirements. The
concept of operation integrates local, state, and federal health and medical support.
MMRS teams are designed to provide initial on-site response and provide for safe patient
transport to hospital emergency rooms in the event of a terrorism incident. The systems
are characterized by specially trained responders, available special pharmaceuticals and
decontamination equipment, on-site health care, and enhanced emergency medical
transportation and emergency room capabilities. The initial DHHS funding allocation
will be $400,000.
Additionally, the City is eligible to receive a $200,000 supplemental funding allocation
during the following fiscal year to plan for an appropriate emergency response to a
biological terrorist attack. This funding provides support for local jurisdictions to
develop/augment plans directed at the early recognition of a biological event, mass
immunization/prophylaxis, mass care, mass fatality management, and environmental
surety.
FINANCIAL IMPACT:
The DHHS will provide the City with an initial funding allocation of $400,000 to develop
an MMRS Program. This funding is contingent on the City's completion of required
planning deliverables specified in the Request for Proposal. The funding will be
disbursed incrementally based on the City's timely submission of the following planning
deliverables:
ITEM
AMOUNT OF PAYMENT
Deliverables I and 2
$120,000
. Meeting with DHHS Project Officer
. MMRS Development Plan
Includes Development Team and
Steering Committee membership
ITEM
AMOUNT OF PAYMENT
Deliverables 3 and 4
$ 40,000
. Basic MMRS Plan
. Plan component for managing the
health consequences of a biological
weapon of mass destruction (WMD)
Deliverable 5
$ 60.000
. MMRS plan component for responding
to a chemical, radiological, nuclear, or
explosive WMD event
Deliverables 6 and 7
$ 20.000
. Plan component for a Metropolitan Medical
Strike Team (MMST), if necessary
. MMRS plan component for the forward
movement of patients regionally or to other
areas of the nation
Deliverables 8. 9, 10, and 11
$160.000
. MMRS plan component for local hospitals
and regional healthcare systems
. MMRS training plan (includes initial and
Refresher training requirements)
. MMRS equipment plan
. Progress Reports (this shall be a brief monthly
Status report) and a Final Operational Report I,
TOTAL $400,000
Funding pnontIes for the MMRS Project include personal protective equipment,
detection and decontamination equipment, pharmaceutical supplies, and communications
equipment. The need for a part-time consultant to assist with program development will
also be evaluated during the initial development phase. The DHHS RFP does not require
a detailed budget at this time; however, the following proposed budget reflects estimated
costs for the above items:
~"
2
MMRS Proposed Bud!!et*
Plannin!!
Personnel** (May be needed)
Consultant ($30/hr x 400 hrs)
$ 12,000
Long Distance Travel
$ 5,000
Planning Total
$ 17,000
Pharmaceuticals
$150,000
Equipmentlfraining
$200,000
Office SuppliesJEquipment
$ 5,100
Total Direct Costs
$372,100
Miscellaneous (Indirect 7.5 % )
$ 27,907
TOTAL COSTS
UQP.QP7
*
A detailed budget cannot be provided at this time since the MMRS Development
Team has not been formed. Once this group is identified, a thorough assessment
of training and equipment needs will be conducted and funding needs will be
prioritized. At that time, we will be able to formulate a more detailed budget for
the MMRS Project.
**
Project management (planning and development) will be provided primarily
through in kind services from the San Bernardino City Fire Department's Disaster
Management Coordinator and EMS Coordinator positions. The use of consultant
services may be necessary during the project planning phase. Funds not used for
consultant services will be applied to additional equipment/supply needs.
The Fire Department's Disaster Preparedness Division will provide overall project
management and will coordinate efforts with other impacted City and County
departments as well as other emergency support agencies. An MMRS Development
Team and Steering Committee will be formed to assess and identify first responder
training and equipment needs for the San Bernardino area. At that point, the City may
begin to procure the special equipment and pharmaceutical supplies to improve local
response to a weapon of mass destruction event. Funding priority will be given to Fire
(HAZMAT and EMS), Police and local hospitals. As each deliverable is completed,
DHHS will direct deposit the indicated funds to a pre-established City account. The City
will, in turn, submit Federal vouchers for each purchased item.
3
All equipment and/or pharmaceutical supplies purchased through this program will be the
property of the City of San Bernardino. As the project develops, there may be a need to
store some of the pharmaceutical supplies at local hospitals. A property officer will be
designated within the Fire Department and Police Department, respectively, to conduct
regular inventories of all purchased items through this contract. This will not be a new
position, but provided through in kind services.
Sustainment funds for future equipment maintenance costs are not provided through this
program, but will be absorbed in the Fire Department's budget. There are no matching
requirements and no net impact to the City's General Fund for fiscal year 2002-2003.
RECOMMENDATION:
Adopt resolution.
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~.0.~W
RESOLUTION NO. '--r'G . ~
I U
RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN
BERNARDINO AUTHORIZING THE SUBMITTAL OF A CONTRACT PROPOSAL
FOR THE DEVELOPMENT AND IMPLEMENTATION OF A METROPOLITAN
MEDICAL RESPONSE SYSTEM (MMRS) AND ACCEPT FUNDING ALLOCATION IN
THE AMOUNT OF $400,000.
BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF
SAN BERNARDINO AS FOLLOWS:
SECTION 1. The City Administrator or designee is authorized to sign and submit a
contract proposal to the Department of Health and Human Services for the development of a
Metropolitan Medical Response System in the amount of $400,000. A copy of the contract
proposal is attached as Attachment "A", and incorporated herein by reference.
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- 27
I
RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN
BERNARDINO AUTHORIZING THE SUBMITTAL OF A CONTRACT PROPOSAL
FOR THE DEVELOPMENT AND IMPLEMENT A TION OF A METROPOLITAN
MEDICAL RESPONSE SYSTEM (MMRS) AND ACCEPT FUNDING ALLOCA nON IN
THE AMOUNT OF $400,000.
2
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I HEREBY CERTIFY that the foregoing resolution was duly adopted by the Mayor and Common
6
Council of the City of San Bernardino at a
meeting thereof, held on the
7
day of
, 2002, by the following vote, to wit:
8
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NAYS
ABSTAIN ABSENT
COUNCILMEMBERS
AYES
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ESTRADA
II
LIEN
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MCGINNIS
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DERRY
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SUAREZ
IS
ANDERSON
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MCCAMMACK
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Rachel Clark, City Clerk
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20 The foregoing resolution is hereby approved this
day of
,2002.
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Judith Valles, Mayor
City of San Bernardino
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Approved as to
Form and legal content:
25
JAMES F. PENMAN,
City Attorney
28 By:
2
Attachment "A"
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Metropolitan Medical Response System
Proposal
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City of San Bernardino
Fire Department
200 East Third Street
San Bernardino, California 92410
RFP #233-02-0042
March 2002
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City of San Bernardino
PROPOSAL FOR THE DEVELOPMENT OF A
METROPOLITAN MEDICAL RESPONSE SYSTEM
TABLE OF CONTENTS
Section I: Technical Proposal
. Introduction
. Situation and Threat Background
. Objective and Scope
. Timetable for Deliverables
Section II: Business Proposal
. Proposed Budget
. Payment Information Form
Section III: Representations and Certifications
. Solicitation, Offer and Award (Standard Form 33)
. Section K - Representations, Certificates, and Other Statements of
Offerors
. Disclosure of Lobbying Activities
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City of San Bernardino
PROPOSAL FOR THE DEVELOPMENT OF A
METROPOLITAN MEDICAL RESPONSE SYSTEM
INTRODUCTION
The City of San Bernardino, with a population of over 186,000, is the largest city in the
largest county in the United States. The County of San Bernardino is geographically the
largest county in the contiguous United States, covering 20,000 square miles of diverse
climate and terrain. The City and County share a very large jurisdiction with resources
that are critical to the State of California and the economy of the United States. The
presence of potential terrorist targets within our military and civilian hazardous materials
handling facilities, transportation corridors, and critical resources is undeniable.
SITUATION AND THREAT BACKGROUND
Terrorism is of increasing concern because ofits potential for mass injury, destruction
and death in venues previously deemed to be safe havens. Chemical and Biological
warfare tactics are being used more frequently by terrorist-type groups and pose an
increasingly serious threat to public safety organizations and the public. The rapid
technological growth in the San Bernardino region during the past few decades has
resulted in an infrastructure that is tightly interconnected by vast systerns of
communications, transportation, industry, government and economic integration.
Threat Assessment - Chemical Facilities
Approximately 8000 facilities in the San Bernardino area handle, process, and dispose of
hazardous materials in quantities requiring disclosure under the State's Emergency
Planning and Community Right to Know law. Ofthese facilities, 412 house chemicals
above the designated threshold planning quantities limits that the EP A has classified as
Extremely Hazardous Substances. These facilities include high volume (bulk tank or
railcar) users of chemicals including but not limited to chlorine, ammonia, nitric acid,
sulfuric acid, and hydrofluoric acid. Highly toxic gases such as arsine, hydrogen
fluoride, hydrogen chloride, and various industrial gases are used in quantities exceeding
reporting thresholds. Due to the type and nature of this chemical handling, some of these
facilities could be targeted for theft, sabotage, or intentional release of chemicals.
Vulnerable zones for the releases of some of these large volume toxic gases (e.g. railcars
of chlorine) have been calculated to exceed 25 miles. Approximately 43 facilities were
required to prepare Risk Management Programs under EP A Accidental Release
Prevention Program requirements. An intentional act of terrorism at any of these
facilities could result in a large-scale disaster.
Threat Assessment - Radioactive Waste
A radioactive waste disposal site is being proposed for a desert area in San Bernardino
County known as Ward Valley, adjacent to Interstate 40. This location has already been
the site of numerous events of civil disobedience and could be targeted for a terrorist act.
In addition to this proposed facility, low-level radioactive waste generated from federal
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Proposal for Development ofMMRS Plan
Technical Proposal
Page 2 of7
TRANSPORTATION INFRASTRUCTURE
The San Bernardino region occupies a strategic location with regard to transportation
corridors. It straddles most of the surface routes connecting the Southern California
Metropolitan Area (including the Ports of Long Beach and Los Angeles) with the rest of
the contiguous United States. Consequently, rail, pipeline, and highway transportation is
a significant factor in both the potential for a large scale release from one of these modes
of bulk transportation due to an intentional act, and in the resulting devastating disruption
in national commerce and civil rest.
The Cajon Pass is a critical geographic feature of the San Bernardino area that co-locates
one Interstate, two railroads, two hazardous liquid pipelines, two high-pressure natural
gas transmission lines, water lines, and two high-power electric transmission corridors.
The lifelines of fuel, power, water, and commerce to Southern California come through
the Cajon Pass. Traffic loads through the Pass can be as high as 250,000 vehicle trips per
day. The California Public Utilities Commission has identified the Cajon Pass as one of
the highest risk sections of rail in the State due to steep terrain and serpentine track
patterns. The Cajon Pass Derailment of 1996 clearly illustrated the strategic location and
national significance of an extended closure of the Cajon Pass. By the third day of the
incident trains were backed up as far to the East as New Mexico, and the economic
impacts were felt all the way to the East Coast.
Hil!hwavs
The San Bernardino region has three major Interstate Highways -- Interstate 10, Interstate
15 and Interstate 40. Interstate 10 is the major connecting route between the Los Angeles
area and the East Coast. Interstate 15 is the only major route that connects from the U.S.-
Mexican border at San Diego to Las Vegas and beyond. Interstate 40 connects Northern
California to the East Coast and is part of the designated route for escorted DoD and
NASA shipments of dinitrogen tetroxide from Aerojet and Vandenberg. Major
connecting freeways include the 60 and 215 Freeways which are State Highways. A
significant portion of State Highway 395 connects Southern California to the Tahoe
Basin.
The Highway 58IUnion Pacific Corridor from Barstow to the Kern County line is the
only southern rail link for the San Francisco Bay Area and Central California. The
significance of its strategic location was demonstrated in February 1997 when a train
collided with a tractor-trailer and was closed for 30 hours. In that time, rail and truck
traffic backed up into Central California. It is also the only designated route for rocket
fuel for both Edwards Air Force Base and Vandenberg Air Force Base.
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Proposal for Development ofMMRS Plan
Technical Proposal
Page 3 of7
Railroads
Four major railroads traverse the San Bernardino region including Union Pacific (UP)
Railroad, Burlington Northern Santa Fe Railroad (BNSF) and passenger lines Amtrak and
Metropolitan Transportation Authority (MTA). Both UP and BNSF have two major
classification yards in the County. As the two remaining transcontinental rail service
providers, all commodities traveling from the Pacific Rim Countries to the Eastern Sea
Board must pass through these terminals. A Transportation Hazards Analysis done for
the Local Emergency Planning Committee (LEPC) indicated that San Bernardino County
rail shipments exceeded all other counties in the LEPC Region in terms of shipments as
well as the variety of hazardous cargo transported.
Pinelines
Several large diameter high-pressure hazardous liquid pipelines traverse the San
Bernardino area connecting points along the pacific coast with points east. A large, high
pressure fuel line known as the CALNEV Pipeline runs from the Los Angeles Basin to
Las Vegas, Nevada, carrying petroleum products, including but not limited to jet fuel for
Nellis Air Force Base. The pipeline travels parallel to both rail lines and major roadways
at various points along its course and is considered a potential target for terrorists. AII-
American pipeline transports petroleum through more than 100 miles of pipeline within
the County, on its path from Santa Barbara to Texas. Two pipelines transporting
hydrogen and oxygen connect suppliers with their major customers. The hydrogen line
runs parallel to the railroad and crosses the rail line and Interstate 10.
Airnorts
There are three international airports within San Bernardino County including Ontario
International Airport (OlA), Southern California International Airport (SCIA) and San
Bernardino International Airport (SBDIA). All three are considered potential targets of a
terrorist act.
Government Facilities
Situated within San Bernardino County are various State and Federal facilities that could
become targets. These include five major military bases: the Marine Corps Logistics
Base at Yermo, the Fort Irwin National Training Center north of Barstow, 29 Palms
Marine Corp Air Ground Combat Center in 29 Palms, the Naval Weapons Center at
China Lake and a portion of Edwards Air Force Base that houses the X-33 Space Shuttle
rocket launching and testing facility. Over 83,000 pounds of liquid hydrogen propellant
are stored and used at the rocket-launching site. The primary mission ofthe military
facilities is to act as national training centers for all branches of the military, including
preparation for desert warfare activities.
Also included within govemment facilities are offices for the: Immigration and
Naturalization Service (INS); USFS Department of Agriculture; Military recruiting
offices; Army ReservelNational Guard Armories; U.S. Bankruptcy Court; California
Franchise Tax Board; the Central U.S. Postal Distribution Facility; and a Mexican
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Proposal for Development ofMMRS Plan
Technical Proposal
Page 4 of7
Consulate Office. State Corrections has three institutions with maximum-security
inmates in the Chino area -- California Institute for Men, California Institute for Women,
and Califomia Youth Authority.
Civilian Venues
San Bernardino County has several large civilian facilities that could be a potential
terrorist target as well. The California Speedway in Fontana attracts crowds over
100,000 four to five times per year. There are large convention centers near Ontario
International Airport and another in San Bernardino. Blockbuster Pavilion, located at the
Glen Helen Regional Park attracts thousands of people during live concert activities. The
annual San Bernardino Route 66 rendezvous attracts in excess of 500,000 people over a
three-day period.
Sources orSare Drinkinl! Water
The California Aqueduct traverses the county bringing drinking water from Northern
California to the Southland, draining into Lake Silverwood Reservoir in the San
Bernardino Mountains. This water eventually is destined for the major metropolitan area
of Los Angeles. This is a popular tourist site as are many of the mountain resorts,
particularly during the winter months and could become a potential terrorist target. The
Colorado River borders the eastern boundary ofthe County and is a source of recreation,
drinking water, and agricultural irrigation for communities in several states.
Medical Facilities
There are no less than ten major hospitals within San Bernardino County. Included
among these is the County Arrowhead Regional Medical Center, Jerry L. Pettis Memorial
Veterans Medical Center, and Loma Linda University Medical Center and Research
Facility, both of which are located in Loma Linda approximately one half mile apart.
OBJECTIVE AND SCOPE
The City of San Bernardino, through a collaborative effort with the County of San
Bernardino and other local jurisdictions and/or agencies within San Bernardino County,
is proposing to enhance the current local resources in response to health and medical
consequences of a nuclear, biological or chemical (NBC) terrorist incident.
The San Bernardino City Fire Department will manage the development and
implementation of the MMRS Project. The San Bernardino MMRS Project will be
integrated with the existing regional San BernardinolRiverside Terrorism Early Warning
Group (TEWG). The goal will be to involve all key agencies represented on the TEWG
including: the County Public Health Department, local hospitals, local Emergency
Medical Providers, Fire Departments (including EMS and Hazardous Materials Teams),
Law Enforcement Agencies (including Bomb Squads and SWAT Teams), Mental Health,
local laboratories, veterinarians, Medical Examiner, Local and State Emergency
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Proposal for Development ofMMRS Plan
Technical Proposal
Page 5 of7
Management, State EMS Authority and Health Department, National Guard, FBI, Public
Utility Agencies, American Red Cross, and other local federal agency representatives.
The MMRS Plan will include the following components:
I. Method for identifying concepts of operation including plans for:
d.
e.
e f.
g.
h.
a. Notification and alert procedures of EMS, fire, law enforcement, hospitals
and public health. This must include procedures for notification of
hospitals, clinics and HMOs;
b. System for command and control;
c. Centralized communications with the ability to contact both local and
national resources. There is a need, not only for a common
communications system among emergency responders, but also between
emergency responders and local county agencies. The MMRS Plan will
address this issue with solutions for a fluid communications system;
A means for management of public affairs;
Identification of agent;
Containment of agent;
Management of victims including decontamination, triage, pre-hospital
treatment, and transportation to appropriate facilities (to local facilities or
other areas within the region or nation as appropriate);
Many victims will present at hospitals and clinics on their own and by-
pass pre-hospital interventions. The MMRS Plan will include provisions
addressing Weapons of Mass Destruction (WMD) recognition and
treatment, lock-down procedures, outside triage, outside decontamination,
proper Personal Protective Equipment (PPE) for healthcare workers, and
adequate security for these sites.
I. Definitive treatment at hospitals;
J. Examination and disposal of deceased;
k. Appropriate response by mental health workers.
2. A mission statement, organization, membership and operational guidelines for the
Metropolitan Medical Strike Team (MMST), if a strike team is determined the
best option for the San Bernardino area.
3. Management of health consequences of a biological WMD. This will include the
integration of the plan with existing local and state health surveillance plans for
bioterrorism and influenza pandemic planning. This portion of the plan will
address five issues:
e
a.
Early Recognition -- including early indicators and who will make
decisions to implement .response plans;
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Proposal for Development ofMMRS Plan
Technical Proposal
Page 6 of7
b. Mass Immunizations -- develop plans for managing and implementing
mass immunizations/prophylaxis;
c. Mass Patient Care -- providing care for a significant portion of the
community;
d. Mass Fatality Management -- develop plans for providing care and
disposition for large numbers of fatalities including
decontamination/isolation procedures
e. Environmental Surety -- identifying environmental risks, decontamination
or vector intervention and re-entry into the suspect area with the help of
local, state and federal environmental agencies.
4. Identification of training requirements for MMRS personnel including emergency
first responders, EMTs, Paramedics, hospital and other personnel who may be
involved in an incident.
a.
As a current recipient of the U.S. Department of Justice's Terrorism
Domestic Preparedness Program, the City, County and other local
emergency support agencies have been participating in aU available
terrorism preparedness courses. The train-the-trainer courses wiU aUow
participating agencies to develop additional training opportunities for their
respective agencies. This training will continue until all appropriate
personnel have been trained.
Continuing education/refresher training will also be conducted along with
system-wide exercise driUs.
This training will include the assessment and implementation of additional
specialized training for San Bernardino Hazardous Materials Team
members in the area of Hazardous Materials and WMD.
There is a need for hospital staff to conduct ongoing Hospital Emergency
Incident Command System (HEICS) training. HEICS Training will be
provided to San Bernardino hospital personnel. There is also a need for
training of other healthcare workers (e.g., clinics, HMOs, etc.). These
groups will be identified and training needs assessed.
b.
c.
d.
5. A pharmaceutical plan wiU be developed to identifY and procure approved
pharmaceuticals to meet the needs of emergency responders and the community
in the event of an NBC terrorist incident. The plan will include a way of
"rotating" pharmaceuticals and a means of maintaining an appropriate supply
beyond the term of this project.
6.
An equipment list will be developed to meet the needs of the San Bernardino area
in the event of an NBC terrorist incident. This list may include personal
protective equipment, detection equipment, decontamination equipment, and
communications equipment. Any equipment purchased will be coordinated with
equipment received by other county agencies from California Office of
Emergency Services, State Department of Health Services, State EMS Authority,
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Proposal for Development of MMRS Plan
Technical Proposal
Page 70f7
DoD, DOJ, DHHS, and FEMA. The San Bernardino City Fire Department will
work with public health, local hospitals, laboratories, law enforcement and other
fire departments to assess the needs. A "property officer" will be identified to be
responsible for all property received under this contract.
TIMETABLE FOR DELIVERABLES
Description ..' .... . ; ...;....Delivery
\. Meet with Project Officer Within I month of contract award
2. MMRS Development Plan Within 45 days of contract award
3. Basic MMRS Plan Within 7 months of contract award
4. MMRS Plan component to manage the Within 8 months of contract award
health consequences in the event of a
biological WMD agent release.
5. MMRS Plan component for responding Within 9 months of contract award
to and managing the health
consequences of an incident resulting
from use of a chemical, radiological;
nuclear, and/or explosive WMD.
6. MMRS Plan component for a Within 12 months of contract award
Metropolitan Medical Strike Team
(MMST) capability, if applicable.
7. MMRS Plan component for addressing Within 18 months of contract award
the Forward Movement of Patients to
other areas of the region or the nation.
8. MMRS Plan component for the local Within 18 months of contract award
Hospital and healthcare system that will
ensure a surge capacity to accommodate
500 critically ill patients in hospitals or
alternative care facilities.
9. MMRS Training Plan Within 18 months of contract award
10. MMRS Equipment Plan Within 18 months of contract award
II. Progress Reports/Final Report Monthly Progress Reports/Final Report due
at end of 18 month contract period
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City of San Bernardino
PROPOSAL FOR DEVELOPMENT OF A
METROPOLITAN MEDICAL RESPONSE SYSTEM
Business Proposal
Budget For 18 Month Project
Planninl!
Personnel.
Consultant ($30/hr x 400 hrs) $ 12,000
Long Distance Travel $ 5,000
Planning Total $ 17,000
Pharmaceuticals $150,000
EquipmentlTraining $200,000
e Office Supplies/Equipment $ 5,000
Total Direct Costs $372,000
Miscellaneous (Indirect 7.5%) $ 27,900
TOTAL COSTS $399,900
.
Project Management (planning and development) will be provided primarily
through in-kind services from the San Bernardino City Fire Department's
Disaster Management Coordinator and EMS Coordinator positions. The use
of consultant services may be necessary during the project planning phase.
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Au~_t.d C1e.rin, House ..,.....~ 'yst_.
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FedoE.l ~loyee: _ CODtr.etor: _ Vendor:
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e
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MdE'.S: IIf .... a. Ibove,
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mateh ld6ress OD
invoice ro~ internal
control' purpose.. I
TlxpayeE IdenUt1eation . ITtNI: 95 6. 0 0 0 7_ ---L. 2
IIf )'ou .n an lad1vidua1. thi.. ~ovrs~a1'"'S.arfi"Y'niiii&eil
1. ..y.... Tel.pllone HUBbel: 1_____'
The (ollOMln' iftfo~tion must be ccapl.~ed by youE finlncill in.t1tu~:Lon
representative:
2. .... of riftlneial
In.~i~ution: WELLS FARr.o ~A!m
3. AddEO" of rlnonc1sl
In.~~tution: Government Banking
707 Wilshire Blvd., 16~h Floor
MAC#E2818-16A, Los An2el~s. CA 90017
4. t1n.n~i.l %n.~l~ution's '.dl,1t ABA Routing ~r fOE
Tnnder of I'll""': 1-.L. -L ..JL ...!L, ...!L. ...2..... ...L ....a...
S. Depositor ~covnt Title: City of San Bernardino
6. Deposi~OE Accovnt N1IIoI>n, 415928H08
,. Type of ~co...t: ~ c:becking _ Savings
I. Sign~tur, MId 1'~. of AuthoEit;ec1 oUicla1 lfinanci.l D
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Telepnone _r:..IJ!li...1 'AL-~"'l Date: 3/12/02
............ The fallDwing ~st be si ned by the p.yec..............
J have verified tho info~tio. on tIli. form.
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233-02-0042
I. THIS CO'\IT RAO IS A RAT EO cnOER
UNDER DPAS (15 CfR 700)
4 I YPE CF salOl AIIO<
o SEALED BID O'Bl
X NEGOT IAI ED (R'P) 02126/02
B ADDRESS CHER 10 Qf at"... t/1alll.", 7)
-... RATING
PAGE Cf PAGES
1 59
b. REQlrSllro<,pUROiASE
NO
??oo89
SOlIOT AT ION, OFFER AND AWARD
2. CQ\IT RACT NO.
3. salOT AllO< NO.
5 DATE ISSUED
. ISSUED BY CXXlE
., DHHSlProgram Support Center
AOSlDivision of Acquisition Management
Parklawn Building. Room 5-10 I
5600 Fishers Lane. Rockville. MD 20857
NOI'E: In sedEldbdsOltdtdic:ns -af" a1d-afer~ ITS:J'S -t:id' a'ICI-t::id:::B-.
SOlIOl AT ION
9. Seded offers in aignd ad 1
hal,Ctx:rriec1 in the d3p:sitoy h:xxfed in
cq:ies fer "snishing the sl.Q:iiES a services in the Sd"Iec:1Je will be receiVEd d the Jja:::e specjfied in itEm 8. a if
S.. Block 7 Lr'llll S-OOp m loed time 04111102
(HQI) (1)7.,
See Sedicn L. PrC>lisicn No. 52.214-7 a 52.215-1. All elfS's aeslt:ie:t 10 dl fS'm; <rod
CAUTION - LAT E SlbTissicn. Modficx:licns. O'ld WlthctONds:
a:rdticns ccntdned in this sdidtdlO'l.
10. FOR A NAME
INFORMAIIO< ....
CALL: ,...
B T LEPH
"00 .......
LECT CALLS
x
C E-MAIL ADDRESS
mtroller@psc.gov
Michele TrOller
(Xl SEC DESORIPTIO< DESOlIPIIO< PAGE(S)
PART I - THE SOiEDULE PART II - CXNT RACT Q.AUSES
X A salOl AT IO</CO'ITRACT FalM I X I CQ\ITRACT Q.AUSES 26-33
X B SUPPLIES al SERVICES AND PRICEs/cons 2-3 PART 111 - LIST CF DCCUMENTS. EXHIBITS AND orHER AT! AO<.
X C DESO?IPTlo<,sPECS./WOlK ST ATEMENT 4-16 X J LIST CF AT! AO<MENT S 34-59
X 0 PACl<AGlNG AND MARKING 17 PART IV - REPRESENT AIIO<S AND INSTRUCT IO<S
X E INSPECTIO< AND A=PT ANCE 18 REPRESENT AIIO<S. CERTIFICATIONS AN:)
X K .-15
X F DELIVERIES al PERFORMANCE 19-20 orHER ST AT EMENT S CF CFFERORS
X G CCNTRACT ADMINISTRATlO< OAT A 21-24 X L INSTRS.. CCNDS.. AND Nor ICES TOCFFERORS 1-3
X H SPEOAL CXNTRACT REQlIREMENTS 25 X M EVALUATlO< FACT ORS FOR AWARD 1
OFFER (Must be Iully crrrpeled ~ cllga)
E: ItEm 12 d:Jes rot Q:X:jy if thesolidtction Irdu::tas thepc:Msicnct 52.214.16. Minirn.mBid~a'CeP&iod.
. In c:x::nP1ac:e with the c:toJe the ..ndIirsiO'lBd cg'ees. If this af. is QX:eJ:ted within cd8'lCtJ CiJ;'s (60 a::JErJdJ ~ crtIe51 odffflfrlt
pgiod is insfiTte::J tIy the cJffila) fran the ct:te fa rElOElij:t a afers spedfied d::Dfe to fll'nish arv a dl ItEWT'S upon wtlIctl p'ic:es ae dfeed ct the piCB set
~ite ea:tl item dalivered ct the de5iglCied pjint(s). within the t1lTB SPJjfied in tne sdlecUe.
~ 10 CALENDAR DAYS 20 CALENDAR DAYS
30 CALENDAR DAYS
40 CALENDAR DAYS
13 OISCOJNT Fm PRo..1PT PAYMENT
(SeeSedia> I. OcuseNa 52-232-B)
14. ACl<NONLEDGMENT CF AMENDMENT S
(The cJff!lry cDcnow/~ rec::St:X cJ aneno.
mErIts to meSa/OT Af/OV fa cJfeICxs md
raded c:t:IO.Jt'n!:nts nurrtBed mcJ crJect)
CXXlE
AMENDMENT NO.
DATE
AMENDMENT NO
DATE
15A. NAME
AND
ADDRESS
Cf
CFFERal
lb. NAME AND TiTLE CF PERSO< AUT HallZED TO SIGN CfFER
(T ype CT pInt)
City of San Bernardino
300 North "n" Street
San Bernardino, CA 92418
15B TELEPHO<E NUMBER 15C O<ECl< IF REMIT! ANCE ADDRESS IS
....... x 0 DIFFERENT FRQ..1 ABOVE ENTER SUO<
384-5122 ADDRESS IN SO<EOULE
Fred
City
Wilson
Administrator
"eo
909
17. SIGNAIURE
18. CFFER DATE
19. A=PTED AS TOITEMS NUMBERED
AW ARD (f 0 be c:urr:Jeled ~ GC>IernrTlfTlf)
20. AMOJNT 21. A=NT ING AND APPRQPRIAT 10<
22. AUIHallTY FO? USING or HER THAN FULL AND <YEN Cl:MPETlTIO<:
010 U.S.C 2304 (c)( 041 U.S.C 253 (c)(
24. ADMINISTERED 8Y (iI at"... thalli.", 7) CXXlE
23. SUBMIT INVOCES 10 ADDRESS SHOWN IN
(4 c:cpes Lrless oth8wise specified) ~
25. PAYMENI WILL BE MADE BY =E
NAME CF CXNTRAOINGCFFlCER (fvpea pint)
27. UNITED SlATES CF AMERICA 2B AWARD DATE
(Si lie ct ecnrra;t, OfiCB)
IMPORT ANT - Awadwill berttdecn fhis Fam 01 on SfO'1c1Jd Fam 26. 01 Oi ofhe' OJthaizedelfidd written notice.
AUTH~IZED Frn LOCAL REPRCDJOICN Sf ANDARD FORM 33 (REV Q.Q7)
PJt'Vltu edl,O"'lI$lA.!sdje PrEl5alt:&j~ Q;A. FA!? (48 CFR)53 214 (C)
C'"ttdl~ I'ff"M<<I:o_~Iba:uhl;JMI4oG~ IEF
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SECTION K - REPRESENTATIONS. CERTIFICATES. AND OTHER STATEMENTS
OF OFFERORS
10.
l.
2.
FAR 52.203-2
FAR 52.203-11
Certificate of Independent Price Determination
Certification and Disclosure Regarding
Payments to Influence Certain Federal
Transactions
Taxpayer Identification
Certification Regarding Debarment, Suspension,
Proposed Debarment and Other Responsibility
Matters
Place of Performance
Small Business Concern Representation
Previous Contracts and Compliance Reports
Affirmative Action Compliance
Certification of Toxic Chemical Release
Reporting
The Pro-Children Act of 1994
To Be Completed by the Offeror: (The Representations and
Certifications must be executed by an individual authorized to
bind the offeror.)
3 .
4.
FAR 52.204-3
FAR 52.209-5
The offeror makes the following Representations and
Certifications as part of its proposal (check or complete all
appropriate boxes or blanks on the following pages) .
5.
6.
7.
8.
9 .
FAR 52.215-6
FAR 52.219-1
FAR 52.222-22
FAR 52.222-25
FAR 52.223-13
233-02-0042
(RFP No.)
P.L. 103-227
City of San Bernardino
(Name of Offeror)
(Signature of Authorized Individual)
(Date)
Fred Wilson, City Administrator
(Typed Name of Authorized Individual)
Note: The penalty for making false statements in offers is
prescribed in 18 U.S.C. 1001.
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SECTION K
233-02-0042
Page 2 of 15
1. 52.203-2 Certificate of Independent Price Determination.
(APR 1985)
(a) The offeror certifies that -
(1) The prices in this offer have been arrived at
independently, without, for the purpose of restricting
competition, any consultation, communication, or
agreement with any other offeror or competitor relating
to -
(i) Those prices;
(ii) The intention to submit an offer;, or
(iii) The methods or factors used to calculate the
prices offered.
(2) The prices in this offer have not been and will not
be knowingly disclosed by the offeror, directly or
indirectly, to any other offeror or competitor before
bid opening (in the case of a sealed bid solicitation)
or contract award (in the case of a negotiated
solicitation) unless otherwise required by law; and
(3) No attempt has been made or will be made by the
offeror to induce any other concern to submit or not to
submit an offer for the purpose of restricting
competition.
(b) Each signature on the offer is considered to be a
certification by the signatory that the signatory -
(1) Is the person in the offeror's organization
responsible for determining the prices being offered in
this bid or proposal, and that the signatory has not
participated and will not participate in any action
contrary to subparagraphs (a) (1) through (a) (3) of this
provision; or
(2) (i) Has been authorized, in writing, to act as agent
for the following principals in certifying that those
principals have not participated, and will not
participate in any action contrary to subparagraphs
(a) (1) through (a) (3) of this provision [insert full
name of person(s) in the offeror's organization
responsible for determining the prices offered in this
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SECTION K 233-02-0042
Page 3 of 15
bid or proposal, and the title of his or her position
in the offeror's organization];
(ii) As an authorized agent, does certify that the
principals named in subdivision (b) (2) (i) of this
provision have not participated, and will not
participate, in any action contrary to
subparagraphs (a) (1) through (a) (3) of this
provision; and
(iii) As an agent, has not personally
participated, and will not participate, in any
action contrary to subparagraphs (a) (1) through
(a) (3) of this provision.
(c) If the offeror deletes or modifies subparagraph (a) (2)
of this provision, the offeror must furnish with its offer a
signed statement setting forth in detail the circumstances
of the disclosure.
2.
52.203-11 Certification and Disclosure Regarding Payments to
Influence Certain Federal Transactions. (APR 1991)
(a) The definitions and prohibitions contained in the
clause, at FAR 52.203-12, Limitation on Payments to
Influence Certain Federal Transactions, included in this
solicitation, are hereby incorporated by reference in
paragraph (b) of this certification.
(b) The offeror, by signing its offer, hereby certifies to
the best of his or her knowledge and belief that on or after
December 23, 1989 -
(1) No Federal appropriated funds have been paid or
will be paid to any person for influencing or
attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress on his
or her behalf in connection with the awarding of any
Federal contract, the making of any Federal grant, the
making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation,
renewal, amendment or modification of any Federal
contract, grant, loan, or cooperative agreement;
(2) If any funds other than Federal appropriated funds
(including profit or fee received under a covered
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SECTXON K 233-02-0042
Page 4 of 15
Federal transaction) have been paid, or will be paid,
to any person for influencing or attempting to
influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress on his or her
behalf in connection with this solicitation, the
offeror shall complete and submit, with its offer, OMS
standard form LLL, Disclosure of Lobbying Activities,
to the Contracting Officer; and
(3) He or she will include the language of this
certification in all subcontract awards at any tier and
require that all recipients of subcontract awards in
excess of $100,000 shall certify and disclose
accordingly.
(c) Submission of this certification and disclosure is a
prerequisite for making or entering into this contract
imposed by section 1352, title 31, United States Code. Any
person who makes an expenditure prohibited under this
provision or who fails to file or amend the disclosure form
to be filed or amended by this provision, shall be subject
to a civil penalty of not less than $10,000, and not more
than $100,000, for each such failure.
3.
52.204-3 Taxpayer Xdentification. (OCT 1998)
(a) Definitions.
Common parent, as used in this prOV1S1on, means that
corporate entity that owns or controls an affiliated group
of corporations that files its Federal income tax returns on
a consolidated basis, and of which the offeror is a member.
Taxpayer Identification Number (TIN), as used in this
provision, means the number required by the Internal Revenue
Service (IRS) to be used by the offeror in reporting income
tax and other returns. The TIN may be either a Social
Security Number or an Employer Identification Number.
(b) All offerors must submit the information required in
paragraphs (d) through (f) of this provision to comply with
debt collection requirements of 31 U.S.C. 7701(c) and
3325(d), reporting requirements of 26 U.S.C. 6041, 6041A,
and 6050M, and implementing regulations issued by the IRS.
If the resulting contract is subject to the payment
reporting requirements described in Federal Acquisition
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SECTION K
233-02-0042
Page 5 of 15
Regulation (FAR) 4.904, the failure or refusal by the
offeror to furnish the information may result in a 31
percent reduction of payments otherwise due under the
contract.
(c) The TIN may be used by the Government to collect and
report on any delinquent amounts arising out of the
offeror's relationship with the Government (31 U.S.C.
7701(c) (3)). If the resulting contract is subject to the
payment reporting requirements described in FAR 4.904, the
TIN provided hereunder may be matched with IRS records to
verify the accuracy of the offeror's TIN.
(d) Taxpayer Identification Number (TIN).
[X] TIN: 95-6000772
TIN has been applied for.
TIN is not required because:
[ ] Offeror is a nonresident alien, foreign corporation, or
foreign partnership that does not have income effectively
connected with the conduct of a trade or business in the
United States and does not have an office or place of
business or a fiscal paying agent in the United States;
[ ] Offeror is an agency or instrumentality of a foreign
government;
[ ] Offeror is an agency or instrumentality of the Federal
Governmen t .
(e) Type of organization.
Sole proprietorship;
Partnership;
Corporate entity (not tax-exempt);
Corporate entity (tax-exempt);
[X] Government entity (Federal, State, or local);
[ ] Foreign government;
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SECTION K
233-02-0042
Page 6 of 15
1 International organization per 26 CFR 1.6049-4;
1 Other
(f) Common parent. N/A
[ 1 Offeror is not owned or controlled by a common parent as
defined in paragraph (a) of this provision.
[ 1 Name and TIN of common parent:
Name
TIN
4. 52.209-5 Certification Regarding Debarment, Suspension,
Proposed Debarment, and Other Responsibility Matters. (APR
2001)
(a) (1) The Offeror certifies, to the best of its knowledge
and belief, that -
(i) The Offeror and/or any of its Principals -
(A) Are [ 1 are not [Xl presently debarred, suspended,
proposed for debarment, or declared ineligible for the
award of contracts by any Federal agency;
(B) Have [ 1 have not [xl, within the three-year period
preceding this offer, been convicted of or had a civil
judgment rendered against them for: commission of fraud
or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal,
state, or local) contract or subcontract; violation of
Federal or state antitrust statutes relating to the
submission of offers; or commission of embezzlement,
theft, forgery, bribery, falsification or destruction
of records, making false statements, tax evasion, or
receiving stolen property;
(C) Are [ 1 are not [xl presently indicted for, or
otherwise criminally or civilly charged by a
governmental entity with, commission of any of the
offenses enumerated in paragraph (a) (1) (i) (B) of this
provision; and
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SECTl:ON K
233-02-0042
Page 7 of 15
(D) Have [ ] have not [X], within a three-year period
preceding this offer, been convicted of or had a civil
judgment rendered against them for: commission of fraud
or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal,
state, or local) contract or subcontract; violation of
Federal or state antitrust statutes relating to the
submission of offers; or commission of embezzlement,
theft, forgery, bribery, falsification or destruction
of records, making false statements, tax evasion, or
receiving stolen property; and
(E) Are [ ] are not [X] presently indicted for, or
otherwise criminally or civilly charged by a
governmental entity with, commission of any of the
offenses enumerated in subdivision (a) (1) (i) (D) of this
provision.
(ii) (A) The offeror, aside from the offenses enumerated
in paragraphs (a) (1) (i) (A), (B), and (e) of this
provision, has [ ] has not [X] within the past three
years, relative to tax, labor and employment,
environmental, antitrust, or consumer protection laws -
(1) Been convicted of a Federal or State felony (or has
any Federal or State felony indictments currently
pending against them); or
(2) Had a Federal court judgment in a civil case
brought by the United States rendered against them; or
(3) Had an adverse decision by a Federal administrative
law judge, board, or commission indicating a willful
violation of law.
(B) If the offeror has responded affirmatively, the
offeror shall provide additional information if
requested by the Contracting Officer; and
(iii) The Offeror has [ ] has not [X], within a
three-year period preceding this offer, had one or more
contracts terminated for default by any Federal agency.
(2) Principals, for the purposes of this certification,
means officers; directors; owners; partners; and,
persons having primary management or supervisory
responsibilities within a business entity (e.g.,
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SECTION K 233-02-0042
Page 8 of 15
general manager; plant manager; head of a subsidiary,
division, or business segment, and similar positions) .
This Certification Concerns a Matter Within the Jurisdiction
of an Agency of the United States and the Making of a False,
Fictitious, or Fraudulent Certification May Render the Maker
Subject to Prosecution Under Section 1001, Title 18, United
States Code.
(b) The Offeror shall provide immediate written notice to
the Contracting Officer if, at any time prior to contract
award. the Offeror learns that its certification was
erroneous when submitted or has become erroneous by reason
of changed circumstances.
(c) A certification that any of the items in paragraph (a)
of this provision exists will not necessarily result in
withholding of an award under this solicitation. However,
the certification will be considered in connection with a
determination of the Offeror's responsibility. Failure of
the Offeror to furnish a certification or provide such
additional information as requested by the Contracting
Officer may render the Offeror nonresponsible.
(d) Nothing contained in the foregoing shall be construed to
require establishment of a system of records in order to
render. in good faith, the certification required by
paragraph (a) of this provision. The knowledge and
information of an Offeror is not required to exceed that
which is normally possessed by a prudent person in the
ordinary course of business dealings.
(e) The certification in paragraph (a) of this provision is
a material representation of fact upon which reliance was
placed when making award. If it is later determined that the
Offeror knowingly rendered an erroneous certification. in
addition to other remedies available to the Government. the
Contracting Officer may terminate the contract resulting
from this solicitation for default.
5.
52.215-6 Place of Performance. (OCT 1997)
(a) The offeror or respondent, in the performance of any
contract resulting from this solicitation, [ ] intends. [X]
does not intend [check applicable block] to use one or more
plants or facilities located at a different address from the
address of the offeror or respondent as indicated in this
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SECTXON K 233-02-0042
Page 9 of 15
proposal or response to request for information.
(b) If the offeror or respondent checks intends in paragraph
(a) of this provision, it shall insert in the following
spaces the required information:
Place of Performance
(Street Address, City,
State, County, Zip Code)
Name and Address of Owner
and Operator of the Plant
or Facility if Other than
Offeror or Respondent
6. 52.219-1 Small Business Program Representations. (MAY 2001)
Alternate X (OCT 2000)
(a) (1) The North American Industry Classification System
(NAICS) code for this acquisition is (NA).
(2) The small business size standard is (NA).
(3) The small business size standard for a concern
which submits an offer in its own name, other than on a
construction or service contract, but which proposes to
furnish a product which it did not itself manufacture,
is (NA).
(b) Representations. (1) The offeror represents as part of
its offer that it [ ] is, [x] is not a small business
concern.
(2) [Complete only if the offeror represented itself as
a small business concern in paragraph (b) (1) of this
provision.] The offeror represents, for general
statistical purposes, that it [ ] is, [ ] is not, a
small disadvantaged business concern as defined in 13
CFR 124.1002.
(3) [Complete only if the offeror represented itself as
a small business concern in paragraph (b) (1) of this
provision.] The offeror represents as part of its offer
that it [ ] is, [ ] is not a women-owned small business
concern.
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(4) [Complete only if the offeror represented itself as
a small business concern in paragraph (b) (1) of this
provision.] The offeror represents as part of its offer
that it [ ] is, [ ] is not a veteran-owned small
business concern.
(5) [Complete only if the offeror represented itself as
a veteran-owned small business concern in paragraph
(b) (4) of this provision.] The offeror represents as
part of its offer that it [ ] is, [ ] is not a
service-disabled veteran-owned small business concern.
(6) [Complete only if offeror represented itself as a
small business concern in paragraph (b) (1) of this
provision.] The offeror represents, as part of its
offer, that -
(i) It [ ] is, [ ] is not a HUBZone small business
concern listed, on the date of this
representation, on the List of Qualified HUBZone
Small Business Concerns maintained by the Small
Business Administration. and no material change in
ownership and control, principal office of
ownership, or HUBZone employee percentage has
occurred since it was certified by the Small
Business Administration in accordance with 13 CFR
Part 126; and
(ii) It [ ] is, [ ] is not a joint venture that
complies with the requirements of 13 CFR Part 126,
and the representation in paragraph (b) (6) (i) of
this provision is accurate for the HUBZone small
business concern or concerns that are
participating in the joint venture. [The offeror
shall enter the name or names of the HUBZone small
business concern or concerns that are
participating in the joint venture:
.] Each HUBZone small
business concern participating in the joint
venture shall submit a separate signed copy of the
HUBZone representation.
(c) Definitions. As used in this provision -
service-disabled veteran-owned small business concern -
(1) Means a small business concern -
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233-02-0042
Page 11 of 15
(i) Not less than 51 percent of which is owned by
one or more service-disabled veterans or, in the
case of any publicly owned business, not less than
51 percent of the stock of which is owned by one
or more service-disabled veterans; and
(ii) The management and daily business operations
of which are controlled by one or more
service-disabled veterans or, in the case of a
veteran with permanent and severe disability, the
spouse or permanent caregiver of such veteran.
(2) Service-disabled veteran means a veteran, as
defined in 38 U.S.C. 101(2), with a disability that is
service-connected, as defined in 38 U.S.C. 101(16).
Small business concern means a concern, including its
affiliates, that is independently owned and operated, not
dominant in the field of operation in which it is bidding on
Government contracts, and qualified as a small business
under the criteria in 13 CFR part 121 and the size standard
in paragraph (a) of this provision.
Veteran-owned small business concern means a small business
concern -
(1) Not less than 51 percent of which is owned by one
or more veterans (as defined at 38 U.S.C. 101(2)) or,
in the case of any publicly owned business, not less
than 51 percent of the stock of which is owned by one
or more veterans; and
(2) The management and daily business operations of
which are controlled by one or more veterans.
Women-owned small business concern means a small business
concern -
(1) That is at least 51 percent owned by one or more
women; or in the case of any publicly owned business,
at least 51 percent of the stock of which is owned by
one or more women; and
(2) Whose management and daily business operations are
controlled by one or more women.
(d) Notice. (1) If this solicitation is for supplies and has
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233-02-0042
Page 12 of 15
been set aside, in whole or in part, for small business
concerns, then the clause in this solicitation providing
notice of the set-aside contains restrictions on the source
of the end items to be furnished.
(2) Under 15 U.S.C. 645(d), any person who
misrepresents a firm's status as a small, HUBZone
small, small disadvantaged, or women-owned small
business concern in order to obtain a contract to be
awarded under the preference programs established
pursuant to section B(a), B(d), 9, or 15 of the Small
Business Act or any other provision of Federal law that
specifically references section B(d) for a definition
of program eligibility, shall -
(i) Be punished by imposition of fine,
imprisonment, or both;
(ii) Be subject to administrative remedies,
including suspension and debarment; and
(iii) Be ineligible for participation in programs
conducted under the authority of the Act.
7.
52.222-22 Previous Contracts and Compliance Reports. (FEB
1999)
The offeror represents that -
(a) It [ I has, [XI has not participated in a previous
contract or subcontract subject the Equal Opportunity clause
of this solicitation;
(b) It [ I has. [ I has not filed all required compliance
reports; and
(c) Representations indicating submission of required
compliance reports, signed by proposed subcontractors. will
be obtained before subcontract awards.
8. 52.222-25 Affirmative Action Compliance. (APR 1984)
The offeror represents that -
(a) It [XI has developed and has on file. [ I has not
developed and does not have on file, at each establishment,
affirmative action programs required by the rules and
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233-02-0042
Page 13 of 15
regulations of the Secretary of Labor (41 CFR 60-1 and
60-2); or
(b) It [ ] has not previously had contracts subject to the
written affirmative action programs requirement of the rules
and regulations of the Secretary of Labor.
9. 52.223-13 Certification of Toxic Chemical Release Reporting.
(OCT 2000)
(a) Submission of this certification is a prerequisite for
making or entering into this contract imposed by Executive
Order 12969, August 8. 1995.
(b) By signing this offer. the offeror certifies that -
(1) As the owner or operator of facilities that will be
used in the performance of this contract that are
subject to the filing and reporting requirements
described in section 313 of the Emergency Planning and
Community Right-to-Know Act of 1986 (EPCRA) (42 U.S.C.
11023) and section 6607 of the Pollution Prevention Act
of 1990 (PPA) (42 U.S.C. 13106), the offeror will file
and continue to file for such facilities for the life
of the contract the Toxic Chemical Release Inventory
Form (Form R) as described in sections 313(a) and (g)
of EPCRA and section 6607 of PPA; or
(2) None of its owned or operated facilities to be used
in the performance of this contract is subject to the
Form R filing and reporting requirements because each
such facility is exempt for at least one of the
following reasons: [Check each block that is
applicable. ]
(i) The facility does not manufacture. process, or
otherwise use any toxic chemicals listed under
section 313(c) of EPCRA, 42 U.S.C. 11023(c);
(ii) The facility does not have 10 or more
full-time employees as specified in section
313 (b) (1) (A) of EPCRA, 42 U.S.C. 11023 (b) (1) (A);
(iii) The facility does not meet the reporting
thresholds of toxic chemicals established under
section 313(f) of EPCRA. 42 U.S.C. 11023(f)
(including the alternate thresholds at 40 CFR
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SECTION K
233-02-0042
Page 14 of lS
372.27, provided an appropriate certification form
has been filed with EPA);
(iv) The facility does not fall within Standard
Industrial Classification Code (SIC) major groups
20 through 39 or their corresponding North
American Industry Classification System (NAICS)
sectors 31 through 33; or
(v) The facility is not located within any State
of the United States, the District of Columbia, .
the Commonwealth of Puerto Rico, Guam, American
Samoa, the United States Virgin Islands, the
Northern Mariana Islands, or any other territory
or possession over which the United States has
jurisdiction.
10. P.L. 103-227 The Pro-Children Act of 1994
CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227, also known as the Pro-Children Act of
1994 (Act), requires that smoking not be permitted in any
portion of any indoor facility owned or leased or contracted
for by an entity and used routinely or regularly for the
provision of health, day care, early childhood development
services, education or library services to children under
the age of 18, if the services are funded by Federal
programs either directly or through State or local
governments, by Federal grant, contract, loan, or loan
guarantee. The law also applies to children's services that
are provided in indoor facilities that are constructed,
operated, or maintained with such federal funds. The law
does not apply to children's services provided in private
residences; portions of facilities used for impatient drug
or alcohol treatment; service providers whose sole source of
applicable Federal funds is Medicare or Medicaid; or
facilities where WIC coupons are redeemed. Failure to
comply with the provisions of the law may result in the
imposition of a civil monetary penalty of up to $1000 for
each violation and/or the imposition of an administrative
compliance order on the responsible entity.
By signing this certification, the offeror/Contractor (for
acquisitions) or applicant/grantee (for grants) certifies
that the submitting organization will comply with the
requirements of the Act and will not allow smoking within
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SECTXON K
233-02-0042
Page lS of lS
any portion of any indoor facility used for the provisions
of services for children as defined by the Act.
The submitting organization agrees that it will require that
the language of this certification be included in any
subawards which contain provisions for children's services
and that all subrecipients shall certify accordingly.
DISClOSURE OF LOBBYING ACTIVITIES
Appro..ed k
Ol<4l-<Jo.c"
NOT APPLICABLE
e
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Complele this lonn 10 disclose lobbyin. ICli.ilies pu"ulnllo ]1 U.S.C. 1352
(See reoe"e lor public burden disclosure.)
1. Type 01 Foderal AClion: :L SIIIUI 01 FecI."./ Action: 1 Report Type:
0 J. conlrJct 0 a. bid/oller/lpplication o I. Inil'aI filin.
b. ."nl b. lnilll' IWlrd b. mllerial chln.e
c. cooperative Ilfeement C. posl.lward For Mllerbl Chlnse Only:
d. lOIn
e. IOln.luulnlee ycar qUI"er
dlle 011..1 report -
fo lOIn insurance
4- Nlme Ind Address 01 Reportlns EnlilJ: S. II Report;ns Enllly in No.4 Is Subawllde.. Ehler Name
a Prime a Subawardee and Address 01 Prime:
ner . if known: ,
-
.
Con~re..ional Dillrlc!, if kno.....: Can~ressiorul Dlllr/cl, if known:
,. Foderal DepartmenUAsency: 7. Federal Prosram NamelOescriplion:
CFDA Number. if applicable:
8. Foderal Aclion Number. if known: ,. AWlld Amount. if kno.....:
S
10. a. Name and Address 01 Lobbyi... Enl~ b. Individuals Perlorn;;:, Senk.. fineludin, add,e.. ,f
lif indNiduI/. Ilslname. linl nam.. II: diRe,enl from No. 101
1/111 nlme. r""name. MIl:
'.11.... e......"".... Ill.."., SloWoo\. d.........'
11. Amounl 01 PaymenllcMck al/lhal apply): 11 Type 01 Paymen'/check all rho. apply):
S a aClual a pllMed a I. retainer
a b. one-lime lee
12. Form 01 Paymen. (chIck all rho. applyJ: a c. commission
a I. cash a d. conlln.en'/ee
a b. in-kind; speclfy: nllure a e. deferred
a f. olher; lpedfy:
_,Iue
14- Brief Descripllon 01 Senlc.. Performed or '0 be Performed and Daltls' 01 Service. Indudln. olftcerisl, employeell'.
or Membens) con.acted. for Paymen'lndlca.ecI in Ilem 11:
I,u,d. CMlittwu.,. SltH"" SI-uL.A.. ,I nK.n.-.vl
15. Conllnualion .hocUsl SF.W-A anachecl: aVes o No
.50 w____. ........~ ....'" ... .... II ......... .,. ... It u.s.e.
Me..... 'In. ... ~............ _1h4dOI ita.....w..,............ Siln,ture:
.. ret .... ....... ,....... .. .-c'" ~, 'h. ,.. ..... ....'" ,.... Prinl Name:
.,--.. - ..... . ............ ""'.........,...... ....-. ..
II U.I.~ uu IWt b.... . .. ... ......... .. ... c..,.. ...
--" ~ ... tie ........ .. ~ ........... .... ..... ... ... . Tlde:
II. the ........... _..... ....... ...... .. . chi.....,., ... ... .... T "ephone No.;
'M._ ..... _ ... ..._...... .... r.a-. Dale:
.'(fecleral u"OfIJy:;:~!if~~~r"fu~'.lf!.t~~.~~ ...._~........ 0..- ......
~".~.''l .._~.t...~.f1'''_+........ . .:-:t......,~;,.;t~'. '.," f:- .,", _ ~;:t~.h.~\)~~........;;;t..,:.:-~...;:~..._.~.... ~'_.UL
-
** FOR OFFICE USE ONLY - NOT A PUBLIC DOCUMENT **
RESOLUTION AGENDA ITEM TRACKING FORM
Meeting Date (Date Adopted): 4 -I-ol Item #
Vote: Ayes 1-'1 Nays rr
Change to motion to amend original documents: -
14 Resolution # c?OOd-1 DO
Abstain..-A----- Absent tr-
Reso. # On Attachments: L Contract teoo: -
Note on Resolution of Attachment stored separately: ==---
Direct City Clerk to (circle I): PUBLISH, POST, RECORD W/COUNTY By:
NullNoid After: -
Date Sent to MayofY' .L\ -3- D :>
Date of Mayor's Signature: 4-4--Od
Date of Clerk/CDC Signature: -4 .-.if -():l-
Reso. Log Updated:
Seal Impressed:
/
V
Date r Sent for Signature:
60 Day Reminder Letter Sent on 30th day:
90 Day Reminder Letter Sent on 45th day:
See Attached:
See Attached:
Date Returned: -
Request for Council Action & Staff Report Attached:
Updated Prior Resolutions (Other Than Below):
Updated CITY Personnel Folders (6413, 6429, 6433,10584,10585,12634):
Updated CDC Personnel Folders (5557):
Updated Traffic Folders (3985, 8234, 655, 92-389):
Yes ,/ No By
Yes NO~ By
Yes No / By
Yes N07 By
Yes N07 By
Copies Distribut?:
City Attorney
Parks & Rec.
Code Compliance
Dev. Services
EDA
Finance
MIS
Police
.Public Services
Water
Others:
hQ.'!5
Notes:
BEFORE FILING, REVIEW FORM TO ENSURE ANY NOTATIONS MADE HERE ARE TRANSFERRED TO THE
YEARLY RESOLUTION CHRONOLOGICAL LOG FOR FUTURE REFERENCE (Contract Term. etc.)
Ready to File: iY'n
Date: --\-'ls--oJ.-
Revised 01/12/0 I