2021-22 Family Hospice Care (Volunteer Org) - Bereavement GroupMEMORANDUM
DATE:
TO:
FROM:
RE:
Please list the Contracting Party / Vendor Name, type of agreement to be executed, including any change orders or
amendments, and the type of services to be provided. Make sure to list any related Project No. and Project Name.
Authority to execute this agreement is based upon:
___ Approved by City Council on ___________________________________________
___ City Manager’s signing authority provided under the City’s Purchasing Police
[Resolution No. 2019-021] for budget expenditures of $50,000 or less.
___ Department Director’s or Manager’s signing authority provided under the City’s
Purchasing Policy [Resolution No. 2019-021] for budget expenditures of $15,000 and
$5,000, respectively, or less.
Procurement Method (one must apply):
___ Bid ___ RFP ___ RFQ ___ 3 written informal bids
___ Sole Source ___ Select Source ___ Cooperative Procurement
Requesting department shall check and attach the items below as appropriate:
___ Agreement payment will be charged to Account No.: _____________________
___ Agreement term: Start Date ________________ End Date ________________
___ Amount of Agreement, Amendment, Change Order, etc.: $____________________
REMINDER: Signing authorities listed above are applicable on the aggregate Agreement amount,
not individual Amendments or Change Orders!
___ Insurance certificates as required by the Agreement for Risk Manager approval
Approved by: ______________________________ Date: _______________
___ Bonds (originals)as required by the Agreement (Performance, Payment, etc.)
___ Conflict of Interest Form 700 Statement of Economic Interests from Consultant(s)
NOTE: Review the “Form 700 Disclosure for Consultants” guidance to determine if a Form 700 is
required pursuant FPPC regulation 18701(2)
___ Business License No. __________________; Expires: __________________
___ Requisition for a Purchase Order has been prepared (Agreements over $5,000)
September 15, 2021
Christina Calderon, Community Services Manager
Monika Radeva, City Clerk
Family Hospice Care, Volunteer Organization Agreement, (FY 2021-2022) for
Bereavement Group at the Wellness Center.
✔
✔
✔10/1/2021 10/2/2022
✔
Nichole Romane 9/20/2021
Page 1 of 2
VOLUNTEER ORGANIZATION
SERVICE AGREEMENT
Our organization, ____________________________, will provide volunteers to
perform only the services as outlined in the attached scope of work for the City of
La Quinta ("City"). We understand that we will not be compensated for our work and
we will complete our organization volunteer duties in a responsible manner. If we
decide to discontinue our organization volunteer services, our contact person
_________________________________, will notify Caroline Doran, City designee.
We understand and agree that:
• No one in the group is to appear for volunteer service under the influence
of any drugs or alcohol.
• Our organization will provide the City with a roster of individual participants
including the names and hours worked.
• Our organization will report any injuries sustained by participants during
their volunteer activities to Caroline Doran, City designee immediately upon
occurrence.
• Our organization is responsible for directly supervising the activities of all the
individuals in our group who will be doing volunteer work, and therefore, in
consideration of our organization and members being permitted to perform
services on City property, our organization agrees to defend, indemnify, and
hold harmless the City and its officials, employees, and agents from any
damage claim or lawsuit for injury, illness, (including exposure to
communicable diseases, illnesses, or viruses), damage or other loss of any
kind to anyone including members of our organization that might arise out of
our activities or the actions of any individuals of our group, except for injuries
or damages caused by the sole negligence of the City.
• Our organization has commercial general liability insurance of at least $1M
per occurrence / $2M general aggregate to cover our activities. A copy of the
certificate of insurance, the additional insured endorsement, naming the City
as an “additional insured,” and a Primary and Non-Contributory endorsement
is attached.
• The City may terminate this agreement at any time without cause, and we
agree that we are volunteering our services at will and may be asked to
discontinue such without prior notice or reason.
This agreement will be in effect for the duration of our volunteer services or one year,
whichever is less, beginning on this date.
Dated this ___________ day of _______________, 20___.
Family Hospice Care
Abby Cohen
7th September 21
Attachment
Scope of Work
Family Hospice Care is providing a FREE Bereavement Support Group to persons who are
experiencing grief after the loss of a loved one.
Bereavement Support Group will include:
• First-time group attendees register with Family Hospice Care.
• Grief group is a non-religious, safe, and caring environment
• Materials and support are provided.
8/19/2021