2023-24 Health Insurance Advocacy Counseling Programs (HIACP)MEMORANDUM
DATE: January 27, 2023
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TO: Christina Calderon, CR Manager
FROM: Caroline Doran, CR Specialist
RE: Health Insurance Counseling Advocacy Programs (HICAP) Free One on One
consultations, Information table, Medicare presentations - Volunteer Agreement
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
F-1_ City Manager's signing authority provided under the City's Purchasing Policy
[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 avoly):
❑_ Bid n RFP n RFQ E_ 3 written informal bids
QSole Source 0 Select Source Cooperative Procurement
Reauestina department shall check and attach the items below as auurouriate:
F-1_ Agreement payment will be charged to Account No.:
Fv l Agreement term: Start Date 01/31/2023 End Date 01/30/2024
F-1_ Amount of Agreement, Amendment, Change Order, etc.: $ n/a
REMINDER; Signing authorities listed above are applicable on the aggregate Agreement amount,
not individual Amendments or Change Orders!
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NOTE:
LJ_
Insurance certificates as required by the Agreement for Risk Manager approval
Approved by: Laurie McGinley Date: 2/28/2023
Bonds (originals) as required by the Agreement (Performance, Payment, etc.)
Conflict of Interest Form 700 Statement of Economic Interests from Consultant(s)
Review the "Form 700 Disclosure for Consultants" guidance to determine if a Form
required pursuant FPPC regulation 18701(2)
Business License No. 770863 Expires: 2/29/2024
Requisition for a Purchase Order has been prepared (Agreements over $5,000)
700 is
VOLUNTEER ORGANIZATION
SERVICE AGREEMENT
Our organization, Health Insurance Counselling Advocacy Program, 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
`� 'r", N-A t , 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;�2.
Paqe 1 of 2
CITY OF LA QUINTA,
AHRISTINA
nia nicip I C or on
c
CA DE ON,
Community Resources Manager
City of La Quinta, California
Dated:
ATTEST:
MONIKA RADEVA, City IClerk
La Quinta, California
Health Insurance Advocacy Program
Name of Organization
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Authorized q aTure on�alf of
Organization
C, a �- � \,� r" Ii
Printed Name
Title
Address i a
R,, V � de C
APPROVED AS TO FORM:
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WILLIAM IHRKE, City Attorney Email Address
City of La Quinta, California
Phone Number
I
CALIFORNIA
Paqe 2 of 2
SCOPE OF WORK
Health Insurance Counselling Advocacy Program (HICAP)
Services offered at the La Quinta Wellness Center
One on One consultation by appointment
CDA (California Dept. On Aging) State Registered HICAP counselor will advise
on Medicare questions in a non -biased meeting.
Wellness Center staff will confirm the appointments with HICAP on the Friday
before the appointment.
Appointments from 10am - ipm
Medicare 101 lectures
Representative from HICAP presents to public.
Wellness Center staff will set up tables and chairs for participants.
Information table - the resources available to the community.
Wellness Center will provide the table and chair/s for HICAP representative.
Date/Time: The 2nd Monday of each month unless there is a Monday holiday. If
the 2nd Monday is a holiday, HICAP and City of La Quinta Wellness Center will agree
on an alternative date.