2024-25 Welbe Health - Nursing Home Care ServicesMEMORANDUM
DATE: June 4, 2024
TO: Christina Calderon, Community Services Deputy Director
FROM: Caroline Doran, Community Services Specialist
RE: Welbe Health - Volunteer Service Agreement
CALIF[7RNE
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 Policy
[Resolution No. 2023-008] 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. 2023-008] for budget expenditures of $15,000 and
$5,000, respectively, or less.
Procurement Method (one must apply):
Bid RFP n RFQ n 3 written informal bids
Sole Source
USelect Source U Cooperative Procurement
Requesting department shall check and attach the items below as appropriate:
N/A
Agreement payment will be charged to Account No.:
Agreement term: Start Date June 3, 2024 End Date June 3, 2025
Amount of Agreement, Amendment, Change Order, etc.: $ _0_
REMINDER: Signing authorities listed above are applicable on the aggregate Agreement amount,
not individual Amendments or Change Orders!
Iv I Insurance certificates as required by the Agreement for Risk Manager approval
Approved by: Oscar Mojica Date: 6/24/2024
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. PENDING Expires:
Requisition for a Purchase Order has been prepared (Agreements over $5,000)
VOLUNTEER ORGANIZATION
SERVICE AGREEMENT
Our organization, WelbeHealth, 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
�p c ria ) I , 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 �A /1.40-- , 20,3)(1
Page 1 of 2
CITY OF LA QUINTA,
California Muni ipal,orporation
ISTINA CAL ERON,
Community Services Deputy
Director City of La Quinta,
California
Dated: (07/11/0249/(f
ATTEST:
MONIKA RADE A,
La Quinta, Californi
APPROVED AS TO FORM:
CtIP
WellbeHealth
Name of Organiza ' n
d/1 4/_,lnS
Authorized Signature on behalf of
Organization
0 an -/,ins
Printed Name
7(j7i
Title (
171/4,elj (,d/1c
Address /`t
WILLIAM IHRKE, City Attorney
City of La Quinta, California
06/ Quigrai
--- c Al 11 Olttit —g
e uX(/r%ck_t
ail Address
1��6' 7 37 S'79
Phone Number
Page 2 of 2
SCOPE OF WORK
WelbeHealth
Service Offered: FREE information about alternative services to nursing home care
so frail seniors can age in place in their homes and communities. Program of All-
inclusive care for the Elderly (PACE).
Date/Times: would be agreed to by both WelbeHealth and the La Quinta Wellness
Center staff.
Location: La Quinta Wellness Center lobby, multipurpose room. The Wellness
Center staff will provide and set up table and chair/s for the WelbeHealth
representatives.
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
760-777-7000
Business Name: WelbeHealth Inland Empire PACE, LLC
DBA: WelbeHealth
BUSINESS LICENSE CERTIFICATE
NON -TRANSFERABLE
Business Type(s): 8322 Emergency and Other Relief Services:
Services for the Elderly and Persons with
Disabilities: Community Food Services: Other
Community Housing Services: Other
Individual and Family Services: Temporary
Shelters
Business Location: 46805 DUNE PALMS RD Mailing Address: 440 N Barranca Ave, #4051
LA QUINTA, CA 92253 COVINA, CA 91723
Owner: WelbeHealth Inland Empire PACE, LLC Weibel-
License
eibelLicense Number: LIC -0771322-2023 License Type: Gross Receipts - Inside City Limits
Issued Date: 10/27/2023 Classification: Class 3
Expiration Date: 10/31/2024 Fees Paid: $21.52
Design and Development Director
Dear Business Owner:
Please be aware that issuance of a business license by the City does not authorize you to conduct business in a building or tenant
space that has not been approved for occupancy by the Design and Development Department. If you have any questions regarding
this issue, or if you are not sure if a Certificate of Occupancy has been issued for your place of business, please contact Design and
Development at (760)777-7000. The Licensee named herein having paid to the City of La Quinta all fees required, license is hereby
granted said licensee to transact the business herein set forth, for the period stated, in conformity with the Provisions of Ordinance
No. 2 of this City. This license is issued without verification that the licensee is subject to or exempt from licensing by the State of
California.
TO BE POSTED IN A CONSPICUOUS PLACE