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20210216 City Council Agenda PacketAgenda City of Vernon Regular City Council Meeting Tuesday, February 16, 2021, 09:00 AM City Hall, Council Chamber 4305 Santa Fe Avenue Vernon, California Leticia Lopez, Mayor Melissa Ybarra, Mayor Pro Tem William Davis, Council Member Carol Menke, Council Member Diana Gonzales, Council Member SPECIAL REMOTE PROTOCOLS In accordance with Governor Newsom's Executive Order N-29-20, this will be a teleconference meeting without a physical location to help stop the spread of COVID-19. This meeting will be conducted entirely by remote participation via Zoom Webinar. The public is encouraged to view the meeting at http://www.cityofvernon.org/webinar-cc or by calling (408) 638-0968, Meeting ID 979-7743-8922#. You may submit comments to PublicComment@ci.vernon.ca.us with the subject line “February 16, 2021 City Council Meeting Public Comment Item #__.” Comments received prior to 8 a.m., Tuesday, February 16, 2021, will be read into the record. CALL TO ORDER FLAG SALUTE ROLL CALL APPROVAL OF THE AGENDA PUBLIC COMMENT At this time the public is encouraged to address the City Council on any matter that is within the subject matter jurisdiction of the City Council. The public will also be given a chance to comment on matters which are on the posted agenda during City Council deliberation on those specific matters. PRESENTATIONS 1.Human Resources Employee Service Pin Awards for January 2021 Recommendation: Regular City Council Meeting Agenda February 16, 2021 Page 2 of 5 No action required by City Council. This is a presentation only. 2.Health and Environmental Control Department Implementation Plan for Senate Bill 1383 (SB 1383) - Short-Lived Climate Pollutants Reduction Act Recommendation: No action is required by City Council. This is a presentation only. CONSENT CALENDAR All matters listed on the Consent Calendar are to be approved with one motion. Items may be removed from the Consent Calendar by any member of the Council. Those items removed will be considered immediately after the Consent Calendar. 3.City Clerk Approval of Minutes Recommendation: Approve the February 2, 2021 Regular City Council meeting minutes. 1. 20210202 City Council Minutes 4.Finance/Treasury City Payroll Warrant Register Recommendation: Approve City Payroll Warrant Register No. 776, for the period of January 1 through January 31, 2021, which totals $2,189,824.01 and consists of ratification of direct deposits, checks and taxes totaling $1,428,095.34 and ratification of checks and electronic fund transfers (EFT) for payroll related disbursements totaling $761,728.67 paid through operating bank account. 1. City Payroll Account Warrant Register No. 776 5.Finance/Treasury Operating Account Warrant Register Recommendation: Approve Operating Account Warrant Register No. 61, for the period of January 3 through January 16, 2021, which totals $10,275,103.09 and consists of ratification of electronic payments totaling $10,069,951.71 and ratification of the issuance of early checks totaling $205,151.38. 1. Operating Account Warrant Register No. 61 6.Fire Department Fire Department Activity Report Recommendation: Receive and file the November 2020 Report. 1. Fire Department Activity Report - November 2020 Regular City Council Meeting Agenda February 16, 2021 Page 3 of 5 7.Police Department Police Department Activity Report Recommendation: Receive and file the December 2020 Report. 1. Police Department Activity Report – December 2020 8.Human Resources Addendum and Amendment to Medicare Advantage Group Agreement with Blue Cross of California dba Anthem Blue Cross Recommendation: Ratify Addendum and Amendment to Medicare Advantage Group Agreement with Blue Cross of California dba Anthem Blue Cross for the renewal of Medicare health plan benefits and rates for the period of January 1, 2021 through December 31, 2021, covering the City’s Medicare eligible retirees and their eligible spouses. 1. Renewal Addendum and Amendment to Medicare Advantage Group Agreement 2. 2021 Renewal Presentation 9.Public Works Extend Purchase Contract with Priority Building Services, LLC for COVID-19 Related Janitorial Services Recommendation: Authorize an extension of the purchase contract with Priority Building Services, LLC to November 17, 2021 for COVID-19 related janitorial services, increasing the original contract amount by $129,480, for a total not-to-exceed contract cost of $233,400. 1. Purchase Contract No. CS-1211 Priority Building Services NEW BUSINESS 10.Public Works Local Government Planning Support Grants Program Recommendation: Adopt Resolution No. 2021-01 approving and authorizing the submittal of an application to the Department of Housing and Community Development for, and receipt of, local government planning support grant program funds. 1. Resolution No. 2021-01 2. LEAP Application ORAL REPORTS City Administrator Reports on Activities and Other Announcements. City Council Reports on Activities (including AB1234), Announcements, or Directives to Staff. CLOSED SESSION Regular City Council Meeting Agenda February 16, 2021 Page 4 of 5 11.Public Works CONFERENCE WITH REAL PROPERTY NEGOTIATORS Government Code Section 54956.8 Assessor's Parcel Numbers: 6304-007-900, 6314-033-901 and 6314-033-005 Agency Negotiators: Carlos Fandino, City Administrator Negotiating Party: Los Angeles County Flood Control District and Magellan Atlantic LLC Under Negotiation: Price and Terms of Payment CLOSED SESSION REPORT ADJOURNMENT I hereby certify under penalty of perjury under the laws of the State of California, that the foregoing agenda was posted in accordance with applicable legal requirements. Regular and Adjourned Regular meeting agendas may be amended up to 72 hours prior to the meeting. Dated this 11th day of February, 2021. By: __________________________________ Sandra Dolson, Administrative Secretary Guide to City Council Proceedings Meetings of the City Council are held the first and third Tuesday of each month at 9:00 a.m. and are conducted in accordance with Rosenberg's Rules of Order (Vernon Municipal Code Section 2.1-1). Copies of all agenda items and back-up materials are available for review in the City Clerk Department, Vernon City Hall, 4305 Santa Fe Avenue, Vernon, California, and are available for public inspection during regular business hours, Monday through Thursday, 7:00 a.m. to 5:30 p.m. Agenda reports may be reviewed on the City's website at www.cityofvernon.org or copies may be purchased for $0.10 per page. Disability-related services are available to enable persons with a disability to participate in this meeting, consistent with the Americans with Disabilities Act (ADA). In compliance with ADA, if you need special assistance, please contact the City Clerk department at CityClerk@ci.vernon.ca.us or (323) 583-8811 at least 48 hours prior to the meeting to assure arrangements can be made. The Public Comment portion of the agenda is for members of the public to present items, which are not listed on the agenda but are within the subject matter jurisdiction of the City Council. The City Council cannot take action on any item that is not on the agenda but matters raised under Public Comment may be referred to staff or scheduled on a future agenda. Comments are limited to three minutes per speaker unless a different time limit is announced. Speaker slips are available at the entrance to the Council Chamber. Regular City Council Meeting Agenda February 16, 2021 Page 5 of 5 Public Hearings are legally noticed hearings. For hearings involving zoning matters, the applicant and appellant will be given 15 minutes to present their position to the City Council. Time may be set aside for rebuttal. All other testimony shall follow the rules as set for under Public Comment. If you challenge any City action in court, you may be limited to raising only those issues you or someone else raised during the public hearing, or in written correspondence delivered to the City Clerk at or prior to the public hearing. Consent Calendar items may be approved by a single motion. If a Council Member or the public wishes to discuss an item, it may be removed from the calendar for individual consideration. Council Members may indicate a negative or abstaining vote on any individual item by so declaring prior to the vote on the motion to adopt the Consent Calendar. Items excluded from the Consent Calendar will be taken up following action on the Consent Calendar. Public speakers shall follow the guidelines as set forth under Public Comment. New Business items are matters appearing before the Council for the first time for formal action. Those wishing to address the Council on New Business items shall follow the guidelines for Public Comment. Closed Session allows the Council to discuss specific matters pursuant to the Brown Act, Government Code Section 54956.9. Based on the advice of the City Attorney, discussion of these matters in open session would prejudice the position of the City. Following Closed Session, the City Attorney will provide an oral report on any reportable matters discussed and actions taken. At the conclusion of Closed Session, the Council may continue any item listed on the Closed Session agenda to the Open Session agenda for discussion or to take formal action as it deems appropriate. City Council Agenda Item Report Agenda Item No. COV-500-2021 Submitted by: Veronica Avendano Submitting Department: Human Resources Meeting Date: February 16, 2021 SUBJECT Employee Service Pin Awards for January 2021 Recommendation: No action required by City Council. This is a presentation only. Background: Submitted herewith is a list of employees who are eligible to receive their service pin based on the number of service years with the City of Vernon. Thirty Years of Service Anthony J. Serrano, Business & Account Supervisor, Hired January 1991 Victor Vasquez, Sr., Lead Meter Reader, Hired January 1991 Twenty Years of Service Efrain Sandoval, Principal Resource Scheduler/Trader, Hired January 2001 Ignacio S. Estrada III, Police Sergeant, Hired January 2001 Fiscal Impact: There is no fiscal impact associated with this report. Attachments: City Council Agenda Item Report Agenda Item No. COV-487-2021 Submitted by: Veronica Petrosyan Submitting Department: Health and Environmental Control Department Meeting Date: February 16, 2021 SUBJECT Implementation Plan for Senate Bill 1383 (SB 1383) - Short-Lived Climate Pollutants Reduction Act Recommendation: No action is required by City Council. This is a presentation only. Background: In September 2016, Governor Brown signed into law Senate Bill 1383 (SB 1383) establishing methane emissions reduction targets in a statewide effort to reduce emissions of short-lived climate pollutants in various sectors of California's economy. Actions to reduce short-lived climate pollutants are essential to address the many impacts of climate change on human health, especially in California's most at risk communities, and on the environment. SB 1383 establishes targets to achieve a 50 percent reduction in level of the statewide disposal of organic waste from the 2014 level by 2020 and a 75 percent reduction by 2025. The law grants CalRecycle the regulatory authority required to achieve the organic waste disposal reduction targets, and establishes an additional target that not less than 20 percent of currently disposed edible food is recovered for human consumption by 2025. SB 1383 will further support California's efforts to achieve the statewide 75 percent recycling goal by 2020 (established by Assembly Bill 341), and strengthen the implementation of mandatory commercial organics recycling (established by Assembly Bill 1826). It should be noted that the Health and Environmental Control Department presented information on SB 1383 to the Green Vernon Commission at its December 16, 2020 meeting with no formal recommendations provided by staff at that time. The February 16, 2021 presentation to City Council will provide information on the City of Vernon SB 1383 implementation plan, and will include recommendations from the Department that will align the City with the targets set forth by SB 1383. Fiscal Impact: There is no fiscal impact associated with this report. Attachments: City Council Agenda Item Report Agenda Item No. COV-456-2021 Submitted by: Sandra Dolson Submitting Department: City Clerk Meeting Date: February 16, 2021 SUBJECT Approval of Minutes Recommendation: Approve the February 2, 2021 Regular City Council meeting minutes. Background: Staff has prepared and hereby submits the minutes for approval. Fiscal Impact: There is no fiscal impact associated with this report. Attachments: 1. 20210202 City Council Minutes MINUTES VERNON CITY COUNCIL REGULAR MEETING TUESDAY, FEBRUARY 2, 2021 COUNCIL CHAMBER, 4305 SANTA FE AVENUE CALL TO ORDER Mayor Lopez called the meeting to order at 9:00 a.m. FLAG SALUTE Mayor Lopez led the Flag Salute. ROLL CALL PRESENT:Leticia Lopez, Mayor (via remote access) Melissa Ybarra, Mayor Pro Tem (via remote access) William Davis, Council Member (via remote access) Carol Menke, Council Member (via remote access) Diana Gonzales, Council Member (via remote access) STAFF PRESENT: Carlos Fandino, City Administrator Arnold Alvarez-Glasman, Interim City Attorney (via remote access) Norma Copado, Interim Assistant City Attorney (via remote access) Lisa Pope, City Clerk Scott Williams, Finance Director (via remote access) Abraham Alemu, Public Utilities General Manager (via remote access) Fredrick Agyin, Health and Environmental Control Director (via remote access) Michael Earl, Human Resources Director (via remote access) Anthony Miranda, Police Chief (via remote access) Dan Wall, Public Works Director (via remote access APPROVAL OF THE AGENDA MOTION Mayor Pro Tem Ybarra moved and Council Member Davis seconded a motion to approve the agenda. The question was called and the motion carried unanimously. PUBLIC COMMENT Jonathan Hawes submitted comments via email regarding El Monte Promise Foundation Scholarship Fund and alleged embezzlement. Regular City Council Meeting Minutes Page 2 of 7 February 2, 2021 PRESENTATIONS 1.Plan to Establish a COVID-19 Testing Site in the City of Vernon Recommendation: No action is required by City Council. This is a presentation only. Health and Environmental Control Director Agyin presented the item. Henry Haskell submitted comments via email suggested a vaccination site rather than testing site. In response to Council questions, Health and Environmental Control Director Agyin discussed cost prohibition of a testing site and indicated he would provide cost information from surrounding cities’ sites; potential to learn from the City of Long Beach experience; survey sent to local businesses regarding potential vaccine uptake; distribution process; and administration of vaccines. CONSENT CALENDAR Mayor Pro Tem Ybarra pulled Item No. 2. Council Member Menke pulled Item No. 7. Council Member Gonzales pulled Item No. 8. MOTION Council Member Davis moved and Council Member Menke seconded a motion to approve the Consent Calendar, with the exception of Item Nos. 2, 7, and 8. The question was called and the motion carried unanimously. The Consent Calendar consisted of the following items: 3.Operating Account Warrant Register Recommendation: Approve Operating Account Warrant Register No. 60, for the period of January 3 through January 16, 2021, which totals $6,599,441.83 and consists of ratification of electronic payments totaling $6,504,719.99 and ratification of the issuance of early checks totaling $94,721.84. 4.Public Works Department Monthly Report Recommendation: Receive and file the December 2020 Building Report. 5.Acceptance of Electrical Easement at 5100 Boyle Avenue (APN 6303-028-014) Recommendation: A. Find that the acceptance of the Electrical Easement proposed in this staff report is not a “project” as that term is defined under the California Environmental Quality Act (CEQA) Guidelines Section 15378, and even if it were a project, it would be categorically exempt in accordance with CEQA Guidelines Sections 15301 (maintenance, repair or minor alteration of an existing facility and involves negligible or no expansion of an existing use) and 15061(b)(3) (general rule that CEQA only applies to projects that may have a significant effect on the environment); Regular City Council Meeting Minutes Page 3 of 7 February 2, 2021 and B. Accept the Electrical Easement and authorize the Mayor to execute the Certificate of Acceptance. 6.AT&T Dedicated Internet Pricing Addendum Recommendation: Approve and authorize the City Administrator to execute a Dedicated Internet Pricing Addendum with AT&T, in substantially the same forma as submitted, extending the term of the agreement for an additional two years through February 2023, and authorizing an additional amount of $30,225 to be expended on such services. The following items were pulled from the Consent Calendar for individual consideration: 2.Waive Further Reading Recommendation: After the City Clerk has read the title, waive full reading of ordinances considered on this agenda for introduction on first reading and/or second reading and adoption. In response to Council questions, City Clerk Pope explained the purpose of the item. Interim City Attorney Alvarez-Glasman confirmed. MOTION Mayor Pro Tem Ybarra moved and Council Member Menke seconded a motion to, after the City Clerk has read the title, waive full reading of ordinances considered on this agenda for introduction on first reading and/or second reading and adoption. The question was called and the motion carried unanimously. 7.Amendment No. 1 to the Services Agreement with Southeast Rio Vista Family YMCA (a branch of the YMCA of Metropolitan Los Angeles) for Community Based Wellness Programming for the City of Vernon Recommendation: Approve and authorize the City Administrator to execute Amendment No. 1 to the Services Agreement with the YMCA Metropolitan Los Angeles/Southeast- Rio Vista Family YMCA (YMCA), in substantially the same form as submitted, to extend the term for one additional year, revising the expiration date from February 3, 2021 to February 3, 2022, with all other terms remaining the same. In response to Council questions, City Administrator Fandino explained that the funds from last year were being rolled over, with the exception of the expended $7,194. Council Member Menke discussed the YMCA providing food to elderly and disabled residents and suggested partnering with local restaurants to provide food. City Administrator Fandino stated staff would evaluate opportunities and report back to Council. He confirmed that memberships will be extended since they were unused due to COVID-19. MOTION Council Member Menke moved and Mayor Pro Tem Ybarraseconded a motion to Approve and authorize the City Administrator to execute Amendment No. 1 to the Services Agreement with the YMCA Metropolitan Los Angeles/Southeast-Rio Vista Family Regular City Council Meeting Minutes Page 4 of 7 February 2, 2021 YMCA (YMCA), in substantially the same form as submitted, to extend the term for one additional year, revising the expiration date from February 3, 2021 to February 3, 2022, with all other terms remaining the same. The question was called and the motion carried unanimously. 8.City Housing Quarterly Report Update Recommendation: Receive and file the January 2021 City Housing Quarterly Report Update. In response to Council questions, City Clerk Pope explained that, as Secretary of the Housing Commission, she input the report into the system. Public Works Director Wall explained housing lottery draw on February 1, 2021 and qualification verification of the two new tenants. City Administrator Fandino discussed the delinquent tenant and process to obtain payment. MOTION Council Member Menke moved and Council Member Gonzales seconded a motion to receive and file the January 2021 City Housing Quarterly Report Update. The question was called and the motion carried unanimously. PUBLIC HEARINGS 9.Second Reading of Ordinance No. 1273 - Los Angeles County Fire Code Title 32 Recommendation: Conduct second reading and adopt Ordinance No. 1273 repealing and replacing Chapter 7, Article II, Fire Code, adopting the 2019 edition of the California Fire Code, 2018 edition of the International Fire Code and the 2020 edition of the Los Angeles County Fire Code - Title 32 (Consolidated Fire Protection District of Los Angeles County Fire Code), ratifying the more restrictive building standards contained in that code. City Clerk Pope presented the staff report. Mayor Lopez opened the public hearing. There being no speakers, Mayor Lopez closed the public hearing. MOTION Mayor Pro Tem Ybarra moved and Council Member Menke seconded a motion to Conduct second reading and adopt Ordinance No. 1273 repealing and replacing Chapter 7, Article II, Fire Code, adopting the 2019 edition of the California Fire Code, 2018 edition of the International Fire Code and the 2020 edition of the Los Angeles County Fire Code - Title 32 (Consolidated Fire Protection District of Los Angeles County Fire Code), ratifying the more restrictive building standards contained in that code. The question was called and the motion carried unanimously. Regular City Council Meeting Minutes Page 5 of 7 February 2, 2021 NEW BUSINESS 10.Second Reading of Ordinance No. 1271 - Municipal Code Clean Up Recommendation: Conduct second reading and adopt Ordinance No. 1271 amending various sections of the Municipal Code in Chapters 1, 2, 11, 12, 13 and 16. City Clerk Pope presented the staff report. MOTION Council Member Davis moved and Mayor Pro Tem Ybarra seconded a motion to:Conduct second reading and adopt Ordinance No. 1271 amending various sections of the Municipal Code in Chapters 1, 2, 11, 12, 13 and 16. The question was called and the motion carried unanimously. 11.Second Reading of Ordinance No. 1272 - Motion Pictures, Television, Commercial Digital Media and Still Photography Productions Recommendation: Conduct second reading and adopt Ordinance No. 1272 amending Vernon Municipal Code Section 5.65 - Motion Picture Production to be Motion Pictures, Television, Commercial Digital Media and Still Photography Productions. City Clerk Pope presented the staff report. MOTION Council Member Gonzales moved and Mayor Pro Tem Ybarra seconded a motion to Conduct second reading and adopt Ordinance No. 1272 amending Vernon Municipal Code Section 5.65 - Motion Picture Production to be Motion Pictures, Television, Commercial Digital Media and Still Photography Productions. The question was called and the motion carried unanimously. 12.Office Lease Agreement with the Vernon Chamber of Commerce (Continued from January 19, 2021) Recommendation: Approve and authorize the City Administrator to execute an Office Lease Agreement with the Vernon Chamber of Commerce for a portion of the City- owned property located at 2724 Leonis Boulevard, Vernon, CA for a one-year term beginning February 1, 2021. Finance Director Williams presented the staff report. Council Members Menke and Gonzales expressed concern with the safety of the building due to asbestos. Interim City Attorney Alvarez-Glasman stated the Chamber of Commerce could be advised not to disrupt the asbestos. MOTION Council Member Menke moved and Council Member Gonzales seconded a motion to approve and authorize the City Administrator to execute an Office Lease Agreement with the Vernon Chamber of Commerce for a portion of the City-owned property located at 2724 Leonis Boulevard, Vernon, CA for a one-year term beginning February 1, 2021, Regular City Council Meeting Minutes Page 6 of 7 February 2, 2021 adding advice to the tenant to not disrupt ceiling tiles. The question was called and the motion carried unanimously. 13.Regulation of Commercial Cannabis Businesses: State Law Authority, Local Regulation, and Policy Considerations (Continued from January 19, 2021) Recommendation: Hold a discussion and provide further direction to the City Attorney's Office and staff regarding regulation of commercial cannabis businesses, including providing directives or guidance in preparing a draft ordinance to include any provision, terms and standards discussed. Interim Assistant City Attorney Copado presented the staff report. In response to Council questions, Interim Assistant City AttorneyCopado explained CEQA analysis for each project; non-op fees to be negotiated in operating agreement; sample operating agreement; and collection of penalties in the City of Commerce. MOTION Mayor Lopez moved to direct staff to conduct two community town hall meetings and a Business and Industry Commission meeting on the topic of regulating commercial cannabis businesses. FRIENDLY AMENDMENT Council Member Menke seconded the motion and added direction to the City Attorney’s Office to begin drafting an ordinance. The maker accepted the amendment. FRIENDLY AMENDMENT Mayor Pro Tem Ybarra amended the motion to receive a report back in 60 days. The maker and seconder accepted the amendment. The question was called on the amended motion and the motion carried unanimously. 14.Labor and Materials Contract with McAvoy & Markham Engineering and Sales Co. Recommendation: Approve and authorize the City Administrator to execute a Labor and Materials Contract with McAvoy & Markham Engineering and Sales Co., in substantially the same form as submitted, for the purchase of electric meters for an amount not to exceed $298,498 over a three-year term, with an effective date of February 4, 2021. Public Utilities General Manager Alemu presented the staff report. In response to Council questions, Public Utilities General Manager Alemu explained the conservative estimate to install 176 meters per year; the second and third phases; and total cost to migrate to new meters. MOTION Regular City Council Meeting Minutes Page 7 of 7 February 2, 2021 Mayor Pro Tem Ybarra moved and Mayor Lopez seconded a motion to approve and authorize the City Administrator to execute a Labor and Materials Contract with McAvoy & Markham Engineering and Sales Co., in substantially the same form as submitted, for the purchase of electric meters for an amount not to exceed $298,498 over a three-year term, with an effective date of February 4, 2021. The question was called and the motion carried unanimously. 15.Emergency Order Mandating Masks During COVID-19 Pandemic Recommendation: Introduce and adopt Emergency Ordinance No. 1274 adding Chapter 13, Article VII mandating wearing masks and imposing fines for violations of public health orders related to COVID-19. City Administrator Fandino presented the report. In response to Council questions, City Administrator Fandino discussed enforcement, education, and citation. MOTION Council Member Menke moved and Mayor Lopez seconded a motion to introduce and adopt Emergency Ordinance No. 1274 adding Chapter 13, Article VII mandating wearing masks and imposing fines for violations of public health orders related to COVID-19. The question was called and the motion carried unanimously. ORAL REPORTS City Administrator Reports on Activities and other Announcements. City Administrator Fandino provided an update on recent Police and Fire activities. He stated all board meetings would continue to be conducted remotely and the next Business and Industry Commission meeting would be held on February 11, 2021, at 9:00 a.m. City Council Reports on Activities (including AB1234), Announcements, or Directives to Staff. None. ADJOURNMENT Mayor Lopez adjourned the meeting at 11:01 a.m. ______________________________ LETICIA LOPEZ, Mayor ATTEST: _____________________________________ LISA POPE, City Clerk (seal) City Council Agenda Item Report Agenda Item No. COV-504-2021 Submitted by: John Lau Submitting Department: Finance/Treasury Meeting Date: February 16, 2021 SUBJECT City Payroll Warrant Register Recommendation: Approve City Payroll Warrant Register No. 776, for the period of January 1 through January 31, 2021, which totals $2,189,824.01 and consists of ratification of direct deposits, checks and taxes totaling $1,428,095.34 and ratification of checks and electronic fund transfers (EFT) for payroll related disbursements totaling $761,728.67 paid through operating bank account. Background: Section 2.13 of the Vernon Municipal Code indicates the City Treasurer, or an authorized designee, shall prepare warrants covering claims or demands against the City which are to be presented to City Council for its audit and approval. Pursuant to the aforementioned code section, the City Treasurer has prepared City Payroll Account Warrant Register No. 776 covering claims and demands presented during the period of January 1 through January 31, 2021, drawn, or to be drawn, from East West Bank for City Council approval. Fiscal Impact: The fiscal impact of approving City Payroll Warrant Register No. 776, totals $2,189,824.01. The Finance Department has determined that sufficient funds to pay such claims/demands, are available in the respective accounts referenced on City Payroll Warrant Register No. 776. Attachments: 1. City Payroll Account Warrant Register No. 776 Raquel Franco | 2/8/2021 1:57 PMPAYROLL WARRANT REGISTERCity of VernonNo.776Month ofFebruary 2021I hereby Certify: that claims or demands covered by the This is to certify that the claims or demandsabove listed warrants have been audited as to accuracycovered by the above listed warrants have beenand availability of funds for payments thereof; and that audited by the City Council of the City of Vernonsaid claims or demands are accurate and that funds are and that all of said warrants are approved for pay-available for payments thereof. mentsScott A. WilliamsDATEDirector of Finance / City TreasurerDATEDate:Page 1 of 1Payroll Warrant Register Memo : Warrant2/9/2021 Payrolls reported for the month of January: 12/20/20 - 01/02/21, Paydate 01/14/21 12/20/20 - 01/02/21, Paydate 01/14/21 01/03/21 - 01/16/21, Paydate 01/28/21 Payment Method Date Payment Description Amount CHECKS 01/14/21 Net payroll, checks 8,595.19$ ACH 01/14/21 Net payroll, direct deposits 549,837.71 ACH 01/14/21 Payroll taxes 144,959.43 ACH 01/14/21 Net payroll, checks 139.90 ACH 01/14/21 Net payroll, direct deposits 2,937.90 ACH 01/14/21 Payroll taxes 1,386.00 CHECKS 01/28/21 Net payroll, checks 15,272.60 ACH 01/28/21 Net payroll, direct deposits 557,378.10 ACH 01/28/21 Payroll taxes 147,588.51 Total net payroll and payroll taxes 1,428,095.34 10801 01/14/21 ICMA 26,034.36 606843 01/14/21 Franchise Tax Board 242.31 10800 01/14/21 IBEW Dues 3,169.67 10799 01/14/21 Vernon Police Officers' Benefit Association 2,084.18 10804 01/19/21 CalPERS 179,734.21 10805 01/14/21 California State Disbursement Unit 110.76 10728 01/12/21 Mutual of Omaha 10,171.46 10813 01/15/21 AFLAC 11,529.84 10814 01/15/21 Colonial 5,609.02 10734 01/14/21 Blue Shield of California 282,895.77 10736 01/14/21 Metlife - Group Benefits 22,551.10 10815 01/19/21 MES Vision 3,218.35 10808 01/28/21 ICMA 26,670.43 10807 01/28/21 Teamsters Local 911 2,196.00 606843 01/28/21 Franchise Tax Board 242.31 10806 01/28/21 Vernon Police Officers' Benefit Association 2,084.18 10811 02/02/21 CalPERS 183,073.96 10812 01/29/21 California State Disbursement Unit 110.76 Payroll related disbursements, paid through Operating bank account 761,728.67 Total net payroll, taxes, and related disbursements 2,189,824.01$ Page 1 of 1 City Council Agenda Item Report Agenda Item No. COV-505-2021 Submitted by: John Lau Submitting Department: Finance/Treasury Meeting Date: February 16, 2021 SUBJECT Operating Account Warrant Register Recommendation: Approve Operating Account Warrant Register No. 61, for the period of January 3 through January 16, 2021, which totals $10,275,103.09 and consists of ratification of electronic payments totaling $10,069,951.71 and ratification of the issuance of early checks totaling $205,151.38. Background: Section 2.13 of the Vernon Municipal Code indicates the City Treasurer, or an authorized designee, shall prepare warrants covering claims or demands against the City which are to be presented to City Council for its audit and approval. Pursuant to the aforementioned code section, the City Treasurer has prepared Operating Account Warrant Register No. 61 covering claims and demands presented during the period of January 3 through January 16, 2021, drawn, or to be drawn, from East West Bank for City Council approval. Fiscal Impact: The fiscal impact of approving Operating Account Warrant Register No. 61, totals $10,275,103.09. The Finance Department has determined that sufficient funds to pay such claims/demands, are available in the respective accounts referenced on Operating Account Warrant Register No. 61. Attachments: 1. Operating Account Warrant Register No. 61 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021I hereby cerƟfy that claims and/or demands included in above listed warrantregister have been audited for accuracy and availability of funds for payments andthat said claims and/or demands are accurate and that the funds are available forpayments thereof.____________________________________________________________ScoƩ WilliamsDirector of Finance / City TreasurerDate: _______________________________________________________This is to cerƟfy that the claims or demands covered by the above listed warrantshave been audited by the City Council of the City of Vernon and that all of saidwarrants are approved for payments except Warrant Numbers:________________________________________________________________________________________________________________________Printed: 2/9/2021 10:52:48AM2/9/2021 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE055.9200.500180 $ 4,000.00 North System 163PIONEER COMMUNITY ENERGY006802 ‐ $ 4,000.0001/20/2021 10743055.9200.500150 $ 367,935.39 Monthly Energy 12202001BICENT (CALIFORNIA) MALBURG, L003336 ‐ 055.9200.500180 $ 3,657,717.60 Monthly Capacity Payment 12202001055.9200.500150 $ 10,866.85 COV Calculated Monthly Heat Rate 12202001$ 4,036,519.8401/20/2021 10744055.9200.500170 $ 21,870.00 Electric Energy TransacƟons GA198152DEPARTMENT OF WATER & POWER002468 ‐ 055.9200.550022 $ 575.00 Electric Energy TransacƟons GA198152$ 22,445.0001/21/2021 10745055.9200.500180 $ 225,608.00 Minimum Cost 01/21 PV0121SO CAL PUBLIC POWER AUTHORITY002517 ‐ 055.9200.500150 $ 51,425.00 Variable Cost 12/20 PV0121055.122100 $ 10,000.00 PSF Cost 12/20 PV0121$ 287,033.0001/21/2021 10746011.110021 $ 501.83 Employee Computer Loan 011121EUGENIO CERDA001645 ‐ $ 501.8301/21/2021 10747055.9200.500160 $ 36,940.00 Natural Gas 12/20 1220108456CIMA ENERGY, LP006298 ‐ $ 36,940.0001/21/2021 10748Printed: 2/9/2021 10:52:48AMPage 1 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE055.9200.500162 $ 143,031.85 Biomethane Gas 12/20 RC4306ELEMENT MARKETS RENEWABLE NATU004665 ‐ 055.9200.500162 $ 205,176.63 Biomethane Gas 12/20 RC4307$ 348,208.4801/21/2021 10749057.1057.596200 $ 10,717.00 Fiber OpƟc Equipment Maintenance & 91901813FUJITSU NETWORK COMMUNICATIONS001701 ‐ 057.1057.596200 $ 71,139.00 Fiber OpƟc Equipment Maintenance & 91901931$ 81,856.0001/21/2021 10750011.1046.520000 $ 92.51 Parts & Services~ 134651 011.0014433GARVEY EQUIPMENT COMPANY000399 ‐ $ 92.5101/21/2021 10751011.9019.520010 $ 688.60 Power BI Pro ‐ SubscripƟon License ~ 1100792686 011.0014647INSIGHT PUBLIC SECTOR, INC003606 ‐ $ 688.6001/21/2021 10752055.9200.500160 $ 940,229.75 Natural Gas 12/20 GASI00150588MACQUARIE ENERGY, LLC006086 ‐ $ 940,229.7501/21/2021 10753Printed: 2/9/2021 10:52:48AMPage 2 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE011.1031.850000 $ 11,891.88 H91TGD9PW7N~ 16131457 011.0014603MOTOROLA SOLUTIONS, INC000016 ‐ 011.1031.850000 $ 973.35 Q806~ 16131457 011.0014603011.1031.850000 $ 2,835.00 H38~ 16131457 011.0014603011.1031.850000 $ 567.00 Q361~ 16131457 011.0014603011.1031.850000 $ 850.50 QA00580~ 16131457 011.0014603011.1031.850000 $ 1,398.60 Q498~ 16131457 011.0014603011.1031.850000 $ 1,510.11 Q15~ 16131457 011.0014603011.1031.850000 $ 567.00 QA09001~ 16131457 011.0014603011.1031.850000 $ 189.00 G996~ 16131457 011.0014603011.1031.850000 $ 885.60 NMN6274A~ 16131457 011.0014603011.1031.850000 $ 340.80 PMNN4486~ 16131457 011.0014603011.1031.850000 $ 403.92 NNTN8863A Impres 2 Single Unit Charger 16131457 011.0014603011.1031.850000 $ 330.00 ADD: 3Y EssenƟal Service 16131457 011.0014603011.1031.850000 $ 2,295.79 Sales Tax 10.25 16131457$ 25,038.5501/21/2021 10754055.8200.596200 $ 712.50 Technical Design Services 1790NORTHWEST ELECTRICAL SERVICES,005614 ‐ 020.1084.900000 $ 47,737.50 Technical Design Services 1790020.1084.900000 $ 285.00 Technical Design Services 1790$ 48,735.0001/21/2021 10755055.9200.500160 $ 90,390.00 Natural Gas 12/20 230770PACIFIC SUMMIT ENERGY, LLC005908 ‐ $ 90,390.0001/21/2021 10756Printed: 2/9/2021 10:52:48AMPage 3 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE055.9200.500154 $ 512,571.52 Desert Harvest Project DH0121SO CAL PUBLIC POWER AUTHORITY002517 ‐ $ 512,571.5201/21/2021 10757055.9200.500154 $ 195,958.48 Antelope DSR 1 Solar Project DSR10121SO CAL PUBLIC POWER AUTHORITY002517 ‐ $ 195,958.4801/21/2021 10758055.8400.590000 $ 4,189.99 Fully Equipped Portable Security Booth 817599 055.0002863UNIFORM WAREHOUSE, INC006958 ‐ 055.8400.590000 $ 350.00 Freight 817599 055.0002863055.8400.590000 $ 429.47 Sales Tax 10.25 817599$ 4,969.4601/21/2021 10759Printed: 2/9/2021 10:52:48AMPage 4 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE055.9200.500150 $ 177,687.83 IniƟal Charges 01/21 202101193147995076CALIFORNIA ISO002412 ‐ 055.9200.500210 $ 10,816.78 IniƟal Charges 01/21 202101193147995076055.9200.500170 $ ‐15,275.80 IniƟal Charges 01/21 202101193147995076055.9200.500190 $ ‐1,541.59 IniƟal Charges 01/21 202101193147995076055.9200.500150 $ 24,807.93 RecalculaƟon Charges 12/20 202101193147995076055.9200.500170 $ 41,559.49 RecalculaƟon Charges 12/20 202101193147995076055.9200.500190 $ 883.68 RecalculaƟon Charges 12/20 202101193147995076055.9200.500210 $ 136.08 RecalculaƟon Charges 12/20 202101193147995076055.9200.500240 $ 257.64 RecalculaƟon Charges 12/20 202101193147995076$ 239,332.0401/25/2021 10760055.9200.500160 $ 190,819.00 Natural Gas 12/20 68423CALPINE ENERGY SERVICES, LP002060 ‐ $ 190,819.0001/25/2021 10761055.9200.500160 $ 24,000.00 Natural Gas 12/20 150834CONOCOPHILLIPS COMPANY005388 ‐ $ 24,000.0001/25/2021 10762Printed: 2/9/2021 10:52:48AMPage 5 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE055.9200.500160 $ 360,753.75 Natural Gas 12/20 1205026EDF TRADING NORTH AMERICA, LLC004116 ‐ $ 360,753.7501/25/2021 10763055.9200.500160 $ 234,773.40 Natural Gas 12/20 3342398MERCURIA ENERGY AMERICA, LLC006262 ‐ $ 234,773.4001/25/2021 10764055.9200.500160 $ 88,983.40 Natural Gas 12/20 279067MIECO, LLC006318 ‐ $ 88,983.4001/25/2021 10765055.9200.500160 $ 53,923.25 Biomethane RPS122020BIOFUEL GENERATION SERVICES, L005067 ‐ $ 53,923.2501/26/2021 10766055.9200.500154 $ 86,786.78 Puente Hills Landfill Gas Project PHL0121SO CAL PUBLIC POWER AUTHORITY002517 ‐ $ 86,786.7801/26/2021 10767055.9200.596200 $ 5,739.88 ResoluƟon Billing 121SO CAL PUBLIC POWER AUTHORITY002517 ‐ 055.7200.596702 $ 12,033.36 ResoluƟon Billing 121$ 17,773.2401/26/2021 10768055.9200.500180 $ 29,212.33 Boulder Canyon Project Charges 12/20 GG1766W1220US DEPARTMENT OF ENERGY002227 ‐ 055.9200.500150 $ 15,809.94 Boulder Canyon Project Charges 12/20 GG1766W1220$ 45,022.2701/26/2021 10769Printed: 2/9/2021 10:52:48AMPage 6 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE055.200230 $ 88,298.95 Electrical Energy Surcharge 10/20 ‐ 012121CA DEPARTMENT OF TAX & FEE ADM002242 ‐ $ 88,298.9501/26/2021 10770055.9000.595200 $ 42,461.03 Re: Bicent PPA Outage 4596499MORGAN, LEWIS & BOCKIUS, LLP001441 ‐ $ 42,461.0301/26/2021 10771055.9200.500150 $ 28,556.34 RecalculaƟon Charges 12/14/20 ‐ 202101123147928733CALIFORNIA ISO002412 ‐ 055.9200.500170 $ 31,963.37 RecalculaƟon Charges 12/14/20 ‐ 202101123147928733055.9200.500190 $ 1,314.19 RecalculaƟon Charges 12/14/20 ‐ 202101123147928733055.9200.500210 $ 359.95 RecalculaƟon Charges 12/14/20 ‐ 202101123147928733055.9200.500170 $ 308.40 RecalculaƟon Charges 12/20/20 ‐ 202101123147928733055.9200.500150 $ ‐3,581.59 RecalculaƟon Charges 12/21/20 ‐ 202101123147928733055.9200.500190 $ ‐360.91 RecalculaƟon Charges 12/21/20 ‐ 202101123147928733055.9200.500210 $ ‐22.07 RecalculaƟon Charges 12/21/20 ‐ 202101123147928733$ 58,537.6801/19/2021 10772055.9000.596200 $ 32,250.00 ConsultaƟon & Support Services VERNPVHDECEMBER2020PORT CANAVERAL PWR CONSULTANTS002459 ‐ $ 32,250.0001/26/2021 10773Printed: 2/9/2021 10:52:48AMPage 7 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE011.1026.594200 $ 18,500.01 Brokerage & ConsulƟng Services 1541956ALLIANT INSURANCE SERVICES006890 ‐ $ 18,500.0101/28/2021 10774011.1033.596200 $ 410.94 Billing Services 12/20 2012069WITTMAN ENTERPRISES, LLC004527 ‐ $ 410.9401/28/2021 10775011.1043.590000 $ 10,250.00 Street Sweeping Services 12/20 LB5632WEBCO LB, LLC005699 ‐ $ 10,250.0001/28/2021 10776011.9019.520010 $ 4,400.00 MBG Teleworker Service 10 Pkg IN2021007 011.0014682CROSSPOINT NETWORK SOLUTIONS,000956 ‐ 011.9019.520010 $ 4,500.00 Mitel 3300ICP Enterprise User licenses IN2021008 011.0014683$ 8,900.0001/28/2021 10777055.8100.590000 $ 4,170.00 Line Item: 000010~ 9345048155 055.0002857ELECTROMARK002195 ‐ 055.8100.590000 $ 36.40 Freight 9345048155 055.0002857055.8100.590000 $ 427.44 Sales Tax 10.25 9345048155057.1057.590000 $ 2,600.00 Line Item: 000010~ 9345075311 057.0000089057.1057.590000 $ 52.58 Freight 9345075311 057.0000089057.1057.590000 $ 266.50 Sales Tax 10.25 9345075311$ 7,552.9201/28/2021 10778011.1049.900000 $ 108,190.78 Fire StaƟon #76 Improvements 8022FASONE CONSTRUCTION, INC006919 ‐ $ 108,190.7801/28/2021 10779Printed: 2/9/2021 10:52:48AMPage 8 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE011.1021.797000 $ 17,600.00 Professional Services~ DEC20JEMMOTT ROLLINS GROUP, INC005108 ‐ $ 17,600.0001/28/2021 10780011.9019.860000 $ 45.00 Workforce Central SoŌware 11705208KRONOS INCORPORATED005034 ‐ $ 45.0001/28/2021 10781011.1049.590000 $ 3,582.00 Landscape Maintenance 91588MARIPOSA LANDSCAPES, INC006422 ‐ $ 3,582.0001/28/2021 10782011.1060.595200 $ 2,400.00 Health Officer Services V014LAURENE MASCOLA006869 ‐ $ 2,400.0001/28/2021 10783056.5600.590000 $ 1,011.00 CalibraƟon Services 219882MEASUREMENT CONTROL SYSTEMS, I000839 ‐ $ 1,011.0001/28/2021 10784011.9019.560010 $ 249.09 Audio Conferencing Charges USINV2012147655NTT CLOUD COMMUNICATIONS U.S.006801 ‐ $ 249.0901/28/2021 10785055.9200.596200 $ 867.00 Electronic Tagging~ 160524 055.0002815OPEN ACCESS TECHNOLOGY INTL, I000629 ‐ $ 867.0001/28/2021 10786020.1084.900000 $ 4,603.75 Design Services 4516PACIFIC ADVANCED CIVIL ENGINEE006787 ‐ $ 4,603.7501/28/2021 10787Printed: 2/9/2021 10:52:48AMPage 9 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE011.9019.590110 $ 627.40 VEEAM BACKUP FOR MO 365 SUB 1YRMLIC B12822741 011.0014675SHI INTERNATIONAL CORP005925 ‐ 011.9019.590110 $ 2,189.60 VEEAM BU FOR MS OFFICE365 1YR MLIC SUB B12822741 011.0014675$ 2,817.0001/28/2021 10788011.1043.590000 $ 3,239.00 Traffic Signal Repair & Maintenance 5610251707SIEMENS MOBILITY, INC001079 ‐ 011.1043.590000 $ 1,618.15 Traffic Signal Repair & Maintenance 5620032406011.1043.590000 $ 5,957.36 Traffic Signal Repair & Maintenance 5620033515$ 10,814.5101/28/2021 10789055.9200.550022 $ 217,839.98 ReservaƟon & Transmission Charges~ 011321THE GAS COMPANY001581 ‐ $ 217,839.9801/28/2021 10790011.1033.596200 $ 1,165,929.57 Fire ProtecƟon Services~ C0009651COUNTY OF LOS ANGELES001444 ‐ 011.1033.596200 $ 112,025.47 Fire ProtecƟon Services~ C0009651011.1033.596200 $ 27,517.60 Fire ProtecƟon Services~ C0009651$ 1,305,472.6401/29/2021 10791020.1084.900000 $ 25,150.00 EATON SPX250A0‐4A2N1~ 6680702 011.0014586ELECTRICAL SALES, INC006918 ‐ 020.1084.900000 $ 990.00 EATON OPTCQ~ 6680702 011.0014586020.1084.900000 $ 2,679.35 Sales Tax 10.25 6680702$ 28,819.3501/29/2021 10792Printed: 2/9/2021 10:52:48AMPage 10 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE011.1070.550000 $ 118.16 Halloween Bag for Residents 102220US BANK CORPORATE005594 ‐ 011.9019.520010 $ 282.82 IT Label Maker 102220011.1070.550000 $ 23.74 Items for Halloween Bags 102220011.9019.520010 $ 512.44 Memory Card / Fire End of Watch Program 102220011.1070.550000 $ 1.00 Parking Charges 102220055.8400.590000 $ 433.62 Power Plant Diesel Drive 102220011.1002.520000 $ 137.34 Remote Back PD Gate 102220011.1070.550000 $ 15.30 Supplies / Fire End of Watch Program 102220011.9019.520010 $ 77.38 Zoom MeeƟng Camera 102220055.8400.590000 $ 388.42 BaƩery Backup 102220(10)020.1084.900000 $ 2,068.24 Coplanar TransmiƩer 102220(10)020.1084.900000 $ 2,068.24 Coplanar TransmiƩer 102220(10)011.1002.596500 $ 193.74 Meals / MeeƟng 102220(10)055.9000.596700 $ 34.46 Meals / Well 11 Callout 102220(10)011.9019.520010 $ 22.00 Supplies 102220(10)011.1048.520000 $ 624.80 Supplies 102220(11)011.1049.520000 $ 139.43 Supplies 102220(11)011.1043.520000 $ 1,704.05 Supplies 102220(12)011.9019.520010 $ 52.99 Adobe Cloud System 102220(13)011.9019.520010 $ 917.75 GoToMeeƟng SoŌware 102220(13)011.9019.520010 $ 936.00 Gsuite for VPU/PW 102220(13)011.9019.520010 $ 396.70 Helpdesk SoŌware 102220(13)011.9019.520010 $ 82.05 Laptop Cases 102220(13)Printed: 2/9/2021 10:52:48AMPage 11 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE011.9019.520010 $ 280.99 Office 365 102220(13)US BANK CORPORATE005594 ‐ 011.9019.520010 $ 43.78 Phone Case 102220(13)011.9019.590110 $ 468.30 Spare IP Dome Cameras 102220(13)011.9019.520010 $ 102.02 Spare SD Cards 102220(13)011.9019.520010 $ 1,038.54 Spare VOIP Phones 102220(13)011.9019.520010 $ 9.99 Zendesk Approval Queue App 102220(13)011.9019.520010 $ 80.40 Adobe DC SoŌware 102220(13)011.9019.520010 $ 239.90 Zoom Remote MeeƟngs 102220(13)011.9019.520010 $ 14.32 Amazon Prime Membership 102220(13)011.9019.520010 $ 9.99 Arlo Cameras SubscripƟon 102220(13)011.9019.520010 $ 38.85 Canva SoŌware for VPU 102220(13)011.9019.520010 $ 399.98 CerƟficate Renewal 102220(13)011.9019.520010 $ 64.95 Domain Name Renewal 102220(13)011.9019.520010 $ 41.85 Equipment for VPU 102220(13)011.9019.520010 $ 29.95 GoodSync SoŌware for VPU 102220(13)011.1046.520000 $ 735.50 Supplies 102220(14)011.1033.520000 $ 1,679.79 Supplies 102220(15)011.1033.540000 $ 31.96 Uniforms 102220(15)011.1043.520000 $ 1,756.01 Supplies 102220(16)011.1031.520000 $ 26.38 Camera Memory Cards 102220(17)011.1031.596200 $ 800.00 Radio Frequency TesƟng 102220(17)011.1031.520000 $ 922.27 Supplies 102220(17)011.1031.520050 $ 53.85 Supplies 102220(17)Printed: 2/9/2021 10:52:48AMPage 12 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE011.1031.596700 $ 60.00 Training 102220(17)US BANK CORPORATE005594 ‐ 011.1031.596700 $ 85.00 Training / A. Encinas 102220(17)011.1031.596700 $ 85.00 Training / A. Escobedo 102220(17)011.1031.596700 $ 125.00 Training / B. Arellano 102220(17)011.1031.596700 $ 129.00 Training / D. Onopa 102220(17)011.1031.596700 $ 75.00 Training / L. Gaytan 102220(17)011.1031.596700 $ 60.00 Training / R. Godoy 102220(17)011.1031.596500 $ ‐1,849.79 Credit 102220(17)011.1031.596700 $ 129.00 Training / R. Landa 102220(17)011.1031.596700 $ 695.00 Training / R. Sousa 102220(17)011.1031.596500 $ 755.28 Hotels / C. Maciel 102220(17)011.1031.596500 $ 422.61 Hotels / G. MarƟnez 102220(17)011.1031.596500 $ 396.00 Hotels / J. Chavez 102220(17)011.1031.596200 $ 875.00 IACP Net SubscripƟon 102220(17)011.1031.540000 $ 19.51 Police Patches 102220(17)011.1031.520000 $ 106.20 Portable Inverter Generator 102220(17)011.1031.520000 $ 1,391.00 Portable Inverter Generator 102220(17)011.1048.520000 $ 338.74 Supplies 102220(18)011.1049.520000 $ 124.20 Supplies 102220(18)055.9000.550000 $ 327.59 AdverƟsement / PromoƟon 102220(19)055.9000.520000 $ 16.60 Postage 102220(19)055.9000.520000 $ 29.54 Supplies 102220(19)055.8000.540000 $ 251.26 Uniforms 102220(19)Printed: 2/9/2021 10:52:48AMPage 13 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE055.9000.540000 $ 867.84 Uniforms 102220(19)US BANK CORPORATE005594 ‐ 020.1084.900000 $ 388.42 Water System SCADA 102220(19)020.1084.900000 $ 3,089.58 Well #17 Panelboard 102220(19)011.1026.596905 $ 83.01 Meals / EHS Interview Panel 102220(2)011.1026.596700 $ 75.00 Training 102220(2)011.1026.520000 $ 114.96 Sympathy Flowers 102220(20)011.1031.570000 $ 86.11 Vehicle Expense 102220(21)011.1026.596700 $ 1,350.00 Training 102220(22)020.1084.900000 $ 1,878.45 Water System SCADA 102220(23)011.1046.520000 $ 49.97 Supplies 102220(24)011.1043.520000 $ 1,246.83 Supplies 102220(25)011.1049.520000 $ 262.77 Supplies 102220(25)011.1049.520000 $ 1,967.76 Supplies 102220(26)011.1004.596700 $ 150.00 Training / J. Lau 102220(27)011.5031.560000 $ 61.56 Cable SubscripƟon 102220(28)011.1031.520000 $ 594.89 Supplies 102220(28)057.1057.900000 $ 1,010.74 Fiber Mode Conversion 102220(29)055.9000.596700 $ 51.33 Meals / MeeƟng 102220(3)055.9000.520000 $ 117.28 Supplies 102220(3)020.1084.590000 $ 473.13 Maintenance & Repairs 102220(30)020.1084.900000 $ 4,287.32 Water System SCADA 102220(30)011.1060.520000 $ 156.78 Supplies 102220(31)020.1084.900000 $ 1,268.15 Water System SCADA 102220(32)Printed: 2/9/2021 10:52:48AMPage 14 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE020.1084.900000 $ 2,320.70 Well No. 15 RehabilitaƟon 102220(32)US BANK CORPORATE005594 ‐ 020.1084.900000 $ 1,268.15 Well No. 17 RehabilitaƟon 102220(32)055.9000.596550 $ 77.66 Cable SubscripƟon 102220(4)055.9000.596700 $ 250.41 Sympathy Flowers 102220(4)055.9000.596700 $ 1,375.00 Training / Staff 102220(4)011.1031.520000 $ 263.00 Meals / Mutual Aid Lunch 102220(5)011.1031.520000 $ 270.96 Supplies 102220(5)011.1031.540000 $ 171.73 Uniforms 102220(5)011.1031.596700 $ 250.00 Training 102220(6)011.1040.520000 $ 158.72 Supplies 102220(7)056.5600.520000 $ 158.74 Supplies 102220(8)011.1002.520000 $ 29.45 Engraved Name Plate 102220(9)011.1002.520000 $ 54.36 Flag Display Case 102220(9)011.1002.520000 $ 72.75 Framed ProclamaƟon 102220(9)011.1023.596600 $ 54.49 LA Times SubscripƟon 102220(9)011.1001.596500 $ 100.28 Meals / MeeƟng 102220(9)011.1002.596500 $ 98.16 Meals / MeeƟng 102220(9)011.1001.596500 $ 200.00 RegistraƟon / CC Members 102220(9)$ 51,553.4212/29/2020 10793Printed: 2/9/2021 10:52:48AMPage 15 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE011.1043.520000 $ ‐64.83 Deposit Refund 112320US BANK CORPORATE005594 ‐ 011.1043.520000 $ 150.00 Equipment Rental Deposit 112320011.1043.520000 $ 2,023.11 Supplies 112320011.1049.520000 $ 766.24 Keys 112320(10)011.1048.520000 $ ‐312.40 Refund for Duplicate Charge in October 112320(10)011.1048.520000 $ 1,444.03 Supplies 112320(10)011.1049.520000 $ 56.19 Supplies 112320(10)011.1049.520000 $ 299.00 Supplies 112320(10)011.1043.520000 $ 3,873.08 Supplies 112320(11)011.9019.520010 $ 52.99 Adobe Cloud System 112320(12)011.9019.520010 $ 442.97 Helpdesk SoŌware 112320(12)011.9019.520010 $ 282.31 Ink For PD ID Card Printer 112320(12)011.9019.520010 $ 219.40 iPad Keyboards for City Council 112320(12)011.9019.520010 $ 396.81 iPad Keyboards for City Council 112320(12)011.9019.520010 $ 26.45 Laptop Case 112320(12)011.9019.520010 $ 280.99 Office 365 112320(12)011.9019.520010 $ 9.99 PM SoŌware 112320(12)011.9019.520010 $ 38.85 Publishing SoŌware for VPU 112320(12)011.9019.520010 $ 181.29 Spare Webcams 112320(12)011.9019.520010 $ 110.10 Spare Wired Mice 112320(12)011.9019.520010 $ 80.40 Adobe DC SoŌware 112320(12)011.9019.520010 $ 408.00 Survey SoŌware for VPU 112320(12)011.9019.520010 $ 167.57 TV Mount Bracket for PW 112320(12)Printed: 2/9/2021 10:52:48AMPage 16 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE011.9019.590110 $ 239.90 Zoom Remote MeeƟngs 112320(12)US BANK CORPORATE005594 ‐ 011.9019.520010 $ 14.32 Amazon Prime Membership 112320(12)011.9019.520010 $ 9.99 Arlo Cameras SubscripƟon 112320(12)011.9019.520010 $ 93.48 Domain Name Renewal 112320(12)011.9019.520010 $ 1,075.72 Google Suite SoŌware 112320(12)011.9019.520010 $ 222.75 GoToAssist SoŌware 112320(12)011.9019.520010 $ 14.00 GoToMeeƟng Professional 112320(12)011.9019.520010 $ 681.00 GoToMeeƟng SoŌware 112320(12)011.1046.520000 $ 153.02 Supplies 112320(13)011.1004.595200 $ 5.49 Federal E‐Filing 112320(14)011.1049.520000 $ 3,808.27 Supplies 112320(15)011.1031.520000 $ 169.28 Camera Memory Cards 112320(16)011.1031.550000 $ 98.46 Christmas Cards 112320(16)011.1031.596500 $ 422.61 Hotels / G. MarƟnez 112320(16)011.1031.596500 $ 144.73 Hotels / M. Velez 112320(16)011.1031.596700 $ 517.00 Records Supervisor Training / G. Garcia 112320(16)011.1031.520000 $ 1,731.59 Supplies 112320(16)011.1031.540000 $ 728.92 Uniforms 112320(16)011.1049.520000 $ 85.32 Keys 112320(17)011.1049.520000 $ 250.00 Locksmith 112320(17)011.1049.520000 $ 865.55 Supplies 112320(17)055.9000.596700 $ 575.00 APPA Webinar 112320(18)055.8100.540000 $ 3,481.10 Uniforms 112320(18)Printed: 2/9/2021 10:52:48AMPage 17 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE055.9000.540000 $ 178.58 Uniforms 112320(18)US BANK CORPORATE005594 ‐ 055.9100.540000 $ 89.29 Uniforms 112320(18)011.1070.797000 $ 2,520.04 Books & PublicaƟons 112320(19)011.1002.520000 $ 6,122.91 City Hall Weight Room Equipment 112320(2)011.9019.520000 $ 130.04 Desk Outlet for IT 112320(2)011.1002.570000 $ 10.01 Fuel for City Vehicle 112320(2)011.1070.550000 $ 206.67 Halloween Basket Giveaway 112320(2)011.1002.520000 $ 23.14 Halloween Décor 112320(2)011.1070.550000 $ 632.93 Inflatables for Christmas Event 112320(2)011.1070.550000 $ 51.40 Supplies / Halloween Door 112320(2)011.1002.520000 $ 40.74 Supplies / Xmas Give Away 112320(2)011.1026.596900 $ 158.66 Halloween Employee Event 112320(20)011.1031.570000 $ 44.20 Fuel for City Vehicle 112320(21)011.1026.596900 $ 1,423.73 Halloween Employee Event 112320(22)011.1046.520000 $ 2,801.34 Auto Parts 112320(23)011.1046.520000 $ 90.00 Freight Charge 112320(23)011.1046.520000 $ 23.15 Keys 112320(23)011.1046.520000 $ 32.96 Supplies 112320(23)011.1049.520000 $ 1,409.37 COVID‐19 Supplies 112320(24)011.1049.520000 $ 2,292.92 Supplies 112320(24)011.1049.520000 $ 791.60 Flags 112320(25)011.1049.520000 $ 704.72 Supplies 112320(25)011.5031.560000 $ 61.68 Cable SubscripƟon 112320(26)Printed: 2/9/2021 10:52:48AMPage 18 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE011.1031.520000 $ 266.58 Marsy's Law Cards 112320(26)US BANK CORPORATE005594 ‐ 011.1031.520000 $ 29.03 Postage 112320(26)011.1031.520000 $ 300.20 Supplies 112320(26)011.1031.520000 $ 256.45 Supplies 112320(26)020.1084.900000 $ 2,527.28 Supplies 112320(27)011.1060.596700 $ 3,200.00 Cross ConnecƟon Training 112320(28)011.1060.596700 $ 202.50 HAZWOPER Training 112320(28)011.1060.520000 $ 253.36 Supplies 112320(28)011.1046.520000 $ 761.53 Auto Parts 112320(29)055.7100.596700 $ 150.00 Books & PublicaƟons 112320(3)055.9000.596550 $ 155.42 Cable SubscripƟon 112320(3)055.8000.596700 $ 550.00 Training / B. Montoya 112320(3)020.1084.900000 $ 2,033.04 Inline Pressure TransmiƩer 112320(30)011.1031.520000 $ 425.40 Pepper Spray 112320(4)011.1031.520000 $ 2,966.86 Supplies 112320(4)020.1084.900000 $ 251.37 Supplies 112320(5)011.1002.596500 $ 80.56 Lunch MeeƟng 112320(6)011.1043.596600 $ 40.00 Books & PublicaƟons 112320(7)056.5600.520000 $ 147.77 Supplies 112320(8)011.1001.596500 $ 65.00 Conference RegistraƟon / C. Menke 112320(9)011.1023.596600 $ 122.45 LA Times SubscripƟon 112320(9)$ 60,944.9212/29/2020 10794Printed: 2/9/2021 10:52:48AMPage 19 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE020.1084.520000 $ 117.48 Office Supplies 129971948001OFFICE DEPOT002190 ‐ 020.1084.520000 $ 12.04 Sales Tax 10.25 129971948001020.1084.520000 $ 174.29 Office Supplies 131229361001020.1084.520000 $ 17.86 Sales Tax 10.25 131229361001020.1084.520000 $ 9.95 Office Supplies 131229702001020.1084.520000 $ 1.02 Sales Tax 10.25 131229702001056.5600.560000 $ 187.42 Office Supplies 133014798001056.5600.560000 $ 19.21 Sales Tax 10.25 133014798001056.5600.520000 $ 13.19 Office Supplies 133030328001056.5600.520000 $ 1.35 Sales Tax 10.25 133030328001056.5600.520000 $ 429.99 Office Supplies 133030337001056.5600.520000 $ 44.07 Sales Tax 10.25 133030337001055.7100.520000 $ 124.05 Office Supplies 134272864001055.8000.520000 $ 19.49 Office Supplies 134272864001055.8100.520000 $ 321.49 Office Supplies 134272864001055.9000.520000 $ 214.96 Office Supplies 134272864001055.9100.520000 $ 58.51 Office Supplies 134272864001055.7100.520000 $ 19.46 Office Supplies 134328819001055.9000.520000 $ 19.46 Office Supplies 134328819001055.8100.520000 $ 44.18 Office Supplies 134328820001055.8100.520000 $ 41.06 Office Supplies 134328824001055.9100.520000 $ 4.38 Office Supplies 134328826001055.8100.520000 $ 355.55 Office Supplies 134328827001Printed: 2/9/2021 10:52:48AMPage 20 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE055.9100.520000 $ 32.48 Office Supplies 136871742001OFFICE DEPOT002190 ‐ 011.1040.520000 $ 15.67 Office Supplies 140176255001011.1041.520000 $ 75.77 Office Supplies 140176255001011.1043.520000 $ 30.15 Office Supplies 140176255001011.1040.520000 $ 1.61 Sales Tax 10.25 140176255001011.1041.520000 $ 7.76 Sales Tax 10.25 140176255001011.1043.520000 $ 3.07 Sales Tax 10.25 140176255001011.1041.520000 $ 15.99 Office Supplies 141834062001011.1041.520000 $ 1.64 Sales Tax 10.25 141834062001011.1031.520000 $ 29.96 Office Supplies 143124640001011.1031.520000 $ 3.07 Sales Tax 10.25 143124640001011.1031.520000 $ 84.00 Office Supplies 143124650001011.1031.520000 $ 8.61 Sales Tax 10.25 143124650001011.1004.520000 $ 92.85 Office Supplies 143269885001011.1004.520000 $ 9.52 Sales Tax 10.25 143269885001011.1004.520000 $ 135.99 Office Supplies 143320306001011.1004.520000 $ 29.99 Freight 143320306001011.1004.520000 $ 13.94 Sales Tax 10.25 143320306001011.1031.520000 $ 107.76 Office Supplies 144515801001011.1031.520000 $ 11.05 Sales Tax 10.25 144515801001011.1031.520000 $ 281.65 Office Supplies 144516224001011.1040.520000 $ 14.37 Office Supplies 144520262001011.1040.520000 $ 1.47 Sales Tax 10.25 144520262001Printed: 2/9/2021 10:52:48AMPage 21 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021ELECTRONICVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTPAYMENTNUMBERPAYMENTDATE$ 3,258.8301/22/2021 10795011.9019.520000 $ 14.57 Office Supplies 136286909001OFFICE DEPOT002190 ‐ 011.1002.520000 $ 27.69 Office Supplies 136286909001011.9019.520000 $ 1.49 Sales Tax 10.25 136286909001011.1002.520000 $ 2.84 Sales Tax 10.25 136286909001011.1002.520000 $ 21.18 Office Supplies 136290576001011.1002.520000 $ 2.17 Sales Tax 10.25 136290576001011.1002.520000 $ 19.49 Office Supplies 136290579001011.1002.520000 $ 2.00 Sales Tax 10.25 136290579001$ 91.4301/29/2021 10796011.1041.520000 $ 31.91 Period: 12/20 933312510(2)UPS001617 ‐ 011.1041.520000 $ 97.02 Period: 12/20 933312520(2)$ 128.9301/29/2021 10797011.210210 $ 4,155.40 Reimb. Overwithheld Social Security 012721JIM ENRIQUEZ006987 ‐ $ 4,155.4001/28/2021 10798TOTAL ELECTRONIC$ 10,069,951.71Printed: 2/9/2021 10:52:48AMPage 22 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021EARLY CHECKSVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTCHECKNUMBERPAYMENTDATE055.8100.596200 $ 122.43 Portable Restrooms 674771A THRONE CO, INC000005 ‐ 055.8100.596200 $ 279.14 Portable Restrooms 674772055.8100.596200 $ 122.43 Portable Restrooms 674773020.1084.520000 $ 84.95 Portable Restrooms 676607$ 608.9501/19/2021 606777011.1046.590000 $ 745.00 Labor to Repair Wire Loom 34005 011.0014626ANAYA SERVICE CENTER006308 ‐ $ 745.0001/19/2021 606778055.8400.590000 $ 90.00 Backflow Valve InspecƟon 978472BACKFLOW APPARATUS & VALVE COM000294 ‐ $ 90.0001/19/2021 606779011.1041.595200 $ 546.30 4th Qtr 10/01/20 ‐ 12/31/20 010721CA BUILDING STANDARDS COMMISSI003749 ‐ $ 546.3001/19/2021 606780011.1033.560000 $ 83.64 Period: 10/22/20 ‐ 11/19/20 112020(2)CALIFORNIA WATER SERVICE CO000778 ‐ 011.1033.560000 $ 83.64 Period: 11/20/20 ‐ 12/21/20 122220(2)$ 167.2801/19/2021 606781011.1046.520000 $ 46.42 Auto Parts~ 365181 011.0014431CENTRAL FORD004163 ‐ 011.1046.520000 $ 261.20 Auto Parts~ 365590 011.0014431011.1046.520000 $ 161.87 Auto Parts~ 365773 011.0014431$ 469.4901/19/2021 606782Printed: 2/9/2021 10:52:48AMPage 23 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021EARLY CHECKSVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTCHECKNUMBERPAYMENTDATE011.1049.590000 $ 590.00 Overhead Doors Maintenance 19203COMMERCIAL DOOR OF LOS ANGELES000331 ‐ $ 590.0001/19/2021 606783020.1084.900000 $ 256.42 Electrical Supplies~ 265701 011.0014437CURRENT WHOLESALE ELECTRIC SUP001336 ‐ $ 256.4201/19/2021 606784011.1041.595200 $ 3,620.20 Mapping Fee 4th Qtr 2020 010721DEPARTMENT OF CONSERVATION000977 ‐ $ 3,620.2001/19/2021 606785011.1026.596200 $ 52.00 Reimb. Live Scan 011221CHRISTOPHER DONER006976 ‐ $ 52.0001/19/2021 606786011.1046.520000 $ 51.24 Auto Parts~ 109609621 011.0014432FACTORY MOTOR PARTS006696 ‐ 011.1046.520000 $ 1,545.55 Auto Parts~ 123774761 011.0014432011.1046.520000 $ 977.75 Auto Parts~ 123785532 011.0014432$ 2,574.5401/19/2021 606787056.5600.590000 $ 3,420.00 Corrosion Engineering Services 20670INFARWEST CORROSION CONTROL CO.002947 ‐ $ 3,420.0001/19/2021 606788011.9019.560010 $ 46.42 Period: 12/16/20 ‐ 01/15/21 121620FRONTIER005825 ‐ $ 46.4201/19/2021 606789020.1084.500140 $ 1,316.66 Sodium Hypochlorite 142751FULLER ENGINEERING, INC006622 ‐ $ 1,316.6601/19/2021 606790Printed: 2/9/2021 10:52:48AMPage 24 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021EARLY CHECKSVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTCHECKNUMBERPAYMENTDATE011.1046.520000 $ 165.00 Windshield Front~ WOI0497920 011.0014625GTO AUTO GLASS004035 ‐ 011.1046.520000 $ 120.00 Moldings~ WOI0497920 011.0014625011.1046.590000 $ 75.00 Labor to install windshield. WOI0497920 011.0014625011.1046.520000 $ 27.08 Sales Tax 9.5% WOI0497920$ 387.0801/19/2021 606791011.1031.502030 $ 1,250.00 Employer ContribuƟon 02/01/21~ 010621HSA BANK004239 ‐ $ 1,250.0001/19/2021 606792011.1031.594200 $ 22.56 InterpretaƟon Services 4925482LANGUAGE LINE SERVICES, INC003272 ‐ $ 22.5601/19/2021 606793011.1049.520000 $ 9.84 Small Tools, Plumbing & Building 111586 011.0014465LB JOHNSON HARDWARE CO #1000804 ‐ 011.1046.520000 $ 11.15 Small Tools, Plumbing & Building 111620 011.0014465011.1046.520000 $ 39.35 Small Tools, Plumbing & Building 111653 011.0014465011.1048.520000 $ 17.51 Small Tools, Plumbing & Building 111790 011.0014465$ 77.8501/19/2021 606794055.8100.570000 $ 20.00 Car Wash Services~ 1086 055.0002821MAYWOOD CAR WASH000870 ‐ $ 20.0001/19/2021 606795055.8000.900000 $ 5,760.00 Item No. E37‐0518~ 164531 055.0002831MCAVOY & MARKHAM ENGINEERING A000304 ‐ 055.8000.900000 $ 590.40 Sales Tax 10.25 164531$ 6,350.4001/19/2021 606796Printed: 2/9/2021 10:52:48AMPage 25 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021EARLY CHECKSVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTCHECKNUMBERPAYMENTDATE011.9019.590110 $ 660.00 Hosted Maintenance Renewal with Service 8542 011.0014680MDE, INC000039 ‐ $ 660.0001/19/2021 606797056.5600.595200 $ 737.20 Financial Support & Business 10654NEWGEN STRATEGIES & SOLUTIONS,006185 ‐ 056.5600.596200 $ 232.80 Financial Support & Business 10654$ 970.0001/19/2021 606798055.9100.590110 $ 7,912.00 ETAP Maintenance~ 63567IN 055.0002867OPERATION TECHNOLOGY, INC002617 ‐ $ 7,912.0001/19/2021 606799011.1046.520000 $ 32.00 Fuel Pump Gasket 4167 011.0014628PACIFIC AUTO REPAIR004831 ‐ 011.1046.590000 $ 295.00 Labor to diagnose & repair unit. 4167 011.0014628011.1046.520000 $ 3.28 Sales Tax 10.25 4167$ 330.2801/19/2021 606800055.7100.520000 $ 79.00 Business Cards~ 27217 055.0002865SILVA'S PRINTING NETWORK003775 ‐ 055.7100.520000 $ 8.10 Sales Tax 10.25 27217$ 87.1001/19/2021 606801055.9000.900000 $ 322.50 Meteorological Services 2012SIMON WIND, INC005790 ‐ $ 322.5001/19/2021 606802Printed: 2/9/2021 10:52:48AMPage 26 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021EARLY CHECKSVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTCHECKNUMBERPAYMENTDATE056.5600.900000 $ 988.85 T. CHRISTY S03801 KRYLON‐~ S3591690001 056.0000628SMARDAN SUPPLY CO004229 ‐ 056.5600.900000 $ 440.82 YELLOW MARKING PAINT INVERTED TIP S3591690001 056.0000628056.5600.900000 $ 49.05 1/4 BLACK PLUG S3591690001 056.0000628056.5600.900000 $ 249.20 1" BLACK 90 STREET ELL S3591690001 056.0000628056.5600.900000 $ 122.75 1/4 BLK MALL 90 ELBOW S3591690001 056.0000628056.5600.900000 $ 189.69 Sales Tax 10.25 S3591690001056.5600.900000 $ ‐159.36 1" BLACK 90 STREET ELL S3591690002 056.0000628056.5600.900000 $ 119.05 1/4 BLK MALL 90 ELBOW S3591690002 056.0000628056.5600.900000 $ 12.27 Sales Tax 10.25 S3591690002056.5600.900000 $ 617.15 YELLOW MARKING PAINT INVERTED TIP S3591690003 056.0000628056.5600.900000 $ 63.25 Sales Tax 10.25 S3591690003$ 2,692.7201/19/2021 606803055.9100.596200 $ 787.14 OperaƟng Expense 09/20 20805SO CAL JOINT POLE COMMITTEE002079 ‐ $ 787.1401/19/2021 606804011.1033.560000 $ 225.00 Hydrant 010121TRI‐CITY MUTUAL WATER COMPANY000282 ‐ 011.1033.560000 $ 225.00 Hydrant 110120011.1033.560000 $ 225.00 Hydrant 120120$ 675.0001/19/2021 606805055.9000.596600 $ 2,328.00 CapitolTrack Unlimited SubscripƟon~ 47529 055.0002869WAVELENGTH AUTOMATION, INC006955 ‐ $ 2,328.0001/19/2021 606806Printed: 2/9/2021 10:52:48AMPage 27 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021EARLY CHECKSVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTCHECKNUMBERPAYMENTDATE011.1043.520000 $ 365.98 Regulatory Signs & MounƟng Hardware~ 90669011.0014470ZUMAR INDUSTRIES, INC001153 ‐ $ 365.9801/19/2021 606807011.9019.560010 $ 1,147.99 Period: 11/20/20 ‐ 12/19/20 122020AT&T001948 ‐ 011.9019.560010 $ 310.92 Period: 11/20/20 ‐ 12/19/20 122020(2)$ 1,458.9101/26/2021 606808055.9200.560010 $ 152.00 Period: 11/19/20 ‐ 12/18/20 2788898509AT&T001948 ‐ $ 152.0001/26/2021 606809011.1048.530015 $ 245.33 Reimb. Possessory Interest Tax~ 012621SERGIO CANALES000661 ‐ $ 245.3301/26/2021 606810020.1084.500140 $ 976.00 Water Quality TesƟng & ReporƟng 978354CLINICAL LAB OF SAN BERNARDINO003088 ‐ $ 976.0001/26/2021 606811020.1084.900000 $ 810.00 B6X18/12LA/AL~ 265114 011.0014577CURRENT WHOLESALE ELECTRIC SUP001336 ‐ 020.1084.900000 $ 287.50 6P1890HT/AL~ 265114 011.0014577020.1084.900000 $ 420.00 6P1890HT/ELL/AL~ 265114 011.0014577020.1084.900000 $ 155.54 Sales Tax 10.25 265114$ 1,673.0401/26/2021 606812011.1060.595200 $ 4,015.22 Former Thermador Site Cleanup 20SM1806DEPT OF TOXIC SUBSTANCES CTRL000620 ‐ $ 4,015.2201/26/2021 606813Printed: 2/9/2021 10:52:48AMPage 28 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021EARLY CHECKSVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTCHECKNUMBERPAYMENTDATE011.1003.596300 $ 117.97 2021 CA ElecƟon Code Books 011921DFM ASSOCIATES006625 ‐ $ 117.9701/26/2021 606814055.8400.590000 $ 685.00 Emergency Power Generator PreventaƟve S85709DUTHIE POWER SERVICES006714 ‐ $ 685.0001/26/2021 606815011.1003.596550 $ 115.00 Membership Dues 011921IIMC005144 ‐ $ 115.0001/26/2021 606816055.7200.596702 $ 3,394.76 Customer IncenƟve Program 012021INTERNATIONAL TRADING ASSOCIAT006980 ‐ $ 3,394.7601/26/2021 606817055.7200.596702 $ 4,084.74 Customer IncenƟve Program 012121KITCHENWARE CRAFT, INC006981 ‐ $ 4,084.7401/26/2021 606818011.1024.593200 $ 3,296.95 SeƩlement & Release of all Claims~ 012521LAW OFFICE OF MATTHEW STRUGAR006984 ‐ $ 3,296.9501/26/2021 606819Printed: 2/9/2021 10:52:48AMPage 29 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021EARLY CHECKSVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTCHECKNUMBERPAYMENTDATE011.1002.596200 $ 1,943.00 Strategic CommunicaƟons~ 012621FRED MACFARLANE004259 ‐ 011.1002.596200 $ 5,000.00 Strategic CommunicaƟons~ 012621(2)011.1002.596200 $ 5,000.00 Strategic CommunicaƟons~ 012621(3)011.1002.596200 $ 5,000.00 Strategic CommunicaƟons~ 012621(4)011.1002.596200 $ 5,000.00 Strategic CommunicaƟons~ 012621(5)011.1002.596200 $ 5,000.00 Strategic CommunicaƟons~ 012621(6)011.1002.596200 $ 5,000.00 Strategic CommunicaƟons~ 012621(7)$ 31,943.0001/26/2021 606820011.1041.520000 $ 2,734.49 Plan Check Services~ 14263MELVYN GREEN & ASSOCIATES, INC001096 ‐ 011.1041.520000 $ 3,635.86 Plan Check Services~ 14277011.1041.520000 $ 4,027.79 Plan Check Services~ 14285$ 10,398.1401/26/2021 606821011.9019.520010 $ 215.00 Time Tracking System 54428ONEPOINT HUMAN CAPITAL MGMT006475 ‐ $ 215.0001/26/2021 606822011.1049.590000 $ 9,697.89 Janitorial Services 01/21 73707PRIORITY BUILDING SERVICES, LL006416 ‐ 011.1049.590000 $ 8,660.00 Day Porter Services 01/21 73709011.1049.590000 $ 360.00 Janitorial Services 12/20~ 73993$ 18,717.8901/26/2021 606823Printed: 2/9/2021 10:52:48AMPage 30 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021EARLY CHECKSVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTCHECKNUMBERPAYMENTDATE011.1049.900000 $ 765.00 Plumbing Repairs at FS#76 12130QUALITY JET ROOTER, INC004451 ‐ 011.1049.900000 $ 4,500.00 Plumbing Repairs at FS#76 12131011.1049.900000 $ 10,400.00 Plumbing Repairs at FS#76 12164$ 15,665.0001/26/2021 606824011.9019.595210 $ 1,290.60 Temporary Staffing 56542068ROBERT HALF TECHNOLOGY006957 ‐ 011.9019.595210 $ 1,760.00 Temporary Staffing 56612293011.9019.595210 $ 1,600.00 Temporary Staffing 56724817011.9019.595210 $ 1,074.45 Temporary Staffing 56802751$ 5,725.0501/26/2021 606825055.9100.464000 $ 116.00 Joint Pole, Salvage Equipment, & 7501208128SO CAL EDISON000059 ‐ $ 116.0001/26/2021 606826020.1084.596200 $ 7,000.40 Water System Annual Fees~ LW1028987STATE WATER RESOURCES CONTROL000287 ‐ $ 7,000.4001/26/2021 606827011.1043.596200 $ 48,582.33 West‐Side Project Specific Plan 98942THE ARROYO GROUP006975 ‐ $ 48,582.3301/26/2021 606828055.7200.596702 $ 6,783.82 Customer IncenƟve Program 012021TRANSCO INTERNATIONAL006982 ‐ $ 6,783.8201/26/2021 606829055.9000.560010 $ 22.96 Period: 11/24/20 ‐ 12/23/20 9869875509VERIZON WIRELESS001481 ‐ $ 22.9601/26/2021 606830Printed: 2/9/2021 10:52:48AMPage 31 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021EARLY CHECKSVENDOR NAME AND NUMBERACCOUNTNUMBERINVOICEAMOUNTDESCRIPTIONINVOICEP.O.#PAYMENTAMOUNTCHECKNUMBERPAYMENTDATE020.1084.500140 $ 25.00 Water Quality TesƟng & ReporƟng W1A0960COVERNONWECK LABORATORIES, INC001628 ‐ $ 25.0001/26/2021 606831TOTAL EARLY CHECKS$ 205,151.38Printed: 2/9/2021 10:52:48AMPage 32 of 33 CITY OF VERNONOPERATING ACCOUNTWARRANT REGISTER NO. 61FEBRUARY 16, 2021RECAP BY FUNDFUNDELECTRONIC TOTALEARLY CHECK TOTALWARRANT TOTALGRAND TOTALS$ 1,598,763.73$ 1,751,839.50$0.00$ 153,075.77011 ‐ GENERAL105,700.31117,032.780.0011,332.47020 ‐ WATER8,277,689.118,311,349.530.0033,660.42055 ‐ LIGHT & POWER2,012.749,095.460.007,082.72056 ‐ NATURAL GAS85,785.8285,785.820.000.00057 ‐ FIBER OPTICGRAND TOTAL$10,275,103.09$0.00$205,151.38$10,069,951.71TOTAL CHECKS TO BE PRINTED 0Printed: 2/9/2021 10:52:48AMPage 33 of 33 City Council Agenda Item Report Agenda Item No. COV-506-2021 Submitted by: Diana Figueroa Submitting Department: Fire Department Meeting Date: February 16, 2021 SUBJECT Fire Department Activity Report Recommendation: Receive and file the November 2020 Report. Background: Attached is a copy of the Fire Department Activity Report which covers the period of November 1 through November 30, 2020. This report is provided by Los Angeles County Fire and consists of incident details and a summary for the month. Fiscal Impact: There is no fiscal impact associated with this report. Attachments: 1. Fire Department Activity Report - November 2020 Los Angeles County Fire Department November 2020 Incident Report For City of Vernon Alarm Date Time Basic Incident Number (FD1) Cad Initial Cad Incident Type Description Incident Type Address Basic Incident Full Street Address Basic First Arrived At Scene Apparatus ID Basic Property Losses (FD1.35) Basic Content Losses (FD1.36) 11/01/20 LAC20330403 ALRWF 744 - Detector activation, no fire - unintentional 3021 East 44TH VERNON CA 90058 3021 East 44TH Street E52 11/01/20 LAC20330613 ALRA 745 - Alarm system activation, no fire - unintentional 4700 South ALCOA VERNON CA 90058 4700 South ALCOA Avenue E13 11/01/20 LAC20330712 ALRWF 745 - Alarm system activation, no fire - unintentional 3021 East 44TH VERNON CA 90058 3021 East 44TH Street E52 11/01/20 LAC20331024 INVO 812 - Flood assessment South SANTA FE VERNON CA 90058 South SANTA FE Avenue E52 11/02/20 LAC20331871 ALRWFR 744 - Detector activation, no fire - unintentional 5025 HAMPTON VERNON CA 90058 5025 HAMPTON Street E52 11/02/20 LAC20331909 TCB 600 - Good intent call, other South PACIFIC VERNON CA 90058 South PACIFIC Boulevard E52 11/02/20 LAC20332236 MISC1 150 - Outside rubbish fire, other East 26TH VERNON CA 90058 East 26TH Street E52 11/03/20 LAC20332322 ALRWF 745 - Alarm system activation, no fire - unintentional 4900 CORONA VERNON CA 90058 4900 CORONA Avenue E13 11/03/20 LAC20332805 SZR 321 - EMS call, excluding vehicle accident with injury 0000 East 51ST VERNON CA 90058 0000 East 51ST Street E52 11/03/20 LAC20332962 INJB 321 - EMS call, excluding vehicle accident with injury 0 DISTRICT VERNON CA 90058 0 DISTRICT Boulevard E13 11/04/20 LAC20333364 VEHL 131 - Passenger vehicle fire 4340 DISTRICT VERNON CA 90058 4340 DISTRICT Boulevard E13 80,000 80,000 11/04/20 LAC20333381 VEHL 600 - Good intent call, other 4339 FRUITLAND VERNON CA 90270 4339 FRUITLAND Avenue E13 0 0 11/04/20 LAC20333401 ALRWF 611 - Dispatched and cancelled en route 3049 East VERNON VERNON CA 90058 3049 East VERNON Avenue E52 11/04/20 LAC20333695 SZR 321 - EMS call, excluding vehicle accident with injury 3049 East VERNON VERNON CA 90058 3049 East VERNON Avenue S164 11/04/20 LAC20333720 BEHAVB 321 - EMS call, excluding vehicle accident with injury FRUITLAND VERNON CA 90058 FRUITLAND Avenue E52 11/04/20 LAC20333882 MISC1 600 - Good intent call, other 5107 DISTRICT VERNON CA 90058 5107 DISTRICT Boulevard E163 11/04/20 LAC20333912 BEHAVB 321 - EMS call, excluding vehicle accident with injury 4301 South SANTA FE VERNON CA 90058 4301 South SANTA FE Avenue E52 11/04/20 LAC20333982 OD 321 - EMS call, excluding vehicle accident with injury 2720 East 26TH VERNON CA 90023 2720 East 26TH Street S164 11/05/20 LAC20334436 ALRWF 735 - Alarm system sounded due to malfunction 3021 East 44TH VERNON CA 90058 3021 East 44TH Street E52 11/05/20 LAC20334508 TCB 321 - EMS call, excluding vehicle accident with injury 2801 East 46TH VERNON CA 90058 2801 East 46TH Street E52 11/05/20 LAC20334726 EMS 321 - EMS call, excluding vehicle accident with injury 3810 South SANTA FE VERNON CA 90058 3810 South SANTA FE Avenue E52 11/05/20 LAC20334841 VEHL 132 - Road freight or transport vehicle fire 3163 East VERNON VERNON CA 90058 3163 East VERNON Avenue E13 5,000 5,000 Printed On: 12/01/2020 01:17:31 PM1 of 6 Alarm Date Time Basic Incident Number (FD1) Cad Initial Cad Incident Type Description Incident Type Address Basic Incident Full Street Address Basic First Arrived At Scene Apparatus ID Basic Property Losses (FD1.35) Basic Content Losses (FD1.36) 11/05/20 LAC20335051 ALRMAN 700 - False alarm or false call, other 2638 East VERNON VERNON CA 90058 2638 East VERNON Avenue E52 11/05/20 LAC20335108 INJA 300 - Rescue, EMS incident, other South SANTA FE VERNON CA 90058 South SANTA FE Avenue E52 11/07/20 LAC20336402 EMS 321 - EMS call, excluding vehicle accident with injury South ATLANTIC VERNON CA 90201 South ATLANTIC Boulevard E13 11/09/20 LAC20338770 INJB 321 - EMS call, excluding vehicle accident with injury DISTRICT VERNON CA 90058 DISTRICT Boulevard E13 11/09/20 LAC20338799 MISC1 151 - Outside rubbish, trash or waste fire East WASHINGTON VERNON CA 90023 East WASHINGTON Boulevard E52 0 0 11/09/20 LAC20339587 EMS 321 - EMS call, excluding vehicle accident with injury 4305 South SANTA FE VERNON CA 90058 4305 South SANTA FE Avenue E52 11/09/20 LAC20339667 INJA 600 - Good intent call, other 3333 South DOWNEY VERNON CA 90023 3333 South DOWNEY Road E52 11/10/20 LAC20339819 CP 321 - EMS call, excluding vehicle accident with injury 2727 East VERNON VERNON CA 90058 2727 East VERNON Avenue S13 11/10/20 LAC20339886 EMS 611 - Dispatched and cancelled en route East LEONIS VERNON CA 90058 East LEONIS Boulevard E52 11/10/20 LAC20340024 ALRWF 745 - Alarm system activation, no fire - unintentional 4300 DISTRICT VERNON CA 90058 4300 DISTRICT Boulevard E13 11/10/20 LAC20340137 UNC 321 - EMS call, excluding vehicle accident with injury 3100 BANDINI VERNON CA 90023 3100 BANDINI Boulevard E52 11/10/20 LAC20340317 INJA 321 - EMS call, excluding vehicle accident with injury 4366 East 26TH VERNON CA 90023 4366 East 26TH Street E27 11/10/20 LAC20340367 EMS 300 - Rescue, EMS incident, other 2646 South DOWNEY VERNON CA 90023 2646 South DOWNEY Road E52 11/10/20 LAC20340396 ALRWF 735 - Alarm system sounded due to malfunction 4900 CORONA VERNON CA 90058 4900 CORONA Avenue E13 11/10/20 LAC20340415 TEST 2800 South SOTO VERNON CA 90023 2800 South SOTO Street S89 11/10/20 LAC20340569 MISC1 600 - Good intent call, other East VERNON VERNON CA 90058 East VERNON Avenue E52 11/11/20 LAC20340987 ALRA 522 - Water or steam leak 2727 East VERNON VERNON CA 90058 2727 East VERNON Avenue E52 11/11/20 LAC20341459 TCA 600 - Good intent call, other 2042 East VERNON VERNON CA 90058 2042 East VERNON Avenue E52 11/11/20 LAC20341712 ALRA 652 - Steam, vapor, fog or dust thought to be smoke 5700 South ALAMEDA VERNON CA 90058 5700 South ALAMEDA Street E52 11/11/20 LAC20341777 CP 321 - EMS call, excluding vehicle accident with injury 3049 East VERNON VERNON CA 90058 3049 East VERNON Avenue S164 11/12/20 LAC20342042 SICKA 321 - EMS call, excluding vehicle accident with injury 4301 South SANTA FE VERNON CA 90058 4301 South SANTA FE Avenue E52 11/12/20 LAC20342287 ALRA 522 - Water or steam leak 4646 HAMPTON VERNON CA 90058 4646 HAMPTON Street E52 11/12/20 LAC20342946 DB 321 - EMS call, excluding vehicle accident with injury 4580 South PACIFIC VERNON CA 90058 4580 South PACIFIC Boulevard E52 Printed On: 12/01/2020 01:17:31 PM2 of 6 Alarm Date Time Basic Incident Number (FD1) Cad Initial Cad Incident Type Description Incident Type Address Basic Incident Full Street Address Basic First Arrived At Scene Apparatus ID Basic Property Losses (FD1.35) Basic Content Losses (FD1.36) 11/13/20 LAC20343723 TCB 322 - Motor vehicle accident with injuries 1 DISTRICT VERNON CA 90040 1 DISTRICT Boulevard E163 11/14/20 LAC20345008 INVO 911 - Citizen complaint 4720 26TH VERNON CA 90040 4720 26TH Street E13 11/14/20 LAC20345021 PA 553 - Public service 4720 26TH VERNON CA 90040 4720 26TH Street E13 11/15/20 LAC20345324 ALRWF 520 - Water problem, other 3220 East 26TH VERNON CA 90023 3220 East 26TH Street E52 11/15/20 LAC20345550 TREE 150 - Outside rubbish fire, other REGENT VERNON CA 90255 REGENT Street E52 11/15/20 LAC20345984 EMS 321 - EMS call, excluding vehicle accident with injury South DOWNEY VERNON CA 90023 South DOWNEY Road E52 11/15/20 LAC20346001 STRC 111 - Building fire 2731 South SOTO VERNON CA 90023 2731 South SOTO Street S13 100,000 100,000 11/15/20 LAC20346089 TCA 321 - EMS call, excluding vehicle accident with injury DISTRICT VERNON CA 90040 DISTRICT Boulevard Q20 11/16/20 LAC20346221 DB 321 - EMS call, excluding vehicle accident with injury East VERNON VERNON CA 90058 East VERNON Avenue S164 11/16/20 LAC20346248 DB 321 - EMS call, excluding vehicle accident with injury 4646 HAMPTON VERNON CA 90058 4646 HAMPTON Street E52 11/16/20 LAC20346302 TCB 600 - Good intent call, other East 37TH VERNON CA 90058 East 37TH Street E52 11/16/20 LAC20346332 ALRA 735 - Alarm system sounded due to malfunction 3425 East VERNON VERNON CA 90058 3425 East VERNON Avenue E52 11/16/20 LAC20346394 TCB 300 - Rescue, EMS incident, other BANDINI VERNON CA 90201 BANDINI Boulevard E52 11/16/20 LAC20346541 MISC1 118 - Trash or rubbish fire, contained RAILROAD VERNON CA 90255 RAILROAD E164 0 0 11/16/20 LAC20346554 GRS 611 - Dispatched and cancelled en route East SLAUSON VERNON CA 90058 East SLAUSON Avenue E13 11/16/20 LAC20346808 SICKA 300 - Rescue, EMS incident, other 5670 South SANTA FE VERNON CA 90058 5670 South SANTA FE Avenue S164 11/16/20 LAC20346913 SHED 100 - Fire, other East SLAUSON VERNON CA 90255 East SLAUSON Avenue E164 11/16/20 LAC20347031 EMS 300 - Rescue, EMS incident, other SANTA FE East 26TH VERNON CA 90058 SANTA FE East 26TH Street S164 11/16/20 LAC20347197 ALRCO 4950 South SANTA FE VERNON CA 90058 4950 South SANTA FE Avenue E52 11/17/20 LAC20347330 TCB 321 - EMS call, excluding vehicle accident with injury East 46TH VERNON CA 90058 East 46TH Street E13 11/17/20 LAC20347494 CP 321 - EMS call, excluding vehicle accident with injury 3344 BANDINI VERNON CO CA 90023 3344 BANDINI Boulevard S13 11/17/20 LAC20347975 EMS 300 - Rescue, EMS incident, other MALBURG VERNON CA 90058 MALBURG Way S13 11/18/20 LAC20348455 SICKA 300 - Rescue, EMS incident, other 4401 South DOWNEY VERNON CA 90058 4401 South DOWNEY Road E13 11/18/20 LAC20348674 INJA 321 - EMS call, excluding vehicle accident with injury 3030 East LEONIS VERNON CA 90058 3030 East LEONIS Boulevard E13 11/18/20 LAC20349025 TCP 321 - EMS call, excluding vehicle accident with injury East SLAUSON VERNON CA 90058 East SLAUSON Avenue S13 Printed On: 12/01/2020 01:17:31 PM3 of 6 Alarm Date Time Basic Incident Number (FD1) Cad Initial Cad Incident Type Description Incident Type Address Basic Incident Full Street Address Basic First Arrived At Scene Apparatus ID Basic Property Losses (FD1.35) Basic Content Losses (FD1.36) 11/19/20 LAC20349519 ALRWF 731 - Sprinkler activation due to malfunction 2727 East VERNON VERNON CA 90058 2727 East VERNON Avenue E52 11/19/20 LAC20349587 TCP 323 - Motor vehicle/pedestrian accident (MV Ped) East SLAUSON VERNON CA 90058 East SLAUSON Avenue E13 11/19/20 LAC20349671 TCB 321 - EMS call, excluding vehicle accident with injury 4309 DISTRICT VERNON CA 90058 4309 DISTRICT Boulevard E13 11/19/20 LAC20350423 BEHAVB 321 - EMS call, excluding vehicle accident with injury 11 South BOYLE VERNON CA 90058 11 South BOYLE Avenue E13 11/19/20 LAC20350508 ALRWF 2126 East 52ND VERNON CA 90058 2126 East 52ND Street E52 11/20/20 LAC20350676 ALRWF 2126 East 52ND VERNON CA 90058 2126 East 52ND Street E52 11/20/20 LAC20350703 ALRWF 2727 East VERNON VERNON CA 90058 2727 East VERNON Avenue E52 11/21/20 LAC20351746 ALRWFR 744 - Detector activation, no fire - unintentional 2126 East 52ND VERNON CA 90058 2126 East 52ND Street E52 11/21/20 LAC20352065 INVO 522 - Water or steam leak 3268 East VERNON VERNON CA 90058 3268 East VERNON Avenue E52 11/21/20 LAC20352341 ALRWF 735 - Alarm system sounded due to malfunction 5700 South ALAMEDA VERNON CA 90058 5700 South ALAMEDA Street E52 11/21/20 LAC20352421 UNC 321 - EMS call, excluding vehicle accident with injury 5741 South 1ST VERNON CA 90058 5741 South 1ST Street E52 11/22/20 LAC20352782 TCF 130 - Mobile property (vehicle) fire, other 3805 South SOTO VERNON CA 90058 3805 South SOTO Street E52 3,000 200 11/22/20 LAC20352975 TCB 322 - Motor vehicle accident with injuries LOMA VISTA VERNON CA 90058 LOMA VISTA Avenue E13 11/22/20 LAC20353082 GRS South ALAMEDA VERNON CA 90058 South ALAMEDA Street E52 11/22/20 LAC20353145 UNK 100 - Fire, other East 37TH VERNON CA 90058 East 37TH Street Q164 11/22/20 LAC20353175 INVO 611 - Dispatched and cancelled en route 3049 East VERNON VERNON CA 90058 3049 East VERNON Avenue T13 11/22/20 LAC20353497 ASSLTB 321 - EMS call, excluding vehicle accident with injury 4310 MAYWOOD VERNON CA 90058 4310 MAYWOOD E13 11/23/20 LAC20353999 ALRWF 744 - Detector activation, no fire - unintentional 2126 East 52ND VERNON CA 90058 2126 East 52ND Street T13 11/23/20 LAC20354101 DB 321 - EMS call, excluding vehicle accident with injury 3130 East LEONIS VERNON CA 90058 3130 East LEONIS Boulevard E13 11/23/20 LAC20354394 MISC1 150 - Outside rubbish fire, other South ALAMEDA VERNON CA 90058 South ALAMEDA Street E52 11/24/20 LAC20354843 ALRMAN 745 - Alarm system activation, no fire - unintentional 4401 South DOWNEY VERNON CA 90058 4401 South DOWNEY Road E13 11/24/20 LAC20354947 MISC1 East 50TH VERNON CA 90058 East 50TH Street E52 11/24/20 LAC20354955 TCA 321 - EMS call, excluding vehicle accident with injury East 55TH VERNON CA 90058 East 55TH Street S164 11/24/20 LAC20354966 TCB 322 - Motor vehicle accident with injuries 27th South ALAMEDA VERNON 27th South ALAMEDA E52 Printed On: 12/01/2020 01:17:31 PM4 of 6 Alarm Date Time Basic Incident Number (FD1) Cad Initial Cad Incident Type Description Incident Type Address Basic Incident Full Street Address Basic First Arrived At Scene Apparatus ID Basic Property Losses (FD1.35) Basic Content Losses (FD1.36) CA 90058 Street 11/24/20 LAC20355300 911 300 - Rescue, EMS incident, other 2619 Santa Fe South SANTA FE VERNON CA 90058 2619 Santa Fe South SANTA FE Avenue E52 11/24/20 LAC20355908 ALRWF 735 - Alarm system sounded due to malfunction 4900 CORONA VERNON CA 90058 4900 CORONA Avenue E13 11/25/20 LAC20356000 ALRWF 3049 East VERNON VERNON CA 90058 3049 East VERNON Avenue E52 11/25/20 LAC20356350 ALRWFR 611 - Dispatched and cancelled en route 2417 East 26TH VERNON CA 90058 2417 East 26TH Street E52 11/25/20 LAC20356509 TCA 321 - EMS call, excluding vehicle accident with injury East 37TH VERNON CA 90058 East 37TH Street S164 11/25/20 LAC20356550 UNC 321 - EMS call, excluding vehicle accident with injury 2775 East 26TH VERNON CA 90023 2775 East 26TH Street S164 11/25/20 LAC20356599 MISC1 600 - Good intent call, other South ALAMEDA VERNON CA 90058 South ALAMEDA Street E52 11/26/20 LAC20357116 UNC 321 - EMS call, excluding vehicle accident with injury 2775 East 26TH VERNON CA 90023 2775 East 26TH Street S13 11/26/20 LAC20357214 CP 321 - EMS call, excluding vehicle accident with injury East SLAUSON VERNON CA 90058 East SLAUSON Avenue E13 11/26/20 LAC20357369 INJA 300 - Rescue, EMS incident, other Seville East VERNON VERNON CA 90058 Seville East VERNON Avenue T13 11/26/20 LAC20357712 TCB 322 - Motor vehicle accident with injuries 5200 South BOYLE VERNON CA 90058 5200 South BOYLE Avenue E13 11/27/20 LAC20358158 UNC 322 - Motor vehicle accident with injuries 4661 DISTRICT VERNON CA 90058 4661 DISTRICT Boulevard S163 11/27/20 LAC20358314 TCA 321 - EMS call, excluding vehicle accident with injury Pacific South ALCOA VERNON CA 90058 Pacific South ALCOA Avenue E13 11/27/20 LAC20358330 ALRWF 700 - False alarm or false call, other 4900 CORONA VERNON CA 90058 4900 CORONA Avenue E163 11/27/20 LAC20358445 TCB 322 - Motor vehicle accident with injuries East VERNON VERNON CA 90058 East VERNON Avenue E52 11/27/20 LAC20358661 UNC 321 - EMS call, excluding vehicle accident with injury 1875 East 27TH VERNON CA 90058 1875 East 27TH Street E52 11/27/20 LAC20358764 MISC1 150 - Outside rubbish fire, other 25TH VERNON CA 90058 25TH Street E52 11/27/20 LAC20358864 TCP 300 - Rescue, EMS incident, other 5107 DISTRICT VERNON CA 90058 5107 DISTRICT Boulevard S163 11/27/20 LAC20359203 MISC1 154 - Dumpster or other outside trash receptacle fire 4381 BANDINI VERNON CA 90023 4381 BANDINI Boulevard E27 500 11/28/20 LAC20359349 ALRA 735 - Alarm system sounded due to malfunction 5925 South ALCOA VERNON CA 90058 5925 South ALCOA Avenue E13 11/28/20 LAC20359405 MISC1 South ALAMEDA VERNON CA 90058 South ALAMEDA Street E52 11/28/20 LAC20360075 ALRWF 500 - Service call, other 4900 CORONA VERNON CA 90058 4900 CORONA Avenue E13 11/28/20 LAC20360114 ALRWF 735 - Alarm system sounded due to malfunction 4900 CORONA VERNON CA 90058 4900 CORONA Avenue E13 11/29/20 LAC20360598 ALRWF 3021 East 44TH VERNON CA 90058 3021 East 44TH Street E52 Printed On: 12/01/2020 01:17:31 PM5 of 6 Alarm Date Time Basic Incident Number (FD1) Cad Initial Cad Incident Type Description Incident Type Address Basic Incident Full Street Address Basic First Arrived At Scene Apparatus ID Basic Property Losses (FD1.35) Basic Content Losses (FD1.36) Basic Incident Date Time: Cad Basic Incident City Name: 11/30/20 LAC20361451 ALRWF 3021 East 44TH VERNON CA 90058 3021 East 44TH Street E52 11/30/20 LAC20361464 TCB 321 - EMS call, excluding vehicle accident with injury 111 East 50TH VERNON CA 90058 111 East 50TH Street E13 11/30/20 LAC20361736 EMS 321 - EMS call, excluding vehicle accident with injury 4428 South PACIFIC VERNON CA 90058 4428 South PACIFIC Boulevard E52 Count: 121 Report Filters is between '11/1/2020 12:00 AM' and '11/30/2020 01:16 PM' contains 'Vernon' Printed On: 12/01/2020 01:17:31 PM6 of 6 Elite lac Vernon- Incident Type and Totals For November 2020 Cad Initial Cad Incident Type Description Basic Incident Type Code And Description (FD1.21) Number of incidents Property Loss Content Loss Acres Burned Basic Incident Type Category (FD1.21): (None) ALRCO 1 ALRWF 5 GRS 1 MISC1 2 TEST 1 Total: 10 Total: $0 Total: 0 Total: 0 Basic Incident Type Category (FD1.21): 1 - Fire MISC1 118 - Trash or rubbish fire, contained 1 $0 0 MISC1 150 - Outside rubbish fire, other 3 MISC1 151 - Outside rubbish, trash or waste fire 1 $0 0 MISC1 154 - Dumpster or other outside trash receptacle fire 1 $500 SHED 100 - Fire, other 1 STRC 111 - Building fire 1 $100,000 100,000 TCF 130 - Mobile property (vehicle) fire, other 1 $3,000 200 TREE 150 - Outside rubbish fire, other 1 UNK 100 - Fire, other 1 VEHL 131 - Passenger vehicle fire 1 $80,000 80,000 VEHL 132 - Road freight or transport vehicle fire 1 $5,000 5,000 Total: 13 Total: $188,500 Total: 185,200 Total: 0 Basic Incident Type Category (FD1.21): 3 - Rescue & Emergency Medical Service Incident 911 300 - Rescue, EMS incident, other 1 ASSLTB 321 - EMS call, excluding vehicle accident with injury 1 BEHAVB 321 - EMS call, excluding vehicle accident with injury 3 CP 321 - EMS call, excluding vehicle accident with injury 4 DB 321 - EMS call, excluding vehicle accident with injury 4 EMS 300 - Rescue, EMS incident, other 3 EMS 321 - EMS call, excluding vehicle accident with injury 4 INJA 300 - Rescue, EMS incident, other 2 INJA 321 - EMS call, excluding vehicle accident with injury 2 INJB 321 - EMS call, excluding vehicle accident with injury 2 OD 321 - EMS call, excluding vehicle accident with injury 1 SICKA 300 - Rescue, EMS incident, other 2 SICKA 321 - EMS call, excluding vehicle accident with injury 1 SZR 321 - EMS call, excluding vehicle accident with injury 2 TCA 321 - EMS call, excluding vehicle accident with injury 4 TCB 300 - Rescue, EMS incident, other 1 TCB 321 - EMS call, excluding vehicle accident with injury 3 TCB 322 - Motor vehicle accident with injuries 5 TCP 300 - Rescue, EMS incident, other 1 TCP 321 - EMS call, excluding vehicle accident with injury 1 TCP 323 - Motor vehicle/pedestrian accident (MV Ped) 1 Printed On: 12/01/2020 12:27:18 PM1 of 2 Cad Initial Cad Incident Type Description Basic Incident Type Code And Description (FD1.21) Number of incidents Property Loss Content Loss Acres Burned UNC 321 - EMS call, excluding vehicle accident with injury 5 UNC 322 - Motor vehicle accident with injuries 1 Total: 54 Total: $0 Total: 0 Total: 0 Basic Incident Type Category (FD1.21): 5 - Service Call ALRA 522 - Water or steam leak 2 ALRWF 500 - Service call, other 1 ALRWF 520 - Water problem, other 1 INVO 522 - Water or steam leak 1 PA 553 - Public service 1 Total: 6 Total: $0 Total: 0 Total: 0 Basic Incident Type Category (FD1.21): 6 - Good Intent Call ALRA 652 - Steam, vapor, fog or dust thought to be smoke 1 ALRWF 611 - Dispatched and cancelled en route 1 ALRWFR 611 - Dispatched and cancelled en route 1 EMS 611 - Dispatched and cancelled en route 1 GRS 611 - Dispatched and cancelled en route 1 INJA 600 - Good intent call, other 1 INVO 611 - Dispatched and cancelled en route 1 MISC1 600 - Good intent call, other 3 TCA 600 - Good intent call, other 1 TCB 600 - Good intent call, other 2 VEHL 600 - Good intent call, other 1 $0 0 Total: 14 Total: $0 Total: 0 Total: 0 Basic Incident Type Category (FD1.21): 7 - False Alarm & False Call ALRA 735 - Alarm system sounded due to malfunction 2 ALRA 745 - Alarm system activation, no fire - unintentional 1 ALRMAN 700 - False alarm or false call, other 1 ALRMAN 745 - Alarm system activation, no fire - unintentional 1 ALRWF 700 - False alarm or false call, other 1 ALRWF 731 - Sprinkler activation due to malfunction 1 ALRWF 735 - Alarm system sounded due to malfunction 5 ALRWF 744 - Detector activation, no fire - unintentional 2 ALRWF 745 - Alarm system activation, no fire - unintentional 3 ALRWFR 744 - Detector activation, no fire - unintentional 2 Total: 19 Total: $0 Total: 0 Total: 0 Basic Incident Type Category (FD1.21): 8 - Severe Weather & Natural Disaster INVO 812 - Flood assessment 1 Total: 1 Total: $0 Total: 0 Total: 0 Basic Incident Type Category (FD1.21): 9 - Special Incident Type INVO 911 - Citizen complaint 1 Total: 1 Total: $0 Total: 0 Total: 0 Total: 118 Total: $188,500 Total: 185,200 Total: 0 Printed On: 12/01/2020 12:27:18 PM2 of 2 City Council Agenda Item Report Agenda Item No. COV-472-2021 Submitted by: Gregory Garcia Submitting Department: Police Department Meeting Date: February 16, 2021 SUBJECT Police Department Activity Report Recommendation: Receive and file the December 2020 Report. Background: The Vernon Police Department's activity report consists of activity during the specified reporting period, including a summary of calls for service, and statistical information regarding arrests, traffic collisions, stored and impounded vehicles, recovered stolen vehicles, the number of citations issued, and the number of reports filed. Fiscal Impact: There is no fiscal impact associated with this report. Attachments: 1. Police Department Activity Report – December 2020 Type VERNON POLICE DEPARTMENT Department Activity Report Jurisdiction: First Date: Last Date: 12/01/2020 12/31/2020 Department All Units Primary Unit VERNON Description Complaint VPD 10-6 OFFICER IS 10-6 C7,961,962,10-10, WASH, EQUIPM 190 184 10-96C 10-96 CHARLES (CITY HALL SECURITY CHECK)7 7 10-96H PICK UP THE JAIL PAPER WORK FROM HP JAIL 4 4 140 SUPPLEMENTAL REPORT 15 8 166R COURT ORDER VIOLATION REPORT 7 5 20002 NON-INJURY HIT AND RUN 11 4 20002R NON-INJURY HIT AND RUN REPORT 11 8 211R ROBBERY REPORT 3 1 211S SILENT ROBBERY ALARM 13 4 242 BATTERY 4 1 242R BATTERY REPORT 9 5 245 ASSAULT WITH A DEADLY WEAPON 8 2 261R RAPE REPORT 5 1 273.5 DOMESTIC VIOLENCE 7 1 415 DISTURBING THE PEACE 61 22 417 BRANDISHING A WEAPON 18 3 422R TERRORIST THREATS REPORT 1 1 459 BURGLARY 17 4 459A AUDIBLE BURGLARY ALARM 299 154 459R BURGLARY REPORT 13 6 459S SILENT BURGLARY ALARM 14 7 459V BURGLARY TO A VEHICLE 2 1 459VR BURGLARY TO A VEHICLE REPORT 7 6 476R FRAUD REPORT 2 1 484 PETTY THEFT 19 6 484R PETTY THEFT REPORT 13 8 487R GRAND THEFT REPORT 14 12 586 PARKING PROBLEM 24 20 586E PARKING ENFORCEMENT 2 2 594 VANDALISM 5 2 594R VANDALISM REPORT 15 7 602 TRESPASS 51 22 602R TRESPASS REPORT 1 1 647F DRUNK IN PUBLIC 2 1 901 UNKNOWN INJURY TRAFFIC COLLISION 6 3 901T INJURY TRAFFIC COLLISION 15 4 901TR INJURY TRAFFIC COLLISION REPORT 15 7 902T NON-INJURY TRAFFIC COLLISION 52 33 902TR NON-INJURY TRAFFIC COLLISION REPORT 6 2 909C TRAFFIC CONTROL 3 2 909E TRAFFIC ENFORCEMENT 4 3 909T TRAFFIC HAZARD 5 5 911 911 MISUSE / HANGUP 8 4 911A CONTACT THE REPORTING PARTY 11 8 917A ABANDONED VEHICLE 10 7 920PR LOST PROPERTY REPORT 2 2 925 SUSPICIOUS CIRCUMSTANCES 55 25 1Page of 301/13/2021 15:24:51 Type VERNON POLICE DEPARTMENT Department Activity Report Jurisdiction: First Date: Last Date: 12/01/2020 12/31/2020 Department All Units Primary Unit VERNON Description Complaint VPD 927 UNKNOWN TROUBLE 2 1 A211R ATTEMPT ROBBERY REPORT 3 1 A459R ATTEMPT BURGLARY REPORT 5 3 A459VR ATTEMPT BURGLARY TO A VEHICLE REPORT 2 1 ASSISTFD ASSIST FIRE DEPARTMENT 34 14 BOSIG BROKEN SIGNAL OR LIGHT 4 2 BOVEH BROKEN DOWN VEHICLE 20 17 COP COP DETAIL 6 4 DET DETECTIVE INVESTIGATION 60 24 DETAIL DETAIL 8 7 DPTAST DEPARTMENTAL ASSIST 9 4 DUI DRIVING UNDER THE INFLUENCE 2 1 DUPLICATE TO BE USED WHEN A CALL IS DUPLICATED 1 1 FILING OFFICER IS 10-6 REPORT WRITING 116 114 FOUND FOUND PROPERTY REPORT 1 1 FU FOLLOW UP 15 8 GTA GRAND THEFT AUTO 3 1 GTAR GRAND THEFT AUTO REPORT 23 15 HBC HAILED BY A CITIZEN 18 11 ID THEFT RPT IDENTITY THEFT REPORT 1 1 ILLDPG RPT ILLEGAL DUMPING REPORT 5 2 JAILPANIC TEST THE JAIL PANIC ALARM BUTTON 3 3 KTP KEEP THE PEACE 3 1 LOCATE LOCATED VERNON STOLEN VEHICLE / PLATES VI 5 4 LOJACK LOJACK HIT 3 3 LPR LICENSE PLATE READER 6 5 MISPR MISSING PERSON REPORT 1 1 MR60 MISC REPORT 12 3 PANIC ALARM PANIC ALARM/DURESS ALARM 4 2 PAPD PUBLIC ASSIST-POLICE 16 9 PATCK PATROL CHECK 410 336 PEDCK PEDESTRIAN CHECK 77 33 PLATE LOST OR STOLEN PLATES REPORT 5 4 PRSTRAN PRISONER TRANSPORTED 7 6 REC RECOVERED STOLEN VEHICLE IN THE FIELD 41 16 REC PLATE LOST/STOLEN LICENSE PLATES RECOVERED / FO 4 1 RECKLESS DR RECKLESS DRIVING (23103)8 3 REPO REPOSSESSION 2 2 RR RAIL ROAD PROBLEM 3 3 SCAR SUSPECTED CHILD ABUSE REPORT 1 1 SHOTS SHOTS 5 2 SPEED SPEED CONTEST OR SPEEDING (23109)9 3 SRMET SRMET DETAIL 3 2 TRAFFIC STOP TRAFFIC STOP 241 158 TRAINING TRAINING TEST CALL 3 3 UNATTACHED UNATTACHED TRAILER 1 1 VCK VEHICLE CHECK 180 123 2Page of 301/13/2021 15:24:51 Type VERNON POLICE DEPARTMENT Department Activity Report Jurisdiction: First Date: Last Date: 12/01/2020 12/31/2020 Department All Units Primary Unit VERNON Description Complaint VPD VEH RELEASE VEHICLE RELEASE 4 4 VMCVIO VERNON MUNICIPAL CODE VIOLATION 1 1 WARRANT WARRANT ARREST 8 4 WELCK WELFARE CHECK 28 11 Department: 2498 1607 Overall: 2498 1607 3Page of 301/13/2021 15:24:51 VERNON POLICE DEPARTMENT Police Activity Report Period Ending: 12/31/20 TRAFFIC COLLISIONS NO. PROPERTY RECOVERED TOTAL 27 VEHICLES: $104,200.00 NON-INJURY 17 INJURY 10 Persons Injured 14 Pedestrian 1 Fatalities 0 City Property Damage 4 Hit & Run (Felony) 0 Hit & Run (Misdemeanor) 8 VEHICLES STORED PROPERTY RECOVERED FOR Unlicensed Driver/Impounded Vehicle 12 OTHER DEPARTMENTS Unattached Trailer 2 VEHICLES: $69,400.00 Abandoned/Stored Vehicle 4 Traffic Hazard 2 CITATIONS Citations Iss (Prisoner Release) 27 Citations Iss (Other Violations) 0 Parking 80 Hazardous 47 Non-Hazardous 21 Citations Iss (Moving) 68 Citations Iss (Total) 148 CASES CLEARED BY ARREST AR20-392 CR20-2075 10851(A) VC AR20-422 CR20-2213 11364 HS AR20-394 CR20-2089 10851(A) VC AR20-423 CR20-2215 11364 HS AR20-395 CR20-2091 148(A) PC AR20-424 CR20-2107 487 PC AR20-397 CR20-2095 10851(A) VC AR20-425 CR20-2220 487 PC AR20-399 CR20-2099 10851(A) VC AR20-427 CR20-2233 11364 HS AR20-401 CR20-2109 484 PC AR20-403 CR20-2112 417 PC AR20-406 CR20-2121 273.5 PC AR20-409 CR20-2129 647(F) PC AR20-413 CR20-2154 69 PC AR20-414 CR20-2155 484 PC AR20-416 CR20-2174 459 PC AR20-417 CR20-2184 496(A) PC AR20-418 CR20-2185 10851(A) VC AR20-421 CR20-2210 496(A) PC MALE FEMALE TOTAL BURGLARY (& ATTEMPTED)1 1 DRIVING UNDER THE INFLUENCE w/ INJURY 1 1 DOMESTIC VIOLENCE 11 GRAND THEFT: AUTO (& ATTEMPTED)55 GRAND THEFT: PROPERTY (& ATTEMPTED)22 RESISTING ARREST 1 1 ROBBERY 0 WARRANT (VERNON CASE)0 WARRANT (OUTSIDE AGENCY)0 TOTAL FELONY ARRESTS 10 1 11 MALE FEMALE TOTAL BRANDISHING A FIREARM REPLICA 2 2 CARRY CONCEALED DIRK OR DAGGER 11 DRUNK IN PUBLIC 1 1 DRIVING UNDER THE INFLUENCE 2 1 3 PETTY THEFT 2 2 IGNITION INTERLOCK DEVICE REQUIRED 3 3 POSSESSION OF NARCOTICS 0 POSSESSION OF PARAPHERNALIA 3 3 POSSESSION OF STOLEN PROPERTY 1 1 2 RESISTING ARREST 1 1 TRESPASSING 0 VANDALISM 0 WARRANT (VERNON CASE) 4 1 5 WARRANT (OUTSIDE AGENCY)0 TOTAL MISD. ARRESTS 19 4 23 MALE FEMALE TOTAL BURGLARY 0 CARRY LOADED FIREARM IN PUBLIC 0 ROBBERY 0 VANDALISM 0 WARRANT 0 TOTAL JUVENILES DET. 0 0 0 144 276 4 424 TOTAL FELONY ARRESTS (ADULT) TO DATE: TOTAL MISDEMEANOR ARRESTS (ADULT) TO DATE: TOTAL JUVENILES DETAINED (FELONY AND MISDEMEANOR) TO DATE: TOTAL ARRESTS AND DETAINED JUVENILES (FELONY AND MISDEMEANOR) TO DATE: VERNON POLICE DEPARTMENT REPORT FOR PERSONS ARRESTED ADULT FELONY ARRESTS AND DISPOSITIONS PERIOD ENDING: 12/31/2020 ADULT MISDEMEANOR ARRESTS AND DISPOSITIONS JUVENILES DETAINED --- FELONY AND MISDEMEANOR VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/01/202012/01/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012219065764 ALCOA AV, VERNONREC04:11:3212/01/2020VRECRPTDepartmentOCA NumberRMS JurisVPD CR20202065 CA0197300VPDVASQUEZ,LUIS*4104:53:4404:11:32VPDARANA,ANDRE31W04:11:3504:53:4404:13:47VPDSANTOS,DANIELS204:17:1904:17:31202012219172035 E 37TH, VERNONID THEFT RPTJASAN FABRICATION GLASS08:27:3812/01/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202066 CA0197300VPDVILLEGAS,RICHARD*41W08:30:34 08:30:3509:37:2008:38:06202012219242242 E 49TH, VERNON S/A AGTARLDR CONSULTING10:05:0512/01/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202067 CA0197300VPDVILLEGAS,RICHARD*41W10:29:36 10:29:3611:26:0010:48:14202012219303398 LEONIS BL, VERNONASSISTFDSMART FOODS11:50:0912/01/2020ASSTRPTDepartmentOCA NumberRMS JurisVPD CR20202069 CA0197300VPDVALENZUELA,FERNANDO*31E11:51:19 11:52:0114:46:5911:54:05VPDFINO,MARCUS20E11:51:20 11:52:0813:22:4611:55:33VPDMARTINEZ,GABRIELS514:46:5913:00:45202012219324458 PACIFIC BL, VERNON459VRJUT POTTERY12:39:2712/01/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202070 CA0197300VPDVILLEGAS,RICHARD*41W12:49:20 12:51:5714:00:1512:59:49202012219363340 LEONIS BL, VERNON902T13:11:5012/01/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202068 CA0197300VPDFINO,MARCUS*20E14:06:1113:22:471Page of 212/02/202004:57:57 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/01/202012/01/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012219484305 S SANTA FE AV, VERNON166R16:33:3812/01/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202071 CA0197300VPDRECORDS BUREAU*RECD17:23:0016:36:0420201221951ALCOA AV // FRUITLAND AV, VERNON2000218:52:1512/01/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202072 CA0197300VPD*31E18:53:3619:40:5318:57:06VPDGODOY,RAYMOND26W18:54:2719:16:0518:58:51VPDLUCAS,JASON3218:56:3619:09:2019:02:18202012219534401 DOWNEY RD, VERNONMR60GOLDEN WEST TRADING19:14:4412/01/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202073 CA0197300VPDVASQUEZ,LUIS*3219:15:3422:03:3019:17:15VPDSALDANA,CARLOS26W19:16:0822:02:5919:17:18VPDARANA,ANDRE31E01:35:3520:02:25VPD43E19:15:5519:19:11 01:38:3819:42:37VPDHERRERA,GUSTAVO5D3021:18:5401:38:3821:36:34VPDHERNANDEZ,EDWARD5D3221:19:0101:38:3821:36:36VPDSANTOS,DANIELS201:38:3919:18:20VPDESTRADA,IGNACIOS301:38:3919:18:19* Denotes Primary Unit2Page of 212/02/202004:57:57 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/02/202012/02/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201221973E DISTRICT BL // LOMA VISTA AV, VERNON484RBON APETIT03:07:1812/02/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202074 CA0197300VPDVASQUEZ,LUIS*3203:11:0303:52:3103:13:26VPDLANDA,RAFAEL41W03:11:0503:52:31VPDRAMOS,JOSE43E03:52:3203:18:1120201221991BANDINI BL // ATLANTIC BL, VERNON20002JESSICA10:43:3012/02/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202075 CA0197300VPD CR20202076 CA0197300VPDVALENZUELA,FERNANDO*26E10:44:1112:01:0310:46:07VPDSTEVENSON,KENT,JR22W12:30:2610:48:22VPDZOZAYA,OSCAR32E10:44:1212:02:4110:48:13MR C TOWMR C TO11:40:4412:30:2611:52:05VPDMARTINEZ,GABRIELS512:30:2610:49:45202012219924199 BANDINI BL, VERNONGTARJAM`N PRODUCTS11:26:5312/02/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202077 CA0197300VPDVALENZUELA,FERNANDO*26E12:01:29 12:01:3113:03:5312:03:5220201221998E 54TH // SANTA FE AV, VERNON487R14:00:1512/02/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202078 CA0197300VPDOURIQUE,CARLOS*2STOF14:18:4014:00:51202012220006152 S BOYLE AV, VERNON484RALEJANDRA FASHION14:13:2212/02/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202079 CA0197300VPD CR20202080 CA0197300VPDZOZAYA,OSCAR*32E14:17:0215:48:4814:17:46202012220021Page of 212/03/202004:59:09 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/02/202012/02/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012220025511 S DISTRICT BL, VERNONRECPACIFIC PRECISION14:51:2312/02/2020VRECDepartmentOCA NumberRMS JurisVPD CR20202081 CA0197300VPDVALENZUELA,FERNANDO*26E14:54:3714:55:23 15:36:2815:04:35VPDSTEVENSON,KENT,JR22W14:55:1915:36:2815:09:57* Denotes Primary Unit2Page of 212/03/202004:59:09 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/03/202012/03/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201222031E 52D // ALAMEDA, VERNONVCK00:28:4212/03/2020RPTVISRVDDepartmentOCA NumberRMS JurisVPD CR20202082 CA0197300VPDSANTOS,DANIEL*S201:17:5700:28:42VPDARANA,ANDRE31W01:17:5600:34:56VPDESTRADA,IGNACIOS301:17:5700:29:01USTOWUS TOW00:49:46 00:49:5701:17:5701:00:33202012220524561 E 48TH, VERNONA459RTHE TSHIRT SCREENERY08:22:3712/03/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202083 CA0197300VPDOURIQUE,CARLOS*2STOF08:31:45 08:31:4608:32:16VPDSTEVENSON,KENT,JR22W08:48:4909:01:3808:49:16VPDVALENZUELA,FERNANDO31E08:32:1209:13:3308:38:0020201222062E 46TH // ALCOA AV, VERNONUNATTACHEDTR11:29:2912/03/2020VIRPTDepartmentOCA NumberRMS JurisVPD CR20202084 CA0197300VPDSWINFORD,PHILLIP/MACIEL,CYNTHIA*4312:29:0611:29:29MR C TOWMR C TO11:38:12 11:38:1312:29:0611:50:44202012220702646 DOWNEY RD, VERNON487RDYNSASTY PRODUCE13:37:2812/03/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202085 CA0197300VPDREDONA,BRYAN*2XSTO14:18:1813:37:29202012220722345 E 37TH, VERNONGTARCSC LOGISTICS14:01:4812/03/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202086 CA0197300VPDSWINFORD,PHILLIP/MACIEL,CYNTHIA*4314:28:1215:22:1314:33:56202012220761Page of 201/14/202109:33:01 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/03/202012/03/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012220764305 S SANTA FE AV, VERNONDET16:29:4012/03/20201015VPDVELEZ,MARISSA*5D3416:56:2216:29:40VPDHERNANDEZ,EDWARD5D3216:56:2216:29:502020122208015 FWY // CLEGHORN, SAN BERNARDINOLOCATESAN BERNARDINO CHP17:05:3112/03/2020VREC* Denotes Primary Unit2Page of 201/14/202109:33:01 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/04/202012/04/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012221423333 DOWNEY RD, VERNONSRMETUPS09:31:3612/04/2020RPTMETDepartmentOCA NumberRMS JurisVPD CR20202087 CA0197300VPDCERDA,PAUL,JR*4109:33:26 09:42:4910:32:3009:46:07VPDCERDA,EUGENIO/MACIEL,CYNTHIA40E09:36:1812:36:2209:45:08202012221482727 E VERNON AV, VERNON901TRCR LAURENCE13:10:4212/04/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202088 CA0197300VPDNEWTON,TODD*32W13:12:2613:12:34VPDSTEVENSON,KENT,JR2213:12:38 13:13:4313:15:05VPDCERDA,PAUL,JR4113:15:0314:11:5914:05:26* Denotes Primary Unit1Page of 112/05/202005:52:15 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/05/202012/05/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012221922444 ALAMEDA, VERNONREC00:53:1412/05/2020VREC1015CITERPTDepartmentOCA NumberRMS JurisVPD CR20202089 CA0197300VPDCAM,PATRICK*26W02:09:4800:53:15VPDMANNINO,NICHOLAS20W00:53:2801:46:1500:55:58VPDMADRIGAL,ALFONSO31E00:55:2102:01:1000:56:42VPDGODOY,RAYMOND38E00:53:2501:47:0600:55:34VPDESTRADA,IGNACIOS302:09:4801:00:05202012222055700 S SANTA FE AV, VERNON901T04:36:5012/05/20201015VICITYRPTDepartmentOCA NumberRMS JurisVPD CR20202090 CA0197300VPDCAM,PATRICK*26W06:53:4004:36:50VPDMANNINO,NICHOLAS20W04:37:0904:44:14VPDESTRADA,IGNACIOS304:59:0304:58:56202012222064501 DOWNEY RD, VERNON459GEE GEE`S LIQUOR04:39:1512/05/20201015RPTDepartmentOCA NumberRMS JurisVPD CR20202091 CA0197300VPD CR20202092 CA0197300VPDMADRIGAL,ALFONSO*31E04:41:1506:48:3704:41:19VPDMANNINO,NICHOLAS20W06:48:3604:44:18VPDGODOY,RAYMOND38E04:41:1706:48:3704:41:20VPDESTRADA,IGNACIOS306:16:3404:59:08202012222144444 AYERS AV, VERNONPLATEADIR INTERNATIONAL08:22:0012/05/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202093 CA0197300VPDMACIEL,CYNTHIA*41W08:23:55 08:24:3509:31:2308:27:011Page of 212/06/202006:22:47 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/05/202012/05/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012222183031 E VERNON AV, VERNON415AMPM09:59:3212/05/2020RPTMETDepartmentOCA NumberRMS JurisVPD CR20202094 CA0197300VPDDOCHERTY,MICHAEL*4310:00:54 10:01:3310:41:2210:03:23VPDMACIEL,CYNTHIA41W10:03:5912:07:2810:07:43VPDFLORES,TERESA44E10:00:55 10:01:3510:32:2910:06:53VPDONOPA,DANIELS710:41:1910:23:48202012222374927 ALCOA AV, VERNONBOVEH17:23:5912/05/20201015VRECRPTDepartmentOCA NumberRMS JurisVPD CR20202095 CA0197300VPDFLORES,TERESA*44E19:21:0817:23:59VPDMACIEL,CYNTHIA41W17:29:1018:57:4817:31:18VPDDOCHERTY,MICHAEL4317:27:29 17:27:3618:24:0517:31:04VPDONOPA,DANIELS717:29:0318:24:08* Denotes Primary Unit2Page of 212/06/202006:22:47 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/06/202012/06/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201222257E 54TH // SOTO, VERNONHBC02:36:3112/06/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202096 CA0197300VPDMANNINO,NICHOLAS*32E03:42:5602:36:31VPDMADRIGAL,ALFONSO31W02:36:3803:03:0902:47:3320201222264S ATLANTIC BL // BANDINI BL, VERNONWELCKCHP03:21:2412/06/20201015VIRPTDepartmentOCA NumberRMS JurisVPD CR20202097 CA0197300VPDMADRIGAL,ALFONSO*31W03:23:33 03:23:3406:37:1303:26:30VPDCAM,PATRICK2603:28:0006:37:1303:32:0620201222275HOLABIRD AV // GRANDE VISTA, VERNONVCK08:52:0612/06/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202098 CA0197300VPDZOZAYA,OSCAR*41E10:50:3108:52:0620201222286S SANTA FE AV // PACIFIC BL, VERNONREC16:32:2712/06/2020VREC1015RPTDepartmentOCA NumberRMS JurisVPD CR20202099 CA0197300VPDFLORES,TERESA*32W19:02:4116:32:58VPDZOZAYA,OSCAR41E16:33:1817:34:1716:34:59VPDDOCHERTY,MICHAEL4316:33:0017:18:3316:47:21VPDONOPA,DANIELS717:18:4116:36:03202012222874720 E DISTRICT BL, VERNON459AHP TIRES AND WHEELS16:47:4212/06/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202100 CA0197300VPDDOCHERTY,MICHAEL*4317:18:3418:31:0817:29:25VPDZOZAYA,OSCAR41E17:34:2118:38:4417:41:32VPDONOPA,DANIELS717:18:4218:02:4417:29:271Page of 212/07/202005:05:47 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/06/202012/06/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012222905685 ALCOA AV, VERNON245QX LOGISTICS19:24:4912/06/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202101 CA0197300VPD*32E19:26:42 19:26:4720:53:19 21:18:4119:31:15VPDCAM,PATRICK26W20:53:2219:32:33VPD3121:11:2019:31:26VPDLUCAS,JASONXS19:27:2420:53:1819:32:4220201222297ALCOA AV // VERNON AV, VERNONTRAFFIC STOP22:43:5212/06/20201015VICITERPTDepartmentOCA NumberRMS JurisVPD CR20202102 CA0197300VPDMADRIGAL,ALFONSO*3100:04:2622:43:52VPDCAM,PATRICK26W23:17:5523:34:2123:20:29VPDLUCAS,JASONXS22:56:06 22:56:0800:04:2723:03:29* Denotes Primary Unit2Page of 212/07/202005:05:47 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/07/202012/07/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012223222601 S SOTO, VERNON459RJOE K`S07:44:1612/07/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202103 CA0197300VPDVILLEGAS,RICHARD*41W07:45:54 07:49:4708:33:0907:57:4220201222325S ATLANTIC BL // BANDINI BL, VERNONGTAJASON MORALES08:39:5812/07/2020RPTVRECDepartmentOCA NumberRMS JurisVPD CR20202104 CA0197300VPDFINO,MARCUS*38E11:14:3408:53:26VPDVILLEGAS,RICHARD41W10:36:1310:24:25VPDZOZAYA,OSCARMET108:55:1710:24:2708:57:44202012223384500 E DISTRICT BL, VERNON459RLOS ANGELES OPERA11:25:4012/07/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202106 CA0197300VPDVALENZUELA,FERNANDO*32E11:33:5212:39:2611:38:3320201222339S SANTA FE AV // 38TH, VERNON902TAT&T MOBILITY 800 635 6840 411:26:5812/07/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202105 CA0197300VPDVALENZUELA,FERNANDO*32E11:29:30 11:29:4611:33:41VPDFLORES,TERESA20W11:33:3912:23:2211:34:22202012223474580 E 49TH, VERNON487RHANSOLO BUILDING13:52:5812/07/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202107 CA0197300VPDVALENZUELA,FERNANDO*32E14:16:26 14:16:3515:05:3714:23:1920201222357DOWNEY RD // SLAUSON AV, VERNON902TONSTAR TELEMATICS CALL CENTER18:04:0712/07/2020RPTORDepartmentOCA NumberRMS JurisVPD CR20202108 CA0197300VPDFINO,MARCUS*26E18:04:16 18:04:4118:36:3618:07:59VPDVALENZUELA,FERNANDO32E18:06:2318:12:58VPDVILLEGAS,RICHARD41W18:05:4118:36:3718:13:101Page of 212/08/202004:44:10 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/07/202012/07/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201222357DOWNEY RD // SLAUSON AV, VERNON902TONSTAR TELEMATICS CALL CENTER18:04:0712/07/2020RPTORDepartmentOCA NumberRMS JurisVPD CR20202108 CA0197300USTOWUS TOW18:15:2018:36:3718:24:4220201222377IRVING // 37TH, VERNON48423:34:2712/07/20201015RPTVIDepartmentOCA NumberRMS JurisVPD CR20202109 CA0197300VPDSALDANA,CARLOS*32W01:03:3823:34:27VPDARANA,ANDRE31E23:34:3000:58:4223:48:28VPDRAMOS,JOSE4300:43:3523:35:55MR C TOWMR C TO00:32:54 00:33:2801:03:3900:42:51* Denotes Primary Unit2Page of 212/08/202004:44:10 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/08/202012/08/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201222394PACIFIC BL // SANTA FE AV, VERNONREC PLATE08:18:2712/08/2020VRECDepartmentOCA NumberRMS JurisVPD CR20202110 CA0197300VPDVALENZUELA,FERNANDO*3108:48:18 08:50:2208:18:46VPDFINO,MARCUS26E08:48:2608:19:21VPDVILLEGAS,RICHARD41W08:48:1808:26:12VPDZOZAYA,OSCARMET108:48:1808:19:24202012224094305 S SANTA FE AV, VERNONWARRANT12:37:1112/08/2020PRDRPTVPDVELEZ,MARISSA*5D3412:57:5312:37:11VPDGENERA,ELISEO2W4513:19:5212:57:49VPDHERNANDEZ,EDWARD5D3212:57:5112:37:4820201222424LOMA VISTA AV // DISTRICT BL, VERNON901TRALEXANDRIA18:09:4912/08/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202111 CA0197300VPDFINO,MARCUS*26E18:12:1918:41:4218:14:55VPDVILLEGAS,RICHARD41W18:40:2018:17:41202012224255764 ALCOA AV, VERNON417T-Mobile USA 888-662-4662 opt 418:39:2512/08/20201015RPTADVDepartmentOCA NumberRMS JurisVPD CR20202112 CA0197300VPDVALENZUELA,FERNANDO*3118:39:46 18:39:4720:45:4218:45:04VPDFINO,MARCUS26E20:25:1118:47:52VPDARANA,ANDRE31E21:33:3020:45:58VPD3818:42:1518:45:31VPDSALDANA,CARLOS38W21:25:4518:45:33VPDVILLEGAS,RICHARD41W18:40:2220:15:0318:43:46VPDRAMOS,JOSE/LANDA,RAFAEL4418:43:2821:26:2118:47:17VPDZOZAYA,OSCARMET120:37:3018:47:42VPDSANTOS,DANIELS221:00:2218:47:311Page of 212/09/202005:04:47 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/08/202012/08/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012224255764 ALCOA AV, VERNON417T-Mobile USA 888-662-4662 opt 418:39:2512/08/20201015RPTADVDepartmentOCA NumberRMS JurisVPD CR20202112 CA0197300VPDESTRADA,IGNACIOS318:43:4221:00:2418:47:19* Denotes Primary Unit2Page of 212/09/202005:04:47 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/09/202012/09/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012224342900 S SANTA FE AV, VERNON459RABC BIKES03:15:0112/09/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202113 CA0197300VPDLANDA,RAFAEL*41W04:48:0903:15:01VPDSALDANA,CARLOS38W03:15:5304:48:0903:21:44VPDRAMOS,JOSE43E03:15:0404:48:1003:23:2120201222443E 28TH // SANTA FE AV, VERNON902TMILTON FLORES06:35:3212/09/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202115 CA0197300VPDSALDANA,CARLOS*38W06:37:29 06:37:3007:45:4006:43:19VPDSWINFORD,PHILLIP4307:45:4007:30:21202012224443650 E 26TH, VERNON902TUNK06:40:5912/09/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202114 CA0197300VPDARANA,ANDRE*31E06:42:17 06:42:3007:17:1106:48:34202012224595610 ALCOA AV, VERNONTRAFFIC STOP11:09:3212/09/2020VIRPTDepartmentOCA NumberRMS JurisVPD CR20202116 CA0197300VPDCROSS,JEREMY*S412:12:2311:09:35VPDCERDA,PAUL,JR32E11:10:3412:09:0011:12:56VPDZOZAYA,OSCAR41W11:42:2712:08:51VPDMARTINEZ,GABRIELS512:12:2411:10:44USTOWUS TOW11:42:01 11:48:0912:12:2412:01:17202012224632100 E 25TH, VERNON242RRAINBOW MERCHANDISE12:14:4812/09/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202118 CA0197300VPDSTEVENSON,KENT,JR*22E12:19:11 12:19:3512:29:14VPDVALENZUELA,FERNANDO26W12:20:0013:28:3012:29:44202012224641Page of 312/10/202004:51:38 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/09/202012/09/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201222464S SANTA FE AV // 26TH, VERNON901TT-Mobile USA 888-662-4662 opt 412:27:0012/09/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202117 CA0197300VPDMARTINEZ,GABRIEL*S512:28:2212:44:4312:29:53VPDSTEVENSON,KENT,JR22E12:42:5012:41:05VPDZOZAYA,OSCAR41W12:36:0513:28:4312:44:01VPDSWINFORD,PHILLIP4312:28:5713:28:4312:31:36MR C TOWMR C TO12:48:14 12:48:1413:28:4313:08:11VPDCROSS,JEREMYS412:28:3812:44:4012:29:51202012224712900 S SANTA FE AV, VERNON140ABC BIKES13:48:5012/09/2020SUPVPDZOZAYA,OSCAR*41W13:51:35 13:52:0015:31:2914:02:50202012224735837 S DISTRICT BL, VERNONREC14:28:2812/09/2020VRECDepartmentOCA NumberRMS JurisVPD CR20202120 CA0197300VPDVALENZUELA,FERNANDO*26W15:16:1714:28:31VPDSTEVENSON,KENT,JR22E15:16:1614:29:32USTOWUS TOW14:30:29 14:30:3115:16:1714:55:50202012224741925 E VERNON AV, VERNONPLATEPACIFIC COAST TRANSPORT14:38:3612/09/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202122 CA0197300VPDZOZAYA,OSCAR*41W16:27:49 16:27:5016:29:25VPDSWINFORD,PHILLIP4316:29:1416:55:2216:37:0320201222475S SOTO // VERNON AV, VERNON415T-Mobile USA 888-662-4662 opt 415:17:3012/09/20201015RPTDepartmentOCA NumberRMS JurisVPD CR20202121 CA0197300VPDSTEVENSON,KENT,JR*22E15:18:23 15:18:4615:56:0515:22:11VPDVALENZUELA,FERNANDO26W17:03:0715:19:48VPDZOZAYA,OSCAR41W15:46:2415:31:422Page of 312/10/202004:51:38 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/09/202012/09/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201222475S SOTO // VERNON AV, VERNON415T-Mobile USA 888-662-4662 opt 415:17:3012/09/20201015RPTDepartmentOCA NumberRMS JurisVPD CR20202121 CA0197300VPDSWINFORD,PHILLIP4315:18:25 15:18:4815:50:0815:23:40VPDCHAVEZ,JERRY,JRS115:59:2815:22:56VPDCROSS,JEREMYS417:03:0715:27:18VPDMARTINEZ,GABRIELS517:03:0715:27:21202012224854900 CORONA AV, VERNONGTARNEEDLE17:53:0912/09/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202124 CA0197300VPDSTEVENSON,KENT,JR*22E18:31:31 18:31:5019:08:3118:38:04202012224875000 E DISTRICT BL, VERNONGTARBNA COLOR18:33:1412/09/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202123 CA0197300VPDSWINFORD,PHILLIP*4318:34:33 18:34:4819:08:36202012224913616 S SOTO, VERNON484RTHE GREEN OLIVE19:41:5712/09/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202125 CA0197300VPDRAMOS,JOSE*43E19:43:5820:10:5819:48:04* Denotes Primary Unit3Page of 312/10/202004:51:38 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/10/202012/10/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012225262462 E 28TH, VERNON487RWESTGATE MFG08:44:3412/10/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202126 CA0197300VPDSTEVENSON,KENT,JR*22W08:45:53 08:46:0809:32:0908:51:39VPDNEWTON,TODD32W09:32:0908:58:36202012225484800 HAMPTON, VERNONGTARGTS14:41:2812/10/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202127 CA0197300VPDNEWTON,TODD*32W14:44:15 14:45:2216:04:1314:49:04202012225525107 S DISTRICT BL, VERNONDPTAST16:23:3312/10/20201015CITEDepartmentOCA NumberRMS JurisVPD CR20202128 CA0197300VPDCAM,PATRICK*20E16:24:00 16:24:0217:27:3416:30:25VPDFINO,MARCUS38E16:32:2417:27:3416:43:31202012225533737 S SOTO, VERNON415MC DONALDS18:49:0412/10/2020RPT1015CITEDepartmentOCA NumberRMS JurisVPD CR20202129 CA0197300VPDSTEVENSON,KENT,JR*22W19:56:3018:52:25VPDVALENZUELA,FERNANDO/ARANA,ANDRE3119:56:3019:02:02VPDNEWTON,TODD32W19:41:5218:52:57VPDMANNINO,NICHOLAS38E19:01:2619:21:5619:02:19VPDGODOY,RAYMOND4118:54:5719:54:2319:01:43VPDPEREZ,NICKL219:56:3119:06:59VPDLANDA,RAFAELXS19:07:0119:56:31202012225554355 FRUITLAND AV, VERNONRECUNK19:17:0212/10/2020VSRPTDepartmentOCA NumberRMS JurisVPD CR20202130 CA0197300VPDMANNINO,NICHOLAS*38E19:21:5620:19:1019:27:00VPDGODOY,RAYMOND4119:56:0119:54:241Page of 201/14/202108:33:22 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/10/202012/10/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012225554355 FRUITLAND AV, VERNONRECUNK19:17:0212/10/2020VSRPTDepartmentOCA NumberRMS JurisVPD CR20202130 CA0197300MR C TOWMR C TO19:58:51 20:00:0320:38:4420:05:54202012225643420 BOYLE AV, VERNONDPTAST22:21:2412/10/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202131 CA0197300VPDMANNINO,NICHOLAS*38E23:11:3722:21:30VPDMADRIGAL,ALFONSO32W22:21:3623:03:3722:23:14VPDGODOY,RAYMOND4122:21:3723:03:3822:23:16VPDLANDA,RAFAELXS23:03:4022:26:04* Denotes Primary Unit2Page of 201/14/202108:33:22 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/11/202012/11/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201222568DOWNEY RD // VERNON AV, VERNON901TR00:20:2012/11/2020RPCB1015VIDepartmentOCA NumberRMS JurisVPD CR20202133 CA0197300VPDMANNINO,NICHOLAS*38E00:21:5303:59:2300:23:58VPDGODOY,RAYMOND4100:21:5503:47:1900:23:32202012225693333 DOWNEY RD, VERNON415T-Mobile USA 888-662-4662 opt 400:24:5912/11/2020RPTSRVDDepartmentOCA NumberRMS JurisVPD CR20202132 CA0197300VPDMADRIGAL,ALFONSO*32W00:26:1302:18:0000:27:04VPDGODOY,RAYMOND4100:57:2000:28:17VPDLANDA,RAFAELXS00:27:2402:18:0000:32:0420201222579WASHINGTON // SOTO, VERNONLOCATEPEPES TOW07:28:5112/11/2020VRECVPDRECORDS BUREAU*RECD08:25:0007:30:0620201222581AYERS AV // 26TH, VERNONREC09:29:4412/11/2020VRECRPTDepartmentOCA NumberRMS JurisVPD CR20202134 CA0197300VPDFINO,MARCUS*20E10:23:2209:29:44202012225844500 E DISTRICT BL, VERNON140LOS ANGELES OPERA11:36:0512/11/2020SUPVPDFINO,MARCUS*20E11:39:47 11:39:4911:40:14VPDSWINFORD,PHILLIP3111:40:1211:46:04 11:48:5011:41:35202012226002100 E 25TH, VERNON140RAINBOW MERCHANDISE18:27:5312/11/2020ASSTRPTVPDSWINFORD,PHILLIP*3118:50:1918:31:371Page of 212/12/202006:09:27 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/11/202012/11/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012226002100 E 25TH, VERNON140RAINBOW MERCHANDISE18:27:5312/11/2020ASSTRPTVPDNEWTON,TODD26W18:31:3918:51:1718:31:43* Denotes Primary Unit2Page of 212/12/202006:09:27 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/12/202012/12/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012226602634 E 26TH, VERNONGTARTFI TRANSPORT13:44:3612/12/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202135 CA0197300VPDDOCHERTY,MICHAEL*43W13:59:44 13:59:4515:04:2714:05:592020122267960TH // HELIOTROPE, MAYWOODLOCATE19:37:2112/12/2020VRECVPDDISPATCH*DISP20:05:0019:48:02202012226853001 BANDINI BL, VERNONTRAFFIC STOP21:10:1812/12/20201015VIRPTDepartmentOCA NumberRMS JurisVPD CR20202137 CA0197300VPDCAM,PATRICK*20E23:57:4221:10:19VPDMANNINO,NICHOLAS2621:10:20 21:10:2221:21:3021:14:20VPDMADRIGAL,ALFONSO41W21:12:4722:45:2821:14:26* Denotes Primary Unit1Page of 112/13/202005:27:19 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/13/202012/13/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene2020122270815TH // SANTA FE, VERNONTRAFFIC STOP02:59:3812/13/2020VIDepartmentOCA NumberRMS JurisVPD CR20202138 CA0197300VPDCROSS,JEREMY*S404:31:1502:59:39VPDMANNINO,NICHOLAS2602:59:52 02:59:5303:00:47VPDMADRIGAL,ALFONSO41W03:02:5404:31:1503:07:3620201222743DOWNEY RD // LEONIS BL, VERNONRECKLESS DRVNANCY15:38:1912/13/2020CITEVIRPT1015SRVDDepartmentOCA NumberRMS JurisVPD CR20202139 CA0197300VPDDOCHERTY,MICHAEL*4315:39:1416:44:3815:42:26VPDFLORES,TERESA31E15:41:0116:59:4315:42:30VPDFINO,MARCUS41W15:39:1616:44:4015:42:32VPDVELEZ,MARISSA5D3415:58:5415:41:06VPDRAMOS,JOSEXS15:40:1116:44:3616:02:06* Denotes Primary Unit1Page of 112/14/202005:04:00 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/14/202012/14/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201222784S DISTRICT BL // ATLANTIC BL, VERNON20002RCAROLINA08:08:0412/14/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202140 CA0197300VPDFINO,MARCUS*31E08:09:0208:09:42VPDRECORDS BUREAURECD08:21:1008:09:49202012227902840 S ALAMEDA, VERNON459VRSOOFER09:41:1912/14/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202141 CA0197300VPDRECORDS BUREAU*RECD10:20:2609:43:1820201222802S SANTA FE AV // 28TH, VERNONBOVEHFRANK11:49:4712/14/2020VSDepartmentOCA NumberRMS JurisVPD CR20202142 CA0197300VPDFLORES,TERESA*26W11:51:0112:55:3011:58:1320201222806BANDINI BL // ATLANTIC BL, VERNON20002RJEREMY12:45:0312/14/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202143 CA0197300VPDVILLEGAS,RICHARD*4312:50:2413:32:2513:02:02202012228104659 52D DR, VERNON S/A 111SCAR14:37:3712/14/20201098RPTDepartmentOCA NumberRMS JurisVPD CR20202146 CA0197300VPDFINO,MARCUS*31E18:00:3917:06:4620201222812CUDAHY // DISTRICT, VERNON901TRJESSICA MESA14:52:5412/14/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202144 CA0197300VPDFINO,MARCUS*31E14:53:42 14:54:2715:41:2514:58:40VPDVILLEGAS,RICHARD4314:56:5215:56:2015:25:47VPDZOZAYA,OSCARMET114:56:4815:56:2015:25:49* Denotes Primary Unit1Page of 112/15/202004:50:52 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/15/202012/15/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012228512323 E VERNON AV, VERNON594RPETRELLI ELECTRIC05:25:5612/15/2020RPTCITYDepartmentOCA NumberRMS JurisVPD CR20202147 CA0197300VPDRAMOS,JOSE*43W05:27:37 05:27:3805:56:0705:32:47202012228523050 LEONIS BL, VERNON20002RUNK05:28:5112/15/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202148 CA0197300VPDLUCAS,JASON*32E06:13:4605:28:51202012228654820 EVERETT AV, VERNON20002RFRESH PRODUCE10:13:4312/15/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202149 CA0197300VPDMACIEL,CYNTHIA*43E10:17:4011:04:1310:24:32202012228684455 FRUITLAND AV, VERNONREPOUNK11:29:2312/15/2020REPODepartmentOCA NumberRMS JurisVPD CR20202150 CA0197300VPDRECORDS BUREAU*RECD13:01:2211:32:3920201222877E DISTRICT BL // MAYWOOD AV, VERNON902TELI ZEPEDA14:00:2412/15/2020RPTCITYDepartmentOCA NumberRMS JurisVPD CR20202152 CA0197300VPDFLORES,TERESA*26E14:00:46 14:01:5514:11:1614:04:21VPDSWINFORD,PHILLIP/MACIEL,CYNTHIA43E14:01:4914:33:3614:04:51MR C TOWMR C TO14:13:32 14:14:0114:37:1614:22:1320201222878SOTO // MILES, VERNONFU14:08:3312/15/20201015RPTDepartmentOCA NumberRMS JurisVPD CR20202154 CA0197300VPDHERRERA,GUSTAVO*5D3015:58:3114:09:01VPDFLORES,TERESA26E14:11:2017:58:2214:14:50VPDZOZAYA,OSCAR31W14:11:0919:11:5114:12:57VPDVILLEGAS,RICHARD41W14:15:5414:34:0414:23:301Page of 212/16/202005:01:25 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/15/202012/15/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201222878SOTO // MILES, VERNONFU14:08:3312/15/20201015RPTDepartmentOCA NumberRMS JurisVPD CR20202154 CA0197300VPDREYNA,JOSE S5D2318:31:2414:28:45VPDHERNANDEZ,EDWARD5D3214:15:5814:50:5514:09:36VPDESCOBEDO,ALEXY5D3319:11:5114:09:36VPDCHAVEZ,JERRY,JRS116:13:2615:03:0120201222879E 49TH // CORONA AV, VERNONWELCKT-Mobile USA, Inc.14:28:0312/15/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202151 CA0197300VPDSWINFORD,PHILLIP/MACIEL,CYNTHIA*43E14:33:3815:58:5814:34:40VPDVILLEGAS,RICHARD41W14:34:0515:58:5714:40:29VPDCHAVEZ,JERRY,JRS114:38:1014:48:52202012228802050 E 52D, VERNON487RUNK16:32:0812/15/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202153 CA0197300VPDVILLEGAS,RICHARD*41W16:32:46 16:33:0117:06:0316:54:39* Denotes Primary Unit2Page of 212/16/202005:01:25 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/16/202012/16/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012228954700 S BOYLE AV, VERNON48400:32:4212/16/20201015RPTFIDepartmentOCA NumberRMS JurisVPD CR20202155 CA0197300VPDSALDANA,CARLOS*38E02:20:1300:32:42VPDLUCAS,JASON32W01:15:3501:15:4100:34:31VPDRAMOS,JOSE43E00:32:4502:20:1400:34:52VPDESTRADA,IGNACIOS301:33:0100:38:02202012229093825 S SANTA FE AV, VERNON459RUNLIMITED BEAUTY CARE06:14:0312/16/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202156 CA0197300VPDLANDA,RAFAEL*41W06:16:4407:06:0606:17:32VPDRAMOS,JOSE43E06:20:3306:53:3406:26:43202012229213427 FLOWER, VERNON586JULIAN RAMIREZ12:19:1012/16/2020VSCITEHPPDHPPD*HP5P12:55:3112:26:00HPPDHP6P12:55:3112:44:50202012229373851 S SANTA FE AV, VERNON920PR17:47:5412/16/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202157 CA0197300VPDSWINFORD,PHILLIP/MACIEL,CYNTHIA*4318:16:4517:48:08202012229462104 E 57TH, VERNON459VRSCALA LUXURY22:47:1212/16/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202158 CA0197300VPDLANDA,RAFAEL*32W22:49:3923:33:5022:55:08202012229491Page of 212/17/202004:58:33 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/16/202012/16/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012229493056 BANDINI BL, VERNONRECLA TRUCK AND TRAILER23:54:5512/16/2020RPTVRECDepartmentOCA NumberRMS JurisVPD CR20202159 CA0197300VPDRAMOS,JOSE*41E23:58:3500:42:2200:02:36VPDCAM,PATRICK3823:58:4000:55:1000:02:37USTOWUS TOW00:17:14 00:18:2000:55:1000:40:42* Denotes Primary Unit2Page of 212/17/202004:58:33 AddressDept NameTractDept #DispCompOnSceneDispatchComplaintUnit12/17/2020First Date:VERNON12/17/2020Last Date:Jurisdiction: VERNON POLICE DEPARTMENTCall Log Report Type Dept NumberReceivedCaller Call Number PhoneEnroute20201222957VCKVEHICLE CHECK1E WASHINGTON BL //INDIANA, VERNONRPTVSCITE202012019358VPD03:46:17 03:46:17 04:34:1212/17/2020 03:46:1703:46:17*38VPD03:46:17 04:34:1120201222968487RGRAND THEFT REPORT2BIG SAVER4260 CHARTER AV,VERNON323-582-7222RPT202012019368VPD12:51:37 13:08:16 15:16:0112/17/2020 12:37:3013:08:16*26EVPD12:51:37 13:08:1620201222973901TRINJURY TRAFFIC COLLISION REPORT3J AND J SNACK FOODS5401 DOWNEY RD,VERNON323-581-0171CITERPT202012019371VPD15:16:04 15:18:19 16:17:1412/17/2020 15:11:0415:16:23*26EVPD15:16:04 15:16:23 15:18:19 16:17:1416:17:1416:17:1420201222978RECRECOVERED STOLEN VEHICLE IN THE FIELD4UPS3333 DOWNEY RD,VERNON323-260-8951VREC202012019376VPD17:06:45 17:24:03 18:26:4412/17/2020 16:56:2717:06:45*22EVPD17:06:45 17:06:45 17:24:03 18:26:4343WVPD17:24:05 18:26:43* Denotes Primary Unit1Page of 112/18/202005:18:30 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/18/202012/18/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201223019LEONIS BL // PACIFIC BL, VERNON902TRVERIZON WIRELESS 1-800-451-524205:40:2312/18/2020RPTCITEDepartmentOCA NumberRMS JurisVPD CR20202164 CA0197300VPDMANNINO,NICHOLAS*38W05:40:4706:37:5705:41:49VPDMADRIGAL,ALFONSO32E06:37:5605:45:22VPDRAMOS,JOSE4106:37:5705:41:4520201223035SANTA FE // PACIFIC, VERNON20002R17:37:2112/18/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202165 CA0197300VPDNEWTON,TODD*26W18:08:4817:37:23202012230404560 LOMA VISTA AV, VERNONGTARUNK19:23:3812/18/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202166 CA0197300VPDMANNINO,NICHOLAS*38E19:25:14 19:25:1520:07:3619:31:4620201223056DOWNEY RD // FRUITLAND AV, VERNONTRAFFIC STOP21:35:0512/18/20201015SRVDCITERPTDepartmentOCA NumberRMS JurisVPD CR20202167 CA0197300VPDLUCAS,JASON*1T122:07:5021:35:05VPDZOZAYA,OSCAR1T221:35:10 21:35:1122:07:5021:41:05202012230574305 S SANTA FE AV, VERNON166RVERNON POLICE21:50:4412/18/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202168 CA0197300VPDMANNINO,NICHOLAS*38E21:51:59 21:52:0022:33:24202012230582916 S SANTA FE AV, VERNONPATCKFARHAN ENTERPRISES21:52:3012/18/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202169 CA0197300VPDCAM,PATRICK*31W21:58:31 21:58:3223:26:3822:03:041Page of 212/19/202006:42:24 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/18/202012/18/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012230582916 S SANTA FE AV, VERNONPATCKFARHAN ENTERPRISES21:52:3012/18/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202169 CA0197300VPDCROSS,JEREMYS423:21:3421:59:46* Denotes Primary Unit2Page of 212/19/202006:42:24 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/19/202012/19/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene20201223070E 49TH // LOMA VISTA AV, VERNONTRAFFIC STOP01:44:0612/19/2020RPTVIDepartmentOCA NumberRMS JurisVPD CR20202170 CA0197300VPDMADRIGAL,ALFONSO*3202:51:3001:44:06VPDCAM,PATRICK31W01:45:1602:38:3901:47:25VPDMANNINO,NICHOLAS38E01:44:08 01:44:0902:37:5202:19:33VPDCROSS,JEREMYS401:53:4502:30:2301:58:43202012231094305 S SANTA FE AV, VERNONFOUND18:23:1112/19/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202171 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Date:Last Date:12/28/202012/28/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012236384340 E DISTRICT BL, VERNON484RPASHA MERCHANTS12:16:3312/28/2020RPTDepartmentOCA NumberRMS JurisVPDCR20202221CA0197300VPDFINO,MARCUS*38E12:27:29 12:27:2913:29:2112:32:5320201223641S SANTA FE AV // VERNON AV, VERNONBOVEH13:06:1712/28/2020VMRPTDepartmentOCA NumberRMS JurisVPDCR20202223CA0197300VPDFLORES,TERESA*20W14:39:0113:06:17USTOWUS TOW13:14:32 13:14:3214:39:0113:31:5620201223642DOWNEY RD // LEONIS BL, VERNON901T13:29:1612/28/2020RPTDepartmentOCA NumberRMS JurisVPDCR20202222CA0197300VPDCHAVEZ,JERRY,JR*S113:29:21 13:29:2313:41:3813:33:57VPDFINO,MARCUS38E13:29:5914:29:1513:32:55VPDVALENZUELA,FERNANDO4313:36:0014:28:0513:36:29MR C TOWMR C TO13:39:24 13:39:2414:29:1613:48:12202012236433843 S SOTO, VERNONA459RVERNON AND SOTO CHECK CASHING14:10:3212/28/2020RPTDepartmentOCA NumberRMS JurisVPDCR20202224CA0197300VPDVALENZUELA,FERNANDO*4314:28:0615:16:4714:30:52202012236464627 52D DR, VERNON S/A 104MR60LORENA PLATA15:07:4612/28/2020RPTDepartmentOCA NumberRMS JurisVPDCR20202225CA0197300VPDFLORES,TERESA*20W16:43:2415:09:44* Denotes Primary Unit2Page of 212/29/202004:55:34 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/29/202012/29/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012236934305 S SANTA FE AV, VERNON10-610:08:2812/29/20201015RPTCITEVPDHERNANDEZ,EDWARD*5D3212:38:5310:08:28202012236944625 E DISTRICT BL, VERNON487RPACIFIC GIANT10:13:5612/29/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202226 CA0197300VPDVALENZUELA,FERNANDO*43E10:15:15 10:15:1510:51:1310:19:41202012237022929 E 54TH, VERNONDET13:47:1712/29/20201015RPTVPDVELEZ,MARISSA*5D3416:02:5913:47:17VPDREYNA,JOSE S5D2316:02:5813:50:24VPDHERRERA,GUSTAVO5D3016:02:5813:47:45VPDHERNANDEZ,EDWARD5D3216:02:5913:50:3120201223710E VERNON AV // SANTA FE AV, VERNON902TDAWN16:03:3212/29/2020RPTDepartmentOCA NumberRMS JurisVPD CR20202227 CA0197300VPDZOZAYA,OSCAR*32W16:05:0917:22:2516:09:15VPDFINO,MARCUS3116:15:0716:58:5416:23:17USTOWUS TOW16:13:49 16:13:4916:58:5216:39:14202012237154305 S SANTA FE AV, VERNONWARRANT17:29:0412/29/2020CITERPT1015DepartmentOCA NumberRMS JurisVPD CR20202228 CA0197300VPDZOZAYA,OSCAR*32W17:55:5517:30:14202012237241Page of 212/30/202004:57:17 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/29/202012/29/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene2020122372417TH // HOOPER, VERNONLOCATEUS TOW22:25:4812/29/2020VRECVPDDISPATCH*DISP22:27:0222:26:41VPDRECORDS BUREAURECD23:12:3222:26:58* Denotes Primary Unit2Page of 212/30/202004:57:17 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/30/202012/30/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012237542228 E 38TH, VERNONREPO16:42:3812/30/2020RPTREPODepartmentOCA NumberRMS JurisVPDCR20202229CA0197300VPDRECORDS BUREAU*RECD17:00:1116:44:40* Denotes Primary Unit1Page of 112/31/202004:52:39 VERNON POLICE DEPARTMENTCall Log Report Type All Unit Times and Location with OCA'sJurisdiction:First Date:Last Date:12/31/202012/31/2020Call Number DispTenCodeCaller AddressOfficerUnitDepUnit Time DispatchEnrouteDepartArriveRemoveCompVERNONReceivedComplaint OnScene202012237852043 ROSS, VERNONVCK08:27:4012/31/2020VIDepartmentOCA NumberRMS JurisVPDCR20202230CA0197300VPDCERDA,EUGENIO/MACIEL,CYNTHIA*4310:21:5208:27:40VPDVALENZUELA,FERNANDO32W08:32:1708:32:24VPDCERDA,PAUL,JR41E08:32:1808:32:22202012237893851 S SANTA FE AV, VERNON476RHANNIBAL INDUSTRY10:55:5712/31/2020RPTDepartmentOCA NumberRMS JurisVPDCR20202231CA0197300VPDVALENZUELA,FERNANDO*32W11:03:4511:05:26VPDCERDA,EUGENIO/MACIEL,CYNTHIA4311:05:29 11:06:0811:40:29202012237975601 DOWNEY RD, VERNON459ASL HOME FASHIONS16:51:2012/31/2020RPTDepartmentOCA NumberRMS JurisVPDCR20202232CA0197300VPDCERDA,EUGENIO/MACIEL,CYNTHIA*4316:52:31 16:53:3317:07:02VPDSALDANA,CARLOS31W16:52:33 16:53:3418:53:4117:36:24VPDCERDA,PAUL,JR41E17:23:5117:48:1517:36:20VPDMARTINEZ,GABRIELS518:53:3917:48:40202012237984575 PACIFIC BL, VERNON459ALITTLEJOHN REULAND17:01:3512/31/2020CITE1015DepartmentOCA NumberRMS JurisVPDCR20202233CA0197300VPDMARTINEZ,GABRIEL*S517:04:5317:48:4017:08:49VPDMANNINO,NICHOLAS32E18:52:5419:13:0318:54:22VPDMADRIGAL,ALFONSO3819:07:1818:58:09VPDCERDA,PAUL,JR41E17:23:4717:14:00VPDCERDA,EUGENIO/MACIEL,CYNTHIA4317:07:0419:34:1017:08:51202012237993141 E 44TH, VERNONGTARLINEAGE17:16:2012/31/2020RPTDepartmentOCA NumberRMS JurisVPDCR20202234CA0197300VPDARANA,ANDRE*20W18:58:3819:33:5919:01:201Page of 101/01/202105:47:48 City Council Agenda Item Report Agenda Item No. COV-480-2021 Submitted by: Karina Rueda Submitting Department: Human Resources Meeting Date: February 16, 2021 SUBJECT Addendum and Amendment to Medicare Advantage Group Agreement with Blue Cross of California dba Anthem Blue Cross Recommendation: Ratify Addendum and Amendment to Medicare Advantage Group Agreement with Blue Cross of California dba Anthem Blue Cross for the renewal of Medicare health plan benefits and rates for the period of January 1, 2021 through December 31, 2021, covering the City’s Medicare eligible retirees and their eligible spouses. Background: Each year, with the assistance of the City's Health Benefits Brokerage and Consulting Firm, currently Alliant Insurance Services (Alliant), the City reviews the insurance plans for Medicare eligible retirees and eligible spouses. For calendar year 2020, Alliant solicited proposals from various providers to ensure that the City was receiving competitive rates for its Medicare plans, while maintaining the desired level of benefit coverage. There were three carriers who submitted competitive quotes and based on the review of benefit coverage and premium rates from the three competitive quotes received, it was recommended to select Anthem Blue Cross for calendar year 2020. On April 7, 2020, the City Council authorized the City Administrator to execute a Medicare Advantage Group Agreement (Group Agreement) for a total amount of approximately $182,150 with Blue Cross of California dba Anthem Blue Cross (Anthem) to provide health plans for the City’s Medicare eligible retirees and their eligible spouses. In September 2020 HR staff reviewed a renewal presentation provided by Alliant. The presentation which includes a side by side comparison and notes the rates are unchanged has been provided for reference (attachment 2). Staff is now recommending the ratification of an Addendum and Amendment to the Group Agreement with Anthem for the renewal of benefits and rates for the period of January 1, 2021 through December 31, 2021 (Plan Year). Benefits and Rates set forth in the Addendum replace and supersede the Benefit Charts and Rate Sheets under the Group Agreement for Plan Year 2020. For the period of January 1, 2021 through December 31, 2021, Anthem offered a renewal rate pass (no changes in current rates) on the City's two Medicare plans: the Senior Secure (HMO) Plan at a monthly premium of $291.41; and the Anthem Medicare Preferred (PPO) Plan at a monthly premium of $418.55 (with both plans including a Prescription Drug Plan). All other terms and provisions of the Group Agreement remain unchanged. It is in the City’s and its retirees' best interest to maintain the same carrier as long as they remain competitive. Accordingly, the Human Resources Department is recommending ratification of the Addendum and Amendment to the Group Agreement with Anthem. The premium rates and level of benefits will continue to be reviewed annually with the assistance of the City’s Health Benefits Brokerage and Consulting Firm. The Addendum and Amendment to the Group Agreement with Anthem was reviewed and approved as to form by the City Attorney’s Office. Fiscal Impact: The annual premium for the 2021 Addendum and Amendment to Medicare Advantage Group Agreement with Blue Cross of California dba Anthem Blue Cross is approximately $170,133, based on the City's 2020 enrollment. This amount will vary slightly based on the enrollment of Medicare eligible retirees and their eligible spouses in 2021. The total annual premium is offset by retiree contributions, which is estimated to be approximately $65,776. Adequate funds have been included in the 2020-2021 fiscal year budget approved by City Council, and will be included in the 2021-2022 fiscal year budget. Attachments: 1. Renewal Addendum and Amendment to Medicare Advantage Group Agreement 2. 2021 Renewal Presentation 2021 Renewal Addendum and Amendment to Medicare Advantage Group Agreement This is an Addendum and Amendment to the Medicare Advantage Group Agreement (“Group Agreement”) among the City of Vernon and Anthem Insurance Companies, Inc., sponsor of the Anthem Medicare Preferred (PPO) Plan, and Blue Cross of California, sponsor of the Senior Secure (HMO) Plan, regarding renewal of benefits and rates and an Amendment to the Group Agreement for the period January 1, 2021 through December 31, 2021 (“Plan Year”). City of Vernon and Anthem Insurance Companies, Inc., sponsor of the Anthem Medicare Preferred (PPO) Plan and Blue Cross of California, sponsor of the Senior Secure (HMO) Plan hereby renew the Group Agreement for the Plan Year. Effective on January 1, 2021, the Benefits and Rates set forth in the attached 2021 Anthem Medicare Preferred (PPO) and Senior Secure (HMO) Benefit Charts and Rate Sheets, hereby replace and supersede the Benefit Charts and Rate Sheets in effect under the Group Agreement for the period ending December 31, 2020. Note that the “per member per month” premiums shown in the Rate Sheet will be adjusted for those Medicare Members who are eligible for the low income subsidy or who have incurred a late enrollment penalty. All other terms and provisions of the Group Agreement remain unchanged. Your 2021 Medical Benefits Chart PPO Plan 10P High Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Doctor and hospital choice You may go to doctors, specialists, and hospitals in or out of the network. You do not need a referral. Prior authorization* Benefit categories that include services that require prior authorization are marked with an asterisk (*). Additional information can be found on the last page of the medical benefits chart. Annual deductible  The deductible applies to covered services as noted within each category below, prior to the copay or coinsurance, if any, being applied. $0 Combined in-network and out-of-network Inpatient services Inpatient hospital care* Includes inpatient acute, inpatient rehabilitation, long-term care hospitals, and other types of inpatient hospital services. Inpatient hospital care starts the day you are formally admitted to the hospital with a doctor’s order. The day before you are discharged is your last inpatient day. Covered services include but are not limited to:  Semi-private room (or a private room if medically necessary)  Meals, including special diets  Regular nursing services  Costs of special care units (such as intensive or coronary care units)  Drugs and medications  Lab tests  X-rays and other radiology services For Medicare- covered hospital stays: $0 copay per admission No limit to the number of days covered by the plan. $0 copay for Medicare-covered physician services received while an inpatient during a Medicare-covered hospital stay For Medicare- covered hospital stays: $0 copay per admission No limit to the number of days covered by the plan. $0 copay for Medicare-covered physician services received while an inpatient during a Medicare-covered hospital stay Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Inpatient hospital care (con’t)  Necessary surgical and medical supplies  Use of appliances, such as wheelchairs  Operating and recovery room costs  Physical therapy, occupational therapy, and speech language therapy  Inpatient substance abuse services  Inpatient dialysis treatments (if you are admitted as an inpatient to a hospital for special care)  Under certain conditions, the following types of transplants are covered: corneal, kidney, kidney- pancreatic, heart, liver, lung, heart/lung, bone marrow, stem cell, and intestinal/multivisceral. If you need a transplant, we will arrange to have your case reviewed by a Medicare-approved transplant center that will decide whether you are a candidate for a transplant. Transplant providers may be local or outside of the service area. If our in-network transplant services are outside the community pattern of care, you may choose to go locally as long as the local transplant providers are willing to accept the Original Medicare rate. If the plan provides transplant services at a location outside the pattern of care for transplants in your community and you choose to obtain transplants at this distant location, we will arrange or pay for appropriate lodging and transportation costs for you and a companion. The reimbursement for transportation costs are while you and your companion are traveling to and from the medical providers for services related to the transplant care. The plan defines the distant location as a location that is outside of the member’s service area AND a minimum of 75 miles from the member’s home. Transportation and lodging costs will be reimbursed for travel mileage and lodging consistent with current IRS travel mileage and lodging guidelines. Accommodations for lodging will be reimbursed at the lesser of: 1) billed charges, or 2) $50 per day per covered person up to a maximum of $100 per day per covered person consistent with IRS guidelines. If you receive authorized inpatient care at an out-of-network hospital after your emergency condition is stabilized, your cost is the cost- sharing you would pay at an in- network hospital. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Inpatient hospital care (con’t)  Blood – including storage and administration. Coverage of whole blood, packed red cells, and all other components of blood begins with the first pint.  Physician services In-network providers should notify us within one business day of any planned, and if possible, unplanned admissions or transfers, including to or from a hospital, skilled nursing facility, long term acute care hospital, or acute rehabilitation center. Note: To be an inpatient, your provider must write an order to admit you formally as an inpatient of the hospital. Even if you stay in the hospital overnight, you might still be considered an “outpatient.” If you are not sure if you are an inpatient, you should ask the hospital staff. You can also find more information in a Medicare fact sheet called “Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask!” This fact sheet is available on the Web at www.medicare.gov/sites/default/files/2018-09/11435-Are- You-an-Inpatient-or-Outpatient.pdf or by calling 1-800- MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. You can call these numbers for free, 24 hours a day, 7 days a week. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Inpatient mental health care* Covered services include mental health care services that require a hospital stay in a psychiatric hospital or the psychiatric unit of a general hospital. In-network providers should notify us within one business day of any planned, and if possible unplanned admissions or transfers, including to or from a hospital, skilled nursing facility, long term acute care hospital, or acute rehabilitation center. For Medicare- covered hospital stays: $0 copay per admission No limit to the number of days covered by the plan. $0 copay for Medicare-covered physician services received while an inpatient during a Medicare-covered hospital stay For Medicare- covered hospital stays: $0 copay per admission No limit to the number of days covered by the plan. $0 copay for Medicare-covered physician services received while an inpatient during a Medicare-covered hospital stay Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Skilled nursing facility (SNF) care* Inpatient skilled nursing facility (SNF) coverage is limited to 100 days each benefit period. A “benefit period” begins on the first day you go to a Medicare-covered inpatient hospital or a SNF. The benefit period ends when you have not been an inpatient at any hospital or SNF for 60 days in a row. Covered services include but are not limited to:  Semi-private room (or a private room if medically necessary)  Meals, including special diets  Skilled nursing services  Physical therapy, occupational therapy, and speech language therapy  Drugs administered to you as part of your plan of care (this includes substances that are naturally present in the body, such as blood clotting factors)  Blood – including storage and administration. Coverage of whole blood, packed red cells, and all other components of blood begins with the first pint.  Medical and surgical supplies ordinarily provided by SNFs  Laboratory tests ordinarily provided by SNFs  X-rays and other radiology services ordinarily provided by SNFs  Use of appliances such as wheelchairs ordinarily provided by SNFs  Physician/Practitioner services Generally, you will receive your SNF care from plan facilities. However, under certain conditions listed below, you may be able to pay in-network cost-sharing for a facility that isn’t a plan provider, if the facility accepts our plan’s amounts for payment.  A nursing home or continuing care retirement community where you were living right before you went to the hospital (as long as it provides skilled nursing facility care) For Medicare- covered SNF stays: $0 copay for days 1-100 per benefit period No prior hospital stay required. For Medicare- covered SNF stays: $0 copay for days 1-100 per benefit period No prior hospital stay required. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Skilled nursing facility (SNF) care (con’t)  A SNF where your spouse is living at the time you leave the hospital In-network providers should notify us within one business day of any planned, and if possible unplanned admissions or transfers, including to or from a hospital, skilled nursing facility, long term acute care hospital, or acute rehabilitation center. Inpatient services covered when the hospital or SNF days are not covered or are no longer covered* If you have exhausted your inpatient benefits or if the inpatient stay is not reasonable and necessary, we will not cover your inpatient stay. However, in some cases, we will cover certain services you receive while you are in the hospital or a skilled nursing facility (SNF). Covered services include, but are not limited to:  Physician services  Diagnostic tests (like lab tests)  X-ray, radium, and isotope therapy including technician materials and services  Surgical dressings  Splints, casts, and other devices used to reduce fractures and dislocations  Prosthetic and orthotic devices (other than dental) that replace all or part of an internal body organ (including contiguous tissue), or all or part of the function of a permanently inoperative or malfunctioning internal body organ, including replacement or repairs of such devices  Leg, arm, back and neck braces, trusses and artificial legs, arms, and eyes including adjustments, repairs and replacements required because of breakage, wear, loss, or a change in the patient's physical condition  Physical therapy, occupational therapy, and speech language therapy After your SNF day limits are used up, this plan will still pay for covered physician services and other medical services outlined in this benefits chart at the cost share amounts indicated. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Home health agency care* Prior to receiving home health services, a doctor must certify that you need home health services and will order home health services to be provided by a home health agency. You must be homebound, which means leaving home is a major effort. Covered services include, but are not limited to:  Part-time or intermittent skilled nursing and home health aide services (to be covered under the home health care benefit, your skilled nursing and home health aide services combined must total fewer than 8 hours per day and 35 hours per week)  Physical therapy, occupational therapy, and speech language therapy  Medical and social services  Medical equipment and supplies $0 copay for Medicare-covered home health visits Durable Medical Equipment (DME) copay or coinsurance, if any, may apply. $0 copay for Medicare-covered home health visits Durable Medical Equipment (DME) copay or coinsurance, if any, may apply. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Hospice care You may receive care from any Medicare-certified hospice program. You are eligible for the hospice benefit when your doctor and the hospice medical director have given you a terminal prognosis certifying that you’re terminally ill and have six months or less to live if your illness runs its normal course. Your hospice doctor can be an in-network provider or an out-of-network provider. For hospice services and for services that are covered by Medicare Part A or B and are related to your terminal prognosis: Original Medicare (rather than this plan) will pay for your hospice services and any Part A and Part B services related to your terminal prognosis. While you are in the hospice program, your hospice provider will bill Medicare for the services that Original Medicare pays for. Services covered by Original Medicare include:  Drugs for symptom control and pain relief  Short-term respite care  Home care Our plan covers hospice consultation services (one time only) for a terminally ill person who hasn’t elected the hospice benefit. For services that are covered by Medicare Part A or B and are not related to your terminal prognosis: If you need nonemergency, nonurgently needed services that are covered under Medicare Part A or B and that are not related to your terminal prognosis, your cost for these services depends on whether you use a provider in our plan’s network:  If you obtain the covered services from an in-network provider, you only pay the plan cost-sharing amount for in-network services.  If you obtain the covered services from an out-of- network provider, you pay the plan cost-sharing for out-of-network services. You must receive care from a Medicare-certified hospice. When you enroll in a Medicare- certified hospice program, your hospice services and your Part A and B services are paid for by Original Medicare, not this plan. $20 copay for the one time only hospice consultation You must receive care from a Medicare-certified hospice. When you enroll in a Medicare- certified hospice program, your hospice services and your Part A and B services are paid for by Original Medicare, not this plan. $20 copay for the one time only hospice consultation Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Hospice care (con’t) For services that are covered by this plan but are not covered by Medicare Part A or B: This plan will continue to cover plan- covered services that are not covered under Part A or B whether or not they are related to your terminal prognosis. You pay your plan cost-sharing amount for these services. If you have Part D prescription drug coverage, some drugs may be covered under your Part D benefit. Drugs are never covered by both hospice and your Part D plan at the same time. Note: If you need non-hospice care (care that is not related to your terminal prognosis), you should contact us to arrange the services. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Outpatient services Physician services, including doctor’s office visits* Covered services include:  Office visits, including medical and surgical services in a physician’s office  Consultation, diagnosis, and treatment by a specialist  Retail health clinics  Basic diagnostic hearing and balance exams, if your doctor orders it to see if you need medical treatment, when furnished by a physician, audiologist, or other qualified provider  Telehealth services for some physician or mental health services can be found in the section of this benefit chart titled, Video doctor visits. You have the option of getting these services through an in-person visit or by telehealth. If you choose to receive one of these services by telehealth, you must use a network provider who has an agreement with us to provide telehealth services.  Certain telehealth services including consultation, diagnosis, and treatment by a physician or practitioner for patients in certain rural areas or other locations approved by Medicare  Telehealth services for monthly end-stage renal disease- related visits for home dialysis members in a hospital- based or critical access hospital-based renal dialysis center, renal dialysis facility, or the member’s home  Telehealth services to diagnose, evaluate, or treat symptoms of a stroke  Virtual check-ins (for example, by phone or video chat) with your doctor for 5-10 minutes if: o You’re not a new patient and o The check-in isn’t related to an office visit in the past 7 days and o The check-in doesn’t lead to an office visit within 24 hours or the soonest available appointment $10 copay per visit to an in-network Primary Care Physician (PCP) for Medicare-covered services $20 copay per visit to an in-network specialist for Medicare-covered services $10 copay per visit to an in-network retail health clinic for Medicare- covered services $0 copay for Medicare-covered allergy testing $0 copay for Medicare-covered allergy injections See antigen cost share in Part B drug section. $10 copay per visit to an out-of- network Primary Care Physician (PCP) for Medicare- covered services $20 copay per visit to an out-of- network specialist for Medicare- covered services $10 copay per visit to an out-of- network retail health clinic for Medicare-covered services $0 copay for Medicare-covered allergy testing $0 copay for Medicare-covered allergy injections See antigen cost share in Part B drug section. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Physician services, including doctor’s office visits (con’t)  Evaluation of video and/or images you send to your doctor, and interpretation and follow-up by your doctor within 24 hours if: o You’re not a new patient and o The evaluation isn’t related to an office visit in the past 7 days and o The evaluation doesn’t lead to an office visit within 24 hours or the soonest available appointment  Consultation your doctor has with other doctors by phone, internet, or electronic health record if you’re not a new patient  Second opinion by another in-network provider prior to surgery  Physician services rendered in the home  Outpatient hospital services  Non–routine dental care (covered services are limited to surgery of the jaw or related structures, setting fractures of the jaw or facial bones, extraction of teeth to prepare the jaw for radiation treatments of neoplastic cancer disease, or services that would be covered when provided by a physician)  Allergy testing and allergy injections Chiropractic services  We cover only manual manipulation of the spine to correct subluxation. $20 copay for each Medicare-covered visit $20 copay for each Medicare-covered visit Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Acupuncture for chronic low back pain* Covered services include: Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstances: For the purpose of this benefit, chronic low back pain is defined as:  Lasting 12 weeks or longer;  Nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease);  Not associated with surgery; and  Not associated with pregnancy. An additional eight sessions will be covered for those patients demonstrating an improvement. No more than 20 acupuncture treatments may be administered annually. Treatment must be discontinued if the patient is not improving or is regressing. $10 copay for each Medicare-covered visit $10 copay for each Medicare-covered visit Podiatry services* Covered services include:  Diagnosis and the medical or surgical treatment of injuries and disease of the feet (such as hammer toe or heel spurs) in an office setting  Medicare-covered routine foot care for members with certain medical conditions affecting the lower limbs  A foot exam covered every six months for people with diabetic peripheral neuropathy and loss of protective sensations $20 copay for each Medicare-covered visit $20 copay for each Medicare-covered visit Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Outpatient mental health care, including partial hospitalization services* Covered services include:  Mental health services provided by a state-licensed psychiatrist or doctor, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, physician assistant, or other Medicare- qualified mental health care professional as allowed under applicable state laws “Partial hospitalization” is a structured program of active psychiatric treatment provided as a hospital outpatient service that is more intense than the care received in your doctor’s or therapist’s office and is an alternative to inpatient hospitalization. $20 copay for each Medicare-covered professional individual therapy visit $20 copay for each Medicare-covered professional group therapy visit $20 copay for each Medicare-covered professional partial hospitalization visit $0 copay for each Medicare-covered outpatient hospital facility individual therapy visit $0 copay for each Medicare-covered outpatient hospital facility group therapy visit $0 copay for each Medicare-covered partial hospitalization facility visit $20 copay for each Medicare-covered professional individual therapy visit $20 copay for each Medicare-covered professional group therapy visit $20 copay for each Medicare-covered professional partial hospitalization visit $0 copay for each Medicare-covered outpatient hospital facility individual therapy visit $0 copay for each Medicare-covered outpatient hospital facility group therapy visit $0 copay for each Medicare-covered partial hospitalization facility visit Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Outpatient substance abuse services, including partial hospitalization services* “Partial hospitalization” is a structured program of active psychiatric treatment provided as a hospital outpatient service that is more intense than the care received in your doctor’s or therapist’s office and is an alternative to inpatient hospitalization. $20 copay for each Medicare-covered professional individual therapy visit $20 copay for each Medicare-covered professional group therapy visit $20 copay for each Medicare-covered professional partial hospitalization visit $0 copay for each Medicare-covered outpatient hospital facility individual therapy visit $0 copay for each Medicare-covered outpatient hospital facility group therapy visit $0 copay for each Medicare-covered partial hospitalization facility visit $20 copay for each Medicare-covered professional individual therapy visit $20 copay for each Medicare-covered professional group therapy visit $20 copay for each Medicare-covered professional partial hospitalization visit $0 copay for each Medicare-covered outpatient hospital facility individual therapy visit $0 copay for each Medicare-covered outpatient hospital facility group therapy visit $0 copay for each Medicare-covered partial hospitalization facility visit Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Outpatient surgery, including services provided at hospital outpatient facilities and ambulatory surgical centers* Facilities where surgical procedures are performed and the patient is released the same day. Note: If you are having surgery in a hospital, you should check with your provider about whether you will be an inpatient or outpatient. Unless the provider writes an order to admit you as an inpatient to the hospital, you are an outpatient and pay the cost-sharing amounts for outpatient surgery. Even if you stay in the hospital overnight, you might still be considered an “outpatient.” You can also find more information in a Medicare fact sheet called “Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask!” This fact sheet is available on the Web at www.medicare.gov/sites/default/files/2018-09/11435-Are- You-an-Inpatient-or-Outpatient.pdf or by calling 1-800- MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. You can call these numbers for free, 24 hours a day, 7 days a week. $0 copay for each Medicare-covered outpatient hospital facility or ambulatory surgical center visit for surgery $0 copay for each Medicare-covered outpatient observation room visit $0 copay for each Medicare-covered outpatient hospital facility or ambulatory surgical center visit for surgery $0 copay for each Medicare-covered outpatient observation room visit Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Outpatient hospital observation, non-surgical* Observation services are hospital outpatient services given to determine if you need to be admitted as an inpatient or can be discharged. For outpatient hospital observation services to be covered, they must meet the Medicare criteria and be considered reasonable and necessary. Observation services are covered only when provided by the order of a physician or another individual authorized by state licensure law and hospital staff bylaws to admit patients to the hospital or order outpatient tests. Note: Unless the provider has written an order to admit you as an inpatient to the hospital, you are an outpatient and pay the cost-sharing amounts for outpatient hospital services. Even if you stay in the hospital overnight, you might still be considered an “outpatient.” If you are not sure if you are an outpatient, you should ask the hospital staff. You can also find more information in a Medicare fact sheet called “Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask!” This fact sheet is available on the Web at www.medicare.gov/sites/default/files/2018-09/11435-Are- You-an-Inpatient-or-Outpatient.pdf or by calling 1-800- MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. You can call these numbers for free, 24 hours a day, 7 days a week. $10 copay for a visit to an in- network primary care physician in an outpatient hospital setting/clinic for Medicare-covered non-surgical services $20 copay for a visit to an in- network specialist in an outpatient hospital setting/clinic for Medicare-covered non-surgical services $0 copay for each Medicare-covered outpatient observation room visit $10 copay for a visit to an out-of- network primary care physician in an outpatient hospital setting/clinic for Medicare-covered non-surgical services $20 copay for a visit to an out-of- network specialist in an outpatient hospital setting/clinic for Medicare-covered non-surgical services $0 copay for each Medicare-covered outpatient observation room visit Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Ambulance services  Covered ambulance services include fixed wing, rotary wing, water, and ground ambulance services, to the nearest appropriate facility that can provide care only if the services are furnished to a member whose medical condition is such that other means of transportation could endanger the person’s health or if authorized by the plan.  Nonemergency transportation by ambulance is appropriate if it is documented that the member’s condition is such that other means of transportation could endanger the person’s health and that transportation by ambulance is medically required.  Ambulance service is not covered for physician office visits. Your provider must get an approval from the plan before you get ground, air, or water transportation that is not an emergency. $50 copay per one-way trip for Medicare- covered ambulance services Emergency care Emergency care refers to services that are:  Furnished by a provider qualified to furnish emergency services, and  Needed to evaluate or stabilize an emergency medical condition. Emergency outpatient copay is waived if the member is admitted to the hospital within 72 hours for the same condition. A medical emergency is when you, or any other prudent layperson with an average knowledge of health and medicine, believe that you have medical symptoms that require immediate medical attention to prevent loss of life, loss of a limb, or loss of function of a limb. The medical symptoms may be an illness, injury, severe pain, or a medical condition that is quickly getting worse. This coverage is worldwide and is limited to what is allowed under the Medicare fee schedule for the services performed/received in the United States. Cost-sharing for necessary emergency services furnished out- of-network is the same as for such services furnished in- network. If you receive authorized inpatient care at an out-of-network hospital after your emergency condition is stabilized, your cost is the cost-sharing you would pay at an in-network hospital. $75 copay for each Medicare-covered emergency room visit Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Urgently needed services  Urgently needed services are available on a worldwide basis. The urgently needed services copay is waived if the member is admitted to the hospital within 72 hours for the same condition. If you are outside of the service area for your plan, your plan covers urgently needed services, including urgently required renal dialysis. Urgently needed services are services provided to treat a nonemergency, unforeseen medical illness, injury, or condition that requires immediate medical care. Urgently needed services may be furnished by in-network providers or by out-of-network providers when in-network providers are temporarily unavailable or inaccessible. Cost-sharing for necessary urgently needed services furnished out-of-network is the same as for such services furnished in-network. Generally, however, if you are in the plan’s service area and your health is not in serious danger, you should obtain care from an in- network provider. $20 copay for each Medicare-covered urgently needed care visit Outpatient rehabilitation services* Covered services include: physical therapy, occupational therapy, and speech language therapy. Outpatient rehabilitation services are provided in various outpatient settings, such as hospital outpatient departments, independent therapist offices, and Comprehensive Outpatient Rehabilitation Facilities (CORFs). $20 copay for Medicare-covered physical therapy, occupational therapy, and speech language therapy visits $20 copay for Medicare-covered physical therapy, occupational therapy, and speech language therapy visits Cardiac rehabilitation services Comprehensive programs of cardiac rehabilitation services that include exercise, education, and counseling are covered for members who meet certain conditions with a doctor’s order. The plan also covers intensive cardiac rehabilitation programs that are typically more rigorous or more intense than cardiac rehabilitation programs. $20 copay for Medicare-covered cardiac rehabilitation therapy visits $20 copay for Medicare-covered cardiac rehabilitation therapy visits Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Pulmonary rehabilitation services* Comprehensive programs of pulmonary rehabilitation are covered for members who have moderate to very severe chronic obstructive pulmonary disease (COPD) and a referral for pulmonary rehabilitation from the doctor treating their chronic respiratory disease. $20 copay for Medicare-covered pulmonary rehabilitation therapy visits $20 copay for Medicare-covered pulmonary rehabilitation therapy visits Supervised exercise therapy (SET)* SET is covered for members who have symptomatic peripheral artery disease (PAD) and a referral for PAD from the physician responsible for PAD treatment. Up to 36 sessions over a 12-week period are covered if the SET program requirements are met. The SET program must:  Consist of sessions lasting 30-60 minutes, comprising a therapeutic exercise-training program for PAD in patients with claudication  Be conducted in a hospital outpatient setting or a physician’s office  Be delivered by qualified auxiliary personnel necessary to ensure benefits exceed harms, and who are trained in exercise therapy for PAD  Be under the direct supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist who must be trained in both basic and advanced life support techniques SET may be covered beyond 36 sessions over 12 weeks for an additional 36 sessions over an extended period of time if deemed medically necessary by a health care provider. $20 copay for Medicare-covered supervised exercise therapy visits $20 copay for Medicare-covered supervised exercise therapy visits Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Durable medical equipment (DME) and related supplies* Covered items include, but are not limited to: wheelchairs, crutches, powered mattress systems, diabetic supplies, continuous blood glucose monitors, hospital bed ordered by a provider for use at home, IV infusion pumps, speech generating devices, oxygen equipment, nebulizers, and walkers. Copay or coinsurance only applies when you are not currently receiving inpatient care. If you are receiving inpatient care your DME will be included in the copay or coinsurance for those services. We cover all medically necessary durable medical equipment covered by Original Medicare. If our supplier in your area does not carry a particular brand or manufacturer, you may ask them if they can special order it for you. Therapeutic Continuous Glucose Monitors (CGMs) and related supplies are covered by Medicare when they meet Medicare National Coverage Determination (NCD) and Local Coverage Determinations (LCD) criteria. In addition, where there is not NCD/ LCD criteria, therapeutic CGM must meet any plan benefit limits, and the plan’s evidence based clinical practice guidelines. Coverage is limited to 2 sensors per month and one receiver every 2 years. This plan covers only DUROLANE, EUFLEXXA, SUPARTZ, and Gel- SYN-3 Hyaluronic Acids (HA). For new prescriptions, we will not cover other brands unless your provider tells us it is medically necessary. The review of medical necessity for use of HA and any non-preferred brands is part of the plan’s prior authorization process. 5% coinsurance for Medicare-covered DME See the Diabetes self-management training, diabetic services, and supplies benefit section for diabetic supply cost sharing. 5% coinsurance for Medicare-covered DME See the Diabetes self-management training, diabetic services, and supplies benefit section for diabetic supply cost sharing. Prosthetic devices and related supplies* Devices (other than dental) that replace all or a body part or function. These include, but are not limited to, colostomy bags and supplies directly related to colostomy care, pacemakers, braces, prosthetic shoes, artificial limbs, and breast prostheses (including a surgical brassiere after a mastectomy). Includes certain supplies related to prosthetic devices and repair and/or replacement of prosthetic devices. Also includes some coverage following cataract removal or cataract surgery. See “Vision care” later in this section for more detail. 5% coinsurance for Medicare-covered prosthetics and orthotics 5% coinsurance for Medicare-covered prosthetics and orthotics Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Home infusion therapy* Home infusion therapy involves the intravenous or subcutaneous administration of drugs or biologicals to an individual at home. The components needed to perform home infusion include the drug (for example, antivirals, immune globulin), equipment (for example, a pump), and supplies (for example, tubing and catheters). Covered services include but are not limited to:  Professional services, including nursing services, furnished in accordance with the plan of care  Patient training and education not otherwise covered under the durable medical equipment benefits  Remote monitoring  Monitoring services for the provision of home infusion therapy and home infusion drugs furnished by a qualified home infusion therapy supplier  Durable medical equipment – pharmacy services, delivery, equipment set up, maintenance of rented equipment, and training and education on the use of the covered items $0 copay for Medicare-covered professional services provided by a Medicare- certified home health agency or home infusion supplier 5% coinsurance for Medicare-covered durable medical equipment – includes the external infusion pump, the related supplies, and the infusion drug(s) $0 copay for Medicare-covered professional services provided by a Medicare- certified home health agency or home infusion supplier 5% coinsurance for Medicare-covered durable medical equipment – includes the external infusion pump, the related supplies, and the infusion drug(s) Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Diabetes self-management training, diabetic services, and supplies* For all people who have diabetes (insulin and non-insulin users) Covered services include:  Supplies to monitor your blood glucose: Blood glucose monitor, blood glucose test strips, lancet devices and lancets, and glucose control solutions for checking the accuracy of test strips and monitors  Blood glucose monitors are limited to one every year  Up to 200 blood glucose test strips and lancets for a 30- day supply  One pair per year of therapeutic custom molded shoes (including inserts provided with such shoes) and two additional pairs of inserts or one pair of depth shoes and three pairs of inserts (not including the non-customized removable inserts provided with such shoes) for people with diabetes who have severe diabetic foot disease, including fitting of shoes or inserts  Diabetes self-management training is covered under certain conditions 5% coinsurance for a 30-day supply on each Medicare- covered purchase of blood glucose test strips, lancets, lancet devices, and glucose control solutions for checking the accuracy of test strips and monitors 5% coinsurance for Medicare-covered blood glucose monitor 5% coinsurance for Medicare-covered therapeutic shoes and inserts $0 copay for Medicare-covered diabetes self- management training 5% coinsurance for a 30-day supply on each Medicare- covered purchase of blood glucose test strips, lancets, lancet devices, and glucose control solutions for checking the accuracy of test strips and monitors 5% coinsurance for Medicare-covered blood glucose monitor 5% coinsurance for Medicare-covered therapeutic shoes and inserts $0 copay for Medicare-covered diabetes self- management training Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Outpatient diagnostic tests and therapeutic services and supplies* Covered services include, but are not limited to:  X-rays  Complex diagnostic tests and radiology services  Radiation (radium and isotope) therapy, including technician materials and supplies  Testing to confirm chronic obstructive pulmonary disease (COPD)  Surgical supplies, such as dressings  Splints, casts, and other devices used to reduce fractures and dislocations  Laboratory tests  Blood – including storage and administration. Coverage of whole blood, packed red cells, and all other components of blood begins with the first pint  Other outpatient diagnostic tests Certain diagnostic tests and radiology services are considered complex and include heart catheterizations, sleep studies, computed tomography (CT), magnetic resonance procedures (MRIs and MRAs), and nuclear medicine studies, which includes PET scans. $20 copay for each Medicare-covered X-ray visit and/or simple diagnostic test $50 copay for Medicare-covered complex diagnostic test and/or radiology visit $20 copay for each Medicare-covered radiation therapy treatment $0 copay for Medicare-covered testing to confirm chronic obstructive pulmonary disease 5% coinsurance for Medicare-covered supplies $0 copay for each Medicare-covered clinical/diagnostic lab test $0 copay per Medicare-covered pint of blood $20 copay for each Medicare-covered X-ray visit and/or simple diagnostic test $50 copay for Medicare-covered complex diagnostic test and/or radiology visit $20 copay for each Medicare-covered radiation therapy treatment $0 copay for Medicare-covered testing to confirm chronic obstructive pulmonary disease 5% coinsurance for Medicare-covered supplies $0 copay for each Medicare-covered clinical/diagnostic lab test $0 copay per Medicare-covered pint of blood Opioid treatment program services* Opioid use disorder treatment services are covered under Part B of Original Medicare. Members of our plan receive coverage for these services through our plan. Covered services include:  FDA-approved opioid agonist and antagonist treatment medications and the dispensing and administration of such medications, if applicable  Substance use counseling  Individual and group therapy  Toxicology testing $20 copay per visit for Medicare- covered opioid treatment program services $20 copay per visit for Medicare- covered opioid treatment program services Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Vision care (non-routine) Covered services include:  Outpatient physician services for the diagnosis and treatment of diseases and injuries of the eye, including treatment for age-related macular degeneration.  For people who are at high risk of glaucoma, we will cover one glaucoma screening each year. People at high risk of glaucoma include: people with a family history of glaucoma, people with diabetes, African-Americans who are age 50 and older, and Hispanic-Americans who are age 65 or older.  For people with diabetes, screening for diabetic retinopathy is covered once per year.  One pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens. (If you have two separate cataract operations, you cannot reserve the benefit after the first surgery and purchase two eyeglasses after the second surgery.) $10 copay for visits to an in-network primary care physician for Medicare-covered exams to diagnose and treat diseases of the eye $20 copay for visits to an in-network specialist for Medicare-covered exams to diagnose and treat diseases of the eye $0 copay for Medicare-covered glaucoma screening $0 copay for Medicare-covered diabetic retinopathy screening $20 copay for glasses/contacts following Medicare- covered cataract surgery $10 copay for visits to an out-of- network primary care physician for Medicare-covered exams to diagnose and treat diseases of the eye $20 copay for visits to an out-of- network specialist for Medicare- covered exams to diagnose and treat diseases of the eye $0 copay for Medicare-covered glaucoma screening $0 copay for Medicare-covered diabetic retinopathy screening $20 copay for glasses/contacts following Medicare-covered cataract surgery Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Preventive services care and screening tests You will see this apple next to preventive services throughout this chart. For all preventive services that are covered at no cost under Original Medicare, we also cover the service at no cost to you in-network. However, if you are treated or monitored for an existing medical condition or an additional non-preventive service, during the visit when you receive the preventive service, a copay or coinsurance may apply for that care received. In addition, if an office visit is billed for the existing medical condition care or an additional non-preventive service received, the applicable in-network primary care physician or in-network specialist copay or coinsurance will apply. Abdominal aortic aneurysm screening A one-time screening ultrasound for people at risk. The plan only covers this screening if you have certain risk factors and if you get a referral for it from your physician, physician assistant, nurse practitioner, or clinical nurse specialist. There is no coinsurance, copayment, or deductible for members eligible for this Medicare- covered preventive screening. There is no coinsurance, copayment, or deductible for members eligible for this Medicare- covered preventive screening. Bone mass measurement For qualified individuals (generally, this means people at risk of losing bone mass or at risk of osteoporosis), the following services are covered every 24 months, or more frequently if medically necessary: procedures to identify bone mass, detect bone loss, or determine bone quality, including a physician's interpretation of the results. There is no coinsurance, copayment, or deductible for the Medicare-covered bone mass measurement. There is no coinsurance, copayment, or deductible for the Medicare-covered bone mass measurement. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Colorectal cancer screening and colorectal services For people 50 and older, the following are covered:  Flexible sigmoidoscopy (or screening barium enema as an alternative) every 48 months One of the following every 12 months:  Guaiac-based fecal occult blood test (gFOBT)  Fecal immunochemical test (FIT) DNA based colorectal screening every 3 years For people at high risk of colorectal cancer, we cover:  Screening colonoscopy (or screening barium enema as an alternative) every 24 months For people not at high risk of colorectal cancer, we cover:  Screening colonoscopy every 10 years, but not within 48 months of a screening sigmoidoscopy Colorectal services:  Include the biopsy and removal of any growth during the procedure, in the event the procedure goes beyond a screening exam There is no coinsurance, copayment, or deductible for the Medicare-covered colorectal cancer screening exam and services. There is no coinsurance, copayment, or deductible for the Medicare-covered colorectal cancer screening exam and services. HIV screening For people who ask for an HIV screening test or who are at increased risk for HIV infection, we cover:  One screening exam every 12 months For women who are pregnant, we cover:  Up to three screening exams during a pregnancy There is no coinsurance, copayment, or deductible for members eligible for the Medicare- covered preventive HIV screening. There is no coinsurance, copayment, or deductible for members eligible for the Medicare- covered preventive HIV screening. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Screening for sexually transmitted infections (STIs) and counseling to prevent STIs We cover sexually transmitted infection (STI) screenings for chlamydia, gonorrhea, syphilis, and Hepatitis B. These screenings are covered for pregnant women and for certain people who are at increased risk for an STI when the tests are ordered by a primary care provider. We cover these tests once every 12 months or at certain times during pregnancy. We also cover up to 2 individual 20 to 30 minute, face-to-face high-intensity behavioral counseling sessions each year for sexually active adults at increased risk for STIs. We will only cover these counseling sessions as a preventive service if they are provided by a primary care provider and take place in a primary care setting, such as a doctor’s office. There is no coinsurance, copayment, or deductible for the Medicare-covered screening for STIs and counseling for STIs preventive benefit. There is no coinsurance, copayment, or deductible for the Medicare-covered screening for STIs and counseling for STIs preventive benefit. Medicare Part B immunizations Covered services include:  Pneumonia vaccine  Flu shots, including H1N1, once each flu season in the fall and winter, with additional flu shots if medically necessary  Hepatitis B vaccine if you are at high or intermediate risk of getting Hepatitis B  Other vaccines if you are at risk and they meet Medicare Part B coverage rules If you have Part D prescription drug coverage, some vaccines are covered under your Part D benefit (for example, the shingles vaccine). Please refer to your Part D prescription drug benefits. There is no coinsurance, copayment, or deductible for the pneumonia, influenza, Hepatitis B, or other Medicare-covered vaccines when you are at risk and they meet Medicare Part B rules. There is no coinsurance, copayment, or deductible for the pneumonia, influenza, Hepatitis B, or other Medicare-covered vaccines when you are at risk and they meet Medicare Part B rules. Breast cancer screening (mammograms) Covered services include:  One baseline mammogram between the ages of 35 and 39  One screening mammogram every 12 months for women age 40 and older  Clinical breast exams once every 24 months There is no coinsurance, copayment, or deductible for Medicare-covered screening mammograms. There is no coinsurance, copayment, or deductible for Medicare-covered screening mammograms. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Cervical and vaginal cancer screening Covered services include:  For all women, Pap tests and pelvic exams are covered once every 24 months.  If you are at high risk of cervical or vaginal cancer or you are of childbearing age and have had an abnormal Pap test within the past 3 years: 1 Pap test every 12 months. There is no coinsurance, copayment, or deductible for Medicare-covered preventive Pap and pelvic exams. There is no coinsurance, copayment, or deductible for Medicare-covered preventive Pap and pelvic exams. Prostate cancer screening exams For men age 50 and older, the following are covered once every 12 months:  Digital rectal exam  Prostate Specific Antigen (PSA) test There is no coinsurance, copayment, or deductible for a Medicare-covered annual PSA test. There is no coinsurance, copayment, or deductible for a Medicare-covered annual PSA test. Cardiovascular disease risk reduction visit (therapy for cardiovascular disease) We cover one visit per year with your primary care doctor to help lower your risk for cardiovascular disease. During this visit, your doctor may discuss aspirin use (if appropriate), check your blood pressure, and give you tips to make sure you’re eating healthy. There is no coinsurance, copayment, or deductible for the Medicare-covered intensive behavioral therapy cardiovascular disease preventive benefit. There is no coinsurance, copayment, or deductible for the Medicare-covered intensive behavioral therapy cardiovascular disease preventive benefit. Cardiovascular disease testing Blood tests for the detection of cardiovascular disease (or abnormalities associated with an elevated risk of cardiovascular disease) once every 5 years (60 months). There is no coinsurance, copayment, or deductible for Medicare-covered cardiovascular disease testing that is covered once every five years. There is no coinsurance, copayment, or deductible for Medicare-covered cardiovascular disease testing that is covered once every five years. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network “Welcome to Medicare” preventive visit The plan covers a one-time “Welcome to Medicare” preventive visit. The visit includes a review of your health, measurements of height, weight, body mass index, blood pressure, as well as education and counseling about the preventive services you need (including certain screenings and shots), and referrals for other care if needed. Important: We cover the “Welcome to Medicare” preventive visit only within the first 12 months you have Medicare Part B. When you make your appointment, let your doctor’s office know you would like to schedule your “Welcome to Medicare” preventive visit. There is no coinsurance, copayment, or deductible for the Medicare-covered “Welcome to Medicare” preventive visit. There is no coinsurance, copayment, or deductible for the Medicare-covered “Welcome to Medicare” preventive visit. Annual wellness visit If you’ve had Medicare Part B for longer than 12 months, you can get an annual wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. This is covered once every 12 months. Note: Your first annual wellness visit can’t take place within 12 months of your “Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to be covered for annual wellness visits after you’ve had Part B for 12 months. There is no coinsurance, copayment, or deductible for the Medicare-covered annual wellness visit. There is no coinsurance, copayment, or deductible for the Medicare-covered annual wellness visit. Depression screening We cover one screening for depression per year. The screening must be done in a primary care setting that can provide follow- up treatment and/or referrals. There is no coinsurance, copayment, or deductible for a Medicare-covered annual depression screening visit. There is no coinsurance, copayment, or deductible for a Medicare-covered annual depression screening visit. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Diabetes screening We cover this screening (includes fasting glucose tests) if you have any of the following risk factors: high blood pressure (hypertension), history of abnormal cholesterol and triglyceride levels (dyslipidemia), obesity, or a history of high blood sugar (glucose). Tests may also be covered if you meet other requirements, like being overweight and having a family history of diabetes. Based on the results of these tests, you may be eligible for up to 2 diabetes screenings every 12 months. There is no coinsurance, copayment, or deductible for Medicare-covered diabetes screening tests. There is no coinsurance, copayment, or deductible for Medicare-covered diabetes screening tests. Medicare Diabetes Prevention Program (MDPP) MDPP services will be covered for eligible Medicare beneficiaries under all Medicare health plans. MDPP is a structured health behavior change intervention that provides practical training in long-term dietary change, increased physical activity, and problem-solving strategies for overcoming challenges to sustaining weight loss and a healthy lifestyle. There is no coinsurance, copayment, or deductible for the MDPP benefit. There is no coinsurance, copayment, or deductible for the MDPP benefit. Obesity screening and therapy to promote sustained weight loss If you have a body mass index of 30 or more, we cover intensive counseling to help you lose weight. This counseling is covered if you get it in a primary care setting, where it can be coordinated with your comprehensive prevention plan. Talk to your primary care doctor or practitioner to find out more. There is no coinsurance, copayment, or deductible for Medicare-covered preventive obesity screening and therapy. There is no coinsurance, copayment, or deductible for Medicare-covered preventive obesity screening and therapy. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Screening and counseling to reduce alcohol misuse We cover one alcohol misuse screening for adults with Medicare (including pregnant women) who misuse alcohol, but aren’t alcohol dependent. If you screen positive for alcohol misuse, you can get up to four brief face-to-face counseling sessions per year (if you’re competent and alert during counseling) provided by a qualified primary care doctor or practitioner in a primary care setting. There is no coinsurance, copayment, or deductible for the Medicare-covered screening and counseling to reduce alcohol misuse preventive benefit. There is no coinsurance, copayment, or deductible for the Medicare-covered screening and counseling to reduce alcohol misuse preventive benefit. Screening for lung cancer with low dose computed tomography (LDCT) For qualified individuals, a LDCT is covered every 12 months. Eligible enrollees are: people aged 55 – 77 years who have no signs or symptoms of lung cancer, but who have a history of tobacco smoking of at least 30 pack-years or who currently smoke or have quit smoking within the last 15 years, who receive a written order for LDCT during a lung cancer screening counseling and shared decision making visit that meets the Medicare criteria for such visits and be furnished by a physician or qualified non-physician practitioner. For LDCT lung cancer screenings after the initial LDCT screening: the enrollee must receive a written order for LDCT lung cancer screening, which may be furnished during any appropriate visit with a physician or qualified non-physician practitioner. If a physician or qualified non-physician practitioner elects to provide a lung cancer screening counseling and shared decision making visit for subsequent lung cancer screenings with LDCT, the visit must meet the Medicare criteria for such visits. There is no coinsurance, copayment, or deductible for the Medicare-covered counseling and shared decision making visit or for the LDCT. There is no coinsurance, copayment, or deductible for the Medicare-covered counseling and shared decision making visit or for the LDCT. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Medical nutrition therapy This benefit is for people with diabetes, renal (kidney) disease (but not on dialysis), or after a kidney transplant when referred by your doctor. We cover three hours of one-on-one counseling services during your first year that you receive medical nutrition therapy services under Medicare (this includes our plan, any other Medicare Advantage plan, or Original Medicare), and two hours each year after that. If your condition, treatment, or diagnosis changes, you may be able to receive more hours of treatment with a physician’s referral. A physician must prescribe these services and renew their referral yearly if your treatment is needed into another plan year. There is no coinsurance, copayment, or deductible for members eligible for Medicare- covered medical nutrition therapy services. There is no coinsurance, copayment, or deductible for members eligible for Medicare- covered medical nutrition therapy services. Smoking and tobacco use cessation (counseling to quit smoking) If you use tobacco, but do not have signs or symptoms of tobacco-related disease: We cover 2 counseling quit attempts within a 12 month period. Each counseling attempt includes up to 4 face-to-face visits. If you use tobacco and have been diagnosed with a tobacco- related disease or are taking medicine that may be affected by tobacco: We cover cessation counseling services. We cover 2 counseling quit attempts within a 12 month period. Each counseling attempt includes up to 4 face-to-face visits. These visits must be ordered by your doctor and provided by a qualified doctor or other Medicare-recognized practitioner. There is no coinsurance, copayment, or deductible for the Medicare-covered smoking and tobacco use cessation preventive benefits. There is no coinsurance, copayment, or deductible for the Medicare-covered smoking and tobacco use cessation preventive benefits. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Other services Services to treat outpatient kidney disease Covered services include:  Kidney disease education services to teach kidney care and help members make informed decisions about their care. For members with stage IV chronic kidney disease when referred by their doctor, we cover up to six sessions of kidney disease education services per lifetime.  Outpatient dialysis treatments (including dialysis treatments when temporarily out of the service area)  Home dialysis or certain home support services (such as, when necessary, visits by trained dialysis workers to check on your home dialysis, to help in emergencies, and check your dialysis equipment and water supply)  Self-dialysis training (includes training for you and anyone helping you with your home dialysis treatments)  Home and outpatient dialysis equipment and supplies Certain drugs for dialysis are covered under your Medicare Part B drug benefit. For information about coverage for Part B drugs, please go to the section below, “Medicare Part B prescription drugs.” You do not need to get an approval from the plan before getting dialysis. But please let us know when you need to start this care, so we can help coordinate with your doctors. $0 copay for each Medicare-covered kidney disease education session $10 copay for Medicare-covered outpatient dialysis $0 copay for Medicare-covered home dialysis or home support services $10 copay for Medicare-covered self-dialysis training 5% coinsurance for Medicare-covered home dialysis equipment and supplies 5% coinsurance for Medicare-covered outpatient dialysis equipment and supplies You do not need to get an approval from the plan before getting dialysis. But please let us know when you need to start this care, so we can help coordinate with your doctors. $0 copay for each Medicare-covered kidney disease education session $10 copay for Medicare-covered outpatient dialysis $0 copay for Medicare-covered home dialysis or home support services $10 copay for Medicare-covered self-dialysis training 5% coinsurance for Medicare-covered home dialysis equipment and supplies 5% coinsurance for Medicare-covered outpatient dialysis equipment and supplies Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Medicare Part B prescription drugs covered under your medical plan (Part B drugs)* These drugs are covered under Part B of Original Medicare. Members of our plan receive coverage for these drugs through our plan. Covered drugs include:  “Drugs” include substances that are naturally present in the body, such as blood clotting factors  Drugs that usually are not self-administered by the patient and are injected or infused while receiving physician, hospital outpatient, or ambulatory surgical center services  Drugs you take using durable medical equipment (such as nebulizers) that was authorized by the plan  Clotting factors you give yourself by injection if you have hemophilia  Immunosuppressive drugs, if you were enrolled in Medicare Part A at the time of the organ transplant  Injectable osteoporosis drugs, if you are homebound, have a bone fracture that a doctor certifies was related to post-menopausal osteoporosis and cannot self- administer the drug  Antigens  Certain oral anti-cancer drugs and anti-nausea drugs  Certain drugs for home and outpatient dialysis, including heparin, the antidote for heparin when medically necessary, topical anesthetics and erythropoiesis-stimulating agents such as Erythropoietin (Epogen), Procrit or Epoetin Alfa and Darboetin Alfa (Aranesp)  Intravenous Immune Globulin for the home treatment of primary immune deficiency diseases We also cover some vaccines under our Part B prescription drug benefit. $20 copay for Medicare-covered Part B drugs $20 copay for Medicare-covered Part B drug administration $20 copay for Medicare-covered Part B chemotherapy drugs $20 copay for Medicare-covered Part B chemotherapy drug administration $20 copay for Medicare-covered Part B drugs $20 copay for Medicare-covered Part B drug administration $20 copay for Medicare-covered Part B chemotherapy drugs $20 copay for Medicare-covered Part B chemotherapy drug administration Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Medicare Part B prescription drugs covered under your medical plan (Part B drugs) (con’t) Some of Part B covered drugs listed above may be subject to step therapy. You may log into your secure member portal to find the list of Part B drugs that may be subject to step therapy. This list is located with your Plan Documents under your Benefits section. If you have Part D prescription drug coverage, please refer to your Evidence of Coverage for information on your Part D prescription drug benefits. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Additional supplemental benefits, services, and discounts Routine hearing services  Routine hearing exams Routine hearing exams are limited to 1 every 12 months. Routine hearing exams are limited to a $70 maximum benefit every 12 months combined in-network and out-of-network.  Hearing aid fitting evaluations are limited to 1 per covered hearing aid  Hearing aids Hearing aids are limited to a $500 maximum benefit every 12 months combined in-network and out-of-network. Includes digital hearing aid technology and inner ear, outer ear, and over the ear models. Fitting adjustment after hearing aid is received, if necessary. The hearing aid benefit does not provide coverage for amplifiers, internet purchases, assistive listening devices (ALDs) or accessories. We have partnered with Hearing Care Solutions to bring you these discounts and services. For additional benefit information and to locate a Hearing Care Solutions participating provider, please contact Member Services. Hearing benefit management administered by Hearing Care Solutions, an independent company. Must use a Hearing Care Solutions participating provider. $0 copay for routine hearing exams $0 copay for hearing aid fitting evaluations $0 copay for hearing aids Members receive a free battery supply during the first 3 years with a 64-cell limit per year, per hearing aid. After the plan pays benefits for routine hearing exams, hearing aids, and hearing aid fitting evaluations, you are responsible for any remaining cost. $0 copay for routine hearing exams $0 copay for hearing aid fitting evaluations $0 copay for hearing aids Members receive a free battery supply during the first 3 years with a 64-cell limit per year, per hearing aid. After the plan pays benefits for routine hearing exams, hearing aids, and hearing aid fitting evaluations, you are responsible for any remaining cost. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Routine vision services  Routine vision exams Routine vision exams are limited to 1 every calendar year. The routine vision exam is limited to a $70 maximum benefit every calendar year combined in-network and out-of-network.  Eyewear Eyewear is limited to a $100 maximum benefit* every 2 calendar years combined in-network and out-of-network. Covered eyewear includes prescription glasses, lenses, frames and contacts. This is a primary vision care benefit intended to cover only routine eye examinations and corrective eyewear. Blue View Vision is for routine eye care only. If you need medical treatment for your eyes, visit a participating eye care doctor from your medical network. This information is intended to be a brief outline of coverage. For additional benefit information, including exclusions and limitations or to locate a participating Blue View Vision provider, please contact Member Services. You will be directed to the dedicated Blue View Vision Member Services line. If you choose to, you may instead receive covered benefits outside of the Blue View Vision network. Just pay in full at the time of service, obtain an itemized receipt, and file a claim for reimbursement up to your maximum out-of-network allowance. In-network benefits and discounts will not apply. * Any remaining unused eyewear benefit amount must be used in the same calendar year of the first eyewear purchase. Unused amounts cannot carry over to the following calendar year or benefit period. Must use a Blue View Vision provider. $0 copay for routine vision exams $0 copay for eyewear After the plan pays benefits for routine vision exams and eyewear you are responsible for any remaining cost. $0 copay for routine vision exams $0 copay for eyewear After the plan pays benefits for routine vision exams and eyewear you are responsible for any remaining cost. Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Routine foot care  Up to four covered visits per year combined in-network and out-of-network Routine foot care includes the cutting or removal of corns and calluses, the trimming, cutting, clipping or debriding of nails, and other hygienic and preventive maintenance care. $10 copay for each visit to an in- network primary care physician for routine foot care $20 copay for each visit to an in- network specialist for routine foot care After the plan pays benefits for routine foot care, you are responsible for any remaining cost. $10 copay for each visit to an out-of- network primary care physician for routine foot care $20 copay for each visit to an out-of- network specialist for routine foot care After the plan pays benefits for routine foot care, you are responsible for any remaining cost. Annual routine physical exam The annual routine physical exam benefit covers a standard physical exam in addition to the Medicare-covered "Welcome to Medicare" or “Annual Wellness Visit.” $0 copay for an annual physical exam $0 copay for an annual physical exam Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Video doctor visits LiveHealth Online lets you see board-certified doctors and licensed therapists, psychologists and psychiatrists through live, two-way video on your smartphone, tablet or computer. It’s easy to get started! You can sign up at livehealthonline.com or download the free LiveHealth Online mobile app and register. Make sure you have your Membership Card ready – you’ll need it to answer some questions. Sign up for Free:  You must enter your health insurance information during enrollment, so have your Membership Card ready when you sign up. Benefits of a video doctor visit:  The visit is just like seeing your regular doctor face-to- face, but just by web camera.  It’s a great option for medical care when your doctor can’t see you. Board-certified doctors can help 24/7 for most types of care and common conditions like the flu, colds, pink eye and more.  The doctor can send prescriptions to the pharmacy of your choice, if needed.1  If you’re feeling stressed, worried or having a tough time, you can make an appointment to talk to a licensed therapist or psychologist from your home or on the road. In most cases, you can make an appointment and talk with a therapist2 or make an appointment and talk with a psychiatrist3 from the privacy of your home. Video doctor visits are intended to complement face-to-face visits with a board-certified physician and are available for most types of care. LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of this Plan. 1. Prescription is prescribed based on physician recommendations and state regulations (rules). 2. Appointments are typically scheduled within 14 days, but may vary based on therapist/psychologist availability. Video psychologists or therapists cannot prescribe medications. 3. Appointments are typically scheduled within 14 days, but may vary based on psychiatrist availability. Video psychiatrists cannot prescribe controlled substances. $0 copay for video doctor visits using LiveHealth Online Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Health and wellness education programs SilverSneakers® Membership SilverSneakers can help you live a healthier, more active life through fitness and social connection. You are covered for a fitness benefit through SilverSneakers at participating locations1. You have access to instructors who lead specially designed group exercise classes2. At participating locations nationwide1, you can take classes2 plus use exercise equipment and other amenities. Additionally, SilverSneakers FLEX® gives you options to get active outside of traditional gyms (like recreation centers, malls and parks). SilverSneakers also connects you to a support network and virtual resources through SilverSneakers Live, SilverSneakers On-DemandTM and our mobile app, SilverSneakers GOTM. At-home kits are offered for members who want to start working out at home or for those who can’t get to a fitness location due to injury, illness or being homebound. All you need to get started is your personal SilverSneakers ID number. Go to SilverSneakers.com to learn more about your benefit or call 1-888-423-4632 (TTY: 711) Monday through Friday, 8 a.m. to 8 p.m. ET. Always talk with your doctor before starting an exercise program. 1. Participating locations (“PL”) are not owned or operated by Tivity Health, Inc. or its affiliates. Use of PL facilities and amenities is limited to terms and conditions of PL basic membership. Facilities and amenities vary by PL. 2. Membership includes SilverSneakers instructor-led group fitness classes. Some locations offer members additional classes. Classes vary by location. SilverSneakers and SilverSneakers FLEX are registered trademarks of Tivity Health, Inc. SilverSneakers On-Demand and SilverSneakers GO are trademarks of Tivity Health, Inc. © 2020 Tivity Health, Inc. All rights reserved. $0 copay for the SilverSneakers fitness benefit Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Nurse helpline Also, as a member, you have access to a 24-hour nurse line, 7 days a week, 365 days a year. When you call our nurse line, you can speak directly to a registered nurse who will help answer your health-related questions. The call is toll free and the service is available anytime, including weekends and holidays. Plus, your call is always confidential. Call the nurse helpline at 1-800-700-9184. TTY users should call 711. Only the nurse helpline is included in our plan. All other nurse access programs are excluded. $0 copay for nurse helpline Foreign travel emergency and urgently needed services Emergency or urgently needed care services while traveling outside the United States or its territories during a temporary absence of less than six months. Outpatient copay is waived if member is admitted to hospital within 72 hours for the same condition.  Emergency outpatient care  Urgently needed services  Inpatient care (60 days per lifetime) This coverage is worldwide and is limited to what is allowed under the Medicare fee schedule for the services performed/received in the United States. If you are in need of emergency care outside of the United States or its territories, you should call the Blue Cross Blue Shield Global Core Program at 800-810 BLUE or collect at 804- 673-1177. Representatives are available 24 hours a day, 7 days a week, 365 days a year to assist you. When you are outside the United States or its territories, this plan provides coverage for emergency/urgent services only. This is a Supplemental Benefit and not a benefit covered under the Federal Medicare program. For more coverage, you may have the option of purchasing additional travel insurance through an authorized agency. $75 copay for emergency care $20 copay for urgently needed services $0 copay per admission for emergency inpatient care Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Medicare Community Resource Support Need help with a specific issue? Although your plan benefits are designed to cover what Medicare would cover, as well as some additional supplemental benefits as described in this benefits chart, you might need additional help. As a member, your plan provides the support of a community resource outreach team to help bridge the gap between your medical benefits and the resources available to you in your community. The Medicare Community Resource Support team will assist you by providing information and education about community-based services and support programs in your area. If you need assistance or have questions about this benefit, call Member Services at the number listed on the back of your Membership Card. $0 copay for Medicare Community Resource Support Healthy Meals*  Provides up to 14 meals per qualifying event, allows up to four (4) events each year (56 meals in total).  A qualifying event includes when you are in a hospital or a skilled nursing facility and are discharged home or when you have a Body Mass Index (BMI) of 18.5 or under, you have a BMI of 25 or higher or an A1C level more than 9.0 as determined by your provider. For fastest qualification, your provider or case manager is best suited to request this on your behalf. Alternatively, you can contact Member Services and a representative will initiate the process to validate your eligibility. In order for us to provide your meals benefit, we, or a third party acting on our behalf, may need to contact you using the phone number you provided to confirm shipping details and any nutritional requirements. $0 copay for Healthy Meals Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Healthy Pantry* Special Supplemental Benefits for the Chronically Ill Maintaining a healthy diet to support a chronic medical condition can help you maintain or improve your overall health. As a Special Supplemental Benefit for the Chronically Ill, you must:  Meet the CMS mandated criteria. This criteria can be found in the Chapter “Medical benefits (what is covered and what you pay)" in your Evidence of Coverage.  Provide supporting documentation from your physician identifying you, as having a condition that can be made worse by not having or would benefit from having nutritional counseling and help with obtaining appropriate pantry items. We can help you obtain this information. We are unable to initiate your benefit without speaking to you. By requesting this benefit you are expressly authorizing us to contact you by telephone. Upon approval you are eligible for:  Monthly nutritional counseling sessions via phone.  A monthly delivery of non-perishable pantry items sent directly to your home. Your monthly box of staples will consist of a variety of non-perishable foods that can vary each month.  Your nutritional consultations will help you utilize these items and provide you with information on how to supplement them with additional food resources. You can contact Member Services on the back of your Membership Card to begin the process to validate your eligibility. $0 copay for Healthy Pantry Y0114_21_124279_I_C 07/21/2020 2021 STD PPO Plan 10P High Covered services What you must pay for these covered services In-Network Out-of-Network Medicare-approved clinical research studies A clinical research study is a way that doctors and scientists test new types of medical care, like how well a new cancer drug works. They test new medical care procedures or drugs by asking for volunteers to help with the study. If you participate in a Medicare-approved study, Original Medicare pays the doctors and other providers for the covered services you receive as part of the study. Although not required, we ask that you notify us if you participate in a Medicare-approved research study. After Original Medicare has paid its share of the Medicare-approved study, this plan will pay the difference between what Medicare has paid and this plan’s cost- sharing for like services. Any remaining plan cost-sharing you are responsible for will accrue toward this plan’s out-of-pocket maximum. Annual out-of-pocket maximum All copays, coinsurance, and deductibles listed in this benefits chart are accrued toward the medical plan out-of-pocket maximum with the exception of the routine hearing services, routine vision services, and the foreign travel emergency and urgently needed care copay or coinsurance amounts. Part D Prescription drug deductibles and copays do not apply to the medical plan out-of-pocket maximum. $3,400 Combined in-network and out-of-network * Some services that fall within this benefit category require prior authorization. Based on the service you are receiving, your provider will know if prior authorization is needed. This means an approval in advance is needed, by your plan, to get covered services. In the network portion of a PPO, some in-network medical services are covered only if your doctor or other in-network provider gets prior authorization from our plan. In a PPO, you do not need prior authorization to obtain out-of-network services. However, we recommend you ask for a pre-visit coverage decision to confirm that the services you are getting are covered and medically necessary. Benefit categories that include services that require prior authorization are marked with an asterisk in the Benefits Chart. Your 2021 Medical Benefits Chart HMO Plan 5 Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Doctor and hospital choice It is important to know which providers are part of our network because, with limited exceptions, you must use in-network providers while you are a member of our plan. Prior authorization* Benefit categories that include services that require prior authorization are marked with an asterisk (*). Additional information can be found on the last page of the medical benefits chart. Inpatient services Inpatient hospital care* All services must be coordinated by your Primary Care Physician (PCP). Includes inpatient acute, inpatient rehabilitation, long-term care hospitals, and other types of inpatient hospital services. Inpatient hospital care starts the day you are formally admitted to the hospital with a doctor’s order. The day before you are discharged is your last inpatient day. Covered services include but are not limited to:  Semi-private room (or a private room if medically necessary)  Meals, including special diets  Regular nursing services  Costs of special care units (such as intensive or coronary care units)  Drugs and medications  Lab tests  X-rays and other radiology services  Necessary surgical and medical supplies  Use of appliances, such as wheelchairs  Operating and recovery room costs  Physical therapy, occupational therapy, and speech language therapy  Inpatient substance abuse services  Inpatient dialysis treatments (if you are admitted as an inpatient to a hospital for special care) For Medicare-covered hospital stays: $0 copay per admission No limit to the number of days covered by the plan. $0 copay for Medicare-covered physician services received while an inpatient during a Medicare-covered hospital stay Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Inpatient hospital care (con’t)  Under certain conditions, the following types of transplants are covered: corneal, kidney, kidney-pancreatic, heart, liver, lung, heart/lung, bone marrow, stem cell, and intestinal/multivisceral. If you need a transplant, we will arrange to have your case reviewed by a Medicare-approved transplant center that will decide whether you are a candidate for a transplant. Transplant providers may be local or outside of the service area. If our in-network transplant services are outside the community pattern of care, you may choose to go locally as long as the local transplant providers are willing to accept the Original Medicare rate. If the plan provides transplant services at a location outside the pattern of care for transplants in your community and you choose to obtain transplants at this distant location, we will arrange or pay for appropriate lodging and transportation costs for you and a companion. The reimbursement for transportation costs are while you and your companion are traveling to and from the medical providers for services related to the transplant care. The plan defines the distant location as a location that is outside of the member’s service area AND a minimum of 75 miles from the member’s home. Transportation and lodging costs will be reimbursed for travel mileage and lodging consistent with current IRS travel mileage and lodging guidelines. Accommodations for lodging will be reimbursed at the lesser of: 1) billed charges, or 2) $50 per day per covered person up to a maximum of $100 per day per covered person consistent with IRS guidelines.  Blood – including storage and administration. Coverage of whole blood, packed red cells, and all other components of blood begins with the first pint.  Physician services In-network providers should notify us within one business day of any planned, and if possible, unplanned admissions or transfers, including to or from a hospital, skilled nursing facility, long term acute care hospital, or acute rehabilitation center. Note: To be an inpatient, your provider must write an order to admit you formally as an inpatient of the hospital. Even if you stay in the hospital overnight, you might still be considered an “outpatient.” If you are not sure if you are an inpatient, you should ask the hospital staff. You can also find more information in a Medicare fact sheet called “Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask!” This fact sheet is available on the Web at www.medicare.gov/sites/default/files/2018-09/11435-Are-You-an-Inpatient-or-Outpatient.pdf or by calling 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. You can call these numbers for free, 24 hours a day, 7 days a week. If you receive authorized inpatient care at an out-of- network hospital after your emergency condition is stabilized, your cost is the cost-sharing you would pay at an in- network hospital. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Inpatient mental health care* All services must be coordinated by your Primary Care Physician (PCP). Covered services include mental health care services that require a hospital stay in a psychiatric hospital or the psychiatric unit of a general hospital. In-network providers should notify us within one business day of any planned, and if possible, unplanned admissions or transfers, including to or from a hospital, skilled nursing facility, long term acute care hospital, or acute rehabilitation center. For Medicare-covered hospital stays: $0 copay per admission No limit to the number of days covered by the plan. $0 copay for Medicare-covered physician services received while an inpatient during a Medicare-covered hospital stay Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Skilled nursing facility (SNF) care* All services must be coordinated by your Primary Care Physician (PCP). Inpatient skilled nursing facility (SNF) coverage is limited to 100 days each benefit period. A “benefit period” begins on the first day you go to a Medicare-covered inpatient hospital or a SNF. The benefit period ends when you have not been an inpatient at any hospital or SNF for 60 days in a row. Covered services include but are not limited to:  Semi-private room (or a private room if medically necessary)  Meals, including special diets  Skilled nursing services  Physical therapy, occupational therapy, and speech language therapy  Drugs administered to you as part of your plan of care (this includes substances that are naturally present in the body, such as blood clotting factors)  Blood – including storage and administration. Coverage of whole blood, packed red cells, and all other components of blood begins with the first pint.  Medical and surgical supplies ordinarily provided by SNFs  Laboratory tests ordinarily provided by SNFs  X-rays and other radiology services ordinarily provided by SNFs  Use of appliances such as wheelchairs ordinarily provided by SNFs  Physician/Practitioner services Generally, you will receive your SNF care from plan facilities. However, under certain conditions listed below, you may be able to pay in-network cost-sharing for a facility that isn’t a plan provider, if the facility accepts our plan’s amounts for payment.  A nursing home or continuing care retirement community where you were living right before you went to the hospital (as long as it provides skilled nursing facility care)  A SNF where your spouse is living at the time you leave the hospital In-network providers should notify us within one business day of any planned, and if possible, unplanned admissions or transfers, including to or from a hospital, skilled nursing facility, long term acute care hospital, or acute rehabilitation center. For Medicare-covered SNF stays: $0 copay for days 1-100 per benefit period No prior hospital stay required. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Inpatient services covered when the hospital or SNF days are not covered or are no longer covered* All services must be coordinated by your Primary Care Physician (PCP). If you have exhausted your inpatient benefits or if the inpatient stay is not reasonable and necessary, we will not cover your inpatient stay. However in some cases, we will cover certain services you receive while you are in the hospital or a skilled nursing facility (SNF). Covered services include, but are not limited to:  Physician services  Diagnostic tests (like lab tests)  X-ray, radium and isotope therapy, including technician materials and services  Surgical dressings  Splints, casts, and other devices used to reduce fractures and dislocations  Prosthetic and orthotic devices (other than dental) that replace all or part of an internal body organ (including contiguous tissue), or all or part of the function of a permanently inoperative or malfunctioning internal body organ, including replacement or repairs of such devices  Leg, arm, back and neck braces, trusses and artificial legs, arms and eyes, including adjustments, repairs and replacements required because of breakage, wear, loss, or a change in the patient's physical condition  Physical therapy, occupational therapy, and speech language therapy After your SNF day limits are used up, this plan will still pay for covered physician services and other medical services outlined in this benefits chart at the cost share amounts indicated. Home health agency care* All services must be coordinated by your Primary Care Physician (PCP). Prior to receiving home health services, a doctor must certify that you need home health services and will order home health services to be provided by a home health agency. You must be homebound, which means leaving home is a major effort. Covered services include, but are not limited to:  Part-time or intermittent skilled nursing and home health aide services (to be covered under the home health care benefit, your skilled nursing and home health aide services combined must total fewer than 8 hours per day and 35 hours per week)  Physical therapy, occupational therapy, and speech language therapy  Medical and social services  Medical equipment and supplies $0 copay for Medicare-covered home health visits Durable Medical Equipment (DME) copay or coinsurance, if any, may apply. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Hospice care You may receive care from any Medicare-certified hospice program. You are eligible for the hospice benefit when your doctor and the hospice medical director have given you a terminal prognosis certifying that you’re terminally ill and have six months or less to live if your illness runs its normal course. Your hospice doctor can be an in-network provider or an out-of-network provider. For hospice services and for services that are covered by Medicare Part A or B and are related to your terminal prognosis: Original Medicare (rather than this plan) will pay for hospice services and any Part A and Part B services related to your terminal prognosis. While you are in the hospice program, your hospice provider will bill Medicare for the services that Original Medicare pays for. Services covered by Original Medicare include:  Drugs for symptom control and pain relief  Short-term respite care  Home care Our plan covers hospice consultation services (one time only) for a terminally ill person who hasn’t elected the hospice benefit. For services that are covered by Medicare Part A or B and are not related to your terminal prognosis: If you need nonemergency, nonurgently needed services that are covered under Medicare Part A or B and that are not related to your terminal prognosis, your cost for these services depends on whether you use a provider in our plan’s network:  If you obtain the covered services from an in-network provider, you only pay the plan cost- sharing amount for in-network services.  If you obtain the covered services from an out-of-network provider, you pay the cost- sharing under Fee-for-Service Medicare (Original Medicare). For services that are covered by this plan but are not covered by Medicare Part A or B: This plan will continue to cover plan-covered services that are not covered under Part A or B whether or not they are related to your terminal prognosis. You pay your plan cost-sharing amount for these services. If you have Part D prescription drug coverage, some drugs may be covered under your Part D benefit. Drugs are never covered by both hospice and your Part D plan at the same time. Note: If you need non-hospice care (care that is not related to your terminal prognosis), you should contact us to arrange the services. You must receive care from a Medicare-certified hospice. When you enroll in a Medicare-certified hospice program, your hospice services and your Part A and B services are paid for by Original Medicare, not this plan. $15 copay for the one time only hospice consultation Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Outpatient services Physician services, including doctor’s office visits* All services must be coordinated by your Primary Care Physician (PCP). Covered services include:  Office visits, including medical and surgical services in a physician’s office  Consultation, diagnosis, and treatment by a specialist  Basic diagnostic hearing and balance exams, if your doctor orders it to see if you need medical treatment, when furnished by a physician, audiologist, or other qualified provider  Telehealth services for some physician or mental health services can be found in the section of this benefit chart titled, Video doctor visits. You have the option of getting these services through an in-person visit or by telehealth. If you choose to receive one of these services by telehealth, you must use a network provider who has an agreement with us to provide telehealth services.  Certain telehealth services including consultation, diagnosis, and treatment by a physician or practitioner for patients in certain rural areas or other locations approved by Medicare  Telehealth services for monthly end-stage renal disease-related visits for home dialysis members in a hospital-based or critical access hospital-based renal dialysis center, renal dialysis facility, or the member’s home  Telehealth services to diagnose, evaluate, or treat symptoms of a stroke  Virtual check-ins (for example, by phone or video chat) with your doctor for 5-10 minutes if: o You’re not a new patient and o The check-in isn’t related to an office visit in the past 7 days and o The check-in doesn’t lead to an office visit within 24 hours or the soonest available appointment  Evaluation of video and/or images you send to your doctor, and interpretation and follow- up by your doctor within 24 hours if: o You’re not a new patient and o The evaluation isn’t related to an office visit in the past 7 days and o The evaluation doesn’t lead to an office visit within 24 hours or the soonest available appointment  Consultation your doctor has with other doctors by phone, internet, or electronic health record if you’re not a new patient $5 copay per visit to an in-network Primary Care Physician (PCP) for Medicare-covered services $15 copay per visit to an in-network specialist for Medicare-covered services $0 copay for Medicare-covered allergy testing $0 copay for Medicare-covered allergy injections See antigen cost share in Part B drug section. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Physician services, including doctor’s office visits (con’t)  Second opinion by another in-network provider prior to surgery  Physician services rendered in the home  Outpatient hospital services  Non-routine dental care (covered services are limited to surgery of the jaw or related structures, setting fractures of the jaw or facial bones, extraction of teeth to prepare the jaw for radiation treatments of neoplastic cancer disease, or services that would be covered when provided by a physician)  Allergy testing and allergy injections Chiropractic services All services must be coordinated by your Primary Care Physician (PCP).  We cover only manual manipulation of the spine to correct subluxation. $15 copay for each Medicare-covered visit Acupuncture for chronic low back pain* Covered services include: Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstances: For the purpose of this benefit, chronic low back pain is defined as:  Lasting 12 weeks or longer;  Nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease);  Not associated with surgery; and  Not associated with pregnancy. An additional eight sessions will be covered for those patients demonstrating an improvement. No more than 20 acupuncture treatments may be administered annually. Treatment must be discontinued if the patient is not improving or is regressing. $5 copay for each Medicare-covered visit Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Podiatry services* All services must be coordinated by your Primary Care Physician (PCP). Covered services include:  Diagnosis and the medical or surgical treatment of injuries and disease of the feet (such as hammer toe or heel spurs), in an office setting  Medicare-covered routine foot care for members with certain medical conditions affecting the lower limbs  A foot exam covered every six months for people with diabetic peripheral neuropathy and loss of protective sensations $15 copay for each Medicare-covered visit Outpatient mental health care, including partial hospitalization services* All services must be coordinated by your Primary Care Physician (PCP). Covered services include:  Mental health services provided by a state-licensed psychiatrist or doctor, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, physician assistant, or other Medicare-qualified mental health care professional as allowed under applicable state laws “Partial hospitalization” is a structured program of active psychiatric treatment provided as a hospital outpatient service that is more intense than the care received in your doctor’s or therapist’s office and is an alternative to inpatient hospitalization. $15 copay for each Medicare-covered professional individual therapy visit $15 copay for each Medicare-covered professional group therapy visit $15 copay for each Medicare-covered professional partial hospitalization visit $0 copay for each Medicare-covered outpatient hospital facility individual therapy visit $0 copay for each Medicare-covered outpatient hospital facility group therapy visit $0 copay for each Medicare-covered partial hospitalization facility visit Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Outpatient substance abuse services, including partial hospitalization services* All services must be coordinated by your Primary Care Physician (PCP). “Partial hospitalization” is a structured program of active psychiatric treatment provided as a hospital outpatient service that is more intense than the care received in your doctor’s or therapist’s office and is an alternative to inpatient hospitalization. $15 copay for each Medicare-covered professional individual therapy visit $15 copay for each Medicare-covered professional group therapy visit $15 copay for each Medicare-covered professional partial hospitalization visit $0 copay for each Medicare-covered outpatient hospital facility individual therapy visit $0 copay for each Medicare-covered outpatient hospital facility group therapy visit $0 copay for each Medicare-covered partial hospitalization facility visit Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Outpatient surgery, including services provided at hospital outpatient facilities and ambulatory surgical centers* All services must be coordinated by your Primary Care Physician (PCP). Facilities where surgical procedures are performed and the patient is released the same day. Note: If you are having surgery in a hospital, you should check with your provider about whether you will be an inpatient or outpatient. Unless the provider writes an order to admit you as an inpatient to the hospital, you are an outpatient and pay the cost-sharing amounts for outpatient surgery. Even if you stay in the hospital overnight, you might still be considered an “outpatient.” You can also find more information in a Medicare fact sheet called “Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask!” This fact sheet is available on the Web at www.medicare.gov/sites/default/files/2018-09/11435-Are-You-an-Inpatient-or-Outpatient.pdf or by calling 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. You can call these numbers for free, 24 hours a day, 7 days a week. $0 copay for each Medicare-covered outpatient hospital facility or ambulatory surgical center visit for surgery $0 copay for each Medicare-covered outpatient observation room visit Outpatient hospital observation, non-surgical* All services must be coordinated by your Primary Care Physician (PCP). Observation services are hospital outpatient services given to determine if you need to be admitted as an inpatient or can be discharged. For outpatient hospital observation services to be covered, they must meet the Medicare criteria and be considered reasonable and necessary. Observation services are covered only when provided by the order of a physician or another individual authorized by state licensure law and hospital staff bylaws to admit patients to the hospital or order outpatient tests. Note: Unless the provider has written an order to admit you as an inpatient to the hospital, you are an outpatient and pay the cost-sharing amounts for outpatient hospital services. Even if you stay in the hospital overnight, you might still be considered an “outpatient.” If you are not sure if you are an outpatient, you should ask the hospital staff. You can also find more information in a Medicare fact sheet called “Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask!” This fact sheet is available on the Web at www.medicare.gov/sites/default/files/2018-09/11435-Are-You-an-Inpatient-or-Outpatient.pdf or by calling 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. You can call these numbers for free, 24 hours a day, 7 days a week. $5 copay for a visit to an in-network primary care physician in an outpatient hospital setting/clinic for Medicare-covered non-surgical services $15 copay for a visit to an in-network specialist in an outpatient hospital setting/clinic for Medicare-covered non-surgical services $0 copay for each Medicare-covered outpatient observation room visit Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Ambulance services Your provider must get an approval from the plan before you get ground, air, or water transportation that is not an emergency. All nonemergent ambulance services must be coordinated by your Primary Care Physician (PCP).  Covered ambulance services include fixed wing, rotary wing, water, and ground ambulance services to the nearest appropriate facility that can provide care only if the services are furnished to a member whose medical condition is such that other means of transportation could endanger the person’s health or if authorized by the plan.  Nonemergency transportation by ambulance is appropriate if it is documented that the member’s condition is such that other means of transportation could endanger the person’s health and that transportation by ambulance is medically required.  Ambulance service is not covered for physician office visits. $50 copay per one- way trip for Medicare- covered ambulance services Emergency care Emergency care refers to services that are:  Furnished by a provider qualified to furnish emergency services, and  Needed to evaluate or stabilize an emergency medical condition. Emergency outpatient copay is waived if the member is admitted to the hospital within 72 hours for the same condition. A medical emergency is when you, or any other prudent layperson with an average knowledge of health and medicine, believe that you have medical symptoms that require immediate medical attention to prevent loss of life, loss of a limb, or loss of function of a limb. The medical symptoms may be an illness, injury, severe pain, or a medical condition that is quickly getting worse. This coverage is worldwide and is limited to what is allowed under the Medicare fee schedule for the services performed/received in the United States. Cost sharing for necessary emergency services furnished out-of-network is the same as for such services furnished in-network. If you receive inpatient care at an out-of-network hospital and need inpatient care after your emergency condition is stabilized, you must have your inpatient care at the out-of-network hospital authorized by the plan and your cost is the cost-sharing you would pay at an in-network hospital. $50 copay for each Medicare-covered emergency room visit Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Urgently needed services  Urgently needed services are available on a worldwide basis. The urgently needed services copay is waived if the member is admitted to the hospital within 72 hours for the same condition. If you are outside of the service area for your plan, your plan covers urgently needed services, including urgently required renal dialysis. Urgently needed services are services provided to treat a nonemergency, unforeseen medical illness, injury, or condition that requires immediate medical care. Urgently needed services may be furnished by in-network providers or by out-of-network providers when in-network providers are temporarily unavailable or inaccessible. Cost sharing for necessary urgently needed services furnished out-of-network is the same as for such services furnished in-network. Generally, however, if you are in the plan’s service area and your health is not in serious danger, you should obtain care from an in-network provider. $15 copay for each Medicare-covered urgently needed care visit Outpatient rehabilitation services* All services must be coordinated by your Primary Care Physician (PCP). Covered services include: physical therapy, occupational therapy, and speech language therapy. Outpatient rehabilitation services are provided in various outpatient settings, such as hospital outpatient departments, independent therapist offices, and Comprehensive Outpatient Rehabilitation Facilities (CORFs). $15 copay for Medicare-covered physical therapy, occupational therapy, and speech language therapy visits Cardiac rehabilitation services All services must be coordinated by your Primary Care Physician (PCP). Comprehensive programs of cardiac rehabilitation services that include exercise, education, and counseling are covered for members who meet certain conditions with a doctor’s order. The plan also covers intensive cardiac rehabilitation programs that are typically more rigorous or more intense than cardiac rehabilitation programs. $15 copay for Medicare-covered cardiac rehabilitation therapy visits Pulmonary rehabilitation services* All services must be coordinated by your Primary Care Physician (PCP). Comprehensive programs of pulmonary rehabilitation are covered for members who have moderate to very severe chronic obstructive pulmonary disease (COPD) and a referral for pulmonary rehabilitation from the doctor treating their chronic respiratory disease. $15 copay for Medicare-covered pulmonary rehabilitation therapy visits Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Supervised exercise therapy (SET)* All services must be coordinated by your Primary Care Physician (PCP). SET is covered for members who have symptomatic peripheral artery disease (PAD) and a referral for PAD from the physician responsible for PAD treatment. Up to 36 sessions over a 12-week period are covered if the SET program requirements are met. The SET program must:  Consist of sessions lasting 30-60 minutes, comprising a therapeutic exercise-training program for PAD in patients with claudication  Be conducted in a hospital outpatient setting or a physician’s office  Be delivered by qualified auxiliary personnel necessary to ensure benefits exceed harms, and who are trained in exercise therapy for PAD  Be under the direct supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist who must be trained in both basic and advanced life support techniques SET may be covered beyond 36 sessions over 12 weeks for an additional 36 sessions over an extended period of time if deemed medically necessary by a health care provider. $15 copay for Medicare-covered supervised exercise therapy visits Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Durable medical equipment (DME) and related supplies* All services must be coordinated by your Primary Care Physician (PCP). Covered items include, but are not limited to: wheelchairs, crutches, powered mattress systems, diabetic supplies, continuous blood glucose monitors, hospital bed ordered by a provider for use at home, IV infusion pumps, speech generating devices, oxygen equipment, nebulizers, and walkers. Copay or coinsurance only applies when you are not currently receiving inpatient care. If you are receiving inpatient care your DME will be included in the copay or coinsurance for those services. We cover all medically necessary durable medical equipment covered by Original Medicare. If our supplier in your area does not carry a particular brand or manufacturer, you may ask them if they can special order it for you. Therapeutic Continuous Glucose Monitors (CGMs) and related supplies are covered by Medicare when they meet Medicare National Coverage Determination (NCD) and Local Coverage Determinations (LCD) criteria. In addition, where there is not NCD/ LCD criteria, therapeutic CGM must meet any plan benefit limits, and the plan’s evidence based clinical practice guidelines. Coverage is limited to 2 sensors per month and one receiver every 2 years. This plan covers only DUROLANE, EUFLEXXA, SUPARTZ, and Gel-SYN-3 Hyaluronic Acids (HA). For new prescriptions, we will not cover other brands unless your provider tells us it is medically necessary. The review of medical necessity for use of HA and any non-preferred brands is part of the plan’s prior authorization process. $0 copay for Medicare-covered DME See the Diabetes self- management training, diabetic services, and supplies benefit section for diabetic supply cost sharing. Prosthetic devices and related supplies* All services must be coordinated by your Primary Care Physician (PCP). Devices (other than dental) that replace all or a body part or function. These include, but are not limited to, colostomy bags and supplies directly related to colostomy care, pacemakers, braces, prosthetic shoes, artificial limbs, and breast prostheses (including a surgical brassiere after a mastectomy). Includes certain supplies related to prosthetic devices and repair and/or replacement of prosthetic devices. Also includes some coverage following cataract removal or cataract surgery, see “Vision care” later in this section for more detail. $0 copay for Medicare-covered prosthetics and orthotics Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Home infusion therapy* All services must be coordinated by your Primary Care Physician (PCP). Home infusion therapy involves the intravenous or subcutaneous administration of drugs or biologicals to an individual at home. The components needed to perform home infusion include the drug (for example, antivirals, immune globulin), equipment (for example, a pump), and supplies (for example, tubing and catheters). Covered services include but are not limited to:  Professional services, including nursing services, furnished in accordance with the plan of care  Patient training and education not otherwise covered under the durable medical equipment benefits  Remote monitoring  Monitoring services for the provision of home infusion therapy and home infusion drugs furnished by a qualified home infusion therapy supplier  Durable medical equipment – pharmacy services, delivery, equipment set up, maintenance of rented equipment, and training and education on the use of the covered items $0 copay for Medicare-covered professional services provided by a Medicare-certified home health agency or home infusion supplier $0 copay for Medicare-covered durable medical equipment – includes the external infusion pump, the related supplies, and the infusion drug(s) Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Diabetes self-management training, diabetic services, and supplies* All services must be coordinated by your Primary Care Physician (PCP). For all people who have diabetes (insulin and non-insulin users) Covered services include:  Supplies to monitor your blood glucose: Blood glucose monitor, blood glucose test strips, lancet devices and lancets, and glucose control solutions for checking the accuracy of test strips and monitors  Blood glucose monitors are limited to one every year  Up to 200 blood glucose test strips and lancets for a 30-day supply  One pair per year of therapeutic custom molded shoes (including inserts provided with such shoes) and two additional pairs of inserts or one pair of depth shoes and three pairs of inserts (not including the non-customized removable inserts provided with such shoes) for people with diabetes who have severe diabetic foot disease, including fitting of shoes or inserts  Diabetes self-management training is covered under certain conditions $0 copay for a 30- day supply on each Medicare-covered purchase of blood glucose test strips, lancets, lancet devices, and glucose control solutions for checking the accuracy of test strips and monitors $0 copay for Medicare-covered blood glucose monitor $0 copay for Medicare-covered therapeutic shoes and inserts $0 copay for Medicare-covered diabetes self- management training Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Outpatient diagnostic tests and therapeutic services and supplies* All services must be coordinated by your Primary Care Physician (PCP). Covered services include, but are not limited to:  X-rays  Complex diagnostic tests and radiology services  Radiation (radium and isotope) therapy, including technician materials and supplies  Testing to confirm chronic obstructive pulmonary disease (COPD)  Surgical supplies, such as dressings  Splints, casts, and other devices used to reduce fractures and dislocations  Laboratory tests  Blood – including storage and administration. Coverage of whole blood, packed red cells, and all other components of blood begins with the first pint.  Other outpatient diagnostic tests Certain diagnostic tests and radiology services are considered complex and include heart catheterizations, sleep studies, computed tomography (CT), magnetic resonance procedures (MRIs and MRAs), and nuclear medicine studies, which includes PET scans. $15 copay for each Medicare-covered X- ray visit and/or simple diagnostic test $50 copay for Medicare-covered complex diagnostic test and/or radiology visit $15 copay for each Medicare-covered radiation therapy treatment $0 copay for Medicare-covered testing to confirm chronic obstructive pulmonary disease $0 copay for Medicare-covered supplies $0 copay for each Medicare-covered clinical/diagnostic lab test $0 copay per Medicare-covered pint of blood Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Opioid treatment program services* All services must be coordinated by your Primary Care Physician (PCP). Opioid use disorder treatment services are covered under Part B of Original Medicare. Members of our plan receive coverage for these services through our plan. Covered services include:  FDA-approved opioid agonist and antagonist treatment medications and the dispensing and administration of such medications, if applicable  Substance use counseling  Individual and group therapy  Toxicology testing $15 copay per visit for Medicare-covered opioid treatment program services Vision care (non-routine) All services must be coordinated by your Primary Care Physician (PCP). Covered services include:  Outpatient physician services for the diagnosis and treatment of diseases and injuries of the eye, including treatment for age-related macular degeneration  For people who are at high risk of glaucoma, we will cover one glaucoma screening each year. People at high risk of glaucoma include: people with a family history of glaucoma, people with diabetes, African-Americans who are age 50 and older, and Hispanic- Americans who are age 65 or older.  For people with diabetes, screening for diabetic retinopathy is covered once per year.  One pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens. (If you have two separate cataract operations, you cannot reserve the benefit after the first surgery and purchase two eyeglasses after the second surgery.) $5 copay for visits to an in-network primary care physician for Medicare-covered exams to diagnose and treat diseases of the eye $15 copay for visits to an in-network specialist for Medicare-covered exams to diagnose and treat diseases of the eye $0 copay for Medicare-covered glaucoma screening $0 copay for Medicare-covered diabetic retinopathy screening $0 copay for glasses/contacts following Medicare- covered cataract surgery Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Preventive services care and screening tests You will see this apple next to preventive services throughout this chart. For all preventive services that are covered at no cost under Original Medicare, we also cover the service at no cost to you in-network. However, if you are treated or monitored for an existing medical condition or an additional non-preventive service, during the visit when you receive the preventive service, a copay or coinsurance may apply for that care received. In addition, if an office visit is billed for the existing medical condition care or an additional non-preventive service received, the applicable in-network primary care physician or in-network specialist copay or coinsurance will apply. Abdominal aortic aneurysm screening All services must be coordinated by your Primary Care Physician (PCP). A one-time screening ultrasound for people at risk. The plan only covers this screening if you have certain risk factors and if you get a referral for it from your physician, physician assistant, nurse practitioner, or clinical nurse specialist. There is no coinsurance, copayment, or deductible for members eligible for this Medicare- covered preventive screening. Bone mass measurement All services must be coordinated by your Primary Care Physician (PCP). For qualified individuals (generally, this means people at risk of losing bone mass or at risk of osteoporosis), the following services are covered every 24 months, or more frequently if medically necessary: procedures to identify bone mass, detect bone loss, or determine bone quality, including a physician's interpretation of the results. There is no coinsurance, copayment, or deductible for the Medicare-covered bone mass measurement. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Colorectal cancer screening and colorectal services All services must be coordinated by your Primary Care Physician (PCP). For people 50 and older, the following are covered:  Flexible sigmoidoscopy (or screening barium enema as an alternative) every 48 months One of the following every 12 months:  Guaiac-based fecal occult blood test (gFOBT)  Fecal immunochemical test (FIT) DNA based colorectal screening every 3 years For people at high risk of colorectal cancer, we cover:  Screening colonoscopy (or screening barium enema as an alternative) every 24 months For people not at high risk of colorectal cancer, we cover:  Screening colonoscopy every 10 years, but not within 48 months of a screening sigmoidoscopy Colorectal services:  Include the biopsy and removal of any growth during the procedure, in the event the procedure goes beyond a screening exam There is no coinsurance, copayment, or deductible for the Medicare-covered colorectal cancer screening exam and services. HIV screening All services must be coordinated by your Primary Care Physician (PCP). For people who ask for an HIV screening test or who are at increased risk for HIV infection, we cover:  One screening exam every 12 months For women who are pregnant, we cover:  Up to three screening exams during a pregnancy There is no coinsurance, copayment, or deductible for members eligible for the Medicare-covered preventive HIV screening. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Screening for sexually transmitted infections (STIs) and counseling to prevent STIs All services must be coordinated by your Primary Care Physician (PCP). We cover sexually transmitted infection (STI) screenings for chlamydia, gonorrhea, syphilis, and Hepatitis B. These screenings are covered for pregnant women and for certain people who are at increased risk for an STI when the tests are ordered by a primary care provider. We cover these tests once every 12 months or at certain times during pregnancy. We also cover up to 2 individual 20 to 30 minute, face-to-face high-intensity behavioral counseling sessions each year for sexually active adults at increased risk for STIs. We will only cover these counseling sessions as a preventive service if they are provided by a primary care provider and take place in a primary care setting, such as a doctor’s office. There is no coinsurance, copayment, or deductible for the Medicare-covered screening for STIs and counseling for STIs preventive benefit. Medicare Part B immunizations All services must be coordinated by your Primary Care Physician (PCP). Covered services include:  Pneumonia vaccine  Flu shots, including H1N1, once each flu season in the fall and winter, with additional flu shots if medically necessary  Hepatitis B vaccine if you are at high or intermediate risk of getting Hepatitis B  Other vaccines if you are at risk and they meet Medicare Part B coverage rules If you have Part D prescription drug coverage, some vaccines are covered under your Part D benefit (for example, the shingles vaccine). Please refer to your Part D prescription drug benefits. There is no coinsurance, copayment, or deductible for the pneumonia, influenza, Hepatitis B, or other Medicare- covered vaccines when you are at risk and they meet Medicare Part B rules. Breast cancer screening (mammograms) You can get this service on your own, without a referral from your provider. Covered services include:  One baseline mammogram between the ages of 35 and 39  One screening mammogram every 12 months for women age 40 and older  Clinical breast exams once every 24 months There is no coinsurance, copayment, or deductible for Medicare-covered screening mammograms. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Cervical and vaginal cancer screening You can get this service on your own, without a referral from your provider. Covered services include:  For all women, Pap tests and pelvic exams are covered once every 24 months.  If you are at high risk of cervical or vaginal cancer or you are of childbearing age and have had an abnormal Pap test within the past 3 years: 1 Pap test every 12 months. There is no coinsurance, copayment, or deductible for Medicare-covered preventive Pap and pelvic exams. Prostate cancer screening exams All services must be coordinated by your Primary Care Physician (PCP). For men age 50 and older the following are covered once every 12 months:  Digital rectal exam  Prostate Specific Antigen (PSA) test There is no coinsurance, copayment, or deductible for a Medicare-covered annual PSA test. Cardiovascular disease risk reduction visit (therapy for cardiovascular disease) All services must be coordinated by your Primary Care Physician (PCP). We cover one visit per year with your primary care doctor to help lower your risk for cardiovascular disease. During this visit, your doctor may discuss aspirin use (if appropriate), check your blood pressure, and give you tips to make sure you’re eating healthy. There is no coinsurance, copayment, or deductible for the Medicare-covered intensive behavioral therapy cardiovascular disease preventive benefit. Cardiovascular disease testing All services must be coordinated by your Primary Care Physician (PCP). Blood tests for the detection of cardiovascular disease (or abnormalities associated with an elevated risk of cardiovascular disease) once every 5 years (60 months). There is no coinsurance, copayment, or deductible for Medicare-covered cardiovascular disease testing that is covered once every five years. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services “Welcome to Medicare” preventive visit All services must be coordinated by your Primary Care Physician (PCP). The plan covers a one-time “Welcome to Medicare” preventive visit. The visit includes a review of your health, measurements of height, weight, body mass index, blood pressure, as well as education and counseling about the preventive services you need (including certain screenings and shots), and referrals for other care if needed. Important: We cover the “Welcome to Medicare” preventive visit only within the first 12 months you have Medicare Part B. When you make your appointment, let your doctor’s office know you would like to schedule your “Welcome to Medicare” preventive visit. There is no coinsurance, copayment, or deductible for the Medicare-covered “Welcome to Medicare” preventive visit. Annual wellness visit All services must be coordinated by your Primary Care Physician (PCP). If you’ve had Medicare Part B for longer than 12 months, you can get an annual wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. This is covered once every 12 months. Note: Your first annual wellness visit can’t take place within 12 months of your “Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to be covered for annual wellness visits after you’ve had Part B for 12 months. There is no coinsurance, copayment, or deductible for the Medicare-covered annual wellness visit. Depression screening All services must be coordinated by your Primary Care Physician (PCP). We cover one screening for depression per year. The screening must be done in a primary care setting that can provide follow-up treatment and/or referrals. There is no coinsurance, copayment, or deductible for a Medicare-covered annual depression screening visit. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Diabetes screening All services must be coordinated by your Primary Care Physician (PCP). We cover this screening (includes fasting glucose tests) if you have any of the following risk factors: high blood pressure (hypertension), history of abnormal cholesterol and triglyceride levels (dyslipidemia), obesity, or a history of high blood sugar (glucose). Tests may also be covered if you meet other requirements, like being overweight and having a family history of diabetes. Based on the results of these tests, you may be eligible for up to 2 diabetes screenings every 12 months. There is no coinsurance, copayment, or deductible for Medicare-covered diabetes screening tests. Medicare Diabetes Prevention Program (MDPP) All services must be coordinated by your Primary Care Physician (PCP). MDPP services will be covered for eligible Medicare beneficiaries under all Medicare health plans. MDPP is a structured health behavior change intervention that provides practical training in long- term dietary change, increased physical activity, and problem-solving strategies for overcoming challenges to sustaining weight loss and a healthy lifestyle. There is no coinsurance, copayment, or deductible for the MDPP benefit. Obesity screening and therapy to promote sustained weight loss All services must be coordinated by your Primary Care Physician (PCP). If you have a body mass index of 30 or more, we cover intensive counseling to help you lose weight. This counseling is covered if you get it in a primary care setting, where it can be coordinated with your comprehensive prevention plan. Talk to your primary care doctor or practitioner to find out more. There is no coinsurance, copayment, or deductible for Medicare-covered preventive obesity screening and therapy. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Screening and counseling to reduce alcohol misuse All services must be coordinated by your Primary Care Physician (PCP). We cover one alcohol misuse screening for adults with Medicare (including pregnant women) who misuse alcohol, but aren’t alcohol dependent. If you screen positive for alcohol misuse, you can get up to four brief face-to-face counseling sessions per year (if you’re competent and alert during counseling) provided by a qualified primary care doctor or practitioner in a primary care setting. There is no coinsurance, copayment, or deductible for the Medicare-covered screening and counseling to reduce alcohol misuse preventive benefit. Screening for lung cancer with low dose computed tomography (LDCT) All services must be coordinated by your Primary Care Physician (PCP). For qualified individuals, a LDCT is covered every 12 months. Eligible enrollees are: people aged 55 – 77 years who have no signs or symptoms of lung cancer, but who have a history of tobacco smoking of at least 30 pack-years or who currently smoke or have quit smoking within the last 15 years, who receive a written order for LDCT during a lung cancer screening counseling and shared decision making visit that meets the Medicare criteria for such visits and be furnished by a physician or qualified non-physician practitioner. For LDCT lung cancer screenings after the initial LDCT screening: the enrollee must receive a written order for LDCT lung cancer screening, which may be furnished during any appropriate visit with a physician or qualified non-physician practitioner. If a physician or qualified non-physician practitioner elects to provide a lung cancer screening counseling and shared decision making visit for subsequent lung cancer screenings with LDCT, the visit must meet the Medicare criteria for such visits. There is no coinsurance, copayment, or deductible for the Medicare-covered counseling and shared decision making visit or for the LDCT. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Medical nutrition therapy All services must be coordinated by your Primary Care Physician (PCP). This benefit is for people with diabetes, renal (kidney) disease (but not on dialysis), or after a kidney transplant when referred by your doctor. We cover three hours of one-on-one counseling services during your first year that you receive medical nutrition therapy services under Medicare (this includes our plan, any other Medicare Advantage plan, or Original Medicare), and two hours each year after that. If your condition, treatment, or diagnosis changes, you may be able to receive more hours of treatment with a physician’s referral. A physician must prescribe these services and renew their referral yearly if your treatment is needed into another plan year. There is no coinsurance, copayment, or deductible for members eligible for Medicare-covered medical nutrition therapy services. Smoking and tobacco use cessation (counseling to quit smoking) All services must be coordinated by your Primary Care Physician (PCP). If you use tobacco, but do not have signs or symptoms of tobacco-related disease: We cover 2 counseling quit attempts within a 12 month period. Each counseling attempt includes up to 4 face-to-face visits. If you use tobacco and have been diagnosed with a tobacco-related disease or are taking medicine that may be affected by tobacco: We cover cessation counseling services. We cover 2 counseling quit attempts within a 12 month period. Each counseling attempt includes up to 4 face-to-face visits. These visits must be ordered by your doctor and provided by a qualified doctor or other Medicare-recognized practitioner. There is no coinsurance, copayment, or deductible for the Medicare-covered smoking and tobacco use cessation preventive benefits. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Other services Services to treat outpatient kidney disease You do not need to get an approval from the plan before getting dialysis. But please let us know when you need to start this care, so we can help coordinate with your doctors. All services must be coordinated by your Primary Care Physician (PCP). Covered services include:  Kidney disease education services to teach kidney care and help members make informed decisions about their care. For members with stage IV chronic kidney disease when referred by their doctor, we cover up to six sessions of kidney disease education services per lifetime.  Outpatient dialysis treatments (including dialysis treatments when temporarily out of the service area)  Home dialysis or certain home support services (such as, when necessary, visits by trained dialysis workers to check on your home dialysis, to help in emergencies, and check your dialysis equipment and water supply)  Self-dialysis training (includes training for you and anyone helping you with your home dialysis treatments)  Home and outpatient dialysis equipment and supplies Certain drugs for dialysis are covered under your Medicare Part B drug benefit. For information about coverage for Part B drugs, please go to the section below, “Medicare Part B prescription drugs.” $0 copay for each Medicare-covered kidney disease education session $5 copay for Medicare-covered outpatient dialysis $0 copay for Medicare-covered home dialysis or home support services $5 copay for Medicare-covered self-dialysis training $0 copay for Medicare-covered home dialysis equipment and supplies $0 copay for Medicare-covered outpatient dialysis equipment and supplies Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Medicare Part B prescription drugs covered under your medical plan (Part B drugs)* All services must be coordinated by your Primary Care Physician (PCP). These drugs are covered under Part B of Original Medicare. Members of our plan receive coverage for these drugs through our plan. Covered drugs include:  “Drugs” include substances that are naturally present in the body, such as blood clotting factors  Drugs that usually are not self-administered by the patient and are injected or infused while receiving physician, hospital outpatient, or ambulatory surgical center services  Drugs you take using durable medical equipment (such as nebulizers) that was authorized by the plan  Clotting factors you give yourself by injection if you have hemophilia  Immunosuppressive drugs, if you were enrolled in Medicare Part A at the time of the organ transplant  Injectable osteoporosis drugs, if you are homebound, have a bone fracture that a doctor certifies was related to post-menopausal osteoporosis and cannot self-administer the drug  Antigens  Certain oral anti-cancer drugs and anti-nausea drugs  Certain drugs for home and outpatient dialysis, including heparin, the antidote for heparin when medically necessary, topical anesthetics, and erythropoiesis-stimulating agents such as Erythropoietin (Epogen), Procrit or Epoetin Alfa and Darboetin Alfa (Aranesp)  Intravenous Immune Globulin for the home treatment of primary immune deficiency diseases We also cover some vaccines under our Part B prescription drug benefit. Some of Part B covered drugs listed above may be subject to step therapy. You may log into your secure member portal to find the list of Part B drugs that may be subject to step therapy. This list is located with your Plan Documents under your Benefits section. If you have Part D prescription drug coverage, please refer to your Evidence of Coverage for information on your Part D prescription drug benefits. $0 copay for Medicare-covered Part B drugs $0 copay for Medicare-covered Part B drug administration $0 copay for Medicare-covered Part B chemotherapy drugs $0 copay for Medicare-covered Part B chemotherapy drug administration Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Additional benefits Routine hearing services  Routine hearing exams Routine hearing exams are limited to 1 every 12 months. Routine hearing exams are limited to a $70 maximum benefit every 12 months.  Hearing aid fitting evaluations are limited to 1 per covered hearing aid  Hearing aids Hearing aids are limited to a $500 maximum benefit every 12 months. Includes digital hearing aid technology and inner ear, outer ear and over the ear models. Fitting adjustment after hearing aid is received, if necessary. The hearing aid benefit does not provide coverage for amplifiers, internet purchases, assistive listening devices (ALDs) or accessories. For additional benefit information and to locate a Hearing Care Solutions participating provider, please contact Member Services. You will be directed to the dedicated Hearing Care Solutions Member Services line. Hearing benefit management administered by Hearing Care Solutions, an independent company. Must use a Hearing Care Solutions participating provider. $0 copay for routine hearing exams $0 copay for hearing aid fitting evaluations $0 copay for hearing aids Members receive a free battery supply during the first 3 years with a 64-cell limit per year, per hearing aid. After the plan pays benefits for routine hearing exams, hearing aids and hearing aid fitting evaluations, you are responsible for any remaining cost. Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Routine vision services  Routine vision exams Routine vision exams are limited to 1 every calendar year. The routine vision exam is limited to a $70 maximum benefit every calendar year.  Eyewear Eyewear is limited to a $100 maximum benefit* every 2 calendar years Covered eyewear includes prescription glasses, lenses, frames and contacts. This is a primary vision care benefit intended to cover only routine eye examinations and corrective eyewear. Blue View Vision is for routine eye care only. If you need medical treatment for your eyes, visit a participating eye care doctor from your medical network. This information is intended to be a brief outline of coverage. For additional benefit information, including exclusions and limitations or to locate a participating Blue View Vision provider, please contact Member Services. You will be directed to the dedicated Blue View Vision Member Services line. * Any remaining unused eyewear benefit amount must be used in the same calendar year of the first eyewear purchase. Unused amounts cannot carry over to the following calendar year or benefit period. Must use a Blue View Vision provider. $0 copay for routine vision exams $0 copay for eyewear After the plan pays benefits for routine vision exams and eyewear you are responsible for any remaining cost. Routine foot care  Up to four covered visits per year Routine foot care includes the cutting or removal of corns and calluses, the trimming, cutting, clipping or debriding of nails, and other hygienic and preventive maintenance care. $5 copay for each visit to an in-network primary care physician for routine foot care $15 copay for each visit to an in-network specialist for routine foot care After the plan pays benefits for routine foot care, you are responsible for any remaining cost. Annual routine physical exam The annual routine physical exam benefit covers a standard physical exam in addition to the Medicare-covered “Welcome to Medicare” or “Annual Wellness Visit.” $0 copay for an annual physical exam Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Video doctor visits LiveHealth Online lets you see board-certified doctors and licensed therapists, psychologists and psychiatrists through live, two-way video on your smartphone, tablet or computer. It’s easy to get started! You can sign up at livehealthonline.com or download the free LiveHealth Online mobile app and register. Make sure you have your Membership Card ready – you’ll need it to answer some questions. Sign up for Free:  You must enter your health insurance information during enrollment, so have your Membership Card ready when you sign up. Benefits of a video doctor visit:  The visit is just like seeing your regular doctor face-to-face, but just by web camera.  It’s a great option for medical care when your doctor can’t see you. Board-certified doctors can help 24/7 for most types of care and common conditions like the flu, colds, pink eye and more.  The doctor can send prescriptions to the pharmacy of your choice, if needed.1  If you’re feeling stressed, worried or having a tough time, you can make an appointment to talk to a licensed therapist or psychologist from your home or on the road. In most cases, you can make an appointment and talk with a therapist2 or make an appointment and talk with a psychiatrist3 from the privacy of your home. Video doctor visits are intended to complement face-to-face visits with a board-certified physician and are available for most types of care. LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of this Plan. 1. Prescription is prescribed based on physician recommendations and state regulations (rules). 2. Appointments are typically scheduled within 14 days, but may vary based on therapist/psychologist availability. Video psychologists or therapists cannot prescribe medications. 3. Appointments are typically scheduled within 14 days, but may vary based on psychiatrist availability. Video psychiatrists cannot prescribe controlled substances. $0 copay for video doctor visits using LiveHealth Online Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Health and wellness education programs SilverSneakers® Membership SilverSneakers can help you live a healthier, more active life through fitness and social connection. You are covered for a fitness benefit through SilverSneakers at participating locations1. You have access to instructors who lead specially designed group exercise classes2. At participating locations nationwide1, you can take classes2 plus use exercise equipment and other amenities. Additionally, SilverSneakers FLEX® gives you options to get active outside of traditional gyms (like recreation centers, malls and parks). SilverSneakers also connects you to a support network and virtual resources through SilverSneakers Live, SilverSneakers On-DemandTM and our mobile app, SilverSneakers GOTM. At-home kits are offered for members who want to start working out at home or for those who can’t get to a fitness location due to injury, illness or being homebound. All you need to get started is your personal SilverSneakers ID number. Go to SilverSneakers.com to learn more about your benefit or call 1-888-423-4632 (TTY: 711) Monday through Friday, 8 a.m. to 8 p.m. ET. Always talk with your doctor before starting an exercise program. 1. Participating locations (“PL”) are not owned or operated by Tivity Health, Inc. or its affiliates. Use of PL facilities and amenities is limited to terms and conditions of PL basic membership. Facilities and amenities vary by PL. 2. Membership includes SilverSneakers instructor-led group fitness classes. Some locations offer members additional classes. Classes vary by location. SilverSneakers and SilverSneakers FLEX are registered trademarks of Tivity Health, Inc. SilverSneakers On-Demand and SilverSneakers GO are trademarks of Tivity Health, Inc. © 2020 Tivity Health, Inc. All rights reserved. $0 copay for the SilverSneakers fitness benefit Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Nurse helpline Also, as a member, you have access to a 24-hour nurse line, 7 days a week, 365 days a year. When you call our nurse line, you can speak directly to a registered nurse who will help answer your health-related questions. The call is toll free and the service is available anytime, including weekends and holidays. Plus, your call is always confidential. Call the nurse helpline at 1-800- 700-9184. TTY users should call 711. Only the nurse helpline is included in our plan. All other nurse access programs are excluded. $0 copay for nurse helpline Foreign travel emergency and urgently needed services Emergency or urgently needed care services while traveling outside the United States or its territories during a temporary absence of less than six months. Outpatient copay is waived if member is admitted to hospital within 72 hours for the same condition.  Emergency outpatient care  Urgently needed services  Inpatient care (60 days per lifetime) This coverage is worldwide and is limited to what is allowed under the Medicare fee schedule for the services performed/received in the United States. If you are in need of emergency care outside of the United States or its territories, you should call the Blue Cross Blue Shield Global Core Program at 800-810 BLUE or collect at 804-673-1177. Representatives are available 24 hours a day, 7 days a week, 365 days a year to assist you. When you are outside the United States or its territories, this plan provides coverage for emergency/urgent services only. This is a Supplemental Benefit and not a benefit covered under the Federal Medicare program. For more coverage, you may have the option of purchasing additional travel insurance through an authorized agency. $50 copay for emergency care $15 copay for urgently needed services $0 copay per admission for emergency inpatient care Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Medicare Community Resource Support Need help with a specific issue? Although your plan benefits are designed to cover what Medicare would cover, as well as some additional supplemental benefits as described in this benefits chart, you might need additional help. As a member, your plan provides the support of a community resource outreach team to help bridge the gap between your medical benefits and the resources available to you in your community. The Medicare Community Resource Support team will assist you by providing information and education about community-based services and support programs in your area. If you need assistance or have questions about this benefit, call Member Services at the number listed on the back of your Membership Card. $0 copay for Medicare Community Resource Support Healthy Meals*  Provides up to 14 meals per qualifying event, allows up to four (4) events each year (56 meals in total).  A qualifying event includes when you are in a hospital or a skilled nursing facility and are discharged home or when you have a Body Mass Index (BMI) of 18.5 or under, you have a BMI of 25 or higher or an A1C level more than 9.0 as determined by your provider. For fastest qualification, your provider or case manager is best suited to request this on your behalf. Alternatively, you can contact Member Services and a representative will initiate the process to validate your eligibility. In order for us to provide your meals benefit, we, or a third party acting on our behalf, may need to contact you using the phone number you provided to confirm shipping details and any nutritional requirements. $0 copay for Healthy Meals Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Healthy Pantry* Special Supplemental Benefits for the Chronically Ill Maintaining a healthy diet to support a chronic medical condition can help you maintain or improve your overall health. As a Special Supplemental Benefit for the Chronically Ill, you must:  Meet the CMS mandated criteria. This criteria can be found in the Chapter “Medical benefits (what is covered and what you pay)" in your Evidence of Coverage.  Provide supporting documentation from your physician identifying you, as having a condition that can be made worse by not having or would benefit from having nutritional counseling and help with obtaining appropriate pantry items. We can help you obtain this information. We are unable to initiate your benefit without speaking to you. By requesting this benefit you are expressly authorizing us to contact you by telephone. Upon approval you are eligible for:  Monthly nutritional counseling sessions via phone.  A monthly delivery of non-perishable pantry items sent directly to your home. Your monthly box of staples will consist of a variety of non-perishable foods that can vary each month.  Your nutritional consultations will help you utilize these items and provide you with information on how to supplement them with additional food resources. You can contact Member Services on the back of your Membership Card to begin the process to validate your eligibility. $0 copay for Healthy Pantry Y0114_21_124297_I_C 07/22/2020 2021 STD HMO Plan 5 - CA Covered services What you must pay for these covered services Medicare-approved clinical research studies A clinical research study is a way that doctors and scientists test new types of medical care, like how well a new cancer drug works. They test new medical care procedures or drugs by asking for volunteers to help with the study. If you participate in a Medicare-approved study, Original Medicare pays the doctors and other providers for the covered services you receive as part of the study. Although not required, we ask that you notify us if you participate in a Medicare-approved research study. After Original Medicare has paid its share of the Medicare-approved study, this plan will pay the difference between what Medicare has paid and this plan’s cost- sharing for like services. Any remaining plan cost-sharing you are responsible for will accrue toward this plan’s out-of-pocket maximum. Annual out-of-pocket maximum All copays, coinsurance, and deductibles listed in this benefits chart are accrued toward the medical plan out-of-pocket maximum with the exception of routine hearing services, routine vision services, and the foreign travel emergency and urgently needed services copay or coinsurance amounts. Part D prescription drug deductibles and copays do not apply to the medical plan out-of- pocket maximum. $3,000 * Some services that fall within this benefit category require prior authorization. Based on the service you are receiving, your provider will know if prior authorization is needed. This means an approval in advance is needed, by your plan, to get covered services. Benefit categories that include services that require prior authorization are marked with an asterisk in the Benefits Chart. Y0114_21_121505_I_C 03/11/2020 7/1/2020 2021 STD Basic 5/20/50_No Ded_Full Gap_CMAX B3TC (3)_ECDMLP_SG Rx-1 Your 2021 Prescription Drug Benefits Chart Basic 5/20/50 (with Senior Rx Plus) Your retiree drug coverage includes Medicare Part D drug benefits and non-Medicare supplemental drug benefits. The cost shown below is what you pay after all benefits under your retiree drug coverage have been provided. Formulary Basic Deductible None Covered Services What you pay Part D Initial Coverage Below is your payment responsibility until the amount paid by you and the Coverage Gap Discount Program for covered Part D prescriptions reaches your True Out of Pocket limit of $6,550. Retail Pharmacy per 30-day supply (Specialty limited to a 30-day supply) Select Generics $0 copay Generics $5 copay Preferred Brands $20 copay Non-Preferred Drugs, including Specialty Drugs $50 copay Many of our retail pharmacies can dispense more than a 30-day supply of medication. If you purchase more than a 30-day supply at these retail pharmacies, you will need to pay one copay for each full or partial 30-day supply filled. For example, if you order a 90-day supply, you will need to pay three 30-day supply copays. If you get a 45-day or 50-day supply, you will need to pay two 30-day copays. Mail-Order Pharmacy per 90-day supply (Specialty limited to a 30-day supply; 30-day Retail copay or coinsurance applies) Select Generics $0 copay Generics $10 copay Preferred Brands $40 copay Non-Preferred Drugs, including Specialty Drugs $100 copay Y0114_21_121505_I_C 03/11/2020 7/1/2020 2021 STD Basic 5/20/50_No Ded_Full Gap_CMAX B3TC (3)_ECDMLP_SG Rx-2 Covered Services What you pay Part D Catastrophic Coverage Your payment responsibility changes after the cost you and the Coverage Gap Discount Program have paid for covered drugs reaches your True Out of Pocket limit of $6,550. Retail and Mail-Order Pharmacies Up to a 90-day supply (Specialty limited to a 30-day supply) Select Generics $0 copay Generic Drugs 5% coinsurance with a minimum copay of $3.70 and a maximum copay of $5 Brand-Name Drugs 5% coinsurance with a minimum copay of $9.20 and a maximum copay of $20 Vaccines: Medicare covers some vaccines under Medicare Part B medical coverage and other vaccines under Medicare Part D drug coverage. Vaccines for Flu, including H1N1, and Pneumonia are covered under Medicare medical coverage. Vaccines for Chicken Pox, Shingles, Tetanus, Diphtheria, Meningitis, Rabies, Polio, Yellow Fever, and Hepatitis A are covered under Medicare drug coverage. Hepatitis B is covered under drug coverage unless you fall into a high risk category, then it is covered under medical coverage. Other common vaccines are also covered under Medicare drug coverage for Medicare-eligible individuals under 65. You can fill your vaccines at a network pharmacy or they can be administered at a physician’s office. However, the physician will only submit a claim for a Part B vaccine. If you want to get a Part D vaccine at your physician’s office you will pay for the entire cost of the vaccine and its administration and then ask your drug plan to pay its share of the cost. Please see your Evidence of Coverage for complete details on what you pay for vaccines. Senior Rx Plus: Your supplemental drug benefit is non-Medicare coverage that reduces the amount you pay, after your Group Part D benefits and the Coverage Gap Discount. The copay or coinsurance shown in this benefits chart is the amount you pay for covered drugs filled at network pharmacies. Y0114_21_121505_I_C 03/11/2020 7/1/2020 2021 STD Basic 5/20/50_No Ded_Full Gap_CMAX B3TC (3)_ECDMLP_SG Rx-3 Your 2021 Extra Covered Drugs Benefits Chart Covered Services What you pay Extra Covered Drugs These are drugs that are covered by your retiree drug plan that are often excluded from Part D coverage. These drugs are covered by your Senior Rx Plus benefits. Some of these drugs may be required on your retiree drug plan by state regulations. These drugs do not count towards your True Out of Pocket expenses. They do not qualify for lower Catastrophic copays. Retail Pharmacy per 30-day supply Cough and Cold Vitamins and Minerals Erectile Dysfunction (ED) See Drug List for complete list of drugs covered Generics $5 copay Preferred Brands $20 copay Non-Preferred Drugs $50 copay Other Non-Part D Coverage Copay or coinsurance Contraceptive Devices $20 copay per Covered Device Mail-Order Pharmacy per 90-day supply Cough and Cold Vitamins and Minerals Erectile Dysfunction (ED) See Drug List for complete list of drugs covered Generics $10 copay Preferred Brands $40 copay Non-Preferred Drugs $100 copay Other Non-Part D Coverage Copay or coinsurance Contraceptive Devices $20 copay per Covered Device 8/4/2020T.C.1. Featured Plans and Rates - MAPD City of Vernon Effective: January 01, 2021 through December 31, 2021 LPPO $10P High, no deductible HMO $5 LPPO $10P High Plan - No Deductible Basic 5/20/50 ECDMLP Basic 5/20/50 ECDMLP $5/$15/$25 (10R) ECDHLP Standard Standard Custom Members Monthly billed PMPM rates Members Monthly billed PMPM rates Members Monthly billed PMPM rates 29 $184.62 7 $57.48 29 $142.65 $184.62 $57.48 $166.24 Monthly billed PMPM rates Monthly billed PMPM rates Monthly billed PMPM rates $135.76 $135.91 $215.19 $98.17 $98.02 $0.00 $233.93 $233.93 $233.08 Monthly billed PMPM rates Monthly billed PMPM rates Monthly billed PMPM rates $418.55 $291.41 $357.84 $12,138 $2,040 $10,377 $145,655 $24,478 $124,528 Medical Plan Pharmacy Plan Medical Medical Rate Medical PMPM Premium Pharmacy Part D Rate Total Rate Senior Rx Plus Rate Total monthly premium Total annual premium Pharmacy PMPM Premium Total 8/4/2020T.C.2. City of Vernon Assumptions & Conditions Effective 01/01/2021 through 12/31/2021 o Rates and benefits may be revised based on legislative, regulatory or other changes including, but not limited to, CMS guidance effective for the quoted product years. Plan options, such as the Preferred Retail Pharmacy option, and formularies are filed and approved with CMS on an annual basis and could change in January each year. o This quote assumes co-branding (plan sponsor name and/ or logo is allowed on member materials including Medicare Advantage plan quality and health programs). o Participants have Medicare Parts A and B. o Eligibility for coverage for subscribers or their dependents is based on the subscriber meeting their employer's requirements for coverage of retiree medical benefits. o Contracted rates are on a Per-Member-Per-Month (PMPM) basis. Each individual will receive the same equal rate; a two member contract would receive twice the rate; a three member contract would receive triple the rate. o The employer will contribute at least 50% towards the premium. If the contribution strategy does change, Anthem must be notified and reserves the right to re-evaluate its underwriting position. If more than one plan is offered to members, then City of Vernon shall offer Anthem plan coverage to all eligible Members at terms and contribution levels that are no less favorable than those applicable to any other health coverage available through City of Vernon. o This plan may be limited in some states to employers that qualify as a large group within that state. The large group definition varies by state. o The pricing census included a total of 36 retired members, including 1 Medicare eligible, pre-65 retired members. If the enrolled membership differs from the pricing census by more than 10% we reserve the right to review and change the pricing if necessary. o Broker Commissions are excluded. o This quote assumes Anthem will be the exclusive post-65 retiree offering. Furthermore, the quote assumes that Anthem will offer a single plan design. Any additional plan selections will be subject to underwriting consideration. o The employer's eligibility policy does not allow for retirees to enroll in an employer sponsored medical plan if the retiree has previously declined coverage. o This quote is contingent upon the majority of the enrolled membership residing in an adequate network service area. The service area and plan design are subject to CMS approval. o Medical and prescription drug plans must be sold as a package. o Pharmacy benefits are based on a two plan benefit structure: an EGWP plan that covers the standard Part D benefit plan as defined by CMS and the Senior Rx Plus plan that provides the additional drug coverage. City of Vernon Medicare HMO Plan Medicare PPO Plan Exhibits Disclosures City Council Agenda Item Report Agenda Item No. COV-496-2021 Submitted by: Jazmine Hooks Submitting Department: Public Works Meeting Date: February 16, 2021 SUBJECT Extend Purchase Contract with Priority Building Services, LLC for COVID-19 Related Janitorial Services Recommendation: Authorize an extension of the purchase contract with Priority Building Services, LLC to November 17, 2021 for COVID-19 related janitorial services, increasing the original contract amount by $129,480, for a total not-to-exceed contract cost of $233,400. Background: After having been effectively shut down in response to the COVID-19 crisis and declaration of a local emergency, the City of Vernon re-opened City Hall and other City facilities on May 18, 2020. Based on State and County requirements for reopening workplaces, constant cleaning and disinfecting of shared, busy work spaces is required. In an effort to maintain the health and safety of those working in and visiting City facilities, Priority Building Services, LLC. (“Priority”), the City's janitorial contractor, was directed to provide two porters, 5-days per week, each for 10 hours per day to continuously clean and sanitize frequently touched common areas and surfaces such as public counters, lobbies, hallways, kitchens and break rooms, restrooms, and doorknobs. The cost of this additional COVID-19 related janitorial work is $8,660 per month. Additionally, since City staff are stationed at the power plant, Priority was also directed to provide COVID-19 related janitorial work at this location. Priority cleans and sanitizes the Power Plant twice a day, seven days per week, at a rate of $4,560 per month. The cost for the increased level of services at the Power Plant was not initially included in the estimated cost of the original contract. Staff has included this cost into the proposed Priority contract extension not-to-exceed total. Since COVID-19 continues to threaten the health and safety of the public, and additional measures to clean and sanitize common areas on a regular basis are required to mitigate the spread of this disease, staff recommends the City Council authorize the extension of this purchase contract. Staff has flagged Priority's COVID-19 related duties as an item that may qualify for emergency reimbursement from FEMA, and will submit expenditures as such. The City may cancel all or any portion of the contract at any time prior to the delivery of services. Should the need for these COVID-19 related services cease prior to the proposed extension, staff will terminate the contract accordingly. Fiscal Impact: The total not-to-exceed cost for COVID-19 related janitorial services covered by this purchase contract through November 2021 is $233,400 (the original contract amount of $103,920 + the additional $129,480 cost for the extended time period). Funds to cover the contract are available in the 2020-2021 fiscal year budget, and will be included in the 2021-2022 fiscal year budget. Services at City Hall will be expensed to 011.1049.596200 and services at the Power Plant will be expensed to Vernon Public Utilities account 055.8400.596200. Staff will seek reimbursement for COVID-19 related janitorial services, as such services are categorized as emergency related expenditures. Attachments: 1. Purchase Contract No. CS-1211 Priority Building Services City of Vernon Purchase Contract City of Vernon Finance Department Purchasing Division 4305 Santa Fe Avenue Vernon, CA 90058 Phone #: (323) 583-8811 Fax #: (323) 826-1491 Internet Address: www.cityofvernon.org Contract Date Page Buyer: CS-1211 5/14/2020 1 of 4 DANIEL WALL Ship To: CITY OF VERNON 4305 SANTA FE AVE. VERNON, CA 90058 Vendor:Bill To: CITY OF VERNON ATTN: ACCOUNTS PAYABLE 4305 SANTA FE AVE VERNON, CA 90058 PRIORITY BUILDING SERVICES 521 MERCURY LANE BREA, CA 92821 Start Date Completion Date Contract Total 5/18/2020 5/17/2021 $103,920.00 Janitorial/Day Porter Services for 12 months (2) Porters Monday - Friday / 10 hours Monthly Fee $8,660.00 Purchase Contract not to exceed $103,920.00 Important Notice to Vendors: The attached Terms and Conditions of Purchase Order /Contract shall be part of this Purchase Order/Contract. Vendors performing services must indicate acceptance of City Terms and Conditions and return a copy of this acknowledgement to the City prior to performance. Failure to do so will void this Purchase Order/Contract. All shipments, shipping papers, invoices and correspondence must be identified with our Purchase Order/Contract Number. Failure to do so may delay payment processing. Attachments/Appendices are a part of this Order/Contract. Services Vendor Signature DatePrint or Type Name Authorized City Signature Date 5/14/2020 Print or Type Name Carlos R. Fandino Jr. Page 1 of 4 DocuSign Envelope ID: 8AFD1501-601F-4A3E-9952-DAE8AD4E0A7F 05-15-2020Eddie Rocha TERMS AND CONDITIONS OF PURCHASE ORDER/CONTRACT (SERVICES) - CITY OF VERNON This is a government contract. The terms are not changed by any words added by Contractor, nor superseded because of any form used by Contractor in the course of business. Any change in terms must be agreed to by an authorized representative of the City, in writing. Acceptance by the City of goods, materials or services is not an acceptance of Contractor’s other terms. 1. Parties: (a) Purchaser: City of Vernon (“City”); (b) Contractor: as set forth in Purchase Order/Contract (“Contractor”). 2. Contractor agrees to furnish the services described in the Purchase Order /Contract to which this is attached and subject to all terms and conditions of the Purchase Order /Contract, this Attachment to the Purchase Order/Contract, and all other attachments hereto. 3. Contractor agrees to submit all invoices to the address indicated on the Purchase Order/Contract. 4. Contractor agrees to invoice at net prices without federal excise tax or federal fuel tax. 5. Contractor agrees to show on all invoices the name of the department to which services were furnished, whether the invoice covers complete or partial performance, the Purchase Order/Contract number, and any applicable cash discount. 6. Contractor agrees to show applicable sales or use tax as separate items on all invoices. 7. Any item ordered on the face hereof that is listed in the Safety Orders of the California Division of Industrial Safety shall fully comply with the latest revised requirements of said Safety Orders. 8. Unless otherwise specified, all work performed will be subject to final inspection and approval on the site where services are supplied, or, in the event installation of equipment is required, such inspection and approval shall be at a place of installation . The making of periodic payments by City shall not be construed as acceptance of work up to the time of payments. 9. Contractor shall diligently and carefully perform all work required hereunder in a good and workmanlike manner, and shall furnish all labor, supervision, machinery, materials, equipment, and supplies as necessary. 10. Contractor warrants that all work performed under this Purchase Order /Contract shall conform to specifications, drawings, samples, or other descriptions furnished or adopted by City; and all workmanship or service rendered will be in accordance with standards established by City. Contractor agrees that the supplies /services furnished under this Purchase Order /Contract shall be covered by the most favorable commercial warranties the Contractor gives to any customer for such supplies /services, and that the rights and remedies provided herein are in addition to, and do not limit any rights afforded to the City by, and other clause of a Purchase Order/Contract awarded hereunder. 11. Prior to the issuance of the Purchase Order /Contract, Contractor may be required to provide to City evidence of insurance . Failure to maintain the required amounts and types of coverage throughout the duration of services supplied shall constitute a material breach of this Purchase Order/Contract and shall entitle the City to terminate this Purchase Order/Contract. 12. As respects acts, errors, or omissions in the performance of services under this Purchase Order/Contract, the Contractor agrees to indemnify and hold harmless the City, its officers, agents, employees, representatives, and volunteers from and against all claims, demands, defense costs, liability, or consequential damages arising out of the Contractor’s negligent acts, errors, or omissions in the performance of its professional services under the terms of this Purchase Order/Contract or those of Contractor’s subcontractors or anyone for whom Contractor is legally liable. As respects all acts or omissions which do not arise directly out of the performance of services, including but not limited to those acts or omissions normally covered by general and automobile liability insurance, the Contractor agrees to indemnify, defend (at City’s option), and hold harmless the City, it officers, agents, employees, representatives, and volunteers from and against all claims, demands, defense costs liability, or consequential damages arising out of or in connection with the Contractor’s (including Contractor’s employees, representatives, subcontractors or anyone for whom Contractor is legally liable) performance or failure to perform under this Agreement; excepting those which arise out of the sole negligence of City. Page 2 of 4 DocuSign Envelope ID: 8AFD1501-601F-4A3E-9952-DAE8AD4E0A7F 13. Contractor shall indemnify and save harmless City from laborers, mechanics’, and materialmen’s liens upon materials, equipment, work in progress, or the premises on which the work is to be performed. 14. Contractor shall not perform work on City owned property, and shall not commence work or cause materials to be delivered to the job site, until so authorized in writing by the Head of the Department (or designee) for whom the work was ordered. Contractor shall perform all work in such manner as not to interfere with use of premises by City or other contractors . Contractor agrees that there shall be no interruptions of City ’s use except as stated on this Purchase Order/Contract. Contractor shall take all necessary precautions (including those required by City’s safety regulations) to protect the premises and all persons and property thereon from damage or injury and shall assume responsibility for the taking of such precautions by Contractor’s and subcontractor’s employees, agents, licensees, and permittees, and subcontractors. Upon completion of the work, Contractor shall leave the premises clean and free of all tools, equipment, waste material, and rubbish. 15. Contractor certifies and represents that, during the performance of this Purchase Order /Contract, the Contractor and each subcontractor shall adhere to equal opportunity employment practices to assure that applicants and employees are treated equally and are not discriminated against because of their race, religion, color, national origin, ancestry, disability, sex, age, medical condition or marital status. Contractor further agrees that it will not maintain any segregated facilities. 16. Contractor shall obtain a City Business License under the terms and conditions of Vernon City Code, Sections 5.20, et seq., where required. 17. Contractor hereby represents, warrants and certifies that no officer or employee of the Contractor is a director, officer or employee of the City of Vernon, or a member of any boards, commission or committees, except to the extent permitted by law. 18. Contractor shall keep sufficient and accurate records of all costs incurred as they relate to the basis of compensation as outlined on this Purchase Order/Contract. The City, or its authorized auditors or representatives, shall have access to and the right to audit and reproduce any of the Contractor 's records to the extent the City deems necessary to ensure it is receiving all money to which it is entitled under the Purchase Order /Contract and/or is paying the amounts to which Contractor is properly entitled to under the Purchase Order/Contract or for other purposes relating to the Purchase Order /Contract. The Contractor shall maintain and preserve all such records for a period of at least 3 years after the termination of the Purchase Order /Contract. The Vendor shall maintain all such records in the City of Vernon. If not, the Contractor shall, upon request, promptly deliver the records to the City of Vernon or reimburse the City for all reasonable and extra costs incurred in conducting the audit at a location other than the City of Vernon, including, but not limited to, such additional (out of the City) expenses for personnel , salaries, private auditors, travel, lodging, meals and overhead. 19. It is understood that in the performance of any services herein provided, for Contractor shall be, and is, an independent contractor, and is not an agent or employee of City and shall furnish such services in its own manner and method, except as required by this Purchase Order/Contract. Further, Contractor has and shall retain the right to exercise full control over the employment, direction, compensation, and discharge of all persons employed by Contractor in the performance of the services hereunder. Contractor shall be solely responsible for, and shall indemnify, defend, and save City harmless from all matters relating to the payment of its employees, including compliance with social security, withholding and all other wages, salaries, benefits, taxes, exactions, and regulations of any nature whatsoever. Contractor acknowledges that Contractor and any subcontractors, agents or employees are not entitled to any of the benefits or rights afforded employees of City, including, but not limited to, sick leave, vacation leave, holiday pay, Public Employees Retirement System benefits, or health, life, dental, long-term disability or Workers’ Compensation insurance benefits. 20. In case of conflict between the terms of this Purchase Order /Contract and the terms of any other document which is a part of this transaction, the terms of this Purchase Order/Contract shall strictly prevail. 21. Contractor shall not assign or transfer this Purchase Order /Contract or any rights hereunder with out the prior written consent of the City which may be withheld in the City ’s sole discretion. Any unauthorized assignment of transfer shall be null and void and shall constitute a material breach of Contractor of its obligations under this Purchase Order /Contract. All subcontractors shall be approved by City. Contractor agrees to secure proper agreements from all subcontractors necessary to protect City in the same manner as Contractor has herein agreed. Page 3 of 4 DocuSign Envelope ID: 8AFD1501-601F-4A3E-9952-DAE8AD4E0A7F 22. Time is strictly of the essence of this Purchase Order/Contract and each and every covenant, term and provision hereof. 23. In case of default by Contractor, the City reserves the right to procure the goods or services from other sources and to hold the Contractor responsible for any excess costs occasioned to the City thereby. Contractor shall not be held accountable for additional costs incurred due to delay or default as a result of Force Majeure. Contractor must notify the City immediately upon knowing that non-performance or delay will apply to this Purchase Order /Contract as a result of Force Majeure. At that time Contractor is to submit in writing a Recovery Plan for this Purchase Order /Contract. If the Recovery Plan is not acceptable to the City or not received within 10 days of the necessary notification of Force Majeure default, then the City may cancel this Purchase Order/Contract in its entirety at no cost to the City, owing only for goods and services completed to that point. 24. The failure of City to insist upon performance of any provision of this Purchase Order /Contract or to exercise any right or privilege granted to City under this Purchase Order /Contract shall not be construed as waiving any such provisions, and the same shall continue in force. The City’s waiver of any term, condition, breach or default of this Purchase Order /Contract shall not be valid unless set forth in a writing, signed by both parties, and shall not be considered to be a waiver of any other term , condition, default of breach, not of a subsequent breach of the one waived. 25. The provisions of Vernon’s Living Wage Ordinance, Vernon City Code, Sections 2.131, et seq., require that contractors providing labor or services to the City pay employees in accordance with the Ordinance. The provisions of California Labor Code Sections 1770, et seq., regarding the payment of prevailing wages on public works, and related regulations, apply to all City Contracts. In addition, Contractor must be currently registered and qualified (including payment of any required fee) with the State Department of Industrial Relations pursuant to Labor Code section 1725.5. This project is subject to compliance monitoring and enforcement by the State Department of Industrial Relations . If Living Wage provisions and Prevailing Wage provisions should both apply, then contractor shall pay the higher of the applicable wages to the extent required by law. 26. The City reserves the right to cancel any portion of this Purchase Order /Contract at any time prior to the delivery of services. 27. This Purchase Order/Contract shall be deemed a contract and shall be governed by and construed in accordance with the laws of the State of California. Contractor agrees that the State and Federal courts which sit in the State of California shall have exclusive jurisdiction over all controversies and disputes arising hereunder, and submits to the jurisdiction thereof. 28. This Purchase Order/Contract, including any Exhibits attached hereto, constitutes the entire agreement and understanding between the parties regarding its subject matter and supersedes all prior or contemporaneous negotiations, representations, understandings, correspondence, documentation and agreements (written or oral). 29. All additional terms and conditions must be approved as to form by the City Attorney in writing . 30. This Purchase Order/Contract does not and is not intended to confer any benefit on nor create any right exercisable or enforceable by any third party. 31. If any provision of this Purchase Order /Contract shall be determined to be invalid or unenforceable, such provision shall be deemed to be severed and the remainder of the Purchase Order/Contract shall be given full force and effect. Page 4 of 4 DocuSign Envelope ID: 8AFD1501-601F-4A3E-9952-DAE8AD4E0A7F City Council Agenda Item Report Agenda Item No. COV-491-2021 Submitted by: Jazmine Hooks Submitting Department: Public Works Meeting Date: February 16, 2021 SUBJECT Local Government Planning Support Grants Program Recommendation: Adopt Resolution No. 2021-01 approving and authorizing the submittal of an application to the Department of Housing and Community Development for, and receipt of, local government planning support grant program funds. Background: The Department of Housing and Community Development (HCD) has issued a Notice of Funding Availability (NOFA) as part of the Local Early Action Planning (LEAP) Support Grants Program in the amount of $119,040,000 to provide assistance to all California Jurisdictions. The City of Vernon is eligible to receive up to $65,000 of LEAP funds. This funding is provided to jurisdictions for the preparation and adoption of planning documents, process improvements that accelerate housing production, and to facilitate compliance in implementing the sixth cycle of the regional housing needs assessment, as provided by the HCD. The HCD has been an accessible, informative resource for the City, and staff was advised to submit a "placeholder" application by the January 31, 2021 deadline. As such, an incomplete application was delivered to the HCD to ensure that the City would remain eligible and be considered for a grant award in this round of funding. With the adoption of the proposed resolution, the grant application will be complete, and the City will formally submit the application in its entirety to the HCD. Resolution No. 2021-01 will approve and authorize the Director of Public Works to apply for LEAP funding and, if awarded, will allow the Director to enter into, execute, and deliver a Standard Agreement with the State of California and any and all other documents required to evidence and secure the LEAP grant. Fiscal Impact: If the City is awarded a LEAP Program grant, the funding will offset the cost of the Housing Element update currently being performed by The Arroyo Group as part of the Westside Specific Plan Project. Attachments: 1. Resolution No. 2021-01 2. LEAP Application RESOLUTION NO. 2021-01 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF VERNON APPROVING AND AUTHORIZING THE SUBMITTAL OF AN APPLICATION TO THE DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT FOR, AND RECEIPT OF, LOCAL GOVERNMENT PLANNING SUPPORT GRANT PROGRAM FUNDS SECTION 1. Recitals. A.Pursuant to Health and Safety Code 50515 et. seq, the Department of Housing and Community Development (“Department”) is authorized to issue a Notice of Funding Availability (“NOFA”) as part of the Local Government Planning Support Grants Program (hereinafter referred to by the Department as the “Local Early Action Planning, or “LEAP”, Grants program”); and B.The City Council of the City of Vernon desires to submit a LEAP Grant application package (“Application”), on the forms provided by the Department, for approval of grant funding for projects that assist in the preparation and adoption of planning documents and process improvements that accelerate housing production and facilitate compliance to implement the sixth cycle of the regional housing needs assessment; and C.The Department issued a NOFA and Application on January 27, 2020, in the amount of $119,040,000 for assistance to all California jurisdictions. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF VERNON AS FOLLOWS: SECTION 2. The City Council of the City of Vernon hereby finds and determines that the above recitals are true and correct. SECTION 3. The City Council hereby authorizes and directs the Director of Public Works to apply for and submit to the Department the Application package. SECTION 4. In connection with the LEAP grant, if the Application is approved by the Department, the City Council hereby authorizes the Director of Public Works , enter into, execute, and deliver on behalf of the City of Vernon, a State of California Agreement (“Standard Agreement”) for the amount of sixty-five thousand dollars ($65,000.00), and any and all other documents required or deemed necessary or appropriate to evidence and secure the LEAP Grant, the City of Vernon’s obligations related thereto, and all amendments thereto. SECTION 5. The City of Vernon shall be subject to the terms and conditions as specified in the NOFA, and the Standard Agreement provided by the Department after approval. The Application and any and all accompanying documents are incorporated in Resolution No. 2021-01 Page 2 of 2 _______________________ full as part of the Standard Agreement. Any and all activities funded, information provided, and timelines represented in the Application will be enforceable through the fully executed Standard Agreement. Pursuant to the NOFA and in conjunction with the terms of the Standard Agreement, the Applicant hereby agrees to use the funds for eligible uses and allowable expenditures in the manner presented and specifically identified in the approved Application. SECTION 6.The City Clerk shall certify the passage and adoption of this resolution and enter it into the book of original resolutions. APPROVED AND ADOPTED this 16th day of February, 2021. ______________________ LETICIA LOPEZ, Mayor ATTEST: LISA POPE, City Clerk (seal) APPROVED AS TO FORM: _________________________________ ARNOLD M. ALVAREZ-GLASMAN, Interim City Attorney Local Early Action Planning Grant Application State of California Governor Gavin Newsom Alexis Podesta, Secretary Business, Consumer Services and Housing Agency Doug McCauley, Acting Director Department of Housing and Community Development Zachary Olmsted, Deputy Director Department of Housing and Community Development Housing Policy Development 2020 West El Camino, Suite 500 Sacramento, CA 95833 Website: https://www.hcd.ca.gov/grants-funding/active-funding/leap.shtml Email: EarlyActionPlanning@hcd.ca.gov January 27, 2020 LEAP NOFA Application Rev. 6/1/2020 Page 2 of 14 LEAP Application Packaging Instructions The applicant is applying to the Department of Housing and Community Development (Department) for a grant authorized underneath the Local Early Action Planning Grants (LEAP) provisions pursuant to Health and Safety Code Sections 50515 through 50515.05. LEAP provides funding to jurisdictions for the preparation and adoption of planning documents, process improvements that accelerate housing production and facilitate compliance in implementing the sixth cycle of the regional housing need assessment. If you have questions regarding this application or LEAP, email earlyactionplanning@hcd.ca.gov. If approved for funding, the LEAP application is incorporated as part of your Standard Agreement with the Department. In order to be considered for funding, all sections of this application, including attachments and exhibits if required, must be complete and accurate. All applicants must submit a complete, signed, original application package and digital copy on CD or USB flash drive to the Department and postmarked by the specified due date in the NOFA. Applicants will demonstrate consistency with LEAP requirements by utilizing the following forms and manner prescribed in this application. o Pages 3 through 14 constitute the full application (save paper, print only what is needed) o Attachment 1: Project Timeline and Budget: Including high-level tasks, sub-tasks, begin and end dates, budgeted amounts, deliverables, and adoption and implementation dates. o Attachment 2: Nexus to Accelerating Housing Production o Attachment 3: State and Other Planning Priorities o Attachment 4: Required Resolution Template o Government Agency Taxpayer ID Form (available as a download from the LEAP webpage located at https://www.hcd.ca.gov/grants-funding/active-funding/leap.shtml o If the applicant is partnering with another local government or other entity, include a copy of the legally binding agreement; and o Supporting documentation (e.g., letters of support, scope of work, project timelines, etc.) Pursuant to Section XII of the LEAP 2020 Notice of Funding Availability (NOFA), the application package must be postmarked on or before July 1, 2020, and received by the Department at the following address: Department of Housing and Community Development Division of Housing Policy Development 2020 West El Camino Ave, Suite 500 Sacramento, CA 95833 LEAP NOFA Application Rev. 6/1/2020 Page 3 of 14 A. Applicant Information and Certification Applicant (Jurisdiction) City of Vernon Applicant’s Agency Type Municipal government agency Applicant’s Mailing Address 4305 S. Santa Fe Avenue City Vernon State California Zip Code 90058 County Los Angeles Website Cityofvernon.org Authorized Representative Name Daniel Wall Authorized Representative Title Director of Public Works Phone 323-583-8811 Ext. 305 Fax 323-826-1435 Email dwall@ci.vernon.ca.us Contact Person Name Jazmine Hooks Contact Person Title Administrative Analyst Phone 323-583-8811 Ext. 321 Fax 323-826-1435 Email jhooks@ci.vernon.ca.us Proposed Grant Amount $ 65,000 Pursuant to Health and Safety Code Section 50515.03 through (d) of the Guidelines, all applicants must meet the following two requirements to be eligible for an award: 1. Does the application demonstrate a nexus to accelerating housing production as shown in Attachment 2? Yes No 2. Does the application demonstrate that the applicant is consistent with State Planning or Other Priorities shown in Attachment 3? Yes No Is a fully executed resolution included with the application package? Yes No Does the address on the Government Agency Taxpayer ID Form exactly match the address listed above? Yes No Is the applicant partnering with another eligible local government entity? If Yes, provide a fully executed copy of the legally binding agreement. Yes No As the official designated by the governing body, I hereby certify that if approved by HCD for funding through the Local Early Action Planning Program (LEAP), the City of Vernon assumes the responsibilities specified in the Notice of Funding Availability and certifies that the information, statements and other contents contained in this application are true and correct. Signature: Name: Daniel S. Wall Date:1/28/2021 Title: Director of Public Works LEAP NOFA Application Rev. 6/1/2020 Page 4 of 14 B. Proposed Activities Checklist Check all activities the locality is undertaking. Activities must match the project description. 1 Rezoning and encouraging development by updating planning documents and zoning ordinances, such as general plans, community plans, specific plans, implementation of sustainable communities’ strategies, and local coastal programs 2 Completing environmental clearance to eliminate the need for project-specific review 3 Establishing housing incentive zones or other area based housing incentives beyond State Density Bonus Law such as a workforce housing opportunity zone pursuant to Article 10.10 (commencing with Section 65620) of Chapter 3 of Division 1 of Title 7 of the Government Code or a housing sustainability district pursuant to Chapter 11 (commencing with Section 66200) of Division 1 of Title 7 of the Government Code 4 Performing infrastructure planning, including for sewers, water systems, transit, roads, or other public facilities necessary to support new housing and new residents 5 Planning documents to promote development of publicly owned land such as partnering with other local entities to identify and prepare excess or surplus property for residential development 6 Revamping local planning processes to speed up housing production 7 Developing or improving an accessory dwelling unit ordinance in compliance with Section 65852.2 of the Government Code 8 Planning documents for a smaller geography (less than jurisdiction-wide) with a significant impact on housing production including an overlay district, project level specific plan, or development standards modifications proposed for significant areas of a locality, such as corridors, downtown or priority growth areas 9 Rezoning to meet requirements pursuant to Government Code Section 65583(c)(1) and other rezoning efforts to comply with housing element requirements, including Government Code Section 65583.2(c) (AB 1397, Statutes of 2018) 10 Upzoning or other implementation measures to intensify land use patterns in strategic locations such as close proximity to transit, jobs or other amenities 11 Rezoning for multifamily housing in high resource areas (according to Tax Credit Allocation Committee/Housing Community Development Opportunity Area Maps); Establishing Pre-approved architectural and site plans 12 Preparing and adopting housing elements of the general plan that include an implementation component to facilitate compliance with the sixth cycle RHNA 13 Adopting planning documents to coordinate with suballocations under Regional Early Action Planning Grants (REAP) that accommodate the development of housing and infrastructure and accelerate housing production in a way that aligns with state planning priorities, housing, transportation equity and climate goals, including hazard mitigation or climate adaptation 14 Zoning for by-right supportive housing, pursuant to Government Code section 65651 (Chapter 753, Statutes of 2018) 15 Zoning incentives for housing for persons with special needs, including persons with developmental disabilities 16 Planning documents related to carrying out a local or regional housing trust fund 17 Environmental hazard assessments; data collection on permit tracking; feasibility studies, site analysis, or other background studies that are ancillary (e.g., less than 15% of the total grant amount) and part of a proposed activity with a nexus to accelerating housing production 18 Other planning documents or process improvements that demonstrate an increase in housing related planning activities and facilitate accelerating housing production 19 Establishing Prohousing Policies LEAP NOFA Application Rev. 6/1/2020 Page 5 of 14 C. Project Description Provide a description of the project and each activity using the method outlined below, and ensure the narrative speaks to Attachment 1: Project Timeline and Budget. a. Summary of the Project and its impact on accelerating production b. Description of the tasks and major sub-tasks c. Summary of the plans for adoption or implementation Please be succinct and use Appendix A or B if more room is needed. The Housing Element (HE) will be prepared to meet requirements from the state Housing and Community Development Department (HCD). Housing Element law has been strengthened considerably since the previous cycle; and although, the City of Vernon (City) has a very low allocation of housing units due to its unique character, the City seeks to revise its housing goals to align with its other planning efforts. The City has hired a consultant to provide expertise and develop a detailed timeline of work that will enable the prescriptive portions of the Housing Element to be developed based on the development of a Mixed-Use Specific Plan for the City’s west side. This is the ideal opportunity to review the different options available to best accommodate the eight (8) additional housing units prescribed in the City’s RHNA allocation. During the background analysis of the HE updates, our consultants will conduct a document review, evaluate our current HE, and assess housing needs, constraints, and resources for the City of Vernon. Next, consultants will work with various stakeholders to identify potential housing sites in the Mixed-Use Specific Plan, identifying necessary rezoning or General Plan Amendments that may be needed. Among the sites identified, we will specifically identify and discuss sites or types of sites appropriate for housing to serve the area’s unhoused population. The consultant will prepare a programmatic-level analysis of environmental constraints and adequate infrastructure per Government Code Section 65583.2(b)(4). As a result of the previous analyses, our consultant will work with the City to develop goals and policies to clarify the City’s housing vision in balance with the other elements of the General Plan. In addition, our consultant will prepare a matrix displaying the quantitative objectives of the Housing Element by income level and type of housing (i.e. new construction, rehabilitation, or conversion) based on their analysis of sites, implementation resources, and housing programs. The consultant will prepare a draft Housing Element to be reviewed by City staff, the general public, and HCD. Following review by HCD, The consultant will revise the appropriate sections of the HCD Review Draft Housing Element. After adoption, the document will be packaged into a final Housing Element and sent for final certification by HCD. The City will work closely with our consultant to develop materials that include information about the Housing Element. Next, they will lead a study session with the Vernon City Council to familiarize decision-makers with the requirements and potential recommendations of the Housing Element and receive feedback. We will also conduct at least one (1) public hearing on the intended HE updates. We will also prepare a focused General Plan Amendment that will ensure compliance between the Mixed-Use Specific Plan, Housing Element and City’s General Plan. We anticipate minor changes to the General Plan Land Use Element, Circulation Element and other adopted elements. (Continued on Appendix A) LEAP NOFA Application Rev. 6/1/2020 Page 6 of 14 D. Legislative Information District # Legislator Name Federal Congressional District 40 Lucille Roybal-Allard State Assembly District 53 Miguel Santiago State Senate District 33 Lena Gonzalez Applicants can find their respective State Senate representatives at https://www.senate.ca.gov/, and their respective State Assembly representatives at https://www.assembly.ca.gov/. Attachment 1: Project Timeline and Budget: (if more room is needed, duplicate Attachment 1 or add attachment labeled Attachment 1A) Task Est. Cost Begin End Deliverable Notes Background analysis $17,460 October 2020 December 2020 Data request to City staff; review of the past performance matrix; text and tables for Administrative draft of the Housing Element. Site inventory and analysis $10,300 January 2021 March 2021 Review past performance matrix. Goals, policies, and programs $7,610 January 2021 March 2021 Develop goals and policies to clarify the City’s housing vision. Housing Element updates $7,740 April 2021 June 2021 Administrative-, Public Review-, and HCD Review Draft Housing Element; transmittal letter; Completeness Review Checklist; final Housing Element. Community engagement 6,390 October 2020 September 2021 Developer interview summary; one (1) study session with a presentation; one (1) City Council Public Hearing with a presentation. Housing Element adoption $0 July 2021 September 2021 Adopt Housing Element at City Council meeting. General Plan amendment introduction/history $1,020 October 2020 March 2021 History of Vernon land use and General Plans. Land Use Element update $2,880 April 2021 June 2021 Add new land use category or overlay district; update land use maps; add and refine goals and policies of Land Use Element. Circulation and Infrastructure Element update $3,790 April 2021 June 2021 Propose changes to street classifications as required by the Mixed-Use Specific Plan; update Circulation Element to include multimodal circulation needs. General Plan amendment $2,310 April 2021 June 2021 Administrative-, Public Review-, and City Council draft General Plan Amendment; final General Plan Amendment. General Plan amendment adoption $0 July 2021 September 2021 Adopt General Plan amendments at City Council meeting. Hire COG staff position on LEAP subject matter $650 July 1, 2020 June 30, 2021 Onboarding contract with staff hired. See COG JPA attachment. Housing Element Implementation $1,100 September 2021 Ongoing Project administration $3,250 January 2021 September 2021 Submit requirements to HCD timely. Total Projected Cost $ $65,000 Include high-level tasks, major sub-tasks (Drafting, Outreach, Public Hearings and Adoption), budget amounts, begin and end dates and deliverables. If other funding is used, please note the source and amount in the Notes section. LEAP NOFA Application Rev. 6/1/2020 Page 7 of 14 LEAP NOFA Application Rev. 6/1/2020 Page 8 of 14 Attachment 2: Application Nexus to Accelerating Housing Production Applicants shall demonstrate how the application includes a nexus to accelerating housing production by providing data regarding current baseline conditions and projected outcomes such as a reduction in timing, lower development costs, increased approval certainty, increases in number of entitlements, more feasibility, or increases in capacity. An expected outcome should be provided for each proposed deliverable. If necessary, use Appendix B to explain the activity and its nexus to accelerating housing production. Select at least one *Baseline **Projected ***Difference Notes Timing (e.g., reduced number of processing days) Development cost (e.g., land, fees, financing, construction costs per unit) Approval certainty and reduction in discretionary review (e.g., prior versus proposed standard and level of discretion) Entitlement streamlining (e.g., number of approvals) Feasibility of development Infrastructure capacity (e.g., number of units) 60 units 70 units +10 units 8 additional units are prescribed in the City’s RHNA allocation Impact on housing supply and affordability (e.g., number of units) * Baseline – Current conditions in the jurisdiction (e.g. 6-month development application review, or existing number of units in a planning area) **Projected – Expected conditions in the jurisdiction because of the planning grant actions (e.g. 2-month development application review) ***Difference – Potential change resulting from the planning grant actions (e.g., 4-month acceleration in permitting, creating a more expedient development process) LEAP NOFA Application Rev. 6/1/2020 Page 9 of 14 Attachment 3: State and Other Planning Priorities Certification (Page 1 of 3) Applicants must demonstrate that the locality is consistent with State Planning or Other Planning Priorities by selecting from the list below activities that are proposed as part of this application or were completed within the last five years. Briefly summarize the activity and insert a date of completion. State Planning Priorities Date of Completion Brief Description of the Action Taken Promote Infill and Equity Rehabilitating, maintaining, and improving existing infrastructure that supports infill development and appropriate reuse and redevelopment of previously developed, underutilized land that is presently served by transit, streets, water, sewer, and other essential services, particularly in underserved areas. Seek or utilize funding or support strategies to facilitate opportunities for infill development. Other (describe how this meets subarea objective) Promote Resource Protection Protecting, preserving, and enhancing the state’s most valuable natural resources, including working landscapes such as farm, range, and forest lands; natural lands such as wetlands, watersheds, wildlife habitats, and other wildlands; recreation lands such as parks, trails, greenbelts, and other open space; and landscapes with locally unique features and areas identified by the state as deserving special protection. Actively seek a variety of funding opportunities to promote resource protection in underserved communities. Currently Staff are currently applying for the 2020 Growth Award with the Arbor Day Foundation. Other (describe how this meets subarea objective) Encourage Efficient Development Patterns Ensuring that any infrastructure associated with development, other than infill development, supports new development that does the following: (1) Uses land efficiently. September 2021 Our consultant will make recommendations as to how to best protect, upgrade, or abandon the existing infrastructure facilities that feed the Specific Plan area. LEAP NOFA Application Rev. 6/1/2020 Page 10 of 14 Attachment 3: State and Other Planning Priorities Certification (Page 2 of 3) (2) Is built adjacent to existing developed areas to the extent consistent with environmental protection. (3) Is located in an area appropriately planned for growth. (4) Is served by adequate transportation and other essential utilities and services. (5) Minimizes ongoing costs to taxpayers. Other (describe how this meets subarea objective) Other Planning Priorities Affordability and Housing Choices Incentives and other mechanisms beyond State Density Bonus Law to encourage housing with affordability terms. Efforts beyond state law to promote accessory dwelling units or other strategies to intensify single- family neighborhoods with more housing choices and affordability. Upzoning or other zoning modifications to promote a variety of housing choices and densities. Utilizing surplus lands to promote affordable housing choices. Efforts to address infrastructure deficiencies in disadvantaged communities pursuant to Government Code Section 65302.10. Other (describe how this meets subarea objective) LEAP NOFA Application Rev. 6/1/2020 Page 11 of 14 Attachment 3: State and Other Planning Priorities Certification (Page 3 of 3) Conservation of Existing Affordable Housing Stock Policies, programs or ordinances to conserve stock such as an at-risk preservation ordinance, mobilehome park overlay zone, condominium conversion ordinance and acquisition and rehabilitation of market rate housing programs. Policies, programs and ordinances to protect and support tenants such as rent stabilization, anti- displacement strategies, first right of refusal policies, resources to assist tenant organization and education and “just cause” eviction policies. 12/12/2018 The Vernon Housing Commission enacted policies to limit rent increases to the lesser of the Consumer Price Index for the region or 3% and to limit the initial rental rate of vacated units to HUD’s Fair Market Rate for Vernon. Other (describe how this meets subarea objective) Climate Adaptation Building standards, zoning and site planning requirements that address flood and fire safety, climate adaptation and hazard mitigation. 11/5/2019 Vernon adopted code amendments to the 2019 editions of the California Building Code, California Residential Code, and the California Green Building Standards to address hazard mitigation. Long-term planning that addresses wildfire, land use for disadvantaged communities, and flood and local hazard mitigation. Community engagement that provides information and consultation through a variety of methods such as meetings, workshops, and surveys and that focuses on vulnerable populations (e.g., seniors, people with disabilities, homeless, etc.). Other (describe how this meets subarea objective) Certification: I certify under penalty of perjury that all information contained in this LEAP State Planning and Other Planning Priorities certification form (Attachment 2) is true and correct. Certifying Officials Name: Daniel Wall Certifying Official’s Title: Director of Public Works Certifying Official’s Signature: Date: January 28, 2021 LEAP NOFA Application Rev. 6/1/2020 Page 12 of 14 Attachment 4: Required Resolution Template RESOLUTION NO. [insert resolution number] WHEREAS, pursuant to Health and Safety Code 50515 et. Seq, the Department of Housing and Community Development (Department) is authorized to issue a Notice of Funding Availability (NOFA) as part of the Local Government Planning Support Grants Program (hereinafter referred to by the Department as the Local Early Action Planning Grants program or LEAP); and WHEREAS, the City Council of City of Vernon desires to submit a LEAP grant application package (“Application”), on the forms provided by the Department, for approval of grant funding for projects that assist in the preparation and adoption of planning documents and process improvements that accelerate housing production and facilitate compliance to implement the sixth cycle of the regional housing need assessment; and WHEREAS, the Department has issued a NOFA and Application on January 27, 2020 in the amount of $119,040,000 for assistance to all California Jurisdictions; Now, therefore, the City Council of City of Vernon (“Applicant”) resolves as follows: SECTION 1. The Director of Public Works is hereby authorized and directed to apply for and submit to the Department the Application package; SECTION 2. In connection with the LEAP grant, if the Application is approved by the Department, the Director of Public Works of the City of Vernon is authorized to submit the Application, enter into, execute, and deliver on behalf of the Applicant, a State of California Agreement (Standard Agreement) for the amount of sixty-five thousand dollars, and any and all other documents required or deemed necessary or appropriate to evidence and secure the LEAP grant, the Applicant’s obligations related thereto, and all amendments thereto; and SECTION 3. The Applicant shall be subject to the terms and conditions as specified in the NOFA, and the Standard Agreement provided by the Department after approval. The Application and any and all accompanying documents are incorporated in full as part of the Standard Agreement. Any and all activities funded, information provided, and timelines represented in the Application will be enforceable through the fully executed Standard Agreement. Pursuant to the NOFA and in conjunction with the terms of the Standard Agreement, the Applicant hereby agrees to use the funds for eligible uses and allowable expenditures in the manner presented and specifically identified in the approved Application. ADOPTED ON [insert the date of adoption], by the City Council of City of Vernon by the following vote count: AYES: NOES: ABSENT: ABSTAIN: ATTEST: APPROVED AS TO FORM: [Signature of Attesting Officer] APPROVED [Signature of approval] LEAP NOFA Application Rev. 6/1/2020 Page 13 of 14 Appendix A (Continued) The City of Vernon is located in the Gateway Cities region of Southeast Los Angeles County. The Gateway Cities are a collection of 27 cities and various unincorporated communities with a population of 2.1 million people, including 16 cities with a higher population density than the City of Los Angeles. Housing expertise is needed at the regional level to help reconcile state policies and priorities with local jurisdiction concerns, identify and remove barriers to housing development, and assist cities in meeting housing production goals for the 6th cycle. In recognition of these needs, the City of Vernon will allocate 1% of its maximum eligible LEAP funds to the Gateway Cities Council of Governments (GCCOG), a Joint Powers Authority of the Gateway Cities region, to help continue the regional housing planning efforts begun in 2019 by a similar allocation of SB2 Planning Grant funds. Funding will pay for a COG staff member to focus solely on helping cities accelerate housing production, by organizing region-wide housing workshops, creating shared informational resources, and identifying and promoting best practices from inside and outside the region. The funded COG staff position provides necessary housing expertise, and helps Gateway Cities staff better understand affordable housing production, tax credits, land acquisition policies and practices, options for funding, and other relevant topics related to planning and process improvements to accelerate housing production and facilitate compliance with the 6th cycle housing element. Please see the Joint Powers Agreement supporting the establishment of the COG attached to this application. EXECUTION COPY JOINT EXERCISE OF POWERS AGREEMENT OF THE GATEWAY CITIES COUNCIL OF GOVERNMENTS (A JOINT POWERS AUTHORITY) October 2007 EXECUTION COPY TABLE OF CONTENTS PAGE Section 1. Recitals………………………………………………………………………1 Section 2. Creation of Separate Legal Entity………………………………………...2 Section 3. Name…………………………………………………………………………2 Section 4. Purpose and Powers of the Council………………………………………2 A. Purpose of Council……………………………………...2 B. Common Powers………………………………………..2 C. Exercise of Powers……………………………………...4 D. Restrictions on Exercise of Powers…………………...4 Section 5. Creation of Board of Directors…………………………………………….5 A. Designation of Board of Directors Representatives…5 B. Designation of Alternate Board Representatives……5 C. Eligibility………………………………………………….5 Section 6. Use of Public Funds and Property………………………………………..5 Section 7. Functioning of Board of Directors…………………………………………6 A. Voting and Participation………………………………...6 B. Proxy Voting……………………………………………..6 C. Quorum…………………………………………………..6 D. Committees……………………………………………...6 E. Actions……………………………………………………6 -i- EXECUTION COPY Section 8. Duties of the Board of Directors…………………………………………..6 Section 9. Roberts Rules of Orders…………………………………………………...6 Section 10. Meetings of Board of Directors…………………………………………..7 Section 11. Election of President and Vice-President……………………………….7 Section 12. Creation of Executive Committee of Board of Directors………………7 Section 13. Executive Director…………………………………………………………7 Section 14. Creation of City Managers Policy Advisory Committee……………….8 A. Designation of City Managers Policy Advisory Committee Representatives……………………………8 B. Eligibility…………………………………………………..8 Section 15. Creation of City Managers Policy Advisory Steering Committee…….8 A. Designation of Southeast Los Angeles County City Managers Group Chair…………………………….8 B. Election of Additional City Managers Policy Advisory Steering Committee Members……………….8 Section 16. Designation of Treasurer and Auditor……………………………………9 Section 17. Council of Treasurer and Council Auditor……………………………….9 Section 18. Designation of Other Officers and Employees………………………….9 Section 19. Obligations of Council……………………………………………………..9 Section 20. Control and Investment of Council Funds………………………………9 Section 21. Implementation Agreements……………………………………………..9 -ii- EXECUTION COPY Section 22. Term…………………………………………………………………………9 Section 23. Application of Laws to Council Functions……………………………...10 Section 24. Members…………………………………………………………………..10 A. Withdrawal………………………………………………………10 B. Non-Payment of Dues…………………………………………10 C. Admitting Eligible Members…………………………………...11 D. Admitting New Members………………………………………11 Section 25. Interface With Function of Members……………………………………11 Section 26. Dues of Members…………………………………………………………11 Section 27. Disposition of Assets……………………………………………………..11 Section 28. Amendment……………………………………………………………….11 Section 29. Effective Date…………………………………………………………….11 -iii- EXECUTION COPY 1 JOINT EXERCISE OF POWERS AGREEMENT OF THE GATEWAY CITIES COUNCIL OF GOVERNMENTS (A JOINT POWERS AUTHORITY) This Joint Exercise of Powers Agreement of the Gateway Cities Council of Governments (“Agreement”) is made and entered into by and between the public entities (collectively, “Members”) whose names are set forth on Exhibit A, attached hereto and incorporated herein by this reference, pursuant to Section 6500 et seq. of the Government Code and other applicable law: W I T N E S S E T H: The parties hereto do agree as follows: Section 1. Recitals. This Agreement is made and entered into with respect to the following facts: A. Historically, the cities in Southeast Los Angeles County have worked together on an as needed basis to address area wide problems and issues, ranging from flood control, groundwater contamination, transportation, solid waste, air quality and through numerous professional groupings of city officials to address legislative changes and other issues. However, the growing need for the cities in Southeast Los Angeles County to develop and implement their own sub-regional policies and plans and voluntarily and cooperatively resolve differences among themselves requires a more representative and formal structure. B. There is further a growing need for the cities in Southeast Los Angeles County to involve the unincorporated areas of Los Angeles County (the “County”) located in the Southeast Los Angeles County in the development and implementation of sub-regional policies and plans and in the voluntary and cooperative resolution of differences between the cities and the unincorporated areas. C. The public interest requires a joint powers agency to conduct studies and projects designed to improve and coordinate the common governmental responsibilities and services on an area-wide and sub-regional basis through the establishment of a council of governments; D. The public interest requires that an agency explore areas of intergovernmental cooperation and coordination of government programs and provide recommendations and solutions to problems of common and general concern to its Members; EXECUTION COPY 2 E. The public interest requires that an agency with the aforementioned goals not possess the authority to compel any of its members to conduct any activities or implement any plans or strategies that they do not wish to undertake (except for the payment of dues); F. Each Member is a governmental entity established by law with full powers of government in legislative, administrative, financial, and other related fields; G. Each Member, by and through its legislative body, has determined that a sub-regional organization to assist in planning and voluntary coordination among the cities in Southeast Los Angeles County is required in furtherance of the public interest, necessity and convenience; and H. Each Member, by and through its legislative body, has independently determined that the public interest, convenience and necessity requires the execution of this Agreement by and on behalf of each such Member. Section 2. Creation of Separate Legal Entity. It is the intention of the Members to create, by means of this Agreement, a separate legal entity within the meaning of Section 6503.5 of the Government Code. Accordingly, there is hereby created a separate legal entity which shall exercise its power in accordance with the provisions of this Agreement and applicable law. Section 3. Name. The name of the said separate legal entity shall be the Gateway Cities Council of Governments (“Council”). Section 4. Purpose and Powers of the Council. A. Purpose of Council. The purpose of the creation of the Council is to provide a vehicle for the Members to voluntarily engage in regional and cooperative planning and coordination of government services and responsibilities to assist the Members in the conduct of their affairs. It is the clear intent among cities that the Council shall not possess the authority to compel any of its members to conduct any activities or implement any plans or strategies that they do not wish to undertake (except for the payment of dues). The goal and intent of the Council is one of voluntary cooperation among cities for the collective benefit of cities in Southeast Los Angeles County. B. Common Powers. The Council shall have, and may exercise, the following powers: (1) Serve as an advocate in representing the Members of the Gateway Cities Council of Governments at the regional, state and federal levels on issues of importance to Southeast Los Angeles County; EXECUTION COPY 3 (2) Serve as a forum for the review, consideration, study, development and recommendation of public policies and plans with regional significance, including but not limited to the following: (a) Promote the economic development of the sub-region by maximizing the sub-region’s competitive advantage, to overcome influences that are eroding the sub-region’s economy and to work cooperatively with the private sector; (b) Assume responsibility for the sub-regional transportation planning process, to advocate for maximum public sector funding for the sub-region’s transportation needs, to create an open process for determining the sub-region’s transportation priorities, to elevate the decision making process to the elected officials upon the recommendations of the City Managers of the sub-region; (c) To be sufficiently involved in the activities of the South Coast Air Quality Management District so as to respond to District Actions affecting the best interests of the members of the Council of Governments; (d) To be sufficiently involved in the oversight and management of the data base of the sub-region, including but not limited to the areas of population, employment, and housing so as to avoid manipulation of the data base by others that is not in the best interest of the sub-region; and to strive for accurate and true measures of the needs of the sub-region when judged on a statistical measure for funding, representation or any other purpose; (e) To perform the Southern California Association of Governments (SCAG) sub-regional planning process; (f) Work with the sub-region’s State and federal elected representatives for the benefit of the members of the Council of Governments; (g) Seek to maximize and protect the sub-region’s fair share of all State and Federal funding; EXECUTION COPY 4 (h) Serve as a mechanism for obtaining state, federal or regional grants to assist in financing the expenditures of the Council of Governments; (3) Assist in resolving conflicts among the cities in Southeast Los Angeles County as they work to achieve common goals; (4) Explore practical areas for voluntary intergovernmental cooperation in improving the administration or efficiency in the delivery of government services; (5) Work toward building consensus among the cities of Southeast Los Angeles County as they strive for common goals for themselves or the sub-region; (6) Make and enter into contracts, including contracts for the services of engineers, consultants, planners, attorneys, and single purpose public or private groups; (7) Employ agents, officers and employees; (8) Apply for, receive and administer a grant or grants under any federal, state or regional programs; (9) Receive gifts, contributions and donations of property, funds, services and other forms of financial assistance from person, firms, corporations and any governmental entity; (10) Lease, manage, maintain, and operate any buildings, works or improvements, and (11) Delegate some or all of its powers to the Executive Director as hereinafter provided. C. Exercise of Powers. The Council shall, in addition, have all implied powers necessary to perform its functions. It shall exercise its powers only in a manner consistent with the provisions of applicable law, this Agreement and the Bylaws. D. Restrictions on Exercise of Powers. In accordance with Government Code Section 6509, the powers of the Council shall be exercised in the manner prescribed in the Joint Exercise of Powers Act, Government Code Sections 6500 et seq., as EXECUTION COPY 5 that Act now exists and may hereafter be amended, and shall be subject to the restrictions upon the manner of exercising such powers that are imposed upon the City of Paramount, a general law city, in the exercise of similar powers, provided, however, that if the City of Paramount shall cease to be a member, then the Council shall be restricted in the exercise of its power in the same manner as the City of Pico Rivera, a general law city. Section 5. Creation of Board of Directors. There is hereby created a Board of Directors for the Council (“Board”) to conduct the affairs of the Council. The Board shall be constituted as follows: A. Designation of the Board of Directors Representatives. Except with regard to the County, one person shall be designated as a representative of the Board of Directors by the legislative body of each of the Members (“Board Representative”). The County, in its sole discretion, but subject to the requirement that it shall pay dues and assume all obligations under this Agreement in proportion to the number of its Representatives, shall have one, two or three Board Representatives. The Board Representative(s) for the County shall reside in and/or represent one of the First, Second or Fourth Supervisorial Districts and shall be selected by the respective County Supervisor for said District. The Mayor of the City of Long Beach shall be a Board Representative in addition to one person designated by the city’s legislative body. B. Designation of Alternate Board Representatives. Except with regard to the County, one person shall be designated as an alternate representative of the Board by the legislative body of each of the Members (“Alternate Board Representative”). The County shall have one, two or three Alternate Board Representatives, each acting as an alternate for only one of the First, Second and/or Fourth Supervisorial Districts. The Alternate Board Representative(s) for the County shall be selected by the respective County Supervisor(s) for the First, Second or Fourth Supervisorial Districts and shall reside in and/or represent that same Supervisorial District. C. Eligibility. No person shall be eligible to serve as a Board Representative or an Alternate Board Representative unless that person is, at all times during the tenure of that person as a Board Representative or Alternate Board Representative, a member of the legislative body of one of the appointing Members. Should any person serving on the Board fail to maintain the status as required by this Section 5, that person’s position on the Board shall be deemed vacated as of the date such person ceases to qualify pursuant to the provisions of this Section 5 and the Member shall be entitled to appoint a qualified replacement. Section 6. Use of Public Funds and Property. The Council shall be empowered to utilize for its purposes, public and/or private funds, property and other resources received from the Members and/or from other sources. Subject to the approval of the Board of Directors of the Council, the Members shall participate in the EXECUTION COPY 6 funding of the Council in such a manner as the Board shall prescribe, subject to the provisions of Section 26 of this Agreement. Where applicable, the Board of the Council may permit one or more of the Members to provide in kind services, including the use of property, in lieu of devoting cash to the funding of the Council’s activities. Section 7. Functioning of Board of Directors. A. Voting and Participation. Each Member may cast only one vote for each issue before the Board through its representatives. An Alternate Board Representative may participate or vote in the proceedings of the Board only in the absence of that Member’s Board Representative. Board Representatives and Alternate Board Representatives seated on the Board of Directors shall be entitled to participate and vote on matters pending before the Board only if such person is physically present at the meeting of the Board of Directors and if the Member which that Board Representative or Alternate Board Representative represents has timely and fully paid dues as required by this Agreement and the Bylaws. B. Proxy Voting. No absentee ballot or proxy shall be permitted. C. Quorum. A quorum of the Board of Directors shall consist of not less than fifty percent (50%) plus one (1) of its total voting membership. D. Committees. As needed, the Board may create permanent or ad hoc advisory committees to give advice to the Board of Directors on such matters as may be referred to such committee by the Board. All committees shall have a stated purpose before they are formed. Such a committee shall remain in existence until it is dissolved by the Board. Qualified persons shall be appointed to such committees by the Board and each such appointee shall serve at the pleasure of the Board. Committees, unless otherwise provided by law, this Agreement, the Bylaws or by direction of the Board, may be composed of representatives to the Board and non-representatives to the Board. E. Actions. Actions taken by the Board shall be by not less than fifty percent (50%) plus one (1) of the voting representatives of the Board which are present with a quorum in attendance, unless by a provision of applicable law, this Agreement, the Bylaws or by direction of the Board of Directors, a higher number of votes is required to carry a particular motion. Section 8. Duties of the Board of Directors. The Board shall be deemed, for all purposes, the policy making body of the Council. All of the powers of the Council, except as may be expressly delegated to others pursuant to the provisions of applicable law, this Agreement, the Bylaws or by direction of the Board, shall be exercised by and through the Board. Section 9. Roberts Rules of Order. The substance of Roberts Rules of Order shall apply to proceedings of the Board, except as may otherwise be provided by provisions of applicable law, this Agreement, the Bylaws or by direction of the Board. EXECUTION COPY 7 Section 10. Meetings of Board of Directors. The Board shall, by means of the adoption of Bylaws, establish the dates and times of regular meetings of the Board. The location of each such meeting shall be as directed by the Board. Section 11. Election of President and Vice-President. The President shall be the chairperson of the Board, shall conduct all meetings of the Board and perform such other duties and functions as required of such person by provisions of applicable law, this Agreement, the Bylaws or by the direction of the Board. The Vice-President shall serve as chairperson in the absence of the President and shall perform such duties as may be required by provisions of applicable law, this Agreement, the Bylaws, or by the direction of the Board or the President. At the first regular meeting of the Board, a Board Representative shall be elected to the position of Chair by the Board, and a different Board Representative shall be elected to the position of Vice-Chair of the Board. The terms of office of the Chair and Vice-Chair elected at the first regular meeting of the Board shall expire at the regular meeting of the Board held in June 1998, or upon election of replacements. Thereafter, a Board Representative shall be elected annually to the position of President, and a different Board Representative shall be elected to the position of Vice-President of the Board at the regular meeting of the Board held in June of each calendar year. Thereafter the terms of office of the President and Vice-President shall commence and expire at the regular meeting of the Board held in June of each calendar year. If there is a vacancy, for any reason, in the position of President or Vice- President, the Board shall forthwith conduct an election and fill such vacancy for the unexpired term of such prior incumbent. Section 12. Creation of Executive Committee of the Board of Directors. A. An Executive Committee of the Board of Directors (“Executive Committee”) is created to act on behalf of the Board of Directors, between meetings of the Board, within the scope of the adopted budget and within basic policies of the Board. B. Members of the Executive Committee shall be the President, First Vice- President, Second Vice President and Immediate Past President of the Board of Directors and shall serve as the President, First Vice-President, Second Vice President and Immediate Past President of the Executive Committee. Eight additional Board representatives shall be elected by the Board of Directors from city Members to serve as members of the Executive Committee. Additional positions on the Executive Committee shall be the Mayor of the City of Long Beach and one, two or three members of the Board of Supervisors of the County of Los Angeles, as selected by the Board of Supervisors of the County of Los Angeles. The Board of Directors shall encourage geographic equity with respect to Executive Committee membership. Section 13. Executive Director. The Executive Committee shall appoint an Executive Director upon concurrence by fifty percent (50%) plus one (1) of the total voting membership of the Board of Directors, a qualified person to be Executive Director on any basis the Executive Committee desires including, but not limited to, a contract or EXECUTION COPY 8 employee basis. The Executive Director shall be neither a Board Representative, nor an Alternate Board Representative, nor an elected official of any Eligible Public Entity (as defined in Section 24(c) of this Agreement). The Executive Director shall be the chief administrative officer of the Board. The Executive Director shall receive such compensation as may be fixed by the Executive Committee with the concurrence of the Board of Directors. The Executive Director shall serve at the pleasure of the Board of Directors and may be relieved from such position at any time, without cause, by a vote of fifty percent (50%) plus one (1) of the total voting membership of the Board of Directors taken at a regular, adjourned regular or special meeting of the Board. The Executive Director shall perform such duties as may be imposed upon that person by provisions of applicable law, this Agreement, the Bylaws, or by the direction of the Executive Committee. Section 14. Creation of City Managers Policy Advisory Committee. There is hereby created a City Managers Policy Advisory Committee (“Policy Advisory Committee”) to advise the Board. The Policy Advisory Committee shall be constituted as follows: A. Designation of City Managers Advisory Committee Representatives. The City Manager (or person holding the equivalent position, which position differs only in title) of each of the Members shall be designated as a representative of the City Managers Policy Advisory Committee (“Policy Advisory Committee Representative”) B. Eligibility. No person shall be eligible to serve as a Policy Advisory Committee Representative unless that person is, at all times during the tenure of that person as a Policy Advisory Committee Representative, a city manager (or a person holding the equivalent position, which position differs only in title) of one of the appointing Members. Should any person serving on the Policy Advisory Committee fail to maintain the status as required by this Section 14, that person’s position on the Policy Advisory Committee shall be deemed vacated as of the date such person ceases to qualify pursuant to the provisions of this Section 14 and the Member shall be entitled to appoint a qualified replacement. Section 15. Creation of City Managers Policy Advisory Steering Committee. There is hereby created a City Managers Policy Advisory Steering Committee (“Steering Committee”) to advise the Executive Committee. The Steering Committee shall be constituted as follows: A. Designation of Southeast Los Angeles County City Managers Group Chair. The Chair of the Southeast Los Angeles County (“SELAC”) City Managers Group shall be a member of the Steering Committee regardless if he or she is employed by a city that is not a Member of the Council. B. Election of Additional City Managers Policy Advisory Steering Committee Members. Five additional Policy Advisory Committee EXECUTION COPY 9 Representatives shall be elected by the Policy Advisory Committee to serve as members of the Steering Committee. Section 16. Designation of Treasurer and Auditor. The Board of Directors shall, in accordance with applicable law, designate a qualified person to act as the Treasurer for the Council and a qualified person to act as the Auditor of the Council. The compensation, if any, of a person or persons holding the offices of Treasurer and/or Auditor shall be set by the Board of Directors. Section 17. Council Treasurer and Council Auditor. The person holding the position of Treasurer of the Council shall have charge of the depositing and custody of all funds held by the Council. The Treasurer shall perform such other duties as may be imposed by provisions of applicable law, including those duties described in Section 6505.5 of the Government Code, and such duties as may be required by the Board of Directors. The Council’s Auditor shall perform such functions as may be required by provisions of applicable law, this Agreement, the Bylaws and by the direction of the Board of Directors. Section 18. Designation of Other Officers and Employees. The Board may employ such other officers or employees as it deems appropriate and necessary to conduct the affairs of the Council. Section 19. Obligations of Council. The debts, liabilities and obligations of the Council shall be the debts, liabilities or obligations of the Council alone. No Member of the Council shall be responsible, directly or indirectly, for any obligation, debt or liability of the Council, whatsoever. Section 20. Control and Investment of Council Funds. The Board of Directors shall adopt a policy for the control and investment of its funds and shall require strict compliance with such policy. The policy shall comply, in all respects, with all provisions of applicable law. Section 21. Implementation Agreements. When authorized by the Board of Directors, affected Members may execute an Implementation Agreement for the purpose of authorizing the Council to implement, manage and administer area-wide and regional programs in the interest of the local public welfare. The costs incurred by the Council in implementing a program, including indirect costs, shall be assessed only to those Members who are parties to that Implementation Agreement. Section 22. Term. The Council created pursuant to this Agreement shall continue in existence until such time as this Agreement is terminated. This Agreement may not be terminated except by an affirmative vote of not less than fifty percent (50%) plus one (1) of the then total voting membership of the Board of Directors. EXECUTION COPY 10 Section 23. Application of Laws to Council Functions. The Council shall comply with all applicable laws in the conduct of its affairs, including, but not limited to, the Ralph M. Brown Act. (Section 54950 et seq., of the Government Code.) Section 24. Members. A. Withdrawal. A Member may withdraw from the Council by filing its written notice of withdrawal with the President of the Board of Directors 60 days before the actual withdrawal. Such a withdrawal shall be effective at 12:00 o’clock a.m. on the last day of that 60-day period. The withdrawal of a Member shall not in any way discharge, impair or modify the voluntarily-assumed obligations of the withdrawn Member in existence as of the effective date of its withdrawal. Withdrawal of a Member shall not affect the remaining Members. A withdrawn Member shall not be entitled to the return of any funds or other assets belonging to the Council, until the effective date of termination of this Agreement, except that a withdrawn Member shall be entitled to the balance of the annual dues paid for the year by that Member which were intended for the remaining part of that year. Withdrawal from any Implementation Agreement shall not be deemed withdrawal from the Council. In addition to being entitled to completely withdraw from the Council, the County may also partially withdraw and reduce its annual dues with a corresponding reduction in its ability to participate in and vote on matters before the Board by filing a written notice of partial withdrawal with the President of the Board of Directors 60 days before the actual partial withdrawal. Such partial withdrawal shall indicate which Supervisorial District(s) shall remain active in the Council and which are being withdrawn and shall be effective at 12:00 o’clock am on the last day of that 60-day period. Partial withdrawal shall not change the rights and obligations of the County under this Agreement except that the County’s annual dues shall be adjusted, on a pro rata basis, using the effective date of any Supervisorial District withdrawal and the County shall be entitled to the balance of the annual dues paid for the fiscal year by the County which were intended for the remaining part of that fiscal year for the Supervisorial District(s) being withdrawn from participation and the County shall no longer be able to participate in or vote on behalf of the withdrawn Supervisorial District(s) on any matter before the Board or Council committees. B. Non-Payment of Dues. If a Member fails to pay dues within three months of the annual dues assessment as required under Section 26 of this Agreement and the Bylaws, and after a 30-day written notice is provided to that Member, the Member shall be deemed to be suspended from this Agreement and the Council. When a Member is suspended, no representative of that Member shall participate or vote on the Board of Directors. Such a Member shall be readmitted only upon the payment of all dues then owed by the Member, including dues incurred prior to the suspension and during the suspension. In the case of the County, if the County fails to pay dues for one or more of its Supervisorial Districts within three months of the County’s annual dues assessment as required under Section 26 of this Agreement and the Bylaws, and after a 30-day written notice is provided to the County, no representative of the delinquent Supervisorial District(s) shall participate or vote on the Board. The delinquent Supervisorial District(s) shall be able to resume participation and voting on the Board only upon the payment of all dues then owed by the County on behalf of the delinquent EXECUTION COPY 11 Supervisorial District including dues incurred prior to and during the period of non- payment by the County. C. Admitting Eligible Members. Eligible public entities whose names are set forth on Exhibit A to this Agreement (“Eligible Public Entities”) shall be admitted to the Council by 1) adopting this Agreement by a majority vote of the legislative body of the Eligible Public Entity and 2) properly signing this Agreement, and 3) paying in full all dues owed for then current fiscal year. Since County may be admitted to the Council with voting representatives from one, two or three Supervisorial Districts, the dues to be paid by County will be based upon the number of Supervisorial Districts that will represent the County in the Council. County, in its sole discretion, may be admitted to the Council with representation from fewer than three Supervisorial Districts and may subsequently increase County’s representation by one or more additional Supervisorial Districts contingent only on payment in full at the time that any additional Supervisorial District commences representation of the County of all dues for the then current fiscal year for said Supervisorial District. An Eligible Public Entity may be admitted regardless of whether it adopted and signed this Agreement before or after the Effective Date (as defined in Section 29 of this Agreement). No vote of the Board of Directors shall be required to admit an Eligible Public Entity. D. Admitting New Members. New Members who are not Eligible Public Entities may be admitted to the Council upon an affirmative vote of not less than fifty percent (50%) plus one (1) of the total voting membership of the Board provided that such a proposed new Member is a city whose jurisdiction, or part thereof, lies within and/or immediately adjacent to, Southeast Los Angeles County. Admission shall be subject to such terms and conditions as the Board of Directors may deem appropriate. Section 25. Interference With Function of Members. The Board of Directors shall not take any action which constitutes an interference with the exercise of lawful powers by a Member of the Council. Section 26. Dues of Members. The Members of the Council shall be responsible for the payment to the Council, annually, of dues in amounts periodically budgeted by the Board, as and for the operating costs of the Council (“Dues”) as provided in the Bylaws. Section 27. Disposition of Assets. Upon termination of this Agreement, after the payment of all obligations of the Council, any assets remaining shall be distributed to the Members in proportion to the then obligation of those Members’ obligation to participate in the funding of the Council as provided in Section 26 hereof. Section 28. Amendment. This Agreement may be amended at anytime with the consent of fifty percent (50%) plus one (1) of all of the legislative bodies of the then parties hereto. Section 29. Effective Date. The effective date (“Effective Date”) of this Agreement shall be the first date on which fifty percent (50%) plus one (1) of the Eligible Public Entities adopt and sign this Agreement. EXECUTION COPY 13 EXHIBIT A Artesia Lakewood Avalon Long Beach Bell Lynwood Bell Gardens Maywood Bellflower Montebello Cerritos Norwalk Commerce Paramount Compton Pico Rivera Cudahy Santa Fe Springs Downey Signal Hill Hawaiian Gardens South Gate Huntington Park Vernon La Habra Heights Whittier La Mirada County of Los Angeles EXECUTION COPY 14 Revisions 1999 Section 11. Election of Chair and Vice-Chair 1999 Section 12. Creation of Executive Committee of the Board of Directors 2007 Section 5A. Designation of Board of Directors Representatives 2007 Section 5B. Designation of Alternate Board Representative 2007 Section 11. Election of President and Vice-President 2007 Section 12. Creation of Executive Committee of the Board of Directors 2007 Section 24A. Withdrawal 2007 Section 24B. Non-Payment of Dues 2007 Section 24C. Admitting Eligible Members LEAP NOFA Application Rev. 6/1/2020 Page 14 of 14 Appendix B This page intentionally left blank.