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HomeMy WebLinkAboutCOM 0561.000 2014-2016 .."0-151°. .1 Phone: (808)961-8026 DANIEL K. PALEKA JR. ', Council District 5-Puna Mauka "„\��'• Fax: (808)961-8912 f :6:..,►. 1*: „,.,�'t Email: dpaleka@Hawai`icounty.gov HAWAI`I COUNTY COUNCIL County of Hawai`i 25Aupuni Street, Suite 1402 Hilo, Hawai`i 96720 1-.4 C) CA on =cJ October 27, 2015 in • TO: Dru Mamo Kanuha, Council Chair and Members of the Hawai`i County Council °° FROM: ,.X''Daniel K. Paleka Jr., Council Member SUBJECT: Hawai'i Island Humane Society—Euthanasia& Adoptability Rates I request 45 minutes to allow for discussion to address Hawai`i Island Humane Society (HIHS) and answer the following: 1) What plans are in place to: A. Reduce euthanasia daily, monthly, and annual rates? B. Increase adoptable and adoption rates? C. Create long-lasting partnerships with other organizations to achieve the above? The following reference material has been attached: • Notice to Proceed—Request for Proposal No. 2940: Provide Animal Control Services for the Police Department, County of Hawai`i, dated August 24, 2015 • HIHS September 2015 Program Report to County of Hawai`i • Rescue Partnership Application, Agreement and Outcome Report Please place this matter on the appropriate November 17, 2015, Committee agenda. Should you have any questions, comments, or concerns, please contact my office at 961-8263. Mahalo! DP/nin Att. Comm. No.. 5t° Ref. To: Ps fl l Tc- Ref. Date_10.14-2.0.5-_, Serving the Interests of the People of Our Island Hawaii County Is an Equal Opportunity Provider And Employer 1 August 24, 2015 ; TO: HAWAII ISLAND HUMANE SOCIETY FROM: DIRECTOR OF FINANCE , SUBJECT: REQUEST FOR PROPOSAL NO. 2940: PROVIDE ANIMAL 4 CONTROL SERVICES FOR THE POLICE DEPARTMENT, COUNTY OF HAWAI'I NOTICE TO PROCEED This is to inform you that Supplemental Agreement No. 2 for the subject ' proposal has been approved and accepted. The term of the Agreement shall be 4 extended for the period beginning July 1, 2015, and ending June 30, 2016. 4 All existing prices and conditions of the current agreement shall remain in effect ' throughout the extension period; in conformance with the renewal option provided for 4 in the proposal and the total option year contract amount shall be $1,982,499.96. Attached for your files is a fully executed copy of Supplemental Agreement No. 2. Thank you for your participation. • C�Sinn , JEFFREY E. DANSDILL , Purchasing Agent , Attachments cc: HPD 4 Hawaii County is an Equal Opportunity Provider and Employer , SUPPLEMENTAL AGREEMENT NO. 2 THIS SUPPLEMENTAL AGREEMENT made and entered into this 20 "moi M�day of t7��&ubI , , by and between the COUNTY OF HAWAII, a municipal corporation of the State of Hawai'i, hereinafter referred to as "County", and, HAWAII ISLAND HUMANE SOCIETY of 74-5225 Queen Ka'ahumanu Highway, Kailua-Kona, Hawai'i, 96740, hereinafter referred to as"Contractor", WITNESSETH THAT: WHEREAS, the parties hereto have entered into a Contract dated October 31, 2013, TO PROVIDE ANIMAL CONTROL SERVICES FOR THE HAWAI'I COUNTY POLICE DEPARMTENT, COUNTY OF HAWAI'I, PER REQUEST FOR PROPOSAL NO. 2940 AND PROPOSAL DATED SEPTEMBER 20, 2013, which contract is hereinafter referred to as the"Agreement", and WHEREAS, the contract may be modified according to terms of the original Agreement; and WHEREAS, the County of Hawai'i wishes to modify certain items of the Agreement; and WHEREAS, the parties hereto now desire to amend the Agreement in writing; NOW, THEREFORE, in consideration of the sum of ONE DOLLAR ($1.00) and other valuable consideration paid by each of the parties hereto to each of the other parties hereto, receipt of which is hereby acknowledged by each of the parties hereto, that certain Agreement entered into on October 31, 2013, Supplemental Agreement No. 1 entered into on July 21, 2014, between County and Contractor shall be, and is hereby modified, altered, and changed in the following respects only: 1. The total amount of the Contract shall remain at ONE HUNDRED SIXTY FIVE THOUSAND TWO HUNDRED EIGHT and 33/100 DOLLARS ($165,208.33) each month, thus bringing the total to ONE MILLION NINE HUNDRED EIGHTY TWO THOUSAND FOUR HUNDRED NINETY NINE and 96/100 ($1,982,499.96) for the year. 2. The Agreement shall be extended for an additional one (1) year period beginning July 1, 2015, and ending June 30, 2016. IT IS UNDERSTOOD AND AGREED that this Supplemental Agreement is a supplement to the Agreement heretofore executed by the parties and shall in no way act as a waiver of any of the conditions and obligations imposed upon the parties by the said Agreement or the specifications attached thereto and made a part thereof, and any rights which any of the parties may have by virtue of the said Agreement are to be considered as of full force and effect except as the same may have been altered or modified by this Supplemental Agreement. IT WITNESS WHEREOF, the parties hereto have executed this Supplemental Agreement No. 2 on the day and year first above written. COUNTY OF HAWAI'I By 1-��?��•mmZt aALTF�R�.M. LAU nagiag r or Print Name &Title (Affix Corporate Seal, if applicable) HAWAII ISLAND HUMANE SOCIETY By Gyvvka. (Zkilfriixen DONNA WHITAKER Its Executive Director APPROVED AS TO FORM REC MEND APPROVAL: & LEGALITY: 411.:00P� MEN JUL 14 2015 CORPORATE, COUNSEL POL C DEPARTDate COUNTY 0 HAWAI'I COUNTY OF HAWAI'I 7 ALL-PURPOSE ACKNOWLEDGMENT STATE OF HAWAII ) ) ss. COUNTY OF HAWAII ) On May 28 2015, in the Third Judicial Circuit of the State of Hawaii, before me personally appeared Donna Whitaker as a Executive Director of Hawaii Island Humane Society, who, being by me duly sworn or affirmed, did say that she executed this 2-page Supplemental Agreement N 2, undated, as her free act and deed and if applicable in the capacity shown, having been duly authorized to execute such instrument in such capacity. Witness my hand and official seal. 1.!1j Victor. Vekhova, Notary Public My Commission expires: 1/11/2019 NOTARY PUBLIC CERTIFICATION Victoria Y.Vekhova Th-rd Judicial Circuit Doc Description: a /!a '.41 e No.of Pages: Date of Doc. (4.." 1--- 5/ 0— No,-- * .nature Date , S • OF 14 . 41111 . ;►: • . . . . • :; •' ,TE....N1►�t COUNTY OF HAWAII CERTIFICATION OF AVAILABILITY OF FUNDS I hereby certify that on the date of filing of this contract with the Director of Finance, there remains an unexpended amount of $ 1,982,499.96 in 010.239.5239.01.115 sufficient to cover the obligation of the County of Hawaii under this contract. Contract Title: Supplemental Agreement #2 — RFP#2940: Provide Animal Control Services for Police, County of HI Vendor: Hawaii Island Humane Society Contract No: c.005069 diLd -4 Dire for of Finance Date: July 16, 2015 �,.+.41411 HAWAI30 OP ID:JC ,4C oe CERTIFICATE OF LIABILITY INSURANCE DATE 08106/15(MWDOTYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Phone:808-596-2700 NAMiIEACT Noguchi&Associates-KAM PHONE FAX 1314 S.King St.,#560 Fax:80B-596-2193 `yc,No,Estr: INC,No): Honolulu,HI 96814 EADDRESS: Jaci Sowden 808-887-1404 INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:DTRIC Insurance Co.,Ltd. 37265 INSURED Hawaii Island Humane Society INSURER B: 74-5225 Queen Kaahumanu Hwy. INSURER c. Kailua-Kona,HI 96740 INSURER 0: INSURER e: INSURER F: . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR- TYPE OF INSURANCE IADDL UDR POLICY NUMBER MMJDD(YYYY MM OO!INDUCT EFF I POUCYYYY UMITS XP LTR INSR,yb[n_ _ u L GENERAL LIABILITY 'EACH OCCURRENCE I E 1,000,000 DAMAGE TO RENTEO A X COMMERCIAL GENERAL LIABILITY X 2045605 I 08130!15 06190/16 PREMI6E6(Ea ocvmnce) f 100,000 I I CLAIMS MADE LX J OCCUR MED EXP(My one person) I S 5,000 PERSONAL A ADV INJURY ;5 1,000,000 1 i GENERAL AGGREGATE S 2,000,000 GENII_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S 2,000,000 POLICY I iF 0 (LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea scolded!) S A C X ANY AUTO X 2005605 06/30/15 06/30/16 BODILY INJURY(Per person) I S 1,000,000 ALL OWNED rn SCHEDULED BODILY INJURY(PeraccJdant)Iii$ 1,000,000 -AUTOS II AUTOS --�NON-OWNED PROPERTY DAMAGE i S 260,000 •HIRED AUTOS _AUTOS Per eccdenfj - I _ S !UMBRELLA UAB OCCUR I EACH OCCURRENCE S EXCESS LIAB i CLAIMS-MADE AGGREGATE .___...........5 I DEO I RETENTION f �...... _._. S WORKERS COMPENSATION - I WC STATU- OTH-I AND EMPLOYERS'LIABILITY YIN >- I TORY!OATS ER ANY PROPRIETOR/PARTNER/EXECUTIVE I I i E.L.EACH ACCIDENT I S OFFFICERJMEMBER EXCLUDED? N I A (Mandatory in NH) i L E L.DISEASE•EA EMPLOYEE-S lyes describe ander DESCRIPTION OF OPERATIONS below .E.L.DISEASE-POLICY LIMIT I S I_ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES IAttaeh ACORD 101.Addllforul Remarks Schedule,II mon apace Is squired) Certificate holder is named as additional insured in accordance with the General Liability and Auto Liability policy provisions as respects work performed by the insured for RFP*2940. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN County of Hawaii ACCORDANCE WITH THE POLICY PROVISIONS. 25 Aupuni St. Hilo,HI 96720 AUTHORIZED REPRESENTATIVE I - ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD A COR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 0 3/021201 5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Marsh Risk&Insurance Services NAME: Street PHONE FAX 777 South Figueroa fA/C.No,Ezt1: (A/C,No): Los Angeles,CA 90017.5622 ADDRESS: Attn:losanageles.certreguest@marsh.com INSURER(S)AFFORDING COVERAGE NAIC X 919903-PS-WCXS-15-16 13116 INSURER A: Headland Insurance Company,Inc. 13091 INSURED INSURER B:XL Specialty Insurance Company 37885 ProService Pacific,LLC 6600 Kalanianaole Highway,Suite 200 INSURER C: Honolulu,HI 96825 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: LOS-001586286-0B REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER LTR TYPE OF INSURANCE _It3$R WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DONYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ _ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY _ $ _ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ POLICY n PRO- POLICY LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS- ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTIONS S A WORKERS COMPENSATION HIC2015 03/25/2015 03/25/2016 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE Statutory Limits provided 1,000,000 E L EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N N/A $ (Mandatory In NH) by XL policy. E L DISEASE-EA EMPLOYEE $ 1,000,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 B EX WC&EL RWE500012008 03/25/2015 03/25/2016 Coverage A-Statutory *See Pg.2 for Addnl Limits SIR:$1,100,000 Coverage B-Each Acc. 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Client:HAWAII ISLAND HUMANE SOCIETY S.P.C.A dha HAWAII ISLAND HUMANE SOCIETY Proof of Workers Compensation insurance for co-employees of HAWAII ISLAND HUMANE SOCIETY S.P.C.A.dba HAWAII ISLAND HUMANE SOCIETY in accordance with the terms and conditions of the Client Service Agreement executed belween HAWAII ISLAND HUMANE SOCIETY S.P.C.A.dba HAWAII ISLAND HUMANE SOCIETY and ProService. CERTIFICATE HOLDER CANCELLATION COUNTY OF HAWAII SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 25-AUPUNI ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HILO,HI 96720 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk E.insurance Services l Dick Cook ,_ O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 919903 LOC#: Los Angeles ACO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh Risk 8 Insurance Services ProService Pacific,LLC 6600 Kalanianaole Highway,Suite 200 POLICY NUMBER Honolulu,HI 96825 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Policy Covers: Excess Workers'Compensation and Employers Liability Policy Details: Inv Ur:B Policy g RWE500012008 E0:03/25/2015 Exp:03/2512016 Additional Limits: Each Disease Policy Limit: $5,000,000 Disease Each Employee: $5,000,000 Statutory Limits are provided by the combination of the two policies: $1,000,000 provided by Headland Insurance Workers Compensation Policy Statutory Limits Excess of$1,000,000 provided by XL Specialty Insurance Company ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ' COUNTY OF HAWAII �'•:;"""�:•• Page 1 / 1 DEPARTMENT OF FINANCE-PURCHASING DIVISION . 25 AUPUNI STREET ORIGINAL PO DATE PO NUMBER HILO, HAWAII 96720 (808)961-8231 FAX(80 8) 961-8248 07/01/2015 C.005069 SHIP TO: Hawaii County is an Equal Opportunity Provider and Employer Special Inst: VENDOR: 03467 FOB Point: DESTINATION HAWAII ISLAND HUMANE SOCIETY Terms: NP Net 30 Days 74-5225 QUEEN KAAHUMANU HWY Req.Del.Date: KAILUA KONA, HI 96740 Req.No.: pd.03615 Dept: Contact Name: AIONA, HAUOLI Contact Phone: Confirming? No(If Yes, DO NOT Duplicate) Quantity Unit Description Unit Price Ext.Price Animal control services for period: 1,982,499.96 July 1,2015-June 30,2016 2nd option year RFP#2940 Compliant under HCE SUBTOTAL 1,982.499.96 BILL TO: TAX 0.00 FREIGHT 0.00 TOTAL 1,982,499.96 INSTRUCTIONS: This order is subject to the terms and conditions of the above referenced Request for Quotes (RFQ), Invitation for Bids (IFB)or Request for Proposals (RFP). Shipping and freight charges shall be FOB Destination Prepaid and Allowed unless otherwise noted. Invoices shall include the Purchase Order Number, with the original invoice and one copy being mailed or delivered to the BILL TO: address listed above. No changes or modifications to the terms, quantities or specifications shall be made without written authorization from the Purchasing Division. PURCHASING AGENT - p .0 00 N V 7 L\ •-, 7 N ofc M 7 7 00 C N N'C t7".:' O N C N 7 N 000 „N^. 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'C N M • N 'n0 � o cc 0, m N V,- o 0 N v, ^ o N- 00 vl C x M N C y _ \ \ r --, } M N V 1 -. - N.M C - = a) Cd t— 00 N 'C O', N 00 O� Q N N ^ O 7 x '..,- in sh OM it � , O ) C 0 '6 a) tea) . a) ^ 7 75 a� ?) cr6 `.S1 V, --t c Z O O o z. a) N ti a cc C' p t - O5L) E O. v Cl) 0 aami @ O G 00 i '. E•: .. `' -a - -o Lt - CC .. ° N c _ik -_: a) -c d c d F L o c _ ?, U _ W m n ti, E o c- d z = ? ti _. - U nu 0. O 0 v C ' O -- 1. ,,, ti O .r, c- V r c.. 00.C F. ,r G � � d ZO ad 34 o N „,r-" .-d ....0 > .v •C c W <Ll ,12i o?', m 13cc Q". v ` a.'").-E- LS s '4-.2 :' Cl) a) V: x y W d cy v) > ,G. ... v v w c W sQ c x w " - ^ ^ E _ •- �' • * x c c C c W c c c • C c .- N, % -' r } A Q 4ZCZZZ Z Z 41414 HANNAH ISLAND N(JAIME soeiETY 74-5225 Queen Ka'ahumanu Hwy Kailua-Kona, Hawaii 96740 www.HIHS.org (808)329-1175 Rescue Partnership Application Name: Physical Address: City: State: Zip: Mailing Address: City: State: Zip: Phone: Fax: Email: Primary Contact Person: Title: Phone: Email: Organization Director(if different from above): Phone: Email: Is your agency (please check all that apply): ❑ Government/Municipal ❑ Nonprofit 501(c)(3) ❑ Nonprofit with government contract ❑ Nonprofit pending 501(c)(3) status ❑ Individual Which of the following would you like to adopt? ❑ Dogs ❑ Cats ❑ Other animals (Please specify) Operations Are you an open or limited-admission organization? ❑ Open Admission ❑ Limited Admission How do you accept animals from the public? ❑ Walk-in ❑ Appointment ❑ Only when space is available Do you charge an admitting fee? ❑ No ❑Yes Do you charge an adoption fee? ❑ No ❑ Yes 1 If"Yes," please summarize fees: Do you have potential adopters complete an Adoption Application? ❑ No ❑ Yes Please attach a copy of your Adoption Application, if appplicable. Do you have adopters sign an Adoption Contract or any other form of agreement? ❑ No ❑Yes Please attach a copy of your Adoption Contract, if applicable. Do you have a quarantine procedure? If yes, please describe: Do you use a standardized behavior assessment? ❑ No ❑ Yes (name) Are you currently transferring in animals from other organizations? ❑ No ❑ Yes, what agency(s) Are you currently transferring out animals to other organizations? ❑ No ❑Yes, what agency(s) Where do you perform adoptions? ❑ Shelter ❑ Foster Home ❑ Mobile Sites ❑ Other What is your policy for adoption returns? Housing Where are your animals housed? ❑ Shelter Capacity for dogs cats Briefly describe shelter housing (single cages/runs, communal housing, etc.) Dogs: Cats: ❑ Foster Home Number of homes for dogs Number of homes for cats If utilizing foster homes: a. Are fosters screened? ❑ No ❑ Yes b. Do fosters receive training? ❑ No ❑ Yes c. Do fosters sign a Foster Care Agreement? ❑ No ❑ Yes d. If a Foster Care Agreement is used, please attach a copy to this Application. Veterinary Care Do you have a veterinarian on staff? ❑ Yes ❑ No If yes, name: Phone If no, how is veterinary care handled: 2 What is your standard medical care, including vaccine schedule, tests, examinations, boosters, parasite control, spay/neuter and microchipping procedure? Dogs? Cats? Other Animals? Animal Statistics (Last Year) Annual animal intake: Dogs Cats Others Number of animals adopted: Dogs Cats Others Number of animals returned to owners: Dogs Cats Others Number of animals transferred to another agency: Dogs Cats Others Number of animals euthanized: Dogs Cats Others Marketing How do you market your organization or mission? Right to Review The Hawaii Island Humane Society reserves the exclusive right to review, approve or reject an applicant at HIHS's sole discretion. All applications shall be resubmitted every six months. I hereby certify that I have answered the above questions truthfully. Date: Thank you for your interest! Please return your completed application to: Fax: 808-329-7375 or Mail: Hawaii Island Humane Society at 74-5225 Queen Ka'ahumanu Hwy., Kailua-Kona, Hawaii 96740 3 Hawaii Island Humane Society Rescue Partnership Agreement WHEREAS,the Hawaii Island Humane Society, S.P.C.A. (hereinafter "HIHS") is a 501(c)(3) private nonprofit organization dedicated to the welfare of animals; WHEREAS, one of its responsibilities is to accept all animals regardless of condition or circumstance; WHEREAS, HIHS receives a far greater number of animals than can be adopted into our community; WHEREAS, HIHS recognizes that it can work with Rescue Partners to provide some of these animals with a second chance at recovery and the opportunity to find new homes,the below policies, terms and conditions are designed to enable HIHS and Rescue Partners to help as many animals as possible and to ensure that we share common beliefs, attitudes and practices related to the care and humane treatment of animals; and WHEREAS, HIHS is dedicated to helping animals and therefore, will adopt HIHS animals to qualified Rescue Partners at NO CHARGE, HIHS invites animal rescue organizations and individuals to apply and work with HIHS as a Rescue Partner (hereinafter"RP" or"Releasor") so that together we can improve the lives of companion animals here on Hawaii Island. NOW THEREFORE, HIHS and Rescue Partner hereby enter into this Rescue Partnership Agreement on the terms and conditions stated herein. Rescue Partnership Commitment i. Recognition that all stakeholders in the animal welfare community have a passion for and are dedicated to the mutual goal of saving animals' lives. ii. HIHS and RP, as animal welfare stakeholders, agree to foster a mutual respect for one another. When discussing differences of policy and opinion, either publicly or within and among our own agencies, HIHS and RP agree to refrain from denigrating or speaking ill of one another. iii. RP must have sufficient space to appropriately house the adopted animals. No HIHS animals adopted by the RP should be euthanized after arrival because of lack of space. iv. An off island transfer is a one-way transport. A RP not located on Hawaii Island cannot `reject' an animal once it reaches the destination. v. RP must maintain animals in a healthy and safe environment with appropriate human interaction, meeting the Association of Shelter Veterinarians Guidelines for Standards of Care in Animal Shelters. vi. RP agrees it will utilize behavior modification techniques and methods that will not be physically or mentally stressful or damaging to the animal. vii. RP agrees medical care and treatment provided by RP shall be overseen by a licensed veterinarian. vizi. RP agrees never to allow an animal to be used for medical experimentation, research, fighting, harvesting of organs, or commercial exploitation. 1 Ix. RP must comply with all local, state, national and international laws and may not knowingly place an animal with a person or group that is in non-compliance with local animal control and licensing codes. x. RP must agree to make every attempt to find loving, responsible, lifelong homes for their animals. RP Animal Adoption Procedure Pre-Adoption Contact i. It is understood that current standards of care in animal shelters are for RP's to adopt pets that are less likely to be adopted. HIHS prefers that RP's adopt pets that have spent at least three days at an HIHS shelter as a courtesy to HIHS donors and patrons. If an HIHS animal can be placed by a RP immediately, HIHS will not prevent said adoption. ii. Communication between the designated HIHS coordinator and RP is critical to decide and confirm timing, number and types of animals being transferred, and any health considerations. iii. RP will thoroughly review the behavior observations and health record of each animal before agreeing to accept the adoption. iv. If the RP would like to request additional animals or a different type or breed of animal, it is encouraged to contact HIHS to make the arrangements. Pre-Adoption Behavior and Health Observation i. All animals selected for adoption will be observed by an HIHS representative. During this observation, general notations will be made about the socialization and kennel habits and general health of each animal. ii. HIHS will not place up for adoption an animal that poses a threat to public safety or an animal with a chronic or recurrent disease that may pose a threat to the health of people or other animals. iii. In the event that an HIHS animal placed with a RP develops signs of inappropriate aggression toward humans or other animals, or develops a chronic or recurrent disease that may pose a threat to the health of people or other animals after being transferred to a RP, HIHS would not condone the adoption of that animal and would recommend the RP humanely euthanize the animal. iv. HIHS will make every attempt to disclose any and all information related to the medical condition of the animal, including making available any documents or records related to the animal. v. When approved by HIHS, the RP can adopt animals diagnosed with a medical condition with the understanding that the animal will receive appropriate medical care, as needed. 2 1. After the adoption occurs, HIHS will not be responsible for any medical conditions the animal may have, either diagnosed or undiagnosed. 2. The RP will assume full responsibility for the animal's medical needs and associated costs until such time that the animal is placed into a permanent home. Pre-Adoption Medical Routine The following is subject to change depending on current medical standards of care. ii. All dogs and puppies will have received the following from HIHS: 1. General health exam performed by vet tech. 2. Dewormed with Strongid-T. 3. DHLPP vaccine administered during check in exam, if not previously administered within the last 12 months. Additionally, puppies receive booster vaccinations every 3 weeks until the puppy is over 16 weeks of age. 4. A heartworm test will be done on all dogs over 6 months of age. If negative, Sentinel is administered on a monthly basis to adult dogs as a heartworm preventative. 5. An outgoing visual examination will be conducted for any open sores/wounds, abnormally runny eyes (i.e. conjunctivitis), runny nose, any congestion or trouble breathing, loose stool or diarrhea, pronounced dermatitis, loss of appetite or lethargy. Health records will be updated and current on any medical issues observed. 6. A flea and tick preventative will be administered at check in and monthly thereafter. 7. Spay or neuter surgery will be completed prior to or upon adoption. iii. All cats and kittens will have received the following from HIHS: 1. General health exam performed by vet tech 2. FVRCP vaccine administered at intake. Kittens receive booster vaccinations every 3 weeks until older than 12 weeks of age. 3. A FeLV/FIV test will be done on all kittens and cats. Upon negative test, kittens and cats will be administered a FeLV vaccine at 8 weeks or older, which will be repeated 3 weeks thereafter. 4. A flea preventative will be administered at check in and monthly thereafter. 5. Dewormed with Strongid-T and treated with Ivermectin to prevent ear mites. 6. Ponazuril is given to kittens under 16 weeks of age for the treatment of coccidia. 7. An outgoing visual examination will be conducted for any open sores/wounds, abnormally runny eyes (i.e. conjunctivitis), runny nose, any congestion or trouble breathing, loose stool or diarrhea, pronounced dermatitis, loss of appetite or lethargy. Health records will be updated and current on any medical issues observed. 8. Spay or neuter surgery will be completed prior to or upon adoption. Confirming and Completing Adoption i. Once animals are selected for adoption by RP, HIHS will confirm the availability of each selection and arrangements for pick up will be scheduled by HIHS. ii. After confirmation, no changes can be made to the animals scheduled to be transferred unless new health or behavior concerns are identified. If new concerns are identified: 3 1. HIHS will contact RP to disclose the findings. 2. Based on the new information, RP will confirm whether it can still accept the animal or not. i. If so, the adoption progresses in the normal course. ii. If not, attempts can be made to substitute another candidate into the scheduled transfer if time allows. iii. Once delivery of an animal has been accepted into the hands or care of the RP, legal ownership of that animal transfers to the RP. vi. Animals that are released to RP become the full responsibility of the RP, including any behavioral or medical incidents that may happen while in the care of the RP. Post Adoption i. In the event that the RP transports animals to another island, state or country to facilitate adoptions, the RP agrees to abide by all Live Animal Regulations issued and maintained by the International Air Transport Association and by the standards set forth in the Animal Welfare Act. ii. RP agrees to provide HIHS the valid Name(s), Physical Address, Mailing Address and Phone Number(s) of all persons adopting HIHS-RP animals, as well as the date of adoption. It is preferred that RP finding homes for pets within the County of Hawaii contact HIHS with this information prior to finalizing an adoption, as this information will allow HIHS to help the RP screen potential adopters to prevent inadvertent adoptions to persons on the HIHS Do Not Adopt List, which includes persons convicted of animal cruelty or hoarding. If unable to provide this information prior to finalizing an adoption, an Adoption Outcome Report, attached and incorporated herein as Exhibit"A"to this Agreement, must be submitted to HIHS by fax (808-329-7375) or U.S. mail by the 5th day of each month. iii. RP collaborating with other Rescue or Animal Welfare Organizations are not exempt from the requirement to provide HIHS the adoption date and valid Name(s), Physical Addresses, Mailing Addresses and Phone Number(s) of individuals adopting HIHS-RP animals, even if the animals have been transferred to a Rescue or Animal Welfare Organization within or outside of the County of Hawaii. (i.e. It will not be acceptable to provide the Rescue or Animal Welfare Organization's contact information in lieu of the actual long-term adoptive owner). iv. Any airline kennels or other HIHS property loaned to the RP for transport shall be returned to HIHS at an agreed upon time. IN THE EVENT THAT A RP BREACHES ANY OF THE TERMS AND CONDITIONS HEREIN,HIHS,AT ITS OWN DISCRETION,MAY TERMINATE THIS RESCUE PARTNERSHIP AGREEMENT. FURTHER, HIHS RETAINS THE RIGHT NOT TO SUPPORT RP IN OBTAINING GRANTS OR OTHER FUNDS WHERE "SHELTER SUPPORT" MAY BE A REQUIREMENT. 4 Release In consideration and exchange of HIHS adopting animals to RP, RP for itself, its agents, employees and board of directors (hereinafter"Releasors" or"RP"), Releasors hereby release, acquit and forever discharge HIHS, its agents, employees, board of directors and legal counsel (hereinafter"Released Parties") of and from any and all liability, rights, claims, demands, including but not limited to damages, costs, medical costs, expenses, actions, causes of action, suits of liability, and controversies of any and every kind and description whatsoever, whether at law or equity, under statute, in contract, or in tort, suspected or unsuspected, known or unknown, without exception or reservation, now existing or which may accrue later, on account of, and in any manner arising out of, or related to the adoption of HIHS animals to the Releasor. Indemnification In addition, Releasors/RP shall defend, through counsel selected by HIHS, and shall indemnify the Released Parties, and any of them, from any and all liens, claims, lawsuits, demands, proceedings or actions with respect to the adoption of HIHS animals to Releasors/RP as to any claimed injuries or damages, actual or potential, arising out of or related to the adoption of HIHS animals to Releasors/RP. Review and Understanding of Agreement Releasors/RP represent and warrant that it/they have had the opportunity to obtain and receive independent legal advice from attorneys of RP's choosing with respect to the legal effect of this Agreement, and further represents and warrants that he/she/it has carefully reviewed this entire Agreement Complete Agreement RP understands and agrees that this Agreement constitutes the entire agreement concerning the subject matter herein, that no promise, agreement or inducement not herein expressed has been made to Releasors, and that this Agreement supersedes and replaces all prior and contemporaneous agreements, negotiations, representations, warranties and understandings of Releasors as to the subject matter of this Agreement. All terms and provisions of this Agreement are contractual and not a mere recital. Choice of Law RP and HIHS agree that the laws of the State of Hawaii shall control and apply to this Agreement. RP agrees that RP has accurately represented myself and/or my rescue organization and that I have the authorization to enter into this agreement on behalf of the organization listed below. RP further agrees that he/she/it understands and agrees to adhere to all the terms of this Rescue Partnership Agreement as outlined herein. 5 THE TERM OF THIS AGREEMENT IS FOR SIX (6) MONTHS FROM THE DATE NOTED BELOW. Name of Transfer Partner Organization or Individual: Name of Authorized Representative for above: Position in Organization: Signature: Date: Name of Authorized HIHS Representative: Position in Organization: Signature: Date: Hawaii Island Humane Society, S.P.C.A. 74-5225 Queen Ka'ahumanu Highway Kailua-Kona, Hawaii 96740 (808) 329-1175 www.hihs.org 6 0 \ — ( / rli E 2 r6 LU 5 o 2 CO > W E C 2 _0 § \ = a 2 2 / \ E C k ) _ 2 7 _ « 2 $ td) / CI CoFs g % E 2 Nif \ / / CU _ C Q ƒ 4-' ° Eo 0_ 4,>- E o co N 9 / k 0 \ o / / 3 2 Q ° 0 7 \ ® s I- u 0 2 ) 0 _CCC k E w Z / (13 0 0 to 04-0 vl @ § 2 / E c E \ = O O ƒ E a) E a ƒ 2 k o '- = z C :§ e / O :/ a) / CI. 2 ^ / 0 E -C ¢ 2 / Q \ C ° V) > E / 0 13 CU C \ 0 2 I Oobo - \ 3 § \ _ 0. R3E ° $ = E / t CV k E / LE / 2 5 § 2