Healthcare and Seniors Facility Program Guidelines for the Port of Long Beach Grant Program

Healthcare and Seniors Facility Program Prepared for: The Port of Long Beach Long Beach, California Prepared by: ENVIRON International Corporation Los Angeles, California Date: February 2009

Contents Page 1 Introduction 1 2 Eligible Applicants 3 3 Program Funding 4 3.1 Frequency of Funding and Program Schedule 4 3.2 Disbursement of Funding 5 3.3 Application Submittal 5 3.4 General Application Submittal Details 5 4 Program Types 6 4.1 Testing Programs (Secondary Prevention) 6 4.2 Outreach Programs (Secondary and Tertiary Prevention) 7 4.3 Education Programs (Primary and Secondary Prevention) 8 4.4 Diagnostic Equipment (Secondary Prevention) 8 4.5 Air Impact Mitigation Measures (Primary Prevention) 8 4.5.1 Indoor Air Mitigation Measures 9 4.5.2 Emergency Engine/Generator Retrofits with PM Traps and/or Clean Fuel 10 4.6 Additional Project Options 10 5 Criteria and Ranking for Eligible Applicants and Programs 11 5.1 Program Requirements 11 5.2 Funding Criteria 12 6 Board Approval 13 7 Monitoring/Recordkeeping Required and Audit Provisions 13 List of Tables Table 1. Potential Eligible Applicants ii

1 Introduction The Port of Long Beach (Port) has developed the program described in these guidelines in an effort to mitigate potential cumulative air quality and noise impacts of projects to modernize and upgrade marine terminals and other facilities in the Long Beach harbor area. The California Environmental Quality Act (CEQA) requires consideration, and where feasible, mitigation of all significant project impacts including cumulative impacts. Cumulative impacts are defined as two or more individual effects which, when considered together, are considerable or which compound or increase other environmental impacts. The individual effects may be changes resulting from a single project or a number of separate projects. Cumulative impacts from several projects are considered for other projects proposed within the area that would have the potential to contribute cumulatively to the Port s proposed project air quality incremental impacts and includes other facilities approved and pending project construction and/or operational activities. Cumulative impacts can result from individually minor but collectively significant projects taking place over a period of time. Cumulative analysis of air quality impacts for the Port uses projections from the South Coast Air Quality Management District (SCAQMD) 2007 Air Quality Management Plan 1 (AQMP) for the South Coast Air Basin (Air Basin) and the MATES-II 2 and MATES-III 3 studies. The region of analysis for the Port s cumulative effects on air quality is generally: 1. The Air Basin for criteria pollutants; 2. A zone of influence for health risk analysis purposes, defined as the area within the one-in-a-million isopleths of health risk increment and/or a non-cancer acute or chronic hazard index of 1.0 for the specific project; and 3. Globally for greenhouse gases, with a focus on the state of California. The Air Basin is classified as serious nonattainment for particulate matter less than ten microns in diameter (PM 10 ) and as nonattainment for PM less than 2.5 microns in diameter (PM 2.5 ) federal standards. Moreover, the Air Basin is classified as nonattainment for the state PM 10 standard. Thus, any increases in these pollutants emissions are generally considered to be significant. Studies have shown that sensitive receptors, such as children, the elderly and those with certain pre-existing illnesses, are particularly sensitive to air pollution; children in particular are sensitive and improvements in pediatric pulmonary health can have beneficial effects well into the future. The Healthcare Facility Program Guidelines for the Port of Long Beach (Port) Grant Program (Prevention Program) is to support programs that emphasize prevention of health effects 1 SCAQMD, 2007. 2007 Air Quality Management Plan. Website: http://www.aqmd.gov/aqmp/07aqmp/index.html 2 SCAQMD, 2000. The Multiple Air Toxics Exposure Study (MATES-II) for the South Coast Air Basin. Planning Division. 3 SCAQMD. 2008. Multiple Air Toxics Exposure Study. Draft MATES III Report. Website: http://www.aqmd.gov/prdas/matesiii/matesiii.html 1

associated with cumulative air impacts from sources in the San Pedro Bay Ports area. The related Schools and Related Sites s (School Children s Program) is designed to support projects that reduce or mitigate the effects of the diesel particulate matter (DPM), which is a dominant contributor to health risk in this area on school-age children who are considered a sensitive 4 sub-population for such air pollutants. In contrast, the emphasis of the Prevention Program is to reduce exposure to cumulative air quality impacts though prevention programs designed to identify potentially sensitive individuals (through testing and/or outreach) and educate sensitive individuals or groups on ways they can minimize their exposure to DPM pollutants. As with the requirements under CEQA, the eligibility criteria for prevention programs aimed at sensitive individuals has been developed to take into account that cumulative health impacts as a function of distance from the San Pedro Bay Port area and the related goods movement transportation routes, e.g. I-710 and SR-47. The California Air Resources Board (CARB) Diesel Particulate Matter Exposure Assessment Study for the Ports of Los Angeles and Long Beach study 5 and recent modeling work during the development of the Clean Air Action Plan (CAAP) Baywide health standard have shown that areas downwind (north and east) of the Port are most heavily impacted by pollution steaming from Port activities. For this reason, the guidelines give preference to those prevention programs aimed at sensitive individuals closer to the Port because those individuals will likely be exposed to higher pollution levels. The Port has developed a list of projects, which can be implemented effectively at or by hospitals, healthcare facilities, retirement communities and senior centers, with demonstrated direct improvements to health impacts related to air pollution; these projects have specified eligibility criteria to ensure that the demonstrated improvements will be achieved. The health-related prevention programs are based similar programs promulgated by The Children s Clinic, Long Beach Alliance for Children with Asthma, Orange County School Asthma Program, and the Chicago Mobile C.A.R.E. Foundation, which have been shown to result in a decrease in asthma-related effects. The proposed project types are based on reducing impacts associated with asthma and other related pollutant effects through primary, secondary and tertiary prevention. Under primary prevention, asthma impacts would be reduced by avoidance of environmental and health risks, such as through direct pollution reduction by retrofitting diesel generators or installation of HEPA filters (Section 4.5). Secondary prevention entails the identification and detection of potential asthma problems before noticeable symptoms arise, such as the implementation of testing and outreach programs discussed in Sections 4.1 and 4.2. Under tertiary prevention, sensitive receptors would receive actual treatment for asthma and other steps to improve the quality of life for those diagnosed with the disease. Examples of proposed projects that could contribute to tertiary prevention include outreach and education programs that focus on identifying and 4 Sensitive receptors include children, senior citizens, and people with respiratory illnesses 5 Diesel Particulate Matter Exposure Assessment Study for the Ports of Los Angeles and Long Beach, dated October 3, 2005 2

reducing asthma triggers within the home, retirement community, etc. and programs to educate asthma patients on how to manage their symptoms. These guidelines: (1) establish eligibility criteria for potential applicants based on type of facility, and the proximity of the program to the San Pedro Bay Ports; (2) provide the metrics that will be used to assess a project s health impact mitigation potential; and (3) explain how funding provided by the Port will be distributed among projects and eligible applicants. 2 Eligible Applicants A listing of potential applicants has been compiled for an area surrounding the Port. In order to focus prevention-related mitigation measures on sensitive individuals or groups living closest to the Port, location zones were established. The zones will be used for purposes of ranking each proposed prevention program based on the distance of each facility (or sensitive population the program will serve) to the Port or the Port s transportation routes, e.g. I-710 and SR-47. Facilities within 1 mile of the Port or these truck routes are in Zone 1, facilities within 2 miles are in Zone 2 and facilities within 3 miles are in Zone 3. The ranking was established to address the greater impact of cumulative sources nearest to the Port. Because the prevailing winds coming from the Port head north and east, facilities in these areas will be given priority over those to the north and west. Furthermore, the facilities in the areas to the northwest of the Port also have access to additional funding, such as from the Port of Los Angeles TraPac Agreement. Facilities within this area, although still encouraged to apply for funding, will be given a lower funding priority. A listing of the identified hospitals and other health facilities meeting the distance criteria and in the focus area (north and east of the Port) is shown in Table 1. The location of each potential applicant is also plotted on the attached map (Figure 1). The northwest area subject to lower funding priority has been indicated by hash-marks. 6 Table 1. Potential Eligible Applicants Site Zone 1 Los Angeles County Health Care Harbor View Adolescent Center Pacific Hospital of Long Beach The Vasek Polak Children's Clinic, Family Health Center The Children's Clinic Family Health Center at Cesar Chavez Elementary School The Children's Clinic at International Elementary School The Children's Clinic at Long Beach Multiservice Center for the Homeless Westside Neighborhood Clinic Address 1333 Chestnut Ave. 490 W. 14th St. 2776 Pacific Ave. 1057 Pine Ave. 730 West 3rd St. 700 Locust Ave. 1301 West 12th St. 2125 Santa Fe Avenue 6 Per AQ guidelines 3

Site Address Zone 2 Upjohn Healthcare Services 280 Atlantic Ave. St. Mary Medical Center 1043 Elm Ave., #402 St. Mary Medical Center 1050 Linden Ave. St. Mary Medical Center 432 E. 10th St. St. Mary Medical Center 529 E. 10th St. Villa Maria Care Center 723 E. 9th St. Surgical Suite of Southern CA 1040 Elm Ave. Long Beach Memorial Medical Center 1133 Atlantic Ave. Skylight Convalescent Hospital 1201 Walnut Ave. St Mary Medical Center 1050 Linden Ave. Long Beach Memorial Medical Center 2801 Atlantic Ave. The Children's Clinic, Serving Children & Their Families 455 E Columbia St. Suites 201 & 6 Zone 3 Colonial Care Center 1913 E. 5th St. Broadway by the Sea 2725 E. Broadway The Port acknowledges this list may not include all potential facilities. In addition, the Port recognizes that retirement homes, senior centers and convalescent homes may also benefit from the prevention programs listed in these guidelines. If a healthcare facility, senior center, retirement home or convalescent home is not listed in Table 1 or Figure 1 but is within the zones indicated or would serve sensitive sub-populations in Zones 1, 2 or 3, the facility is still eligible to participate in the programs described in these guidelines by including in the required application an address where the project would occur, the zone in which the facility is located, the type of facility, the type of sensitive sub-population served, and examples of your previous air quality health impact prevention program(s). 3 Program Funding 3.1 Frequency of Funding and Program Schedule The Port has established a fund for eligible projects meeting the criteria listed in Section 4. The Port will issue a Request for Proposal (RFP) to solicit proposals consistent with these guidelines. Upon closing of the RFP listing, the Port will review all proposals and fund all projects that meet the criteria up to a funding cap. If more proposals are received than there is funding available, the Port will use the project criteria included in these guidelines to rank the submitted proposals. Those proposals with the highest ranking will be funded. If an insufficient number of proposals are received that meet the eligible criteria, the Port may re-release the RFP. Applicants should submit a separate proposal for different project types even if the projects will occur at the same facility. The approximate schedule for the grant program process is set forth in Table 2. 4

Table 2. Grant Program Schedule Grant Program Action RFP Release Proposal Due Date Port Review Board Consideration Award of Funding Date 3.2 Disbursement of Funding Funds will be awarded by the Board of Harbor Commissioners (Harbor) based on staff recommendations after proposal review. Grant recipients will be required to submit documents demonstrating fulfillment of the proposed project including a certification from the facility administrator stating the project has been completed as specified in the project application; receipts for all costs incurred for project implementation; and copies of project materials, participation enrollment/attendance sheets, training forms, etc. All requests for reimbursement must be received within TBA months of executing the grant. Upon request, additional funding mechanisms will be considered. 3.3 Application Submittal The applicant shall submit five copies (or one copy of a pdf file on CD) of the application in a sealed envelope, plainly marked in the upper left-hand corner with the name and address of the applicant and the name of the program announcement number. Port of Long Beach Attn: Grants Program 925 Harbor Plaza P.O. Box 570 Long Beach, California 90802 Applicants are strongly encouraged to submit documentation of related air quality health impact prevention program experience and expertise. All applications must be signed by the highest ranking official for the eligible partner with authority to enter into contracts on behalf of the partner. Applications without authorizing signatures will not be accepted. 3.4 General Application Submittal Details Each program announcement and application can be obtained by accessing the Port web site at www.polb.com/. Port staff members will be available to answer questions during the application acceptance period. In order to help expedite assistance, inquiries can be directed to the applicable staff person, as follows: 5

For General, Administrative, or Technical Assistance, please contact: Heather Tomley Tomley@polb.com 562-590-4160 For Questions on Reimbursement/Invoicing, please contact: Contact information TBA 4 Program Types Primary, secondary and tertiary prevention programs should be designed to minimize/prevent exposure to health impacts from local and Port-area air pollution sources, particularly sources of DPM. To maximize the prevention of adverse health effects, the highest priority should be given to mitigation measures that affect communities in the most highly exposed populations (i.e., those in close proximity to the Ports, transportation routes, and other nearby sources) and to sensitive sub-populations (e.g., children, elderly). The approach of giving high priority to highly impacted communities is consistent with the approach being developed under the South Coast Air Quality Management District (SCAQMD) Clean Communities Plan. Elderly people and children are more sensitive to the health impacts of DPM. As an example, the Port s School Children s Program meets the criteria of proximity (i.e., the zone system) and sensitive sub-populations (i.e., school children). The following prevention-related programs may be considered as air quality health impact mitigation programs. 4.1 Testing Programs (Secondary Prevention) Eligible applicants may apply for funding to conduct testing programs, such as asthma vans utilized by Orange County School Asthma Program and Chicago s Mobile C.A.R.E. Program, in order to assess whether residents in the surrounding area are afflicted with asthma or other aliments associated with DPM exposure. Asthma vans have been used around the country to provide respiratory screening, specialized medical diagnosis and treatment, individualized family health education sessions and free training and workshops for healthcare providers. Testing is one way for people to determine if they have asthma and would benefit from education programs for managing asthma. Chicago s Mobile C.A.R.E program has seen a 350% increase in patients with asthma under daily control, a 60% decrease in school absenteeism, and a 50% decrease in emergency room visits after implementation of their asthma van program. 7 7 http://www.mobilecarefoundation.org 6

Each eligible applicant will be required to include in its proposal a detailed plan for implementing an asthma testing program. Potential program elements could include purchase of an asthma mobile to provide on-going asthma and allergy care to school children and/or retirement home residents. The asthma mobile would be equipped with a small waiting area, a testing area and exam rooms. The van would be used by an asthma team that includes a pediatric allergist or Pulmonologist, a pediatric nurse practitioner, a registered nurse, and a driver. The van would visit schools or retirement homes on a rotating schedule in order to offer an asthma and allergy evaluation by an asthma specialist including a comprehensive history, physical exam, pulmonary function test, and limited allergy skin tests. Based on testing results, further services could be provided by asthma van specialists such as: Providing specialized medical diagnosis, and standard and ongoing medical treatment for the child's asthma and allergies including home peak flow monitoring; Educating and training about the management of asthma including proper use of equipment, medications, asthma/allergy triggers, recognition of trouble symptoms, and emergencies; Providing referrals to county and community resources; and Assisting families in obtaining health insurance. 4.2 Outreach Programs (Secondary and Tertiary Prevention) Eligible applicants may apply for funding for purposes of establishing outreach programs to help identify people susceptible to asthma and other DPM ailments who are not aware of other prevention programs, such as testing and education programs. Similar programs have been implemented by The Children s Clinic (TCC) and in partnership with Long Beach Alliance for Children with Asthma (LBACWA). Proposed programs could be used to also ensure that people are getting consistent, scientifically based information. Potential outreach programs could include: Outreach programs at schools, senior center, or retirement communities including on-site pulmonary function and allergy skin testing and implementation of an electronic registry to monitor patient symptoms and progress; and/or At home service in which trained medical professionals visit families in their homes to discuss signs, symptoms, triggers including a home environmental assessment, locations for testing and other asthma related services, medications, equipment use, and a course of action if an asthma attack occurs. Eligible applicants would need to include in their application a detailed description of the goals of the outreach program, who will benefit, and how the program will be implemented. 7

4.3 Education Programs (Primary and Secondary Prevention) These programs can be used to educate people on what they can do to reduce their contribution to emissions and ways to minimize exposure to air pollutants. Programs could include: An in-home, retirement community, or school environmental assessment to identify items that contribute to an unhealthy breathing environment and recommended changes; Periodic educational seminars (in English, Spanish and/or Khmer) to discuss: o o o o o What air pollution is, What are the health effects of air pollution, What everyday sources are, How to minimize exposure to indoor and outdoor air pollution, and How to reduce pollution from your car. Eligible applicants will need to provide a detailed description of the type of education program they plan to pursue, the target audience, and how the program will be implemented. 4.4 Diagnostic Equipment (Secondary Prevention) Program applicants may request funding for the purchase of diagnostic equipment, such as spirometers, that can be used to test sensitive pollution lung functions and/or other asthma-related or DPM-affected ailment markers. Eligible applicants will need to provide a detailed description of the equipment to be purchased and how it will help identify air quality related health impacts, the capital cost for the device, and how the applicant will utilize the equipment (e.g. outreach program, etc.). 4.5 Air Impact Mitigation Measures (Primary Prevention) In addition to the testing, outreach and education programs discussed above, facilities which house or serve sensitive populations could benefit from direct air quality mitigation programs as included in the Port s School Children s Program. As in the Port s School Children Program, the air impact mitigation measures are based on programs initiated by the CARB and SCAQMD (e.g., the Carl Moyer Program and the Air Quality Investment Program) that have been shown to result in a decrease in air quality PM, as well as other criteria pollutant, emissions or to reduce exposure to those pollutants. As cited in the below sections, outside research has further demonstrated the ability of these proposed measures to improve air quality or mitigate the impact of air pollutants on people. In developing these guidelines, the Port has relied heavily on these demonstrated CARB and SCAQMD air quality mitigation programs. 8

4.5.1 Indoor Air Mitigation Measures 4.5.1.1 HEPA Filter Replacement and HVAC Upgrades The main purposes of a heating, ventilation, and air-conditioning (HVAC) system are to help maintain good indoor air quality through adequate ventilation with filtration and provide thermal comfort. HVAC systems are among the largest energy consumers in hospitals. The choice and design of the HVAC system can also affect many other operating parameters, including water consumption and acoustics. One option hospitals, senior living facilities or centers, etc. have to improve better indoor air quality is to install mechanical air filters to remove particles by capturing them on filter materials such as high efficiency particulate air (HEPA) filters. High efficiency filters are often recommended as a cost-effective means of improving indoor air quality performance while minimizing energy consumption. Most HEPA filters are good at capturing larger airborne particles, such as dust, pollen, dust mite and cockroach allergens, some molds, and animal dander. Filter removal efficiency is measured by the minimum efficiency reporting value (MERV), developed by the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), for air filters installed in the ductwork of HVAC systems. MERV ratings (ranging from a low of 1 to a high of 20) also allow comparison of air filters made by different companies. In order to achieve a high level of particulate removal from indoor air at the eligible applicant s facility, HEPA filters with a MERV of 17 to 20 should be installed. During a pilot test in which inefficient filters or lack of filters were replaced with HEPA filters at a number of schools, the SCAQMD measured a 70-90% decrease indoors in outdoor fine particulate matter (PM) and diesel PM (DPM) compared to only 10-20% reduction in PM and DPM without filters. 8 The Port proposes to fund projects by eligible applicants to replace existing low efficiency filters with HEPA filters. A typical HEPA filter costs about $100-150 per filter. It is anticipated that numerous filters will be needed depending on the size of the school. Replacement HEPA filters must meet a MERV rating of 17-20. Because HEPA filters need to be replaced at least every 6 months in order to be effective, the applicant may include in its application a request for funding for HEPA filters needed for 10 years. Alternatively, for those facilities which do not have an existing central HVAC system capable of utilizing HEPA filters, eligible applicants may propose to install stand alone HVAC system(s) complete with HEPA filters. Small stand alone units cost about $8,500. Prices will vary depending on the size of the room it will serve. To be eligible for funding, stand alone units must meet the requirements of the ASHRAE guidelines. 9 Filter installation costs have been assumed to be 50% above the capital cost for the filters. Installation of the stand alone HVAC units is anticipated to be straightforward and not require additional labor. 8 Per a phone conversation with Phil Fine of the SCAQMD on December 18, 2008. 9 http://www.ashrae.org/publications/detail/14891 9

4.5.1.2 New Window/Door Seals and/or Replacement Because improvements in window or door seals and/or replacement of drafty windows and/or doors can also improve ventilation and thus, reduce indoor air quality problems, applicants may also include with their indoor air mitigation application proposals to upgrade existing windows and doors by either replacing the seals or the windows/doors. The application should include specifications for the types of seals, replacement windows and/or replacement doors to be installed as well as the manufacturers guarantee or certification that the replacement will reduce the intrusion of outdoor air indoors. 4.5.2 Emergency Engine/Generator Retrofits with PM Traps and/or Clean Fuel Engines and generators can be retrofitted with diesel particulate filters (DPF) to reduce the emissions of DPM. The removal efficiency varies and depends on the type of DPF, as well as the engine or generator being retrofitted. Several DPFs are currently verified by the California Air Resources Board (CARB), with verified efficiencies of up to 85%. 10 CARB maintains a list of vendors selling verified DPFs which can be found at http://www.arb.ca.gov/diesel/verdev/vt/cvt.htm. In order to mitigate the negative impacts of exposure of sensitive populations to DPM, the Port proposes to fund the retrofit of existing emergency engines or generators not already funded by state agencies or other entities for selected applicants. The cost of retrofitting a diesel backup generator of up to 125 kw is expected to be no more than $12,500, while the cost for a generator of greater than 125 kw is expected to be no more than $20,000. 11 If retrofits are not possible, the Port proposes to provide funding, not to exceed $42,000, for the incremental cost of replacing an existing diesel generator with a generator using clean fuel or equipped with a CARB Level 3 PM trap versus a typical diesel generator. Documentation will be required demonstrating that the replaced generator has been dismantled and disposed of so it does not contribute to DPM pollution through use in another location. Retrofit or replacement units must remain in place at the selected applicant location for a minimum of 10 years. 4.6 Additional Project Options If there is a project not listed above which an applicant believes would help to mitigate air quality health impacts, the facility is encouraged to submit an application consistent with the program guidelines. The application should describe the program type, sensitive group benefited, how the program will be implemented and the expected program costs. 10 CARB. 2008. Verification Procedures Currently Verified. A summary of verified diesel emission control strategies. 11 SCAQMD. 2004. Funding for Particulate Matter Traps on School Diesel Backup Generators Program announcement and application (PA #2005-05). http://www.aqmd.gov/rfp/attachments/2004/pa2005-05.doc 10

5 Criteria and Ranking for Eligible Applicants and Programs The Port has established eligibility and project ranking criteria in order to compare proposals for funding of health impact prevention programs. 5.1 Program Requirements Programs must meet the following criteria: Criteria for Approval Is the program one of the ones listed above or an alternative project meeting program guidelines? Does the program serve populations in the vicinity of the Port? (See Figure 1) Does the program assist sensitive sub-population(s), such as the elderly, children, or those with relevant pre-existing conditions? Eligible Applicant? If yes: eligible If no: not eligible In order to be eligible, air mitigation projects must meet the following approval and cost criteria. Eligible Projects Approvability Criteria Cost Criteria Indoor Air Mitigation HEPA filters Filters must meet certification criteria (at least 70% reduction in fine PM and DPM) with a MERV rating of at least 17. HVAC upgrades or replacement Units must meet minimum engineering specifications set by ASHRAE Window/door seals Must be double-paned or insulated windows and have a manufacturers guarantee or certification that the replacement will reduce the intrusion of outdoor air indoors Emergency Generator Modifications Emergency Retrofits with approved PM controls engine/generator retrofits Replacements with cleanest model by verified CARB vendor (http://www.arb.ca.gov/diesel/verdev/vt/cvt.htm) Unit must remain in place at the school for 10 years. $225 each which includes allotted installation costs (-1 point if greater than $150 each) $8,500/unit for a small unit. Larger unit costs will vary depending on room size. $300/window or door plus $150 for installation $12,500 for retrofit of 125 kw or less unit; $20,000 for retrofit of > 125 kw unit. $42,000 for new incremental costs for a new unit with diesel particulate filter 11

5.2 Funding Criteria If more eligible proposals are received than there is monies available to fund, the Port will use the following point system to rank submitted proposals. Those programs meeting the required approvability criteria and having the highest points for their air quality health impact prevention program ranking below will be funded first. The proposed projects for areas to the northwest of the Port within the hash-mark portion of each zone will be allocated half the total points available for the project in which the applicant is requesting funding for (e.g. a facility in the hash-marked area of zone 1, with 3 years experience that proposes an outreach program benefitting 400 people/$10,000 would be allocated 7 points versus 14 points). Program Ranking Location Served Allocated Points Zone 1 3 Zone 2 2 Zone 3 1 Applicant Experience and Demonstrated Expertise in Implementing the Proposed or Allocated Points Related Program(s) > 5 years 10 1-5 years 5 < 1 year 1 Strength of supporting documentation of Up to +5 additional points experience and expertise Number of People Benefitted per $10,000 awarded 12 Allocated Points (Project-Specific) > 500 5 250-500 3 < 250 1 Type of Project Allocated Points Testing Program 4 Outreach Program 3 12 An additional 2 points will be allocated for projects in which 75% of the people served are in a sensitive subpopulation (e.g. elderly, children). 12

Education Program 2 Diagnostic Equipment 1 Combined Program Up to +5 additional Air Mitigation Projects Points Additional Points HEPA filters added to existing HVAC systems 10 HVAC upgrades with HEPA filters 5 Emergency engine/generator retrofits 2 Strength of proposal and demonstrated experience +2 if also sealing windows and/or doors; +1 if replacing windows and/or doors. Up to +5 points Alternative projects consistent with program guidelines will be ranked according to the benefits the project provides that are similar to the benefits provided by those listed above. 6 Board Approval Port staff will review all applications received. Each application will be evaluated for fulfillment of applicability criteria and ranked if necessary. Staff will then recommend to the Board projects to be funded. The Board will review the recommendations and make final approval determination. 7 Monitoring/Recordkeeping Required and Audit Provisions The following documentation will be required by the selected applicant. Receipts of costs incurred for project implementation; and Copies of seminar sheets, participation roll-call sheets, training forms, etc 13

10 4 7 15 3 21 UV 91 2 5 6 710 City of Los Angeles City of Long Beach 17 19 18 405 Port of LA Port of Long Beach 25 710 24 22 9 8 20 15 7 4 5 3 23 2 Zone 1 10 1 6 13 11 Zone 2 12 16 Zone 3 14 Projection set to: CASP Zone V, feet 0 5,000 1" = 5000' DRAWN BY: SSS DATE: 1/15/08 APPROVED: CONTRACT NUMBER 04-6395O11 REVISED: Legend Port of Long Beach Surrounding Hospitals and Medical Centers 925 Harbor Plz., Long Beach, CA 90802 Hospitals and Medical Centers Haul Routes (On Port HDV) Haul Routes (Off Port HDF) Converted_Graphics Figure 1 FILE: \\irvine06\edms_irvine\01_projects\port_of_long_beach\03_gis\mxd\hatch\figure_3_port_of_long_beach_hospitals-medical_centers.mxd

Legend for Figure 1 Surrounding Hospitals and Medical Center Port of Long Beach Label Site Address (Long Beach) Type Within 1 Mile Range 8 Los Angeles County Health Care 1333 Chestnut Ave. Hospital 9 Harbor View Adolescent Center 490 W. 14th St. Hospital 17 Pacific Hospital of Long Beach 2776 Pacific Ave. Hospital 20 The Vasek Polak Children's Clinic, Family Health Center 1057 Pine Avenue Health Center 22 The Children's Clinic Family Health Center at Cesar Chavez Elementary School 730 West 3rd Street Children's Clinic 23 The Children's Clinic at International Elementary School 700 Locust Avenue Children's Clinic 24 The Children's Clinic at Long Beach Multiservice Center for the Homeless 1301 West 12th Street Children's Clinic 25 Westside Neighborhood Clinic 2125 Santa Fe Avenue Family Clinic Within 2 Mile Range 1 Upjohn Healthcare Services 280 Atlantic Ave. Hospital 2 St. Mary Medical Center (Clinic, Obstetrics, Surgical, etc.) 1043 Elm Ave., #402 Hospital 3 St. Mary Medical Center (Clinic, Obstetrics, Surgical, etc.) 1050 Linden Ave. Hospital 4 St. Mary Medical Center (Clinic, Obstetrics, Surgical, etc.) 432 E. 10th St. Hospital 5 St. Mary Medical Center (Clinic, Obstetrics, Surgical, etc.) 529 E. 10th St. Hospital 6 Villa Maria Care Center 723 E. 9th St. Hospital 7 Surgical Suite of Southern CA 1040 Elm Ave. Hospital 10 Long Beach Memorial Medical Center 1133 Atlantic Ave. Hospital 13 Skylight Convalescent Hospital 1201 Walnut Ave. Hospital 15 St Mary Medical Center 1050 Linden Ave. Hospital 18 Long Beach Memorial Medical Center 2801 Atlantic Ave. Hospital 19 The Children's Clinic, Serving Children & Their Families 455 E Columbia St Suite 201 & Suite 6 Children's Clinic Within 3 Mile Range 11 Colonial Care Center 1913 E. 5th St. Hospital 12 Broadway by the Sea 2725 E. Broadway Hospital Out of 3 Mile Range 14 Veteran Affairs Long Beach Healthcare System 5901 E 7th St. # 9151 Hospital 16 Community Hospital of Long Beach 1720 Termino Ave. Hospital 21 The Children's Clinic Family Health Center at Hamiliton Middle School 1060 East 70th Street Children's Clinic