The opinion
Filed 12/18/25; Certified for Publication 1/5/26 (order attached)
COURT OF APPEAL, FOURTH APPELLATE DISTRICT
DIVISION ONE
STATE OF CALIFORNIA
AMERICAN MEDICAL RESPONSE D085716
OF INLAND EMPIRE,
Plaintiff and Respondent,
(Super. Ct. No. CIVSB2416492)
v.
COUNTY OF SAN BERNARDINO et
al.,
Defendants and Appellants,
CONSOLIDATED FIRE AGENCIES,
Real Party in Interest and
Appellant.
APPEAL from an order of the Superior Court of San Bernardino,
Jay H. Robinson, Judge. Reversed and remanded with directions.
Hooper, Lundy & Bookman, Jordan Kearney, Devin M. Senelick and
Erin Sclar for Defendants and Appellants County of San Bernardino, County
of San Bernardino Board of Supervisors, and Inland Counties Emergency
Medical Agency.
Kingsley Bogard, Lindsay K. Moore; Wright, L’Estrange & Ergastolo,
Andrew E. Schouten, Davin H. Kono and Erica L. Nolen for Real Party in
Interest and Appellant Consolidated Fire Agencies.
William L. Adams for amicus curiae on behalf of Appellants.
Larson, Stephen G. Larson, Jonathan E. Phillips, Mehrunisa Ranjha,
and Benjamin Falstein for Plaintiff and Respondent American Medical
Response of Inland Empire.
For decades, American Medical Response of Inland Empire (AMR) was
the exclusive provider of emergency medical services (EMS) for San
Bernardino County. In 2022, the County initiated a competitive process to
improve its EMS system and issued a request for proposal (RFP) seeking
bidders for a new exclusive contract to provide EMS services. The RFP set
forth three overarching goals for its procurement process—to improve service
delivery to customers and partners, to establish a more efficient EMS system,
and to make investments back into the system. Two organizations responded
to the RFP—AMR and appellant and real party in interest Consolidated Fire
Services (ConFire). At the conclusion of the bidding process, the County’s
Board of Supervisors selected ConFire as its EMS provider. AMR, displeased
with the outcome of the process, unsuccessfully protested the decision and
then filed suit seeking to reverse the County’s decision.
AMR filed its first lawsuit in the Federal District Court for the Central
District of California. That court dismissed AMR’s federal antitrust claim,
without leave to amend, based on the Parker immunity doctrine and declined
2
to exercise jurisdiction over AMR’s state law claims. 1 AMR appealed the
District Court’s decision, and filed the underlying complaint and petition for
writ of mandate in San Bernardino County Superior Court. In this case,
AMR brought a motion for a preliminary injunction seeking to enjoin the
County and ConFire from proceeding with their contract. The trial court
granted AMR’s motion and enjoined the County and ConFire “from
performing, proceeding under, or implementing services pursuant to the
contract for Advanced Life Support and Basic Life Support Ground
Ambulance Services, Interfacility and Critical Care Transport Services for
the exclusive operating areas” at issue during the pendency of the lawsuit.
The County and ConFire appeal from the preliminary injunction order,
asserting the trial court improperly determined the County had a ministerial
duty to advance only AMR’s proposal to the County’s Board of Supervisors
because it was the “highest-scoring” proposal. Further, the County and
ConFire assert the County did not abuse its discretion by advancing both
ConFire’s and AMR’s proposals to the Board and ultimately selecting ConFire
as the provider. AMR, of course, asserts the trial court did not err in its
findings and, therefore, its decision granting the preliminary injunction
should be affirmed.
As we shall explain, we agree with the County and ConFire that the
trial court erred by concluding the County had a ministerial duty to advance
only AMR’s proposal. Further, we hold the trial court erred by imposing the
1 In Parker v. Brown (1943) 317 U.S. 341, the U.S. Supreme Court held
that the Sherman Antitrust Act “did not apply to anticompetitive restraints
imposed by the States.” (City of Columbia v. Omni Outdoor Advertising
(1991) 499 U.S. 365, 370 (Omni Outdoor).) The Court later clarified that a
local government is entitled to Parker immunity when its restriction on
competition is “an authorized implementation of state policy.” (Ibid.)
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preliminary injunction because AMR does not have a likelihood of prevailing
on its claim that the County abused its discretion under either the
Emergency Medical Services System and the Prehospital Emergency Medical
Care Personnel Act (the EMS Act, Health & Saf. Code, § 1797 et seq. 2) or the
RFP. Accordingly, the order is reversed. On remand, the trial court is
directed to enter an order denying AMR’s motion for a preliminary injunction
and to reconsider the amount of the undertaking previously imposed on AMR
in light of this court’s decision.
FACTUAL AND PROCEDURAL BACKGROUND
AMR began operating as the ambulance service provider for the County
in the late 1970s. Since that time, the County has retained AMR as its
exclusive EMS provider, grandfathered into its system in accordance with
section 1797.224 of the EMS Act. That provision, which was enacted in 1984,
states in pertinent part that “[a] local EMS agency may create one or more
exclusive operating areas in the development of a local plan, if a competitive
process is utilized to select the provider or providers of the services pursuant
to the plan. No competitive process is required if the local EMS agency
develops or implements a local plan that continues the use of existing
providers operating within a local EMS area in the manner and scope in
which the services have been provided without interruption since January 1,
1981. A local EMS agency which elects to create one or more exclusive
operating areas in the development of a local plan shall develop and submit
for approval to the authority, as part of the local EMS plan, its competitive
process for selecting providers and determining the scope of their operations.
2 Subsequent undesignated statutory references are to the Health and
Safety Code.
4
This plan shall include provisions for a competitive process held at periodic
intervals.” (§ 1797.224.)
Over the course of several years, the County developed a competitive
process to select a new EMS provider in accordance with section 1797.224,
which culminated with the issuance of the RFP on December 20, 2022. The
RFP stated its policy goals for the process were threefold: (1) “Improve
services delivery to customers and external partners;” (2) “Establish a more
efficient system, through transparent and outcome-based service;” and
(3) “Make investments back into the EMS system.” The RFP also set forth a
process to evaluate bids.
Section I of the RFP provides an introduction and background, which
identifies the stated policy goals, the scope of work and proposed
enhancements to the EMS system sought by the County, and descriptions of
the service areas and the EMS system and its requirements. In subsection
1.3, titled “Scope of Work Summary,” the County states that it “intends to
award an initial five (5) year contract to the highest scoring Proposer whose
proposal conforms to the RFP and whose proposal presents the greatest value
to the residents and visitors in the San Bernardino County Comprehensive
Service Area. The Proposal Review Committee (Committee) will evaluate all
proposals based on the evaluation criteria score sheet as established in this
RFP. The County realizes that criteria other than price is important and will
award a contract based on the highest scoring proposal that demonstrates the
best value and meets the needs of the County.”
Section II of the RFP sets forth instructions for proposers. It explains
the proposal process in detail and begins by stating that “[t]he County
intends to award a contract to the respondent whose proposal meets all of the
[RFP] criteria and receives the highest score from the scoring sheet as
5
evaluated by the [Committee] and best meets the needs of the County.”
Section II then explains pre-submittal activities, explaining how to submit
questions about the RFP; the required “Proposers’ Conference;” the proposal
content and organizational requirements; the process for submission and
correction of errors in proposals; guidelines for proposers’ contact with
County employees; and the process for withdrawal of proposals.
Subsection 2.12 is titled “Selection.” Part A of this subsection states
that proposals that do not conform to the instructions in the RFP will be
rejected but that the County can waive, “in its sole discretion,” non-
consequential deviations. Part B states, “The County will establish a non-
biased Proposal Review Committee. Each member of the Committee will
evaluate and score the proposals based on the criteria specified in the
solicitation scoring sheet. The scores from all the evaluators will be
calculated to arrive at a final score for each proposal. All Proposals will be
evaluated and scored by the Committee and will be invited to participate in
an oral presentation of their proposal. The Committee will recommend the
highest scoring Proposer for final negotiation of contract terms.”
The next subsection, 2.13, is titled “Negotiations and Notice of Intent
To Award.” It states, “The County may require the potential Proposer(s)
selected to participate in negotiations. This may include cost, technical, or
other clarifications needed for contract award.” Part A then provides, “After
selection, negotiations may be conducted with the Proposer of the highest-
ranked proposal. Negotiations, if held, shall be within the Scope of Work in
the RFP.” Part B concerns failure to negotiate, and states that if the selected
proposer fails to negotiate or the County and proposer cannot come to terms,
the County can terminate negotiations and begin negotiations “with the next
highest rated Proposer.” Part C, titled “Notice of Intent to Award (NOIA) –
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Proposer Notification of Selection,” states, “After the completion of contract
negotiations, a written or electronic NOIA and denial letters (or a copy of the
NOIA) will be issued to all Proposers.”
Part D of subsection 2.13 addresses the County’s ability to review the
proposer’s financial information. Part E, titled “Award,” states, “A contract
will be awarded based on the highest scoring proposal received. The content
of the proposal of the successful Proposer will become contractual obligations
and failure to accept these obligations in a contract may result in cancellation
of the award.” The next subsection, 2.14, sets forth the procedure to protest
the County’s award of the contract.
Section III of the RFP identifies evaluation criteria to be used by the
Proposal Review Committee. This section asks proposers to provide specific
information including (1) partners and subcontractors the proposer intends to
use, (2) the proposer’s organizational and leadership experience,
(3) references, (4) the proposer’s financial condition, (5) the proposer’s legal
history, and (6) evidence of insurance. Finally, subsection 3.3, “Evaluation
Criteria,” states, “Proposals will be evaluated by the Committee following the
evaluation criteria outlined in Exhibit 5. Committee participants will have a
broad range of experience in Emergency Medical Services, and county
government administration. Committee members will have an opportunity to
adjust scores based upon additional information provided during oral
presentations.”
The final section of the RFP, section IV, is titled “Scope of Work and
Scoring Criteria.” This section and its exhibits “describe elements of the
proposal” to be scored and directs respondents to “organize responses using”
the organizational format laid out therein. Section IV then sets forth
“System Requirements,” “Response Time Standards,” “Clinical Performance
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Standards,” and asks respondents to provide specific information concerning
their proposed ambulance deployment plan, vehicles, medical supplies and
equipment, and personnel. In addition, section IV sets forth hospital
interface, community involvement, disaster preparedness, quality
management, electronic reporting, minimum service, and financial
requirements for proposers.
After the RFP was issued, the County posted responses to the
proposers’ questions to its website. Of note, in response to a request for the
identification of the members of the Proposal Review Committee, the County
stated that the members would remain anonymous, but they would be
required to sign a conflict of interest statement and “[a]ll procurement
protocols and policies [would] be followed.” 3
The County received responses to the RFP from AMR and ConFire.
Four evaluators scored both proposals. Three of the four evaluators gave
ConFire a higher score. The total cumulative score for AMR, however, was
higher by four points. ConFire received individual scores of: 383, 384, 363
and 385. AMR’s scores were: 373, 419, 346, 381. After the proposals were
scored, in June 2023, the County sent a letter to both AMR and ConFire
stating that because the scores for both proposers were “substantially
equivalent” it intended to “move forward with negotiations” with both
entities. The County’s chief administrative officer also sent an e-mail to both
proposers stating that because the proposals received substantially
equivalent scores, the County would begin negotiations with both, and that
3 In support of its opposition to AMR’s motion for a preliminary
injunction, the County submitted its Policy Manual, which sets forth general
procurement policies for the Board, as well as its Procurement Manual, which
contains additional general guidelines for the County’s competitive
procurement activities.
8
the County’s staff would then make a recommendation to the Board based on
the outcome of the negotiations. The e-mail also stated the timeline for the
RFP would be extended to allow sufficient time for both proposers to “develop
contracts that best meet the county’s needs.”
On October 27, 2023, the County issued a “Notice of Intent to Award,”
stating that “[b]ased on the evaluation, AMR received the highest score and
will receive the independent evaluation committee’s recommendation for
award as stated in the RFP.” The notice also stated that “because the
difference in scores is substantially equivalent, draft contracts from each
proposer will be presented to the Board of Supervisors for consideration and
ultimate award. Neither staff nor the evaluation panel can legally bind the
Board. Pursuant to law and County Policy, the Board is vested with the sole
discretion and ultimate authority to select and approve a contract for services
which best meets the needs of the County and the public.”
On November 3, 2023, AMR submitted a letter protesting the County’s
decision to advance both proposals to the Board. AMR’s counsel asserted the
County failed to follow the procedure set forth in the RFP because AMR had
unquestionably received the highest score from the Proposal Review
Committee, and thus the County could not lawfully enter negotiations with
ConFire. AMR further asserted that the County’s “elevation of ConFire’s
proposal ... creates an appearance of favoritism and bias toward the fire
agency, and puts politics over the health and safety of its citizens. The
County is therefore at risk of acting in an arbitrary and capricious manner
because it has not adhered to the safeguards put in place to prevent bias and
other arbitrary factors from influencing the bid selection.”
On November 28, 2023, the County sent a letter to AMR denying its
protest. Therein, the County explained that only the Board had the authority
9
to approve a contract with the proposers and the RFP did not prohibit the
County from entering contract negotiations with both AMR and ConFire.
The letter also highlighted the fact that subsection 2.13 of the RFP explicitly
stated “ ‘the County may require the potential Proposer(s) selected to
participate in negotiations.’ Emphasis added.” Further, the letter stated
that subsection 2.1 explained the intent of the RFP was “ ‘to award a contract
to the respondent whose proposal meets all of the [RFP] criteria and receives
the highest score from the scoring sheet as evaluated by the Proposal Review
Committee ... and best meets the needs of the County.’ (Italics added.)” Two
days later, on November 30, 2023, AMR submitted a notice of protest, again
challenging the County’s decision to negotiate with both proposers and
setting forth the same arguments contained in its earlier letter.
At a regular meeting of the County’s Board on December 5, 2023, AMR
and ConFire each presented their proposals. Thereafter, the Board heard
several public comments in support of each proposal, including from
representatives of cities within the exclusive operation area for which the
RFP was issued. At the conclusion of the hearing, the Board voted to deny
AMR’s protest and award the service contract to ConFire.
On February 2, 2024, AMR filed suit in Federal Court in the Central
District of California. (American Medical Response of Inland Empire v.
County of San Bernardino (C.D.Cal., Apr. 19, 2024, No. EDCV 24-0267-KK-
SPX) 2024 U.S. Dist. Lexis 72130, affd. (9th Cir., Apr. 30, 2025, No. 24-3195)
2025 U.S. App. Lexis 10389.) In that initial lawsuit, AMR alleged the
County, Inland County Emergency Medical Agency (ICEMA), the Board, and
ConFire violated the Sherman Antitrust Act. (Ibid.) AMR also sought a
peremptory writ of mandamus under Code of Civil Procedure sections 1085
and 1094.5, and declaratory relief under section 1060. (Ibid.) In response,
10
the defendants moved to dismiss the lawsuit on the grounds they were
immune from antitrust liability under the Parker doctrine and asked the
court to decline to exercise supplemental jurisdiction over the state law
claims. (Ibid.) On April 19, 2024, the District Court granted the motion and
dismissed the claims without leave to amend. (Ibid.)
On April 30, 2024, AMR filed the underlying lawsuit. AMR asserted a
claim for writ of mandamus under Code of Civil Procedure section 1085 and
declaratory relief under section 1060. On June 12, 2024, AMR moved for a
preliminary injunction seeking to stop the County from proceeding with the
contract it entered with ConFire. After briefing and argument, on September
12, 2024, the trial court granted AMR’s motion and issued a statement of
decision explaining the basis for its ruling. 4
The trial court found that the County’s selection of an EMS provider
was ministerial in nature because it was directed by the EMS Act and the
RFP. Further, the court concluded AMR was likely to prevail on the merits of
its claim because the RFP required the County to negotiate only with the
proposer with the highest score, which the court found to be AMR. The trial
court stated the County’s “reliance on general principles of ‘best value’ and
‘best needs of the County’ [was] unavailing” and “[n]othing in the RFP
allowed for ‘substantially equivalent scores’ to go to negotiations.”
The court also hedged its ruling by concluding that even if the County’s
decision was not ministerial in nature, it constituted an abuse of discretion
because the process it ultimately followed was not set forth in the RFP: “The
text of the RFP provides no authority for how County Defendants elected to
proceed under the NOIA. None.” The court then set forth a list of rhetorical
4 The trial court subsequently issued an amended order correcting a
factual error unrelated to the issues on appeal.
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questions, including, “Where in the RFP did the County derive the authority
to forward two proposals with ‘substantially equivalent’ scores?” and “How
does the RFP define ‘substantially equivalent scores?” The court stated these
unanswered questions showed the RFP did not authorize the County to
award the EMS contract to a provider other than AMR as the proposer with
the highest score.
After finding AMR was likely to prevail on the merits of its claims, the
trial court also found that the balance of harms weighed in favor of granting
the preliminary injunction. The court first found that because AMR was
likely to prevail, the need to show harm absent the preliminary injunction
was low. The court further found the potential harm to AMR would be
“tantamount to closing a business” and, therefore, it could not be remedied
through monetary damages. The court also found that imposing the
prohibitory injunction would maintain stability in the County’s EMS system
while the case was adjudicated. Finally, the court imposed an undertaking
on AMR, requiring it to post a bond for $181,000, far less than the amount
sought by ConFire in its opposition to AMR’s motion.
Thereafter, ConFire objected to the bond amount, asserting it was
insufficient to provide security against the foreseeable losses arising from the
injunction if it were reversed. The trial court issued an order increasing the
undertaking to $200,220 to reflect reasonable attorney’s fees and costs, but
finding no additional security for expected revenue loss was necessary
because AMR was likely to succeed on the merits of its petition.
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ConFire and the County timely appealed the court’s order imposing the
preliminary injunction and ordering AMR to post a bond. 5
DISCUSSION
On appeal from the court’s order granting the preliminary injunction,
the County, the Board and ICEMA (collectively, County) assert the trial court
erred by finding the County’s decision to advance both AMR’s and ConFire’s
proposals to the Board and ultimately award the contract to ConFire was
ministerial in nature. The County argues the court misinterpreted
section 1797.224 and the EMS Act more broadly, which gives local agencies
discretion and authority to implement EMS plans that meet the needs of
their unique areas, and that the court’s order improperly usurped this
authority. Finally, the County argues the trial court also erred by finding the
balance of harms favored granting the preliminary injunction.
For its part, ConFire also argues the trial court’s determination that
the County’s actions were ministerial was incorrect and that the County did
not abuse the discretion vested to it by the EMS Act. In addition, ConFire
5 After the opening briefs were submitted, the Ninth Circuit Court of
Appeals affirmed the federal district court’s dismissal of AMR’s antitrust
claims without prejudice on the grounds the claim was barred by Parker
immunity. AMR did not address the decision in its respondent’s brief, but
both ConFire and the County raised the issue of collateral estoppel in their
reply briefs, asserting that the appellate memorandum opinion in the federal
appeal barred AMR’s claim for writ of mandamus. At AMR’s request, we
permitted it to file a supplemental brief addressing this issue and we also
permitted ConFire and the County to file supplemental reply briefs
concerning the impact of the federal case.
In addition, the day before oral argument in this case, AMR filed a
request for judicial notice alerting this court that the trial court had issued a
final statement of decision and order granting AMR’s petition for writ of
mandate. Because the order was issued long after the notice of appeal, it is
outside the scope of our review. Accordingly, the request is denied.
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contends the trial court abused its discretion by substituting its judgment for
that of the County. ConFire also asserts the trial court erred by setting the
amount of AMR’s bond during the pendency of the litigation too low.
I
Legal Standards
A
The EMS Act
“Prior to the enactment of the EMS Act, the law governing the delivery
of prehospital emergency medical services was haphazard. For example, the
Government Code identified ambulance services as among the permissible
‘ “[m]unicipal services or functions” ’ of counties, cities, and public districts.
(Gov. Code, § 54980, subds. (b), (c).) Although these entities were permitted
to contract with one another for the performance of ambulance services (id.,
§ 54981), nothing required them to coordinate or integrate their operations in
any fashion.” (County of San Bernardino v. City of San Bernardino (1997) 15
Cal.4th 909, 914 (San Bernardino).)
“As finally enacted in late 1980, the EMS Act ... created a
comprehensive system governing virtually every aspect of prehospital
emergency medical services. The Legislature’s desire to achieve coordination
and integration is evident throughout.” (San Bernardino, supra, 15 Cal.4th
at p. 915.) “The EMS Act accomplishes this integration through what is
essentially a two-tiered system of regulation. At the state level, the
Emergency Medical Services Authority (Authority) performs a number of
different functions relating to the coordination of EMS throughout the state,
including the following: (1) assessing each emergency medical services area
‘utilizing regional and local information ... for the purpose of determining the
need for additional emergency medical services, coordination of emergency
14
medical services, and the effectiveness of emergency medical services’
(§ 1797.102); (2) developing ‘planning and implementation guidelines for
emergency medical services systems,’ addressing personnel and training,
communications, transportation, assessment of hospitals and critical care
centers, system organization and management, data collection and
evaluation, public information and education, and disaster response
(§ 1797.103); (3) providing ‘technical assistance to existing agencies, counties,
and cities for the purpose of developing the components of emergency medical
services systems’ (§ 1797.104); [and] (4) reviewing emergency medical
services plans submitted by local EMS agencies to determine whether the
plans ‘effectively meet the needs of the persons served,’ are ‘consistent with
coordinating activities in the geographical area served,’ and are ‘consistent
with ... both the guidelines and regulations, established by the [A]uthority’
(§ 1797.105, subds. (a), (b)).” (San Bernardino, supra, 15 Cal.4th at p. 915.)
“The second tier of governance under the EMS Act is occupied by the
local EMS agency. Its duties are enumerated in chapter 4 of the act, entitled
‘Local Administration.’ (§§ 1797.200–1797.276.) Section 1797.200 provides
that ‘[e]ach county may develop an emergency medical services program.
Each county developing such a program shall designate a local EMS agency
which shall be the county health department, an agency established and
operated by the county, an entity with which the county contracts for the
purposes of local emergency medical services administration, or a joint
powers agency created for the administration of emergency medical services
by agreement between counties or cities and counties pursuant to the
provisions of Chapter 5 (commencing with Section 6500) of Division 7 of
15
Title 1 of the Government Code.’ ” (San Bernardino, supra, 15 Cal.4th at
p. 916.)
Additional authority is granted to the local EMS agency (LEMSA) in
chapter 5, “entitled ‘Medical Control’ (see §§ 1798–1798.6). It provides that
‘[t]he medical direction and management of an emergency medical services
system shall be under the medical control of the medical director of the local
EMS agency. This medical control shall be maintained in accordance with
standards for medical control established by the [A]uthority.’ (§ 1798,
subd. (a).) Chapter 5 also requires that ‘[m]edical control shall be within an
EMS system which complies with the minimum standards adopted by the
[A]uthority, and which is established and implemented by the local EMS
agency.’ (§ 1798, subd. (b).)” (San Bernardino, supra, 15 Cal.4th at p. 916.)
“In 1984, the EMS Act was amended (see sections 1797.6, 1797.85, and
1797.224) for the purpose of authorizing local EMS agencies to grant
exclusive operating areas to private EMS providers such as ambulance
companies. Such authorization was necessary to immunize the agencies from
liability under the United States Supreme Court’s then-recent decision
holding that local governments granting monopolies would not be exempt
from antitrust laws unless they acted pursuant to ‘ “clearly articulated and
affirmatively expressed” ’ state policy. (Community Communications Co. v.
Boulder (1982) 455 U.S. 40, 51.)” (San Bernardino, supra, 15 Cal.4th at
pp. 917–918.) Section 1797.6 sets forth the amendments’ purpose, stating:
“(a) It is the policy of the State of California to ensure the provision of
effective and efficient emergency medical care. The Legislature finds and
declares that achieving this policy has been hindered by the confusion and
concern in the 58 counties resulting from the United States Supreme Court’s
holding in Community Communications Company, Inc. v. City of Boulder,
16
Colorado, 455 U.S. 40, regarding local governmental liability under federal
antitrust laws. [¶] (b) It is the intent of the Legislature in enacting this
section and Sections 1797.85 and 1797.224 to prescribe and exercise the
degree of state direction and supervision over emergency medical services as
will provide for state action immunity under federal antitrust laws for
activities undertaken by local governmental entities in carrying out their
prescribed functions under this division.”
Section 1797.224, as stated previously, provides, “A local EMS agency
may create one or more exclusive operating areas in the development of a
local [EMS] plan, if a competitive process is utilized to select the provider or
providers of the services pursuant to the plan. ... A local EMS agency which
elects to create one or more exclusive operating areas in the development of a
local plan shall develop and submit for approval to the authority, as part of
the local EMS plan, its competitive process for selecting providers and
determining the scope of their operations. This plan shall include provisions
for a competitive process held at periodic intervals.”
An exclusive operation area (EOA) is defined by the EMS Act as “an
EMS area or subarea defined by the emergency medical services plan for
which a local EMS agency, upon the recommendation of a county, restricts
operations to one or more emergency ambulance services or providers of
limited advanced life support or advanced life support.” (§ 1797.85.) “The
creation of an EOA is an ‘ “important administrative tool for designing an
EMS system” ’ because ‘an EOA permits local EMS agencies to offer private
emergency service providers protection from competition in profitable,
populous areas in exchange for the obligation to serve unprofitable, more
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sparsely populated areas.’ ” (County of Butte v. Emergency Medical Services
Authority (2010) 187 Cal.App.4th 1175, 1182.)
B
Writ of Mandate
“ ‘ “A ministerial act is an act that a public officer is required to perform
in a prescribed manner in obedience to the mandate of legal authority and
without regard to his [or her] own judgment or opinion concerning such act’s
propriety or impropriety, when a given state of facts exists. Discretion ... is
the power conferred on public functionaries to act officially according to the
dictates of their own judgment.” ’ (AIDS Healthcare Foundation v. Los
Angeles County Dept. of Public Health (2011) 197 Cal.App.4th 693, 700.)
‘Generally, mandamus may be used only to compel the performance of a duty
that is purely ministerial in character. [Citation.] The remedy may not be
invoked to control an exercise of discretion, i.e., to compel an official to
exercise discretion in a particular way.’ (Ridgecrest Charter School v. Sierra
Sands Unified School Dist. (2005) 130 Cal.App.4th 986, 1002.)” (HNHPC,
Inc. v. Department of Cannabis Control (2023) 94 Cal.App.5th 60, 70
(HNHPC).)
However, “ ‘[w]hile a party may not invoke mandamus to force a public
entity to exercise discretionary powers in any particular manner, if the entity
refuses to act, mandate is available to compel the exercise of those
discretionary powers in some way.’ ” (HNHPC, supra, 94 Cal.App.5th at
p. 70.) “Mandamus will not lie to control an exercise of discretion, i.e., to
compel an official to exercise discretion in a particular manner. Mandamus
may issue, however, to compel an official both to exercise his discretion (if he
is required by law to do so) and to exercise it under a proper interpretation of
the applicable law.” (Common Cause v. Board of Supervisors (1989) 49
18
Cal.3d 432, 442 (Common Cause); see Khan v. Los Angeles City Employees’
Retirement System (2010) 187 Cal.App.4th 98, 105 [“A writ of traditional
mandamus (Code Civ. Proc., § 1085) may be used to compel the performance
of a duty that is purely ministerial in nature or to correct an abuse of
discretion.”].)
Further, “[m]andamus may issue to correct the exercise of discretionary
legislative power, but only if the action taken is so palpably unreasonable and
arbitrary as to show an abuse of discretion as a matter of law. This is a
highly deferential test.” (Carrancho v. California Air Resources Board (2003)
111 Cal.App.4th 1255, 1265 (Carrancho).) “Our ‘inquiry is whether the
record shows a reasonable basis for the action of the legislative body, and if
the reasonableness of the decision is fairly debatable, the legislative
determination will not be disturbed.’ ” (Weinstein v. County of Los Angeles
(2015) 237 Cal.App.4th 944, 965 (Weinstein).)
In general, “ ‘ “[a] public entity’s ‘ “award of a contract, and all of the
acts leading up to the award, are legislative in character.” ’ ” ’ ” (Michael
Leslie Productions, Inc. v. City of Los Angeles (2012) 207 Cal.App.4th 1011,
1020.) However, “[w]hether a statute imposes a ministerial duty is a
question of statutory interpretation.” (HNHPC, supra, 94 Cal.App.5th at
p. 70.) “ ‘We examine the “language, function and apparent purpose” ’ of the
statute. ... ‘Even if mandatory language appears in [a] statute creating a
duty, the duty is discretionary if the [public entity] must exercise significant
discretion to perform the duty.’ [Citations.] Thus, in addition to examining
the statutory language, we must examine the entire statutory scheme to
determine whether” the government actor has discretion in its performance of
a mandatory duty. (AIDS Healthcare Foundation v. Los Angeles County
Dept. of Public Health (2011) 197 Cal.App.4th 693, 701.) “This question [of
19
statutory interpretation] is generally subject to de novo review on appeal ..., a
question of law for the court.” (Carrancho, supra, 111 Cal.App.4th at
p. 1266.)
C
Preliminary Injunction
“In deciding whether to issue a preliminary injunction, a trial court
must evaluate two interrelated factors: (i) the likelihood that the party
seeking the injunction will ultimately prevail on the merits of his claim, and
(ii) the balance of harm presented, i.e., the comparative consequences of the
issuance and nonissuance of the injunction. [Citations.] The scope of
available preliminary relief is necessarily limited by the scope of the relief
likely to be obtained at trial on the merits.” (Common Cause, supra, 49
Cal.3d at pp. 441–442.)
“ ‘The law is well settled that the decision to grant a preliminary
injunction rests in the sound discretion of the trial court.’ (IT Corp. v. County
of Imperial (1983) 35 Cal.3d 63, 69.) ‘A trial court will be found to have
abused its discretion only when it has “ ‘exceeded the bounds of reason or
contravened the uncontradicted evidence.’ ” ’ (Ibid.) ‘Further, the burden
rests with the party challenging the [trial court’s ruling on the application for
an] injunction to make a clear showing of an abuse of discretion.’ ”
(Shoemaker v. County of Los Angeles (1995) 37 Cal.App.4th 618, 624.)
II
Analysis
A
The Decision to Advance Both Proposals and Award the EMS Contract to
ConFire Was Quasi-Legislative and Discretionary, Not Ministerial
The first step in our analysis is to determine whether the County “had
a ministerial duty capable of direct enforcement or a quasi-legislative duty
20
entitled to a considerable degree of deference.” (Carrancho, supra, 111
Cal.App.4th at p. 1266.) As noted, this is a question of statutory
interpretation that we review de novo. The trial court concluded the County’s
decision was ministerial. We agree with the County and ConFire that this
determination was error.
The EMS Act grants broad authority to local medical emergency service
agencies to create and implement their EMS plan, including using a
competitive process to select EMS providers. The law recognizes that local
agencies, like ICEMA, are best situated to know the service needs of the
areas they are in, explicitly granting them authority to “develop an
emergency medical services program” (§ 1797.200), which includes
“(1) planning, implementing, and evaluating an emergency medical services
system ‘consisting of an organized pattern of readiness and response services
based on public and private agreements and operational procedures’
(§ 1797.204); (2) developing a formal plan for the system in accordance with
the Authority’s guidelines and submitting the plan to the Authority on an
annual basis (§§ 1797.250, 1797.254); [and] (3) ‘consistent with such plan,
coordinat[ing] and otherwise facilitat[ing] arrangements necessary to develop
the emergency medical services system’ (§ 1797.252).” (San Bernardino,
supra, 15 Cal.4th at p. 916.)
Within the broader authority granted to the local agency to develop its
EMS plan, section 1797.224 of the EMS Act grants the local agency the
discretionary authority to create EOAs “if a competitive process is utilized to
select the provider or providers of the services pursuant to the plan.” “ ‘[T]he
Legislature recognized [that] creating an EOA is an important administrative
tool for designing an EMS system, for it allows these agencies to plan and
implement EMS systems that will meet the needs of their constituencies and
21
at the same time ensure that the EMS providers with which they contract
have a territory sufficiently populated to make the provision of these services
economically viable.’ ” (Valley Medical Transport, Inc. v. Apple Valley Fire
Protection Dist. (1998) 17 Cal.4th 747, 759.)
Thus, under section 1797.224, the local agency is entirely responsible
for developing the competitive process it will use to select an EMS provider.
The statute gives no specific directives concerning how the process should
occur, other than requiring it to be submitted as part of the agency’s EMS
plan, which then must receive approval from the Authority, and mandating
that the process occur at unspecified “periodic intervals.” (§ 1797.224.) There
is no dispute among the parties that the County developed its competitive
process, in the form of the RFP, in accordance with section 1797.224. The
parties also agree that the RFP was submitted to the Authority for its
approval and there is no indication in the record that such approval was
withheld. 6
The trial court found that the RFP “contained clear and unambiguous
language describing a proposal’s minimum qualifications, how [the County]
would evaluate and score it, and the negotiations and approval procedure
[the County] would follow for the highest scoring bid.” Further, the court
found that “[t]he scoring and evaluation aspect of the RFP mandated a single
action after scoring competing proposals and prioritizing the proposal with
the highest score. It compelled [the County] to forward that proposal to the
6 The record also does not affirmatively show the Authority approved the
plan, but no party has provided any basis to dispute this presumed fact. The
only citation in the parties’ briefing to the approval is AMR’s Verified First
Amended Complaint and Petition for Writ of Mandate, which states “the
County and its designated LEMSA—ICEMA—received approval from the
State Authority on November 29, 2022 for the RFP.”
22
Board for further negotiations precedent to ultimate approval.” According to
the trial court, “[f]orwarding the highest scoring proposal, therefore,
constituted an entirely ministerial act to be performed ‘in a prescribed
manner in obedience to the mandate’ of the RFP, and ‘without regard’ to
subjective judgments or opinions to the propriety of this act.” (Quoting
County of Los Angeles v. City of Los Angeles (2013) 214 Cal.App.4th 643, 653.)
The trial court’s analysis is wrong in two ways. The court concluded
that by the Authority’s approval of the RFP, it imposed a ministerial duty on
the County to strictly comply with the RFP. Further, the court inserts
requirements into the RFP, which it interprets as ministerial duties, that are
not present in that document.
As to the first error, the EMS Act grants discretionary authority to the
LEMSA to institute a competitive process. The law shields the LEMSA from
antitrust liability and sets forth a broad policy goal—to select EMS providers
who will comply with the act’s base requirements for such service. However,
“the details critical to [that] undertaking are committed to agency judgment.”
(Carrancho, supra, 111 Cal.App.4th at p. 1268.) As the County and ConFire
point out, the EMS Act contains no direction for how a competitive process
should be conducted. Rather, section 1797.224 is clear that the creation of
the process is left to the local agency. Accordingly, and contrary to the trial
court’s conclusion, there is no ministerial duty imposed by the Act with
respect to how the local agency selects its EOA providers. The competitive
process is developed at the discretion of the local governmental agency and is
23
thus a quasi-legislative action. 7 (See Carrancho, at p. 1266 [“ ‘Discretion ... is
the power conferred on public functionaries to act officially according to the
dictates of their own judgment.’ ”]; Mike Moore’s 24-Hour Towing v. City of
San Diego (1996) 45 Cal.App.4th 1294, 1303 (Mike Moore’s) [“The letting of
contracts by a governmental entity necessarily requires an exercise of
discretion guided by considerations of the public welfare.”]; Weinstein, supra,
7 The trial court also stated in its order that a purpose of obtaining the
Authority’s approval is “to fortify section 1767.6’s statutory [antitrust]
immunity through rigid compliance with the approved bidding process.” The
court then reasoned that to maintain antitrust immunity, the RFP
“mandated a single action after scoring competing proposals ... to forward
that proposal to the Board for further negotiations precedent to ultimate
approval,” which it found constituted a ministerial act. This conclusion is
also wrong and was rejected by the Ninth Circuit in its decision affirming the
dismissal of AMR’s antitrust claim. The Ninth Circuit held that even if the
County “awarded the contract ‘in complete disregard of the State-mandated
competitive process’ as AMR alleges, the County Defendants are still entitled
to Parker immunity.” (American Medical Response of Inland Empire v.
County of San Bernardino (9th Cir., Apr. 30, 2025, No 24-3195) 2025 U.S.
App. Lexis 10389 (American Medical Response).) The Ninth Circuit cited
Omni Outdoor, supra, 499 U.S. at p. 371, which held “that a local government
was entitled to Parker immunity even when the nature of its regulation was
allegedly substantively or procedurally defective.” (Ibid.) We agree with
ConFire that to the extent the trial court construed sections 1797.6 and
1797.224 to impose ministerial duties to conform to its misinterpretation of
federal antitrust law, that construction was error.
Of note, the Ninth Circuit also concluded that the County had not
disregarded the competitive process set forth in the RFP. The court stated,
“even if AMR had the ‘highest score,’ the plain language of the state-approved
RFP gave the County Defendants discretion to award the monopoly to the
provider whose proposal presented ‘the greatest value’ to the County.
Moreover, the County Defendants articulated how ConFire presented the
‘greatest value’ to the County, namely, by being eligible for supplemental
state funding, by improving public safety through closer integration or
coordination of services, and by promising faster response times than AMR.”
(American Medical Response, supra, 2025 U.S. App. Lexis 10389.)
24
237 Cal.App.4th at p. 964 [“ ‘A public entity’s “award of a contract, and all of
the acts leading up to the award, are legislative in character.” ’ ”]; Common
Cause, supra, 49 Cal.3d at p. 444 [statement of legislative intent does not
give rise to ministerial duty].)
With respect to the requirements created by the RFP, the trial court
concluded the document created a ministerial duty to only advance the
“highest scoring” proposal for negotiations and approval by the Board. The
court looked to subsections 2.12 part B and 2.13 to reach this conclusion, and
it defined the highest score as the proposal with the greatest combined points
awarded by each of the four scorers. The court also rejected the County’s own
interpretation of the RFP to include its decision to advance both proposals.
Further, because the trial court concluded the RFP created a ministerial duty
to advance only the highest scoring proposal under its definition of that term,
the court refused to consider the County’s broader procurement policies
outside the RFP.
In concluding the RFP imposed a ministerial duty on the County, the
trial court reads the RFP too narrowly. As the County points out, the
document creates flexibility by making clear in the RFP’s introduction, at
subsection 1.3 part A, that the County intends to award the initial five-year
contract to “the highest scoring Proposer whose proposal conforms to the RFP
and whose proposal presents the greatest value to the residents and visitors in
the San Bernardino County Comprehensive Service Area.” (Italics added.)
The same provision also states the “County realizes that criteria other than
price is important and will award a contract based on the highest scoring
proposal that demonstrates the best value and meets the needs of the County.”
(Italics added.) In the subsequent section of the RFP, instructions for
proposers, the very first sentence contained in subsection 2.1., states, “The
25
County intends to award a contract to the respondent whose proposal meets
all of the Request for Proposals (RFP) criteria and receives the highest score
from the scoring sheet as evaluated by the Proposal Review Committee
(Committee) and best meets the needs of the County.” (Italics added.) That
same subsection, 2.1, also provides that the “County reserves the right to
reject any or all Proposals if it is in the best interest of the County to do so”
and that the “County also reserves the right to terminate the RFP process at
any time.” Further, subsection 2.13 itself states, “The County may require
the potential Proposer(s) selected to participate in negotiations.” (Italics
added.)
In short, the RFP’s plain language provides that the County may
negotiate with more than one proposer and that the final determination is
left to the discretion of the Board based on the scoring, and the Board’s
determination of the proposer’s ability to meet the needs of the County and
provide the best value. Contrary to the trial court’s finding, the RFP does not
impose a ministerial duty on the County to negotiate solely with the proposer
who received the highest total score. Indeed, subsection 2.13, titled
“Negotiations and Notice of Intent to Award,” explicitly contemplates more
than one provider by the use of the term “Proposer(s).”
Further, like the Ninth Circuit, we agree with appellants that the
County itself had the discretion under the RFP process to determine what
constituted the “highest score.” The RFP contains no definition of “highest
score,” and “[w]hile AMR received the highest total score, ConFire received
the highest median score.” (American Medical Response, supra, 2025 U.S.
App. Lexis 10389.) In short, the RFP does not impose a ministerial duty on
the County. When the document is taken as a whole, and subsections 2.13
and 2.14 are put in its broader context, this conclusion is clear. The RFP
26
gives the County discretion in its process and ultimately in its selection of the
provider that is awarded the contract. Accordingly, the trial court’s
conclusion that the County had a ministerial duty to advance only AMR’s
proposal to the Board was error.
B
AMR Cannot Show a Likelihood of Prevailing on Its Claim That the County
Abused Its Discretion by Awarding the EMS Contract to ConFire
Having concluded that neither the EMS Act nor the RFP imposes a
ministerial duty, we now must consider the likelihood of AMR proving the
County abused its discretion by awarding the contract to ConFire. “In
reviewing ... quasi-legislative decisions, the trial court does not inquire
whether, if it had power to act in the first instance, it would have taken the
action taken by the administrative agency. The authority of the court is
limited to determining whether the decision of the agency was arbitrary,
capricious, entirely lacking in evidentiary support, or unlawfully or
procedurally unfair.” (Carrancho, supra, 111 Cal.App.4th at p. 1265.)
“[I]f reasonable minds may disagree as to the wisdom of the agency’s
action, its determination must be upheld.” (California Public Records
Research, Inc. v. County of Yolo (2016) 4 Cal.App.5th 150, 182.) “Courts
exercise limited review ‘out of deference to the separation of powers between
the Legislature and the judiciary, to the legislative delegation of
administrative authority to the agency, and to the presumed expertise of the
agency within its scope of authority.’ [Citations.] The court does not ‘weigh
the evidence adduced before the administrative agency or substitute its
judgment for that of the agency, for to do so would frustrate legislative
mandate.’ ” (Carrancho, supra, 111 Cal.App.4th at p. 1265.)
Under this highly deferential standard, we cannot conclude that AMR
is likely to prevail on its claim that the County abused its discretion by
27
awarding the contract to ConFire. The trial court found that AMR was
“equally likely to prevail under the abuse of discretion standard” because the
Notice of Intent to Award letter issued to AMR on October 27, 2023, “created
ex nihilo a new procurement procedure that bore not even a passing
resemblance to the procedure established by the RFP.” The trial court then
substituted its own judgment for that of the County. Without any basis, the
court asserted that it appeared the County “desire[d] a specific outcome for
the RFP” and “embrace[d] a desire for performative acts in public contracting
in arguing against AMR’s likely success on the merits.” AMR repeats these
unfounded accusations in its briefing before this court but provides no
citation to the record in support.
Although it is not this court’s role to search the record for citations, we
see no indication in the record to suggest such wrongdoing. Rather, the
record before this court shows the County was transparent in its decisions
and did not stray outside the process set forth in the RFP. As discussed, the
RFP did not preclude the County from advancing both proposals to the Board
for consideration and negotiation. While the RFP stated the highest scoring
proposer would be recommended to the Board, the RFP did not define the
term “highest scorer” and three of the four evaluators on the Proposal Review
Committee scored ConFire higher than AMR.
Under the discretion granted to the local agency by the EMS Act and in
light of the vagueness in the RFP’s definition of highest score, we cannot hold
the County’s action was “arbitrary, capricious, entirely lacking in evidentiary
support, or unlawfully or procedurally unfair.” (Carrancho, supra, 111
Cal.App.4th at p. 1265.) Rather, after the scoring, the County reasonably
found that no clear winner emerged from the RFP process. The County’s
decision to advance both proposers to negotiate with the Board was
28
consistent with the RFP, which stated in subsection 2.13 that more than one
proposer could advance, and with the County’s procurement manual, which
contains additional guidelines for contract procurement and states the county
may issue invitations to negotiate “with a short list of proposers to obtain
best value during a RFP process.” 8
After advancing both proposals, the Board heard detailed presentations
from AMR and ConFire at a public hearing, followed by many public
comments in support of both proposals, before selecting ConFire. AMR has
not shown that this decision was irrational or disconnected from the
overarching goals of the RFP process to improve service delivery to customers
and partners, to establish a more efficient EMS system, and to make
investments back into the system. Rather, before the Board selected
ConFire, each supervisor outlined the reasons he or she believed ConFire
provided the best value, including that: (1) ConFire was eligible for
supplemental state funding that could support the system and lower the
County’s costs; (2) ConFire would improve public safety by closer “integration
8 As discussed in footnote 7, the Ninth Circuit reached the same
conclusion in its decision affirming the dismissal of AMR’s antitrust claims.
In their reply briefs, the County and ConFire assert the Ninth Circuit’s
decision is entitled to preclusive effect. Although we granted AMR’s request
to file a supplemental brief addressing this issue and the County’s and
ConFire’s requests to file responses thereto (and agree with the Ninth Circuit
that the RFP did not impose a requirement to advance only AMR to further
negotiations) we decline to reach the issue of collateral estoppel because it is
unnecessary to our decision. Rather, we decide this case on its own merits.
We also note the Ninth Circuit’s recognition that “the state court may be a
more appropriate forum to litigate AMR’s challenges to the County[’s]
execution and administration of the RFP.” (American Medical Response of
Inland Empire, supra, 2025 U.S. App. Lexis 10389.)
Because we do not reach the issue of collateral estoppel, we deny
ConFire’s requests for judicial notice, filed on July 7 and August 26, 2025,
and the County’s request for judicial notice, filed on July 7, 2025, as moot.
29
or coordination of services,” particularly during disasters, by consolidating
EMS and fire response; (3) ConFire promised better service with faster
response times, and (4) representatives from cities, towns, and fire agencies
affected by the decision preferred ConFire.
By ruling that AMR was likely to prevail on its claim because the
County abused its discretion, the trial court improperly “substitute[d] its
judgment for that of the agency.” (Mike Moore’s, supra, 45 Cal.App.4th at
p. 1303.) As ConFire asserts, the trial court afforded the County “no
deference, failed to honor the presumptions in their favor, unjustifiably
questioned their understanding of their own solicitation, substituted its
judgment for that of [the County], questioned the wisdom of their actions,
and accused [the County] of improper motivations without any direct
evidence.” This was reversible error.
C
The Balance of Harms Does Not Support Imposition
of the Preliminary Injunction
Lastly, because the court improperly concluded AMR was likely to
prevail, its balance of harms analysis also cannot stand. “ ‘A trial court may
not grant a preliminary injunction, regardless of the balance of interim harm,
unless there is some possibility that the plaintiff would ultimately prevail on
the merits of the claim.’ ” (Anderson v. County of Santa Barbara (2023) 94
Cal.App.5th 554, 570.) “ ‘ “Where there is ... no likelihood that the plaintiff
will prevail, an injunction favoring the plaintiff serves no valid purpose and
can only cause needless harm.” ’ ” (Midway Venture LLC v. County of San
Diego (2021) 60 Cal.App.5th 58, 91.)
Further, “[i]n general, if the plaintiff may be fully compensated by the
payment of damages in the event he prevails, then preliminary injunctive
relief should be denied. [Citation.] Where, as here, the defendants are public
30
agencies and the plaintiff seeks to restrain them in the performance of their
duties, public policy considerations also come into play. There is a general
rule against enjoining public officers or agencies from performing their
duties. [Citations.] This rule would not preclude a court from enjoining
unconstitutional or void acts, but to support a request for such relief the
plaintiff must make a significant showing of irreparable injury.” (Tahoe Keys
Property Owners’ Assn. v. State Water Resources Control Bd. (1994) 23
Cal.App.4th 1459, 1471.) Given our conclusion that AMR cannot show a
likelihood of prevailing on the merits of its mandate claim and the general
rule against enjoining public agencies, AMR has not shown that its risk of
injury supports the imposition of a preliminary injunction.
DISPOSITION
The order is reversed. On remand, the trial court is directed to enter
an order denying AMR’s motion for a preliminary injunction and to
reconsider the amount of the undertaking it imposed on AMR in light of this
court’s decision. Costs of appeal are awarded to appellants County of San
Bernardino, County of San Bernardino Board of Supervisors, Inland Counties
Emergency Medical Agency, and Consolidated Fire Agencies.
McCONNELL, P. J.
WE CONCUR:
IRION, J.
RUBIN, J.
31
Filed 1/5/26
CERTIFIED FOR PUBLICATION
COURT OF APPEAL, FOURTH APPELLATE DISTRICT
DIVISION ONE
STATE OF CALIFORNIA
AMERICAN MEDICAL RESPONSE OF D085716
INLAND EMPIRE,
Plaintiff and Respondent,
(Super. Ct. No. CIVSB2416492)
v.
COUNTY OF SAN BERNARDINO et
al., ORDER CERTIFYING
OPINION FOR PUBLICATION
Defendants and Appellants,
CONSOLIDATED FIRE AGENCIES,
Real Party in Interest and
Appellant.
THE COURT:
The opinion in this case filed December 18, 2025 was not certified for
publication. It appearing the opinion meets the standards for publication
specified in California Rules of Court, rule 8.1105(c), the requests pursuant to
rule 8.1120(a) for publication are GRANTED.
IT IS HEREBY CERTIFIED that the opinion meets the standards for
publication specified in California Rules of Court, rule 8.1105(c); and
ORDERED that the words “Not to Be Published in the Official Reports”
appearing on page one of said opinion be deleted and the opinion herein be
published in the Official Reports.
MCCONNELL, P.J.
Copies to: All parties
2