HomeMy WebLinkAboutContract 46006-A4 CSC NO. 46006
GoFF E� AMENDMENT NO. #4 TO CITY SECRETARY/ J
� s CITY SECRETARY CONTRACT NO. 46006COWRACT NO.
MOBILE SCREENING AGREEMENT
This Fourth Amendment of Fort Worth City Secretary Contract Number 46006 is
entered into by and between the City of Fort Worth (hereafter "Customer"), a home rule
municipal corporation organized under the laws of the State of Texas, with its principal place of
business at 200 Texas Street, Fort Worth, Texas, and Texas Health Harris Methodist Hospital
Fort Worth (hereafter"Hospital"), a Texas non-profit corporation.
WHEREAS, the parties have previously entered into City of Fort Worth City Secretary
Contract No. 46006 (the "Contract"), which was executed on October 3, 2014; and
WHEREAS, the Contract has subsequently been amended in the years 2015, 2016, and
2017.
WHEREAS, the Contract involves Hospital's provision of health services to Customer,
specifically, Mammography Screenings to Customer's employees during the Wellness for Life
Mobile Screening Event(the "Event"); and
WHEREAS, the City and Hospital now wish to amend the Contract and prior
Amendments to specify new Event dates for 2018, update the provision related to primary care
physician requirements, and update the notice provisions in the Contract.
NOW, THEREFORE, Customer and Hospital, acting herein by and through their duly
authorized representatives, enter into the following agreement to amend the contract:
1.
Section 1 is amended to provide the following:
1. Services to be Provided. Hospital hereby agrees to provide mammography screenings to
Customer during the Event scheduled at the date, time, and location listed in Section 1.1
of this Contract.
OFFICIAL RECORD
Amendment No.4 to CSC No.46006 CITY SECRETARY
Page 1 of 5 FT.WORTH,TX
1.1 Event Date(s):
Event Date Minimum
and Event Screening Provided at Participants
Event Time Event Location Event per Screening
Monday,
October 22,
Wellness 2018 CITY OF FORT
for Life Screening WORTH ZIPPER
Mobile Time: 9am- BUILDING 275 WEST
Screening 3pm 13TH STREET;FORT
Event WORTH,TEXAS 76102 Mammography Screenings 19 Participants
Tuesday,
October 23,
Wellness 2018 CITY OF FORT
for Life Screening WORTH ZIPPER
Mobile Time: 9am - BUILDING 275 WEST
Screening 3pm 13TH STREET;FORT
Event WORTH,TEXAS 76102 Mammography Screenings 19 Participants
Wednesday,
October 24, WILL ROGERS
Wellness 2018 MEMORIAL CENTER,
for Life Screening 3401 WEST
Mobile Time: 9am - LANCASTER
Screening 3pm AVENUE; FORT
Event WORTH,TEXAS 76107 Mammography Screenings 19 Participants
Thursday,
October 25,
Wellness 2018 CITY OF FORT
for Life Screening WORTH ZIPPER
Mobile Time: 9am- BUILDING 275 WEST
Screening 3pm 13TH STREET;FORT
Event WORTH,TEXAS 76102 Mammography Screenings 19 Participants
Friday,
October 26,
Wellness 2018 CITY OF FORT
for Life Screening WORTH ZIPPER
Mobile Time: 9am- BUILDING 275 WEST
Screening 3pm 13TH STREET;FORT
Event WORTH, TEXAS 76102 Mammography Screenings 19 Participants
Monday, FORT WORTH POLICE
October 22, DEPARTMENT BOB
Wellness 2018 BOLEN PUBLIC
for Life Screening SAFETY COMPLEX
Mobile Time: 9am- 505 WEST FELIX;
Screening 3pm FORT WORTH,TEXAS
Event 76115 Mammography Screenings 19 Participants
Amendment No.4 to CSC No.46006
Page 2 of 5
1.2 Customer contact name and phone number: Vicki Tieszen, 817-392-8556.
2.
Section 4 is amended to provide the following:
4. Minimum Event Requirements. The Hospital requires the following minimum number of
screening participants for each mobile screening event:
4.1 Mammography= 19 Participants
The minimum participant numbers must be scheduled at least three (3) days prior to the
Event Date or the Event will be cancelled and rescheduled.
3.
Section 7 is amended to provide the following:
7. Event Day.
7.1 Participants. Participants are responsible for providing two (2) forms of
identification (a valid picture ID or Texas issued driver's license and a utility bill, phone bill or
some type of correspondence with the participant's name and correct address to establish proof
of residency). Results of screenings are mailed to the participant's home address.
7.2 Primary Care Physician. Each participant will be asked to identify his/her
primary care physician. A primary care physician is required for patient follow-up. If the
participant does not have a primary care physician, Hospital will assign a physician to be the
participant's primary care physician for receipt of screening results. The participant will be
notified of the physician's name at the time of screening.
4.
Section 9 is amended to provide the following:
9. Notices. Any notice, request or other communication required under the Agreement shall
be in writing and shall be deemed to have been given or made if delivered via certified mail, e-
mail, or facsimile to the parties at the following addresses, or at such other addresses as shall be
Amendment No.4 to CSC No.46006
Page 3 of 5
specified in writing by either of the parties to the other in accordance with the terms and
conditions of this subsection:
If to Hospital: Texas Health Fort Worth
Attn: Joseph DeLeon, President
1300 Pennsylvania Avenue
Fort Worth, Texas 76104
Copy to: Wellness for Life Mobile Screening
Attn: Sylvia Mercado
1300 West Terrell Avenue
Fort Worth, Texas 76104
Phone Number: 817-250-1884
Facsimile Number: 817-887-5266
If to Customer: City of Fort Worth
Attn: Susan Alanis, Assistant City Manager
200 Texas Street
Fort Worth, Texas 76101
Phone Number: 817-392-8180
5.
All other provisions of the Contract which are not expressly amended herein shall remain
in full force and effect.
(Signature page to follow)
Amendment No.4 to CSC No.46006
Page 4 of 5
Executed in multiples this the_ �r�, day of ,2018.
TEXAS HEA TH HARRIS METHODIST CITY OF FORT WORTH
HOSP AL T WORTH
Na e: J seph DeLeon N me Susan Alanis
Title: resident Tit e: Assistant City Manager
Date: Date: g
Contract Compliance Manager:
By signing I acknowledge that I am the
person responsible for monitoring and
administrating of this contract, including
ensuring all performance and reporting
requireme s
Name: Vicki Tieszen
Title: Wellness/EAP Manager
APPROVED AS TO FORM AND APPROVED AS TO FORM AND
LEGALITY: LEGALITY:
TEXAS HEALTH HARRIS METHODIST CITY OF FORT WORTH
HOSPTIAL FORT WOR
Approved As To Form Only:
Terri A. DeSio,Asst GV=NmdrC6"jdCounsel Thomas R. Hansen,Asst City Attorney
ATT TE — �OPIT W�
Mary J. a ,tiSec `Z
V'
Contract Authorization: * 5
M&C: None Required
OFFICIAL RECORD
Amendment No.4 to CSC No.46006 CITY SECRETARY
Page 5 of 5 FT.WORTHS TX