HomeMy WebLinkAboutContract 45299 9
SIEC
This, Educational Experience Program Affiliation Agreement (Agreement) is made and entered
luto by and between Cook Children' Medical Center ("Facility") and The City off' Fort
Worth ("Educational Institution","').
Thais Educational Experience Program Affiliation Agreement includes the following
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The purpose of this agreement is to specify the general activities planned and the assignment t f
responsibilities between the parties. The parties agree that It will be to their mutual interest and
advantage for students and faculty of.the Educational Institution to be give n the opportunity tc
utilize the Facility for educational purposes.
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In consideration of the mutu al Ojectives, and in further consideration of the mutual promises
containea tierei a, the Facility and the Educational, istitutlon agree as :follows:
.GREEM.E:l I"
GENERAL INFORMATION
I. Student Assi niijents. The specific areas of student assi ni-nent for each program
and the number and distribution of students within the Facility will be mutually,
agreed upon each academic semester by the Educational Institution and the
Facility. Educational Institution shall identify a contact person for each program
who will be responsible for arrangi,ng and con firming student assignments with
:Facility.
2. Academic Period and Supervision of Students. The students will be in the
Facility during the regular academic Periods, and will be under the direct.
supervision of a designee of the Facility, or faculty member of ti c Educational"
Institution. The designee of the Facility will l be currently licensed by the
appropriate Texas regulatory agency aid (2) be competent to per.l'on tic duties.
The faculty member of the Educational Institution, will f be c urrently licensed
tensed.
by the appropriate regulatory agency of their state and 2 be competent to
Pcrf,)rm as .faculty coordinator.
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(n B. FACILITY RESPONSIBRATIES
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M 1. 'tic Facility agrees to rovide to the Educational Institutio n necessary conference
and classroom areas for students, as available.
2. ,l"he Facility will rnalc available immediate emergency treatment for students and
faculty during the clinical experience, if needed. Thereafter, ec ssary the
studer t or facu=lty shall be transferred to an adult care facili Tl��
assures io financial responsibility for the student's or fa.cti ty c
City SECRer,41ty,
WoRrhy 7
care and treatment after they leave the Facility. The Facility has an established
protocol, policy and procedure related to post exposure of blood borne pathogens
and all students and faculty shall follow said guidelines as appropriate.
3. The Facility will provide students with an orientation of applicable Facility rules,
regulations, and policies.
4. The Facility retains the responsibility, authority and accountability for the care of
p, ti-eats W students are I
in the Facility participating in care to patients.
5. The Facility may require the Educational Institution to remove any student from
continuing in the educational experience at the Facility if Facility deter-nines that
the student does not meet the professional or other requirements, qualifications and
standards of the Facility. "I"'he Facility will consult wit hthe Educational Institution
prior to any such removal, if reasonably possible. The Facility will provide written
explanation for removal to the Educational ]Institution.
6. The Facility will. per it the authority responsible for accreditation of the
curriculum of the Educational Institution to inspect the facilities and services
provided pursuant to this Agreement as, necessary for accreditation evaluation,
upon reasonable notice and as reasonably required.
7. The Facility will provide learning experiences including observation, direct care,
interdisciplinary collaboration, and part icipation in clinic, conferences and
inservices. Students will. receive appropriate supervision and regular evaluations,
of performance, as applicable.
C. 'EDUCATIONAL INSTITUTION'S RESPONSIBILITIES
I. 'Rules and Regul,ations. The Educational Institution shall require, students to be
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familiar with and abide by all applicable rules, regulations, policies an
procedures that govern.the Facility.
2. Students and Faculty Insurance Cove Educational Institution certifies and
warrants 'that it is basically a self-funded entity and as such, generally, does not
mainta-in a commercial liability insurance policy, and damages for which
Educational, Institution would ultimately be found liable would be paid directly
and primarily by Educational Institution and not by a commercial insurance
company. Educational Institution certifies 'that it would be able to cover damage
awards for students and flaculty of not less than $1,00:0,000 per occurrence and
$3,000,00101 aggregate without holding a commercial liability insurance policy.
3. prerequisites.sites. The Educational Institution shall require that students-.
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a receive instruction in universal blood and body fluid precautions (within
the past year) through Facility and, if involved 'in, patient care activities,,
card 1 opulmonary resuscitation, (,a healthcare basic life support/CPR course
within the past 2 years,); and
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b. comply with the Dallas-Fort, Worth Hospital Council Foundation
Community Standards for Drug Sereenin'g, 'Background Checks &
Immunizations currently in place and as amended from ti
time to me
(current standards, are attached hereto as Exhibit "A" and incorporated
herein by reference).
4. Dress Code. Students and faculty are responsible for providing the necessary and
appropriate attire required, but not provided by, the Facility,. The student shall
dress appropriate to the area they are assigned to and wear a school name tag at al.l.
times while participating in the educational experience at the Facility.
5. Documentation,. Prior, to con-imencement, of the clinical experience, each student
shall provide Facility with an executed copy of Facility's "Release from.
Liability," provide written documentation of current health insurance, and other
written documentation as required by Section C.3 above. Such documentation is
to be submitted to the Academic Affiliations Coordinator or Director of Medical
Education at Facility (as appropriate).
6. Publication. Students and faculty shall not submit for publication any material
relating to the clinical educational experience without prior written approval of
the Facility and the Educational Institution. This provision shall survive the
termination of this Agreement.,
7. Students and faculty shall adhere to the standards of the profession.
D. COMPENSATION
In consideration of the Facility's, agreement to provide a setting for the clinical experience ence of the
Educational Institution, no student or faculty member of the Educational ]Institution providing
services at the Fac*],'flit ,
1 1, , pursuant to the Agreement, shall receive monetary compensation or
employee benefits from Facility includilig, but not limited to, paid vacation,, wolrker's,
compensation, disability insurance and retirement benefits.
E, CONFIDENTIALITY AND DISCLOSURE OF PATIENT INFO"ATION
Both parties acknowledge HIPAA obligations and other regulations implementing the Health
Insurance Portability and Accountability Act of 1996 (42 U.S.C. § 1320(d) (1.41P'AX"). The
parties acknowledge that federal regulations relating to 'the confidentiality of individually
identifiable health information require Facility, as a covered entity, to comply with the privacy
standards adopted by the 'U.S. Department of Health and Human Services as they may be
amended from, time to time. Educational Institution acknowledges that the students are
idered part of the Fac'l*ty"s workforce solely for purposes, of HIPAA. Educaflonal
cons I I I
Institution will require that each student agree to maintain the confidentiality of individually
identifiable healt1i information of F'acil,ity patients as required by 'HIPAA and as required by state
law. ..Educational Institution recognizes, that any breach of confidentiality or misuse oL
information found In and/or obtained frorn patient 'medical records may resit in the termination
of this Agreement and/or legal action. disclosure inay give rise to irreparable
injury to the patient or to the owner of such information, and, accordingly, the patient or ocaner
of such information may seek legal ret-nedies against Pducrational Institution.
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F. COMPLIANCE
In plerforming the services required of it under this Agreement, the parties shall comply with all
applicable federal, state,, county and city statutes, ordinances and regulations. The Facility shall
meet all Joint Commission accreditation and Texas State Hospital licensing requirements,. The
Educational Institution shall meet all requirements necessary for accreditation of the Program.
G. TEXAS LAW TO APPLY
This Agreement shall be construed under and in accordance with. the laws of the State of Texas.
In the event judicial intervention is required under this Agreement, venue shall be exclusively in
Tarrant County.
H. NONDISCRIMINATION
The Educational Institution and the Facility mutually agree not to discriminate on the basis of
race, color, age, national origin, sex, transgender, gender identity or gender expression except as
provided by law, nor will either party to this Agreement discriminate on the basis of handicap
under-the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990.
I. INDEMNIFICATION
To the extent allowed by law, the Educational Institution agrees to defend, indemnify and hold
harmless the Facility, its officers, trustees, employees, servants, affiliated organizations,, insurers,
agents and assigns from any and all claims actions causes of action. 1
11 1 ) demands, suits, liabilities,
losses or expenses in connection with bodily injury, personal injury or property damage resulting
from the acts or omissions of the Educational Institution,, its employees, students, agents, or
servants. The Facility agrees to defend, indemnify and hold harmless the Educational Institution,
its officers, trustees, employees, servants, affiliated organizations and insurers from any and all
claims, actions,, causes, of action, demands, suits,,, liabilities, losses or expenses in connection with
bodily injury, personal injury or property damage resulting from the acts or omissions of the
Facility, its employees, agents or servants. Nothing contained herein shall ever be construed so
as to require Educational Institution to create a sinking fund or to access,, levy and collect any tax
to fund its obligatioins, under this paragraph.
J. TERMS OF AGREEMENT
1. This Agreement shall be effective June 1, 2013, and will terminate on May 31 1,
20 16.
2. Either party may terminate this Agreement upon written notice delivered at least
thirty (301) days prior to the effective date of termination. All students, enrolled in
the Program at the time of termination will be allowed to complete their course
work for that term.
3. The persons signing -this Agreement warrant that they have full authority to do so
and that their signature shall bind the parties, for which they sign.
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4. The parties to this Agreernent understand and agree that eat ier party may revise,
modify ortenninate this Agreement by written agreement when both parties agree
to such amendment.
NOTICE
Any notice re ui I red or pemiitted to be given under this Agreement shall be inwriting and sent to
the addresses set forth below'. Either party may change the address J`or notice by notice to the
other party.
,If to Facility: If to Educational 'Institution-,
Cook Children's Medical (-,,enter The City offort Worth Fire Department,
801 Seventh Avenue 1,0010 Calvert Street
Fort Worth, Texas 761,04 For Worth, Texas 76107
Attn..- Sharon Ransom, MHA, RN, CPN Attn. Lt. James Horton
Academic Affiliations Coordinator
In witness hereof, the authorized representatives of the parties, have executed this Agreern,ent as
indicated bIelow, and agree to the "Ferms and Condition of the Educational Experience Program
Affiliation Agreement', as inatcated by their signatures below. Each respective school or
departm,ent shall be inciucted in the Agreement only as loIn g as, the Educational Experience
1#'� * 'I terininated by
Prograin Affiliation Agreement of theE_'.ducatlona] Institution is in pIlace, or unti.
the school or department pursuant to the Agreement,.
"FACILITY" "EDUCArFIONAL INS"11TU"FION"
Cook Children's Medical Center The City of Fort Wolili,
801 Seventh Avenue 1. 0 0 Street
Fort Worth, Texas 76104 or Worth 1"exas 76107
�le: Charles W. Daniels
Printed Name-� Deborah RLibinsonVN k_N Pr in tL,,,,e
Vj_
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Title': Assistant Vice President of Education Title: Assistant Ci y Manqger
Cook CM kerl'. 1-lea lth Care
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OFFICIAL RECORD oA
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CITY SECRETARY 0 to)do o
FTa IWORTH, TX
EXHIBIT"A"
DALLAS-FORT WORTH HOSPITAL COUiNCIIL FOUNDATION
Community Standards for Drug Screening,
Background Checks & immunizations
(Effective as of January 1, 20131)
These community standards are general guidelines for drug screenings, background checks,,
and immunizations in the North Texas region for schools and hosplitalls/healthcare agencies.
These requirements will be effective for any students being admitted to programs,after
January 1) 2013.
GENERAL GUIDELINES
Prescreening requirements have been introduced into clinical student affiliation agreements. These
prescreening requirements are the same as those re,quiiredi of employees (background checks, drug screens,
and immunizations,). The rationale for extending, these requirements to clinical students and faculty was the
concept of due diligence and competency assessment of all individuals,whose assignments bring them in
contact with patients or employees. Competency extends beyond technical skills to an individual's criminal
history and drug free status. This approach ensures uniform complliance with Joint Commission standards
pertaining to human resource management, Moreover, the, public is now demanding greater diligence in light
of the national reports of deaths resulting from medical errors and patient safety events.
Timing of Prescreening Requirements:
Drug screens and background checks must be conducted within 30 days prior to the start of a person's first
clinical, rotation following enrollment in the college/school or after a break in enrollment. Verification of the
satisfactory results/compliance Must be received by the participating hospital/agency prior to the student's
rotation, start date. Drug screen and background checks will be honored by all hospitals/agencies i for the
duration of the student's enrollment,in the clinical program if the participating student has not had a break in
the enrollment at the college/school. A break in enrollment is defined as nonattendance of one full semester
(Fail or Spring) or moire. The above information must be verifiable through the college/'schololl. Drug screen
and background checks of faculty will: be honored for the duration of the employment of the faculty member
at the college/school. Immunizations must be current prior to a person's first clinical rotation and must be
maintained in current"status, during all clinical rotat,ions.
Reciprocity:
Students whose schools follow these, standards need only meet these requirements prior to the start of their
first clinical rotation. Other DFW Hospital Council members that follow these standards will honor the initial
test results, provided that these results can be verified with the college schoo 1.
Allocation of Cost:
Each institution/school must bear the cost of these requirements,or pass them along to their students/faculty
as they see fit.
Verification of Compliance & Record keepin g IN
Verification of the compliance with these standards should be sent to the designated representative of the
clinical agency prior to the clinical rotation start date. Verification is accomplished by sending a letter from the
institution on leitterhiead stating, that these standards have been met by the student/faculty„ listing the
student's/faculty's full name and clinical rotation, start date. If more than one student is attendiing a clinical
rotation, a comprehensive list,with all the students'/faculty names may be submitted. It is the res,ponsiblility of
each college/school to inform these persons of our requirements prior to enrollment in this curriculum. This
will give studentsfaculty prior notice and an opportunity to decline the clinical training before investing their
Lime and money in the class.
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Participating Hospitalls/Schools:
North Texas Hospitals who, have provided input in review of'these guidelines and come to agreement on
these standards for the region Include, Baylor Health Care System, children''s Medical Center Dallas, Cook
Childreni's Health Care System, HCA— North Texas Division, JPS Health Network, Methodist Health System,
Parkland Health & Hospital, System, 'Tenet Healthcare, and Texas Health Resources. Schools that provided
input include- Collin College, Ell Centro College, ands Tarrant County College.
Questions regarding the Community Standards can be directed to the DFWHC Foundation Workforce
Center. Contact information can be found at www.dfwhcfoundation.org.
DRUG SCREENING
Prel-Assignment, Drug Screening:
Drug Screening can have up to four steps—
Collection Process
Laboratory
GC/MS Confirmation on all Non-Negatives,
Medical Review Officer on all Non-Negatives
By foillowing these steps you are holding kieveryone" to the same standards.
Collection Process,.
Method by Urinalysis -we prescribe an unobserved collection of urine for initial screening. Reasonable
suspicion situations will be observed as determined by faculty. The collection process is to be, done in a
consistent manner with consistent notice given. Collection can be done as a group either at the campus or
at a designated collection site during the same time period. Alternatively, students (whether on-campus,
distance learning,, or late admission) will be given a, specific time-limited period to present themselves to the
appointed/approved collection facility. By taking these steps, students/faculty will be held, to the same legal
standards as it relates to the collection process.
The discovery process is covered in detail when the students are together for the group meeting prior to the
collection. They are told that the on,l,y person they will discuss their medications with is the independent
Medical Review Officer(NVIRO)who will contact them if needed.
The pre-collection group meeting will cover the community standards, the legal statements on the Non-
Federal Chain of Custody that they will be signing, the time and quantity req,uirements for specimen
collection,, privacy information and give students the opportunity to ask questions.
Laboratory:
All tests,will be processed at a certified SAMHSA(Substance,abuse & Mental Health Services
Administration) laboratory. The minimum standard drug screen panel is all Healthcare Professional 10—
Panel with integrity checks for Creatinine and PH levels, acceptable and unacceptable test ranges will follow
the 49 CFR Part 40 Federal Standards.
URN CREATININE 20.0—300.0
Test Screen GC/M;S Units
COCAINE METABOLITES 300, 150 ng/ml
AMPHETAMINES (CLASS) 10,00 500 ng/mIl
BARBITURATES 300 300 ng/m�l
BENZODIAZEPINES 300 300 ng/ml
MARIJUANA METABOLITE 50 1 5 ng/ml
OPIATES 2000 2000 ng/ml
PHEN:,CYCLIDINN 25 25 ng,/m,l
PROPDXYPHEN,E/'IVI,ETABOLICE 300 300 n l
METHADONE 300 300 ng/ml
SYNTHETIC OPIATES, (includes Oxycontin, 100 100 ng/ml
Oxycoldone, Hlydirocodon,e and Morphine)
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SAMHISA laboratories are certified, and regulated by the federal government assuring the highest standards.
All Non-Niegative Spedimens are frozen and maintained in a secure area, with limited access, for one year
in the event that a retest is required. Using the same SAMHSA laboratory for all tests,withlin the group,
assures adherence to the same legal standards.
GC/IVIS Confirmation on, all Non-Negatives:
All Non-Negiative specimens will, be confirmed via GC/MS conifirmat,ion. This step is performed at the
SAIVIHSA laboratory. The result of the GC/IVIS confirmation is sent to an independent Medical Review
Officer, along with a copy of the Chain of Custody.
Meldi�cal Review Offiicer�(MRO) on all No�n-Negativesi:
The i:ndependent MRO is the impartial If quality assurancell component who, advocates, for the accuracy and
integrity of the drug testing process. The quality assurance review of the drug testing process for the
specimens, determines if there is a legitimate medical explanation, fo:r laboratory confirmed positive GC/MS,
adulterated, substituted and invalid drug test'results, ens,ure the timely flow of test result and other
information to school /college and prot'ect the confidentiality of the drug testing infoirmation. The MRO
reviews all GC/MS results fromthe SAMHSA laboratory. If the result remains positive, the, MRO, contact the,
student to determine if there is a valild prescription for the drug in question. If'a valid prescription exists and'
specimen is within prescribed limits, the test result is deemed to be 11 negative$1 and acceptabile. The M,RO is a
medical doctor who specializes in the interpretation of drug screen results. Medical Review Officers do not
make placement decisions; they simply pass along information r,egard�ing legal, versus illegal drug use or
consumption. Medical Review Officers are not re�qui�red�, but are beneficial in, making placement decisions. If
follow up w�ith IVIRO is needed, students, are expected to do so within the MRO's or school's specified time
limit.
The MRO is completely independent of all parties i,n the testing process, including the, col'l:ection, the
SAMHSA laboratory, the s,chool/coll,eg,e and the individual student/faculty. This is the defacto gold standard
-n�egiative drug
i�n drug testing., The MRO is the ONLY person who can make a final decision about a n�o,n,
screen.,
An agency reserves the right to remove a student/faculty from the faciliity for suspicion of substance use or
abuse (including alcohol.) The agency will immediately notify the instructor/college/school to facilitate
immediate removal and' drug testing of the individual. The student/faculty will be required' to consent to,a
drug test at a site identified by the in�s,tru�ctor/col,leg,e/school and the student/faculty or school will be
responsible for the cost. Given the issue of safety and impairment, all' reasonable attempts shall be made to
contact,thel student's1faculty's family; friends, or police to provide transportation., Testing must be co�m,pleted
on the same business day. In all i:nstances, the agency will provide,written documentation of the
student's/faculty's blehavior(s) by two or more agency representatives to the college/school. Regardless of
testing or test results, the agency reserves the right to remove from the facil,ity any student or faculty
member. A student/faculty may have drug testing "for cause" at the discretion of the clinical agency. Failure
to comply will result in immed�iate expulsion from the cl,inical, agency.
An individual with a positive drug screen, or who refuses to submit to a reasonable suspicion, drug screen will
not be,allowed to attend any clinical agency/rotation for a minimum of 12 months. Prior to, returning, to the
clinical agen�cy/roltation, a student must provide proof of a negative drug screen, acceptable background
check and required i,mmu,nizat,ions as verified by the college/school.
NICOTINE TESTING - BAYLOR HEALTH CARE SYSTEM INFORMATION -As a health care system:
committed to improving the health of those,we servef we are asking our employees to model'the same
behaviors we promote to our patients,, Beginning January 1:, 2012, Baylor will no loinger hire individuals who
use nicotine products. Appili�can�ts who: profess to use nicotine will not have their applications, processed.
Anyone who is offered and, accepts a position with BHCS will be tested for nicotine duri�ng our regular po�st-
offer pre-emplolyment testing. Applicants who test positive for,nicotine will be eliminated from consideration
a,nd pending:j�ob offers will be rescinded. At this time, testing for nicotine will not app:ly to clinical students or
faculty.
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CRIMINAL, BACKGROUND CHECK
Criminal background checks should review a person's criminal history. The check should include the cities
and counties of all known residences, not just the DFW area. The following criminal:, histories are examples
of actions that may disqualify an individual from consideration for the clinical rotation. This list is for example
purposes and is not an exhaustive list. (Each criminal record or individual will' be assessed according to
E,EOC req,uirements)-
0 Felony convictions/deferred adjudications
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0 Misdemeanor convictions or felony deferred adjudications involving crimes against persons (physical
or sexual abuse), illegal use,or distribution of drugs
0 Misdemeanor convictions or deferred adjudications related to moral turpitude (prostitution, p ublic
lewd ness/exposu re, theft under$1,500, computer crimes of fraud, etc.)
0 Felony deferred adjudications for the sale, possession, distribution, or transfer of narcotics or
controlled substances
0 Registered sex offenders
0 01G, GSA and Medicaid Sanctions
0 Terrorist Suspect List
0 Pending charges and warrants for arrest
For more detailed information, please reference the following:
0 Texas Health & Safety Code Section 250.006
(-http1/www,statutes.le ci is.state.tx.us/Docs/H S/h-tm/H 5.250.htrn)
0 Texas Occupation Code Section 3011-4535
(http://www.statutelsi.l'eqis.state.tx.us/Docs/OC/h:tm/OC.301.htm)
Texas Admin Code- Section 213.28
(Ilh,ttp:Hin,fo.sos.state.tx.uS/iDis/i)ub/readta_c$e t.TacP'ag..e?sil=T&a ,-9.!&p di,r=F&p rloc=137017&p t1o,
c=14910& &pg=6,&p_tac=&ti=22&pt=1 1&ch=213&r1=28)
NOTES- (1) If a licensing/registry body approves the individual to take the licensing/credentialing
exam, the individual may participate in the clinical rotation,
(2) A schooll/college may request an exception from the first clinical rotation/agency for
a student with a felony deferred adjudication and no alternative recourse through a
licensing/registry authority, i.e. Board of Nurse Examiners of Texas. Following
approval from the agencies, the student may progress as stated above.
IMMUNIZATIONS
Participating hospitals/agencies require that the foillowin,g immunizations be current for stud ents/f'ac u Ity prior
to their first clinical rotation following enrolliment in the college/school or after a break in enrollment. Not alli
immunizatiloins listed below are required at all facilities. Where there is an exception,1 it is noted. Immunization
requirements,are reviewed periodically by participating hospitals, and are subject to change based on
hospital standards, CDC recommendations or Texas Administrative Code rules. Verification of current
immunizations must be received, by the participating hospital/agency prior to the student's rotation start date.
Immunizations must be maintained in current status during all clinical rotations. The information must be
verifiable through the college/school.
Here is the list of required immunizations as of September 1, 2012:
• Full H�eplat,itis B Series and/or immunity to Hepatitis B.
• MMR (Rubeola/Measles, Mumps, Rubella/German Measles) documentation of 2 doses or positive
titers.
• T'DaP (T'et�anus,, Diphtheria & Pertusisis) Booster(one dose as adult) within the last 10 years.
• Varicella vaccination or titer.
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Influenza/Seasonal Flu Immunization (required annually during flu season usuial�ly from, September
'through March or Aprilli). Exceptions made for medical and religious, reasons, but must adhere to
hospital policies.
Negative Tuberculin JB)Test (Annual requ�iremenit) (can be either TST or QFT) and/or negative
CXR. If history of positive PPP test or having, had TB, must provide documentation of negative chest
x-ray or completed treatment.
Meningitis—Only needed for Chilidrens Medical Center for lab techs who handle cultures for
meningococcal meningitis.
Hepatitis A—Only needed for Texas Health Resources for child care;workers, nutrition, &
psychiatric depts.
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am wo
"FoRT Wo RTH
Fiscal Year Oct. 1, 2013 — Sept. 30, 2014
RE Documentation of Insurance
City of Fort'Worth Self-Funded; Insurance Program
To Whom It May Concern:
Please accept this letter as documentation of the City of Fort Worth's insurance program.
The, City of Fort Worth is basically a self-funded entity subject to, statutory tort laws. 'Thle
City does not maintain a commercial policy of general liability 'insurance and/or auto
liability insurance. Damage for which the City of Fort Worth would ultimately be found
liable would be paid directly by the City of Fort Worth and not by a commercial "insurance
company. City owned property is covered under the City of Fort Worth, Fire and
Extended coverage program, by a commercial 'insurance policy. Statutory workers'
compensation insurance, coverage is self-funded to the $750,000.00 retention limit pier
Incident over which commercial coverage responds with no upper cap; and, employer';
liability coverage is maintained at the $1,000,000.00 policy limmit.,
In the e�vent there; are any questions re arcing the City of Fort Worth S, insurance
r i
ram, or 1 f I may be of additional assistance, please contact me at the
po�g
address provided, or phone direct to 8171-3192-7761 or email,
logy
Thank you for your time and attention. Both are appreciated. On behalf of the
City of Fort Worth, we look forward to a continued business relationsnip.
Sincerely
Jo yv Page
Risk Manager
FINANCIAL MANAGEMENT SERVICES DEPARTMENT
IS MANAGEMENT DIVISION,
THE C 7 OF FORT WORTH*1000 OCR CARTON STREET ,F5O WORTH,TEXAS 76102
f
Office 817-392-7402 Fax 817-392-5874