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HomeMy WebLinkAboutContract 45945-A1 ClIn'SECRETA ' cowp=T M. Program Agreement Renewal The undersigned parties confirm that the agreement by and between them entitled "Healthy Solutions° at Home Program Agreement", with an effective date of September 22, 2014 is hereby extended for an additional one year term commencing February 29, 2016. WHEREAS, the Parties desire to extend the term of the Agreement and make other modifications as set forth below. 1. The last sentence of the first paragraph of Section 1.3 of the Original Agreement is hereby deleted and replaced with the following: "HMR WMSC will notify Participants of any price changes for the HMR WMSC Products at least thirty (30) days in advance of the effective date of the change." 2. The first sentence of Section 2.1 of the Original Agreement is hereby deleted in its entirety and replaced with the following: "The term of this Agreement will be for the time period beginning on the Effective Date and continuing until terminated in accordance with the other sections of this Article 2, and applies to the Services to be provided by HMR WMSC." 3. The second sentence of Section 2.6 of the Original Agreement is hereby deleted and replaced by the following: "Any amendments or modifications will not be effective unless mutually agreed in a writing signed by an authorized representative of each Party with specific reference to this Agreement; provided, however, that HMR WMSC may upon reasonable notice to Sponsor given under Section 2.2 or by email, make modifications to the Exhibits hereof as HMR WMSC may determine are reasonable, necessary or desirable to conform to program changes or requirements of law." 4. Current Exhibit B and Exhibit C attached hereto. All other terms and conditions of CSC No. 45945 remain unchanged. Pagel of 2s2 MIS OFRECOR® CITY SECRETARY FT. WORTH, TX IN WITNESS WHEREOF, the parties have duly executed this Agreement extension as of February 29, 2016. HMR WEIGHT MANAGEMENT SERVICES CITY OF FORT WORTH TEXAS By: By: I Name: Desie(p Name: san Alanis Title: ChieOffi r Title: Assistant Ci Manager Date: �o? Date: 4(0 F 0 ATTEST: 0000000 0 $ 0 0 o� ame: Nfary Ka4r/ itle: City Secretary AZ4. 0000000 M&C No.Not Required APPROVM AS TO AND L4, GALITY: ASSISTANT CITY ATTORNEY Page 2 of 2 OFFICIAL RECORD CITY SECRETARY FT.NORTH,TK Exhibit B Healthy Solutions° at Home Diet Kits, HMR°Meal Replacements, and Service Fees Phase 1 Pro ram: Products and Services List Prices Auto-Delivery Program 2,4 Products Quick Start Kit $301.65 Quick Start Kit $271.49 (3 weeks) (3 weeks) Ongoing $205.60 Ongoing $185.04 (2-week orders) (2-week orders) • $11.95 Shipping&Handlingz • Money-back guarantee • Money-back guarantee • Auto-Delivery includes: 0 10% discount on all products o Free shipping • Eligibility for coaching programa Services • Quick Start Call included • Quick Start Call included • Toll-free customer service • Toll-free customer service included included • Weekly group support calls: o $49 per month o $99 for 3 months 'Purchase of HMR weight-loss foods is organized into an initial 3-week kit followed by ongoing 2-week reorders.Actual price may vary depending on customization of kit contents or selection of additional items(a list of HMR products that may be added or substituted by the participants is included in this Exhibit).Fruits and vegetables for the diet are purchased separately. 2There is no charge for shipping with the Auto-Delivery Program or for orders of$225.00 or more shipped within the contiguous United States. Weekly shipping costs will vary depending on frequency and dollar amount of orders. 'Individuals who do not agree to the Auto-Delivery Program in Phase I are not eligible for coaching services. Note:Per Section 1.3 of the Agreement,as a discount on the program,service fees are waivedfor Phase 1 participants receiving auto delivery under the Healthy Sohrtions at Home Phone Support program. `Additional details on the Auto-Delivery Program can be reviewed athttps://www.myhmrprogram.conVHMRInforFermsandConditions. Phase 2 Program: Products and Services List Prices Auto-Delivery Program Products • No minimum product purchase • A standing monthly order(amount • Product order prices are outlined determined by client) is required in the Individual HMR Meal • Free shipping for any standing monthly Replacement Cost section of order this Exhibit • 10% discount on all orders of$100 or • $11.95 Shipping&Handling' greater • Money-back guarantee • Money-back guarantee Services • Phase 2 transition call included • Toll-free customer service included • Weekly group support calls': o $24 per month o $49 for 3 months 'There is no charge for shipping for orders of$225 or more shipped within the contiguous United States.Shipping costs will vary depending on frequency and dollar amount of orders. 2Additional details on the Auto-Delivery Program can be reviewed athttps://Nvww.myhmrprogram.com/HNmlnfo/FermsandConditions. 'Although use of HMR WMSC meal replacements is expected,individuals are not required to participate in Auto Delivery or satisfy any minimum product purchase requirement in order to participate in Phase 2 coaching. Participation in Phase 1,along with its auto-delivery requirements,is a prerequisite for joining Phase 2, HMR WMSC reserves the right to discontinue any participant from the HSAH Phone Program due to lack of attendance or non-compliance with other material aspects of the HSAH Program(as determined in HMR WMSC's sole discretion).Note:Per section 1.3 of the Agreement,as a discount on the program,Phase 2 service fees are waived. Effective 4/1/2016 Individual HMR® Meal Replacement Cost Shakes and Soup Shelf Life HMR 500 Chocolate or Vanilla(18 servings).........$42.25/box 2 years HMR 500 Chicken Soup (18 servings)..................$42.25/box 2 years HMR 70 Plus Chocolate or Vanilla(18 servings)......$47.00/box 2 years HMR 800 Chocolate or Vanilla(18 servings)..........$44.25/box 2 years HMR 120 Chocolate or Vanilla (12 servings)..........$25.50/can 2 years Multigrain Hot Cereal (18 servings)............................$44.25/box 1 year Entrees................................................................$3.70/box 18 months BeneFit8 Bars (24 servings).......................................$31.20/box 1 year Prices are subject to change and rights of the Parties per section 1.3 of this Agreement Effective 4/1/2016 Exhibit C Healthy Solutions° at Home Phone Program Informed Consent Name Phone Address IMPORTANT INFORMATION: Please read the following information about the Healthy Solutions at Home Program carefully. This document contains important information about certain health risks associated with losing weight and any restrictions regarding participation in the Healthy Solutions at Home Program with group phone support(the "Phone Program" ) offered by HMR Weight Management Services Corp. ("HMR WMSC"). It also contains important information about the use and disclosure of personal information about you as a participant in the Phone Program. You should consult with a physician before starting any diet program. Any diet program can pose health risks if not evaluated with your current medical condition and should be assessed by a medical professional to determine if it is right for you. As a participant,you accept the responsibility to seek initial and ongoing medical advice from your doctor or qualified healthcare professional. Program Risks, Benefits, and Restrictions The Phone Program is designed to provide you with information on weight loss, physical activity, and healthy lifestyle behaviors. Phone Program staff and materials provide phone-based instruction and phone-based coaching that can help you reach a healthier weight and lifestyle. This is not a very low-calorie diet. The Phone Program does not provide medical screening, medical monitoring, or ongoing medical care and advice. Although some health coaches may be medical professionals or dietitians, such persons will not be practicing or otherwise functioning in such capacities when acting as a Phone Program health coach. Although reduction of caloric intake, increased physical activity, and coaching is likely to result in weight loss, HMR WMSC cannot guarantee that weight loss or maintenance of weight loss will occur on this Program. Medical studies indicate that people who are overweight or obese(with a BMI of 25 or greater) are at increased risk of many health problems and diseases including coronary heart disease and heart attacks, high blood pressure, strokes, increased cholesterol levels, diabetes, gallbladder disease, kidney disease,gout, osteoarthritis, neurological disorders, and certain types of cancer. Although no guarantees are made with regard to the Phone Program, health risks associated with being overweight or obese can be reduced by achieving an ideal body weight. It is important to know that certain health risks have been associated with losing weight. Any weight-loss program may be associated with side effects including, but not limited to, the following: dizziness or light headedness, bowel changes, muscle cramps, fatigue,temporary anemia, cold sensation, menstrual irregularities, dry skin, temporary skin rash, and temporary hair loss. The following may also be associated with weight loss: the aggravation of pre-existing gallbladder disease,the development of gallbladder sludge or crystals,the appearance of previously undetected gallstones, or the development of gallstones. The development of gallbladder disease could result in the need for surgical removal of the gallbladder. These conditions can also cause inflammation of the pancreas. Pancreatitis can be a serious condition and can become a chronic problem, lasting after any gallbladder disease has been resolved. A small percentage of people may develop symptoms related to gallbladder disease during any weight-reducing diet, including this diet using meal replacement products. A small percentage of people after a considerable weight loss (usually 50 or more pounds)may develop temporary neurological symptoms such as limb weakness or numbness. Avoiding activities that cause compression on nerves, such as prolonged crossing of legs, may prevent this. Weight-Loss Phase (Phase 1): The Phone Program's Phase 1 diet and associated weight loss may result in changes in medical conditions and/or the need to adjust medications. YOU SHOULD CONSULT WITH YOUR PHYSICIAN PRIOR TO STARTING ANY WEIGHT-LOSS PROGRAM. Your physician may recommend medical monitoring while on the Phase 1 diet for a number of medical conditions including, but not limited to, diabetes, high blood pressure, cardiac disease, and kidney disease. The possibility always exists that the combination of any significant disease, such as obesity, with methods employed for its treatment, such as this Program, may lead to previously unobserved or unexpected ill effects. Please consult with your physician if you have any concerns regarding these risks or other medical concerns. In light of the health-related implications of losing weight,you are not eligible to participate in the weight-loss phase of the Phone Program (Phase 1) if you: • are pregnant or have been lactating(nursing a baby)for less than twelve weeks. • are anorexic or bulimic. • are allergic to egg, milk, corn, or soy. (Note: Lactose sensitivity or intolerance does not constitute a milk allergy and can be managed by using the HMR 70 Plus lactose-free shakes.) • are 18 years of age or under, or over 70 years of age and have a history of dizziness, prior TIAs (transient ischemic attacks), or strokes. • are taking the anti-seizure medication Trileptal®(oxacarbazepine). • have had bariatric surgery. By signing this Informed Consent, you are attesting that none of the conditions listed above applies to you and that, if you know or suspect that any of these conditions has become applicable to you after you enroll in the Program, you will immediately notify your Program coach and then will not continue in the Program. In that event, you will be eligible to return any unopened HMR products you have purchased for a full refund. It is important to speak with your doctor about any medical conditions or medications that could be affected by diet or weight loss. In particular, please review the following important information: Important Information for People Who Are Taking Medication to Treat Diabetes • If I am taking diabetes medications, I agree to contact my physician prior to the diet to arrange for medical monitoring during the Phone Program diet. • I understand that if I am compliant with the Phone Program diet and lose weight, I may very likely see a reduction in blood sugar and may require medication adjustment. In addition, I understand that the use of insulin and/or oral agents, in combination with weight loss, can also increase the risk of low blood sugars (hypoglycemia) and may also require my physician to make medication adjustments. • I agree to carefully monitor my blood sugars and review my self-monitored blood glucose(SMBG) log with my physician before starting the diet and continue to do so during the diet to prevent low blood sugar (hypoglycemia)and poor glycemic control while facilitating weight loss. Important Information for People Who Are Taking Diuretics (Water Pills) and Other Drugs for High Blood Pressure • If I am taking high blood pressure medications, including diuretics (water pills), I agree to contact my physician prior to beginning the Phone Program to arrange for medical monitoring during the Phone Program diet. • I understand that being on high blood pressure medication or diuretics,while on a low-salt, weight- reducing diet, such as the Phone Program diet, may cause me to experience dizziness, fatigue, and low blood pressure. Therefore, I understand that my high blood pressure medication may need to be adjusted. Important Information for People Who Are Taking the Anticoagulant(Blood Thinner) Coumadin (warfarin) • I understand that the HMR Shakes are fortified with vitamin K. (This information is located on the Diet Information to Share with Your Primary Care Provider sheet in your Phone Program materials). If I am taking the blood thinner Coumadin(warfarin)this may result in a need to have this medication adjusted. 2 ©2003 -2016 HMR Weight Management Services Corp.,Boston,MA Revised 3/2016 • I agree to consult with my physician about the need for monitoring my PT/INR and any necessary medication adjustment. I understand that the possibility always exists that the combination of any significant disease, such as obesity, with methods employed for its treatment, such as the Phone Program, may lead to previously unobserved or unexpected ill effects. Please consult with your physician if you have any concerns regarding these risks. We have provided a Diet Information to Share with Your Primary Care Provider sheet in your Phone Program materials for you to provide to your doctor or primary care provider. Maintenance Phase (Phase 2): Following the weight-loss phase(Phase 1)of the Phone Program, there is a weight-maintenance phase of the Phone Program (Phase 2). You may decide to enter Phase 2 of the Phone Program after participating in Phase 1 of the Phone Program or after first attending the HMR Program for Weight ManagementTM in person in a clinic setting. The primary goal of Phase 2 is to learn how to better manage your weight by: a) incorporating higher levels of physical activity(PA) into your daily routine; b) reducing overall calorie intake through the use of HMR meal replacements, eating vegetables and fruits, and making healthy food choices. Phase 2 of the Phone Program has the same restrictions as the weight-loss phase (Phase 1) as set forth in that section. Also, as set forth in that section; Current medications and medical conditions may be affected as a result of practicing the lifestyle changes promoted in Phase 2 (weight maintenance) of the Phone Program and any additional weight loss achieved while in Phase 2 may require ongoing adjustments to certain medications for, but not limited to: a) diabetes management b) anti-coagulation therapy(Coumadin) c) blood pressure By signing this Informed Consent,you are • agreeing to contact your doctor for the management of these and any other medications or medical conditions that may be affected by participation in Phase 2 of the Phone Program. • accepting the responsibility for consulting with your doctor about managing or monitoring any current or new medical conditions that may appear during your participation in the Phase 2 of the Phone Program. Collection, Use, and Disclosure of Personal Information As a part of joining the Phone Program,you have provided or will provide HMR WMSC with certain personal information, including: your name, date of birth, sex, initial weight, height, weight-loss goal, food order preference(lactose-free, vegetarian), credit card information, telephone number, email address, and mailing/billing address. Also as you participate in the Phone Program you will provide additional data including weight change, use of meal replacement products, physical activity levels, intake of fruit and vegetables, and other adherence measures of the diet. How this and other information about your participation in the Phone Program is used in the Phone Program and outside the Phone Program as a part of educational, research, and promotional activities that HMR WMSC routinely conducts is described below. How HMR WMSC may use your personal information during your participation in the Phone Program You will participate in weekly group phone sessions with other participants. Some of these other participants may be co-workers, people from your community, etc. These phone classes involve oral exchanges among the participants of personal information about each participant's experience in the Phone Program. Thus, as a participant,you will be expected to share your personal information with the other participants and also the health coach leading the group phone classes, as well as other health coaches who may advise on, participate in, evaluate, or otherwise contribute to the Phone Program and individuals participating in HMR WMSC training programs as described below. 3 0 2003 -2016 HMR Weight Management Services Corp.,Boston, MA Revised 3/2016 Certain other uses and disclosures of your personal information will be involved in the Program. HMR WMSC will use and disclose the personal information it obtains about you as a participant so that HMR WMSC can take appropriate steps to help you lose and maintain weight and adopt a healthier lifestyle and diet, including by informing you about our products and services, as well as to obtain the agreed-upon payment from you for the Phone Program services and products necessary for us to offer you the Phone Program and achieve the objectives described above. This may include contacting you by e-mail, phone, fax, and/or text message using the contact information you provide to HMR WMSC as part of the enrollment process or subsequently. By enrolling in the Program, you expressly agree to such use of your personal health and contact information, including for purposes of contacting you regarding your potential participation in Phase 2 of the Program (the Maintenance Phase) or any other program option offered by HMR WMSC. As a participant in the Phone Program,you will be communicating with HMR WMSC staff via phone and electronic mail. Please use your best judgment in emailing personal information and note that phone communication is an alternative. How HMR WMSC may use your information in health coaching activities, such as to train coaches or provide information to others to support your weight-loss program or to help others itnpletttent weight-management programs In addition, HMR WMSC will use the information on your experience in the Program to help HMR WMSC operate, maintain, and offer a high-quality, phone-based weight-management program, including sharing such information with third-party vendors, staff of HMR programs(including licensed programs), parties interested in becoming HMR programs and consultants. For example, in order to ensure the highest quality weight- management services, HMR WMSC staff members receive focused, ongoing training. This training occurs in a variety of ways. For example, training is sometimes done by recording participants' weekly classes and individual phone calls and playing recordings for the benefit of staff and their trainers—and this may include telephone calls or classes where some of your personal information is disclosed. These types of recordings may be an effective educational tool to help health care providers, staff, students and other related parties practice or improve their skills and to develop and/or implement similar weight-management programs. Sometimes HMR WMSC staff of HMR programs (including licensed programs), parties interested in becoming HMR programs or third parties hired by HMR WMSC will monitor Phone Program classes as part of their training as health coaches or other weight-management specialists or in the role of trainers themselves. Sometimes persons outside HMR WMSC doing research in the field of obesity treatment or third parties serving in a consulting capacity to HMR WMSC will be permitted to listen and learn more about how the Phone Program operates. Sometimes a participant's spouse, other family member, or close friend will also join the phone call to learn more about caring for that participant. Occasionally a person being considered as a new hire may listen to the call to help us and this person better assess whether this person is a good fit at our Phone Program. All of these activities positively impact the quality of the Phone Program and help support overall operations of our weight-management program. How HMR WMSC might otherwise use or share your personally identifiable information HMR WMSC may also use or share your personally identifiable information: • When required by law(for example, subpoena, court or administrative order) • For third-party service providers and similar vendors performing necessary services who will be contractually required to keep your information confidential. For example,HMR WMSC may use data storage, scheduling, and document processing vendors, and require them to agree to keep your personal information confidential. How HMR WMSC may use and disclose de-identied information from the Phone Program for purposes of educational,promotional, and research efforts HMR WMSC may use and disclose "de-identified" information that is collected or developed from your participation in the Phone Program for promotion of the Phone Program and related weight-loss program marketing efforts as well as educational and research efforts. "De-identified" information is information that HMR WMSC reasonably believes does not contain any personally identifying information about you or any other person -- in contrast to personally identifiable information, such as an individual's name, address, telephone number, and similarly individualized information(which HMR WMSC would not use in marketing and 4 ©2003 -2016 HMR Weight Management Services Corp.,Boston,MA Revised 3/2016 promoting the Phone Program). In most or all cases, de-identified information would also be aggregate information. Information that will be shared with City of Fort Worth Texas I understand that I am participating in a program offered by City of Fort Worth Texas to its employees, retirees, surviving spouses of retirees, and friends and family of employees. HMR WMSC will provide periodic and executive summary reports to City of Fort Worth Texas that will provide de-identified, aggregate information about the weight-loss results and related data(including induction, participation, and pre and post outcome data) of all the participants in the Healthy Solutions at Home Program, including me. If agreed upon between HMR WMSC and City of Fort Worth Texas, de-identified survey information about my experience in the Phone Program may also be provided. Special information for Employees, Retirees, and Surviving Spouses of Employees of City of Fort Worth Texas (this section applies only to employees, retirees, and surviving spouses of employees of City of Fort Worth Texas who provide an employee number to HMR WMSC) As part of making these special program arrangements for employees like me, I acknowledge that, in addition to the other data described in this document, HMR WMSC will provide City of Fort Worth Texas with personally identifiable information about me in the form of a"Completers Report"which will include my name, employee number, and whether I attended a minimum of 10 of 12 weeks in the Phone Program. This report is required in order to determine if I may be eligible for incentives provided by City of Fort Worth Texas. HMR WMSC has no role in the determination or provision of such incentives and will provide the Completers Report solely for use by City of Fort Worth Texas. This Informed Consent applies to both the weight-loss phase and the maintenance phase of the Healthy Solutions at Home Program unless you are participating in only one phase, in which case this Informed Consent applies only to such phase. By signing below,you are providing your consent to the terms set forth in this document with respect to the phase or phases in which you plan to participate. CONSENT TO TERMS OF PARTICIPATION I acknowledge responsibility for my own health, including the need to discuss this diet with my physician before beginning the Program. I have read and understand this Informed Consent and I confirm that I do not have any of the conditions it identifies as precluding an individual's participation in the Program. I voluntarily consent to the terms of participation as described in this document, including the terms for use and disclosure of my personal health and contact information, and,to the fullest extent permitted by law, I hereby consent to those terms and voluntarily assume all risks and hazards associated with, or which may arise from my participation in the Program, and, on my own behalf and on behalf of my heirs, personal representatives, and other beneficiaries, I hereby release HMR WMSC,the City of Fort Worth,their affiliates and their respective officers, directors, agents, and employees from any liability and claims of any kind arising from my participation in the Program. Participant's Signature Date 5 0 2003 -2016 HMR Weight Management Services Corp.,Boston,MA Revised 3/2016