HomeMy WebLinkAboutContract 52712-AD1 RECEIVED CSC No. 52712-AD1
JUL 17 2020
CTTYOF FORT WORTH Affiliation Agreement Addendum
CITY SECRETARY
By signing below, City of Fort Worth (facility)acknowledges that their requirements for
Program Participant immunizations,Standard Precautions, CPR and first aid, and drug screening
and background checks do not require satisfaction of obligations 1.8, 1.11,and 1.12 below.
Therefore,facility agrees not to hold TCU responsible for these obligations as originally agreed
to within the Educational Affiliation Agreement for Student internships and Clinical Experiences
Version 2019.1. Nothing else in the agreement has been changed.
Obligations of TCU.
1.8 TCU will provide, upon request, written verification of immunizations required by
applicable regulatory agencies and City's policies, including Hepatitis B ( or waiver)and
current PPD and provide evidence of immunity to chicken pox, measles and rubella.
1.11 If required by the City,TCU will assign only those Program Participants that have: ( 1)
been instructed in Standard Precautions recommended by the Centers for Disease Control
and Prevention (CDC); and (2)completed a cardiopulmonary resuscitation and first aid
course.
1.12 Upon City' s written request,TCU will, with the Program Participant' s consent, prescreen
Program Participants in compliance with the Dallas- Fort Worth Hospital Council
Community Standard for Drug Screening and Background Checks adopted September
2010, subject to the restrictions of HIPAA and FERPA. If such prescreening is required by the
City,the City shall notify the TCU faculty coordinator of such requirements prior
to accepting Program Participants.
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April 202o ECRETA�iY
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ACCEPTED AND AGREED:
CITY OF FORT WORTH CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the
person responsible for the monitoring and
TBsUs Chq� administration of this contract, including
By: Jesus Chapa(Jul l ,202013:39CDT) ensuring all performance and reporting
Name: Jesus J. Chapa requirements.
Title: Deputy City Manager
APPROVAL RECOMMENDED:
By: Sasha Kane(Jul 15,2020 12:25 CDT)
Name: Sasha Kane
Title: Senior Contract Compliance Specialist
By:
E win Kraus(Jul 11,2020 09:02 CDT)
Name: Edwin Kraus APPROVED AS TO FORM AND
Title: Chief of Police LEGALITY:
ATTEST:
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Taylor Paris(Jul 17,202012:47 CDT)
By:
Name: Taylor Paris
By: Title: Assistant City Attorney
Name: Mary J. Kayser��' /�
Title: City Secretar, TG� CONTRACT AUTHORIZATION:
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HDate Approved:
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y Form 1295 Certification No.:
Texas Christian University
By: L t�
Name: Dr. Christopher Watts
Title: Dean
April 2020 KOFFICIAL RECO V
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