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Home My WebLink AboutContract 53086-A1Docusign Envelope ID: 9083AC27-AB10-473A-B6A5-E5813CO240A2 CSC No. 53086-A1 AMENDMENT NO. 1 TO CITY OF FORT WORTH CONTRACT 53086 This Amendment is entered into by and between the City of Fort Worth (hereafter "City"), and Occupational Health Centers of the Southwest, PA., DBA Concentra Medical Centers ("Vendor"). City and Vendor may be referred to individually as a Party and collectively as the Parties. WHEREAS, on January 1, 2020, the Parties entered into City Secretary Contract 53086 for Vendor to provide City with full range occupational health care services ("Agreement"); WHEREAS, the Parties wish to amend the Agreement to increase the total compensation amount allowed under the Agreement for Year 5 (January 1, 2024 to December 31, 2024) by $83,566.00 for a new total amount up to $417,830.00, as authorized by Mayor and Council Communication No. 19-0238 (October 15, 2019) so that Vendor can provide City with an annual flu shot clinic for its employees. NOW, THEREFORE, the Parties, acting herein by the through their duly authorized representatives, enter into the following agreement: 1. AMENDMENTS Section 3, the Compensation provision of the Agreement, shall be deleted in its entirety and amended to read as follows: City shall pay Vendor in accordance with the fee schedule in Exhibit B and in accordance with the provisions of this Agreement. Total payment made under this Agreement for the first year shall be an amount up to two hundred and seventy-five thousand dollars ($275,000.00). Total payment for Years 2 through 7, if renewal options are utilized, shall be as follows: $288,750.00, $303,188.00, $318,347.00, $417,830.00, $350,977.00, and $368.526.00. Vendor shall not provide any additional items or services or bill for expenses incurred for City not specified by this Agreement unless City requests and approves in writing the additional costs for such services. City shall not be liable for any additional expenses of Vendor not specified by this Agreement unless City first approves such expenses in writing. Exhibit "C"- 2024 Flu Clinic and Billing Groups, which describes the services to be provided in relation to the annual flu shot clinic, attached hereto, is hereby added to the Agreement. 2. ALL OTHER TERMS SHALL REMAIN THE SAME All other provisions of the Agreement which are not expressly amended herein shall remain in full force and effect. 3. ELECTRONIC SIGNATURE This Amendment may be executed in multiple counterparts, each of which shall be an original and all of which shall constitute one and the same instrument. A facsimile copy or computer image, such as a PDF or tiff image, or a signature, shall be treated as and shall have the same effect as anoriginal. OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Docusign Envelope ID: 9083AC27-AB10-473A-B6A5-E5813CO240A2 ACCEPTED AND AGREED: CITY OF FORT WORTH: By: Name: Jesica McEachem Title: Assistant City Manager Date: Sep 10, 2024 APPROVAL RECOMMENDED: By: Dianna Giordano (SepCDT) Name: Dianna Giordano Title: Director of Human Resources ATTEST: a°q od p�8 Pv° 8=0 PQ'0 � ,^•-��.._ �p % 4 °nnaFXpSo By: V Name: Jannette Goodall Title: City Secretary CONTRACT COMPLIANCE MANAGER: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. By. Name: Joanne Hinton Title: Interim Assistant Director, HR I:39WZ11230XV I111101071%II:312113r11[ff.114Y614 uJ By: 91�- Name: Jessika Williams Title: Assistant City Attorney CONTRACT AUTHORIZATION: M&C: 19-0238 (October 15, 2019) Vendor: OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST, P.A. ErADocu Signed by: 6ut ;. tkaSSt, ft VOL, A&M 6DII89CF35924C5 By. ...Name: Roert G. Hassett, DO, MPH Title: President, Treasurer & Corp. secretary OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Docusign Envelope ID: 9083AC27-AB10-473A-B6A5-E5813CO240A2 EXHIBIT "C" 2024 Flu Clinic and Billine Groups Section 1 — Service Location(s)* 505 W. Felix (Bob Bolen Auditorium) Fort Worth TX 76115 Marty Humphrey Marqaret. Humphrev(d�fortworthtexas.gov 1000 Calvert (Conference Room) Fort Worth TX 76115 Marty Humphrey Margaret.Humphrev anfortworthtexas.gov 3000 Bolt Street (Conference Room) Fort Worth TX 76115 Marty Humphrey Margaret.Humphrev o)fortworthtexas.gov 1608 11 th Ave. (Water Field Ops Fort Worth TX 76115 Pamela Jordan Large Break Room) Pamela.Jordan(aDfortworthtexas.gov 5001 James Ave. (TPW Breakroom) Fort Worth TX 76115 Cristina Macias Cristina.Macias5fortworthtexas.gov 3401 Lancaster St. (Central Texas Fort Worth TX 76115 Ana Ayala Terrazas Room - Health Fair) ana.avalaterrazas @fortworthtexas.gov Fort Worth TX 76115 Ana Ayala Terrazas 100 Fort Worth Trail ana.avalaterrazas5..fortworthtexas.gov *Additional service locations may be added to this Section 1 by mutual agreement of the parties. City shall make requests for additional service locations via EpisodicEvents5Concentra.com, but no service location shall be added unless it has been confirmed by Vendor staff in Section 3 below. Section 2 — Scope of Services: The Scope of Services performed under this Exhibit A includes those described below and any additional services mutually agreed upon between the parties via EpisodicEvents(o)Concentra.com, but no additional services shall be implemented unless it has been confirmed by Vendor staff in Section 3 below. SCOPE: Onsite Flu Vaccines. City will provide a sanitary and private site location with access only to City approved participants receiving these services/components. Proposed dates and schedule are listed below. Location Date Time* Estimated Number of Vendor Team Members 505 W. Felix 9/23/24 9:OOam — 3:OOpm 3 RN's 1000 Calvert 9/25/24 8:30am — 3:OOpm 2 RN's 505 W. Felix 9/26/24 10:00am — 3:OOpm 2 RN's 505 W. Felix 9/30/24 9:OOam — 3:OOpm 2 RN's 1608 11th Ave 10/1/24 8:OOam—11:OOam 4 RN's 505 W. Felix 10/2/24 9:OOam—1:OOpm 2 RN's 5001 James Ave 10/3/24 7:OOam—10:OOam 3 RN's 3000 Bolt Street 10/4/24 6:30am — 8:30am & 2:30pm — 1 RN 4:30pm 100 Fort Worth Trail 10/23/24 10:00am — 3:OOpm 6 RN's *Staff required to arrive 1 hour prior to start time for setup Docusign Envelope ID: 9083AC27-AB10-473A-B6A5-E5813CO240A2 Section 3 — Administrative Information: Vendor will assign a dedicated project manager to coordinate the logistics of the Service Event(s). In addition, the following Vendor representatives shall oversee the Service Event(s): Vendor Program Operations Oversight: Michelle Sauvigne, (267) 246-8597, MSauvigne@Concentra.com Vendor Program Medical Oversight: Latha Brubaker, MD, (281) 725-7029, Latha_Brubaker@Concentra.com City shall assign a dedicated project manager to serve as City's point of contact for the Service Event(s). City shall identify its project manager by email to EnisodicEvents(DConcentra.com. Section 4 — Term: The term of this SOW commences on August 1, 2024 and terminates on December 31, 2024. Thereafter, the Term may be extended upon mutual written agreement of the parties. Section 5 — Pavment and Invoices: Vendor shall invoice City as the Services are performed and City shall remit payment to Vendor within thirty (30) days of receiving an invoice. City agrees to pay any sales, use, excise or similar taxes applicable to the Services provided hereunder. The Services of this Agreement will be performed by Vendor through its managed professional entities as identified on the attached Exhibit B (the "Billing Groupls j"), and invoices related to Fees for the Services outlined in this Agreement will be transmitted to City by the Billing Groups. Citv invoices shall be sent to: City of Fort Worth 200 Texas St. Fort Worth, Texas 76102 Section 6 — Fees and Expenses: The fee schedule below sets forth the available staffing positions and estimated fees (the "Fees") to be used when calculating project Fees for Services performed at each deployed Service location and Service Event(s) as published under this Exhibit A and any additional services that may be mutually agreed upon and performed by Vendor. *Services Fee Volume Influenza Vaccine $37 1140 Staff Position* Hourly Rates: Weekday/Night & Weekend Rate **Physician $270.00/$330.00 Advanced Practice Clinician (PA/NP) $215.00/$270.00 Physical Therapist or APT $215.00/$270.00 Registered Nurse/LPN $160.00/$215.00 Medical Assistant/Emergency Medical Technician $80.00/$140.00 Front Office Admin $80.00/$140.00 *The Staff Position(s) set forth above are subject to availability and may be adjusted by Vendor as necessary to support the Service Event. **Based on the Services performed at each Service Event, should oversight of the Vendor personnel be required, such hours will be billed back to the City as incurred. Docusign Envelope ID: 9083AC27-AB10-473A-B6A5-E5813CO240A2 ***Should Vendor personnel work more than eight (8) hours during a single day, overtime hours (in excess of the initial eight (8) hours) will be billed in accordance with state labor laws and regulations. Section 7 — Miscellaneous: a. Services will be charged at the above Weekday Rate for any Services performed from 6:00 a.m. to 6:00 p.m. on Monday through Friday. b. Services will be charged at the above Night & Weekend Rate for any Services performed before 6:00 a.m. or after 6:00 p.m. any day of the week or for any services performed at any time of day on Saturday or Sunday. c. Any Vendor recognized holiday that is staffed by Vendor at the request of City will be billed at 2x the applicable hourly Fee from the table provided above. d. If City cancels or delays a Service Event, less than 72 hours before the scheduled time, then City shall be billed at 100% of the scheduled Service Event that has been delayed or cancelled. e. The base estimate is the number of City employees scheduled to arrive for the Services being performed during any Service Event (the "Base Estimate") during the Term. Should the Services performed be less than the Base Estimate provided by City, then City will be billed at 90% of the Base Estimate, (e.g., Base Estimate = 100 participants; actual participants = 40; City will be billed for 90 participants). In the Service Event that the actual number Services performed exceeds the Base Estimate, then City will be billed for the actual Services performed. Section 8 — Travel and Expenses: Travel & mileage expenses will be passed through at the current applicable IRS rate. Section 9 — Additional Expenses Incurred by Vendor: In the event Vendor incurs any additional costs associated with providing the Services listed in this Statement of Work during any Service Event, all additional expenses will be passed through as incurred. Passed through items include, but are not limited to: hardware, software, internet network connectivity, medical supplies, office supplies, marketing or educational materials, personal protective equipment, printing, postage, parking fees, equipment calibration and maintenance, biohazard disposal, freezers, document storage and removal, permitting, licensing, etc. Section 10 — Software License, Hardware and Equipment Fees: Any software, hardware, and/or internet network connectivity costs incurred by Vendor to support this statement of work shall be mutually agreed upon and passed through as incurred without markup. In addition, City will be billed for any furniture, fixtures, or equipment costs incurred by Vendor to support this scope of work. Section 11— Service Location(s) and Set -Up: City shall provide Vendor with information needed to order supplies/equipment at each Service location with sufficient notice prior to each Service Event. Section 12 — Confidentialitv: Confidentiality of Protected Health Information. Both Parties warrant that they will maintain and protect the confidentiality of all individually identifiable health information specifically relating to Participants in accordance with the Health Insurance Portability and Accountability Act of 1996 and all applicable federal and state laws and regulations. However, nothing herein will limit either Party's use of any de -identified Participant information. This Section will survive the termination of this Agreement. Docusign Envelope ID: 9083AC27-AB10-473A-B6A5-E5813CO240A2 Section 13 - Billinq Groups: State Entity State of Billing Address EIN Abre Incorporation AK Occupational Health Centers of Alaska, P.C. AK PO Box 4300, Rancho Cucamonga, California 83-4299793 917729-4300 'AL Occupational Health Centers of Alabama, P.C. AL PO Box 82730, Hapeville, Georgia 30354 87-1954410 AR Occupational Health Centers of Arkansas, P.A. TX PO Box 75388, Oklahoma City, Oklahoma 73147- 75-2688160 0388 AZ Occupational Health Centers of the Southwest, P.A. AZ 1818 East Sky Harbor Circle, North Suite 150, 86-0750222 (AZ) Phoenix, Arizona 85034 CA Occupational Health Centers of California, a Medical CA PO Box 3700, Rancho Cucamonga, California 77-0469725 Corporation 91729-3700 CO Occupational Health Centers of the Southwest, P.A. TX PO Box 9008, Broomfield, Colorado 80021 75-2014828 CT Occupational Health Centers of the Southwest, P.A. TX PO Box 20220, Cranston, Rhode Island 02920 75-2014828 DE Occupational Health Centers of Delaware, P.A. DE PO Box 18277, Baltimore, Maryland 21227 51-0376661 FL Occupational Health Centers of the Southwest, P.A. TX PO Box 82549, Hapeville, Georgia 30354 75-2014828 GA Occupational Health Centers of Georgia, P.C. GA PO Box 82730, Hapeville, Georgia 30354 58-2285009 HI Occupational Health Centers of Hawaii, Inc. HI PO Box 4300, Rancho Cucamonga, California 74-2731442 917729-4300 IA Occupational Health Centers of the Southwest, P.A. TX PO Box 75427, Oklahoma City, Oklahoma 73147- 75-2014828 5427 IL Occupational Health Centers of Illinois, P.C. IL PO Box 488, Lombard, Illinois 60148 46-2554525 IN Occupational Health Centers of the Southwest, P.A. TX PO Box 488, Lombard, Illinois 60148 75-2014828 KS Occupational Health Centers of Kansas, P.A. KS PO Box 369, Lombard, Illinois 60148 47-2063864 KY Occupational Health Centers of the Southwest, P.A. TX PO Box 75388, Oklahoma City, Oklahoma 73147- 75-2014828 0388 (Louisville) KY Occupational Health Centers of the Southwest, P.A., TX PO Box 5012, Southfield, Michigan 48086-5012 75-2014828 P.S.0 (Mineola) LA Occupational Health Centers of Louisiana, a LA PO Box 75430, Oklahoma City, Oklahoma 73147- 74-2891603 Professional Corporation 0430 MA Occupational Health Centers of the Southwest, P.A. TX PO Box 20127, Cranston, Rhode Island 02920 75-2014828 MD Occupational Health Centers of the Southwest, P.A. TX PO Box 18277, Baltimore, Maryland 21227 75-2014828 ME Occupational Health Centers of the Southwest, P.A. TX PO Box 20127, Cranston, Rhode Island 02920 75-2014828 MI Occupational Health Centers of Michigan, P.C. TX PO Box 5106 Southfield, Michigan 48086-5106 38-2857561 MN Occupational Health Centers of Minnesota, P.C. MN PO Box 1297, Brookfield, Wisconsin 53008-1297 83-1272378 MO Occupational Health Centers of Kansas, P.A. TX PO Box 369, Lombard, Illinois 60148 47-2063864 CMS Occupational Health Centers of Mississippi, P.C. MS PO Box 75388, Oklahoma City, Oklahoma 73147- 87-1979933 0388 NC Occupational Health Centers of North Carolina, P.C. NC PO Box 82730, Hapeville, Georgia 30354 26-2484838 NE Occupational Health Centers of Nebraska, P.C. NE PO Box 75428, Oklahoma City, Oklahoma 73147 47-0827928 NH Occupational Health Centers of the Southwest, P.A. TX PO Box 20127, Cranston, Rhode Island 02920 75-2014828 NJ Occupational Health Centers of New Jersey, P.A. NJ PO Box 8750, Elkridge, Maryland 21075-8750 22-3473542 NM Occupational Health Centers of the Southwest, P.A. TX PO Box 9009, Broomfield, Colorado 80021 75-2014828 NV Occupational Health Centers of the Southwest, P.A. TX PO Box 9010, Broomfield, Colorado 80021 75-2014828 OH Occupational Health Centers of Ohio, P.A., Co. OH PO Box 5012, Southfield, Michigan 48086-5012 26-3239286 OK Occupational Health Centers of the Southwest, P.A. TX PO Box 75410, Oklahoma City, Oklahoma 73147- 75-2014828 0410 OR Occupational Health Centers of the Southwest, P.A. TX PO Box 4300, Rancho Cucamonga, California 75-2014828 917729-4300 PA Occupational Health Centers of the Southwest, P.A. TX PO Box 8750, Elkridge, Maryland 21075 75-2014828 RI Occupational Health Centers of the Southwest, P.A. TX PO Box 20127, Cranston, Rhode Island 02920 75-2014828 SC Occupational Health Centers of the Southwest, P.A. TX PO Box 82730, Hapeville, Georgia 30354 75-2014828 TN Occupational Health Centers of the Southwest, P.A. TX PO Box 75388, Oklahoma City, Oklahoma 73147- 75-2014828 0388 TX Occupational Health Centers of the Southwest, P.A. TX PO Box 9005, Addison, Texas 75001 75-2014828 LIT Occupational Health Centers of the Southwest, P.A. AZ PO Box 9008, Broomfield, Colorado 80021 86-0750222 VA Occupational Health Centers of the Southwest, P.A. TX PO Box 18277, Baltimore, Maryland 21227 75-2014828 Docusign Envelope ID: 9083AC27-AB10-473A-B6A5-E5813CO240A2 State Abre Entity VT Occupational Health Centers of the Southwest, P.A. WA Occupational Health Centers of Washington, P.S. WI Occupational Health Centers of the Southwest, P.A. *WV Occupational Health Centers of West Virginia Professional Corporation State of Billing Address EIN Incorporation TX PO Box 20127, Cranston, Rhode Island 02920 75-2014828 WA PO Box 4300, Rancho Cucamonga, California 83-1638410 917729-4300 TX PO Box 1297, Brookfield, Wisconsin 53008-1297 75-2014828 TX PO Box 18277, Baltimore, Maryland 21227 87-2373839