HomeMy WebLinkAboutContract 62315City Secretary Contract No. 62315-----
FORT WORTH®
VENDOR SERVICES AGREEMENT
This VENDOR SERVICES AGREEMENT ("Agreement") is made and entered into by and
between the CITY OF FORT WORTH ("City"), a Texas home-rule municipal corporation and Cindy
Dickason d/b/a PSYCHSCREENING, a sole proprietorship ("Vendor"), each individually referred to as a
"party" and collectively referred to as the "parties."
AGREEMENT DOCUMENTS:
The Agreement documents shall include the following:
1.This Vendor Services Agreement;
2.Exhibit A -Scope of Services;
3.Appendix A -Job Description;
4.Appendix B-TCOLE Form;
5.Appendix C --Texas Administrative Code; and
6.Exhibit B -Verification of Signature Authority Form.
All Exhibits and Appendices, which are attached hereto and incorporated herein, are made a part of this
Agreement for all purposes. In the event of any conflict between the terms and conditions of any Exhibits
and Appendices and the terms and conditions set forth in the body of this Agreement, the terms and
conditions of this Agreement shall control.
1.SCOPE OF SERVICES.
Scope of Services. Vendor agrees to conduct pre-employment psychological services
required by Texas Commission on Law Enforcement (TCOLE) for Public Safety Communicator applicants
for the Fort Worth Police Department ("FWPD"). Such services shall be completed in accordance with:
A.The requirements of the Texas Commission on Law Enforcement (TCOLE);
B.The requirements of the Texas Local Government Code, Title 5, Subtitle A, Chapter
143, Section 143.022;
C.The requirements of the Texas Administrative Code, Title 37, Part 7, Chapter 217,
Rule §217.1 (a) (12); and
D.Fort Worth Police and Fire Civil Service Commission Rules, Chapter 5, Section 5.08.
Exhibit "A," -Scope of Services more specifically describes the services to be provided hereunder.
1.Term. This Agreement shall begin on October 1, 2024 ("Effective Date") and shall expire
on September 30, 2025. ("Expiration Date"), unless terminated earlier in accordance with this Agreement
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("Initial Term"). City shall have the option, in its sole discretion, to renew this Agreement under the same
terms and conditions, for up to four (4) one-year renewal options, at City's sole discretion.
3. Fee. City agrees to pay Vendor $220.00 per applicant for administering the written
examinations, conducting the face-to-face interview assessment and completing and providing to the City
the forms required by TCOLE and the written reports. The total cost for the Initial Term of this Agreement
shall not exceed $50,000.00. If City cancels an applicant after the appointment has begun but only testing
has neem completed, a fee of $75.00 will be charged rather than the full $220.00. The City is only
responsible for paying for services actually received, and does not guarantee a certain amount of business
by entering into this Agreement. The Fee shall be compensation for all Services actually received. Payment
shall be made monthly and shall be based upon the number of applicant evaluations processed during the
previous month, as reflected by notification to the City of assessment results. No payment shall be due for
any applicant until completion by Vendor of all documentation necessary for the City to process payments.
Payment from City to Vendor shall be made on an invoice basis following receipt by City from Vendor of
a signed invoice. The invoice shall be submitted to City, addressed to:
City of Fort Worth Police Department
Attention: Financial Management Division
505 W. Felix St.
Fort Worth, Texas, 76115
Invoices should be received no later than the 15�` day of the month following provision of any Services
under this Agreement. City agrees to pay invoices within thirty (30) days of receipt.
4. Termination.
4.1. Written Notice. Either party may cancel this Agreement at any time and for any
reason by providing the other party with at least thirty days written notice of termination, or the
City may terminate this Agreement immediately if Vendor fails to provide written proof of a
license to practice in the State of Texas by the State Board of Examiners of Psychologists or the
Texas Medical Board or fails to provide written proof of insurance as required by the terms of this
Agreement. In the event this Agreement is terminated prior to expiration of the Term, City shall
pay Vendor only for Services actually rendered as of the efFective date of termination.
4.2 Non-a�ropriation of Funds. In the event no funds or insufficient funds are
appropriated by City in any fiscal period for any payments due hereunder, City will notify Vendor
of such occurrence and this Agreement shall terminate on the last day of the fiscal period for which
appropriations were received without penalty or expense to City of any kind whatsoever, except as
to the portions of the payments herein agreed upon for which funds have been appropriated.
43 Duties and Obli�ations of the Parties In the event that this Agreement is
terminated prior to the Expiration Date, City shall pay Vendor for services actually rendered up to
the effective date of termination and Vendor shall continue to provide City with services requested
by City and in accordance with this Agreement up to the effective date of termination. Upon
termination of this Agreement for any reason, Vendor shall provide City with copies of all
completed or partially completed documents prepared under this Agreement. In the event Vendor
has received access to City Information or data as a requirement to perform services hereunder,
Vendor shall return all City provided data to City in a machine readable format or other format
deemed acceptable to City.
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Disclosure of Conflicts and Con�dential Information.
5.1 Disclosure of Conflicts. Vendor hereby warrants to City that Vendor has
made full disclosure in writing of any eXisting or potential conflicts of interest related to Vendor's
services under this Agreement. In the event that any conflicts of interest arise after the Effective
Date of this Agreement, Vendor hereby agrees immediately to make full disclosure to City in
writing.
5.2 Confidential Information. Vendor, for itself and its officers, agents and employees,
agrees that it shall treat all information provided to it by City ("City Information") as confidential
and shall not disclose any such information to a third party without the prior written approval of
City.
53 Public Information Act. City is a government entity under the laws of the State of
TeXas and all documents held or maintained by City are subject to disclosure under the Texas Public
Information Act. In the event there is a request for information marked Coniidential or Proprietary,
City shall promptly notify Seller. It will be the responsibility of Seller to submit reasons objecting
to disclosure. A determination on whether such reasons are sufficient will not be decided by City,
but by the Office of the Attorney General of the State of Texas or by a court of competent
jurisdiction.
5.4 Unauthorized Access. Vendor shall store and maintain City Information in a secure
manner and shall not allow unauthorized users to access, modify, delete or otherwise corrupt City
Information in any way. Vendor shall notify City immediately if the security or integrity of any
City Information has been compromised or is believed to have been compromised, in which event,
Vendor shall, in good faith, use all commercially reasonable efforts to cooperate with City in
identifying what information has been accessed by unauthorized means and shall fully cooperate
with City to protect such City Information from further unauthorized disclosure.
6. Ri�ht to Audit. Vendor agrees that City shall, until the expiration of three (3) years after
final payment under this contract, or the final conclusion of any audit commenced during the said three
years, have access to and the right to eXamine at reasonable times any directly pertinent books, documents,
papers and records, including, but not limited to, all electronic records, of Vendor involving transactions
relating to this Agreement at no additional cost to City. Vendor agrees that City shall have access during
normal working hours to all necessary Vendor facilities and shall be provided adequate and appropriate
work space in order to conduct audits in compliance with the provisions of this section. City shall give
Vendor reasonable advance notice of intended audits.
7. Indenendent Contractor. It is expressly understood and agreed that Vendor shall operate
as an independent contractor as to all rights and privileges and work performed under this Agreement, and
not as agent, representative or employee of City. Subject to and in accordance with the conditions and
provisions of this Agreement, Vendor shall have the exclusive right to control the details of its operations
and activities and be solely responsible for the acts and omissions of its officers, agents, servants,
employees, Vendors and subVendors. Vendor acknowledges that the doctrine of respondeat superior shall
not apply as between City, its officers, agents, servants and employees, and Vendor, its officers, agents,
employees, servants, Vendors and subVendors. Vendor further agrees that nothing herein shall be
construed as the creation of a partnership or joint enterprise between City and Vendor. It is further
understood that City shall in no way be considered a Co-employer or a Joint employer of Vendor or any
officers, agents, servants, employees or subVendor of Vendor. Neither Vendor, nor any officers, agents,
servants, employees or subVendor of Vendor shall be entitled to any employment beneiits from City.
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Vendor shall be responsible and liable for any and all payment and reporting of taxes on behalf of itself,
and any of its ofiicers, agents, servants, employees or sub Vendor.
8. Professional Competence. Vendor, its staff, employees, psychologists, and psychiatrists
shall maintain all required licenses and certifications to perform the Services rendered under this
Agreement. Vendor also certifies that if it uses any employees, psychologists, psychiatrists, subcontractors,
or other agents in the performance of this Agreement that such person shall have and maintain all of the
current, valid, and appropriate federal, state, and local licenses and permits necessary for the provision of
services under this Agreement. All of the Services under this Agreement shall be performed in accordance
with the applicable professional standard of care. Acceptance of work, payments, or approvals issued by
the City or another entity shall not constitute or be deemed to be a release of the responsibility and liability
of the Vendor, its offcers, psychologists, psychiatrists, agents, employees, contractors and subcontractors
for the accuracy of its services performed hereunder.
9. Duties of Vendor. Each employee of Vendor that conducts, performs, or provides pre-
employment psychological services shall be a licensed to practice in Texas by the State Board of Examiners
of Psychologists or the Texas Medical Board. Vendor shall (i) conduct reasonably diligent background
checks and periodic evaluations of all persons conducting, performing, or providing pre-employment
psychological services has an appropriate, valid state professional license, and document the results of such
checks and evaluations; (ii) conduct primary verification of License, Contractual expectation of compliance
with State/Federal Regulations on all persons conducting, providing, or performing pre-employment
psychological services; and (iii) require that each psychologist adheres to all applicable rules and
regulations of all regulatory agencies with jurisdiction over that psychologist.
10. Liabilitv and Indemnification.
10.1 LIABILITY- VENDOR SHALL BE LIABLE AND RESPONSIBLE FOR ANY
AND ALL PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY,
INCL UDING DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER,
WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT
ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL MISCONDUCT OF
VENDOR, ITS OFFICERS, AGENTS, SERVANTS OR EMPLOYEES.
10.2 GENERAL INDEMNIFICATION - VENDOR HEREBY COVENANTS AND
AGREES TO INDEMNIFY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS,
AGENTS, SERVANTS AND EMPLOYEES, FROMAND AGAINST ANYAND ALL CLAIMS
OR LAWSUITS OFANYKIND OR CHARACTER, WHETHER REAL OR ASSERTED, FOR
EITHER PROPERTYDAMAGE OR LOSS (INCL UDINGALLEGED DAMAGE OR LOSS TO
VENDOR'S BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL
INJURY, INCLUDING DEATH, TO ANYAND ALL PERSONS, ARISING OUT OF OR IN
CONNECTION WITH THIS AGREEMENT, TO THE EXTENT CAtISED BY THE
NEGLIGENT ACTS OR OMISSIONS OR MALFEASANCE OF VENDOR, ITS OFFICERS,
AGENTS, SERVANTS OR EMPLOYEES.
103 INTELLECTUAL PROPERTY INDEMNIFICATION — Vendor agrees to
defend, settle, or pay, at its own cost and expense, any daim or action against City for
infringement of any patent, copyright, trade mark, trade secret, or similar property right
arising from City's use of the software and/or documentation in accordance with this
Agreement, it being understood that this agreement to defend, settle or pay shall not apply if
City modifies or misuses the software and/or documentation. So long as Vendor bears the
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cost and expense of payment for claims or actions against City pursuant to this section,
Vendor shall have the right to conduct the defense of any such claim or action and all
negotiations for its settlement or compromise and to settle or compromise any such claim;
however, City shall have the right to fully participate in any and all such settlement,
negotiations, or lawsuit as necessary to protect City's interest, and City agrees to cooperate
with Vendor in doing so. In the event City, for whatever reason, assumes the responsibility
for payment of costs and expenses for any claim or action brought against City for
infringement arising under this Agreement, City shall have the sole right to conduct the
defense of any such claim or action and all negotiations for its settlement or compromise and
to settle or compromise any such claim; however, Vendor shall fully participate and
cooperate with City in defense of such claim or action. City agrees to give Vendor timely
written notice of any such claim or action, with copies of all papers City may receive relating
thereto. Notwithstanding the foregoing, City's assumption of payment of costs or expenses
shall not eliminate Vendor's duty to indemnify City under this Agreement. If the software
and/or documentation or any part thereof is held to infringe and the use thereof is enjoined
or restrained or, if as a result of a settlement or compromise, such use is materially adversely
restricted, Vendor shall, at its own expense and as City's sole remedy, either: (a) procure for
City the right to continue to use the software and/or documentation; or (b) modify the
software and/or documentation to make it non-infringing, provided that such modification
does not materially adversely affect City's authorized use of the software and/or
documentation; or (c) replace the software and/or documentation with equally suitable,
compatible, and functionally equivalent non-infringing software and/or documentation at no
additional charge to City; or (d) if none of the foregoing alternatives is reasonably available
to Vendor terminate this Agreement, and refund all amounts paid to Vendor by City,
subsequent to which termination City may seek any and all remedies available to City under
law.
11. Assi�nment and Subcontractin�.
11.1 Assi n_� ment. Vendor shall not assign or subcontract any of its duties, obligations
or rights under this Agreement without the prior written consent of City. If City grants consent to
an assignment, the assignee shall execute a written agreement with City and Vendor under which
the assignee agrees to be bound by the duties and obligations of Vendor under this Agreement.
Vendor and Assignee shall be jointly liable for all obligations of Vendor under this Agreement
prior to the effective date of the assignment.
11.2 Subcontract. If City grants consent to a subcontract, sub Vendor shall execute a
written agreement with Vendor referencing this Agreement under which sub Vendor shall agree to
be bound by the duties and obligations of Vendor under this Agreement as such duties and
obligations may apply. Vendor shall provide City with a fully executed copy of any such
subcontract.
12. Insurance. Vendor shall provide City with certificate(s) of insurance documenting
policies of the following types and minimum coverage limits that are to be in effect prior to commencement
of any work pursuant to this Agreement:
12.1 Coverage and Limits
(a) Commercial General Liability:
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$1,000,000 - Each Occurrence
$2,000,000 - Aggregate
(b) Professional Liability (Errors & Omissions):
$1,000,000 - Each Claim Limit
$1,000,000 - Aggregate Limit
Professional Liability coverage may be provided through an endorsement to the
Commercial General Liability (CGL) policy, or a separate policy specific to
Professional E&O. Either is acceptable if coverage meets all other requirements.
Coverage shall be claims-made, and maintained for the duration of the contractual
agreement and for two (2) years following completion of services provided. An
annual certificate of insurance shall be submitted to City to evidence coverage.
12.2 General Requirements
(a) The commercial general liability policiy shall name City as an additional
insured thereon, as its interests may appear. The term City shall include its
employees, officers, officials, agents, and volunteers in respect to the contracted
services.
(b) Intentionally Omitted.
(c) A minimum of Thirty (30) days' notice of cancellation or reduction in
limits of coverage shall be provided to City. Ten (10) days' notice shall be
acceptable in the event of non-payment of premium. Notice shall be sent to the
Risk Manager, City of Fort Worth, 200 Texas Street, Fort Worth, Texas 76102,
with copies to the Fort Worth City Attorney at the same address.
(d) The insurers for all policies must be licensed and/or approved to do
business in the State of Texas. All insurers must have a minimum rating of A- VII
in the current A.M. Best Key Rating Guide, or have reasonably equivalent financial
strength and solvency to the satisfaction of Risk Management. If the rating is
below that required, written approval of Risk Management is required.
(e) Any failure on the part of City to request required insurance
documentation shall not constitute a waiver of the insurance requirement.
(� Certificates of Insurance evidencing that Vendor has obtained all required
insurance shall be delivered to the City prior to Vendor proceeding with any work
pursuant to this Agreement.
13. Comnliance with Laws, Ordinances, Rules and Re�ulations. Vendor agrees that in the
performance of its obligations hereunder, it shall comply with all applicable federal, state and local laws,
ordinances, rules and regulations and that any work it produces in connection with this Agreement will also
comply with all applicable federal, state and local laws, ordinances, rules and regulations. If City notifies
Vendor of any violation of such laws, ordinances, rules or regulations, Vendor shall immediately desist
from and correct the violation.
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14. Non-Discrimination Covenant. Vendor, for itself, its personal representatives, assigns,
subVendors and successors in interest, as part of the consideration herein, agrees that in the performance
of Vendor's duties and obligations bereunder, it shall not discriminate in the treatment or employment of
any individual or group of individuals on any basis prohibited by law. IF ANY CLAIM ARISES FROM
AN ALLEGED VIOLATION OF THIS NON-DISCRIMINATION COVENANT BY VENDOR, ITS
PERSONAL REPRESENTATIVES, ASSIGNS, SUBVENDORSS OR SUCCESSORS IN
INTEREST, VENDOR AGREES TO ASSUME SUCH LIABILITY AND TO INDEMNIFY AND
DEFEND CITY AND HOLD CITY HARMLESS FROM SUCH CLAIM.
15. Notices. Notices required pursuant to the provisions of this Agreement shall be
conclusively determined to have been delivered when (1) hand-delivered to the other party, its agents,
employees, servants or representatives, (2) delivered by facsimile with electronic confirmation of the
transmission, or (3) received by the other party by United States Mail, registered, return receipt requested,
addressed as follows:
To CITY:
City of Fort Worth
Attn: Assistant City Manager
100 Fort Worth Trail
Fort Worth, TX 76102
To VENDOR:
Cindy Dickason
PsychScreening, Inc., Owner
7801 Oakmont Blvd, Ste 101
Fort Worth, Texas 76132
With copy to Fort Worth City Attorney's Office at
same address
16. Solicitation of Emnlovees. Neither City nor Vendor shall, during the term of this
Agreement and additionally for a period of one year after its termination, solicit for employment or employ,
whether as employee or independent contractor, any person who is or has been employed by the other
during the term of this Agreement, without the prior written consent of the person's employer.
Notwithstanding the foregoing, this provision shall not apply to an employee of either party who responds
to a general solicitation of advertisement of employment by either party.
17. Governmental Powers. It is understood and agreed that by execution of this Agreement,
City does not waive or surrender any of its governmental powers or immunities.
18. No Waiver. The failure of City or Vendor to insist upon the performance of any term or
provision of this Agreement or to exercise any right granted herein shall not constitute a waiver of City's or
Vendor's respective right to insist upon appropriate performance or to assert any such right on any future
occasion.
19. Governin� Law / Venue. This Agreement shall be construed in accordance with the laws
of the State of Texas. If any action, whether real or asserted, at law or in equity, is brought pursuant to this
Agreement, venue for such action shall lie in state courts located in Tarrant County, Texas or the United
States District Court for the Northern District of TeXas, Fort Worth Division.
20. Severabilitv. If any provision of this Agreement is held to be invalid, illegal or
unenforceable, the validity, legality and enforceability of the remaining provisions shall not in any way be
affected or impaired.
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21. Force Maieure. City and Vendor shall eXercise their best efforts to meet their respective
duties and obligations as set forth in this Agreement, but shall not be held liable for any delay or omission
in performance due to force majeure or other causes beyond their reasonable control, including, but not
limited to, compliance with any government law, ordinance or regulation, acts of God, acts of the public
enemy, fires, strikes, lockouts, natural disasters, wars, riots, material or labor restrictions by any
governmental authority, transportation problems and/or any other similar causes.
22. Headings not Controllin�. Headings and titles used in this Agreement are for reference
purposes only, shall not be deemed a part of this Agreement, and are not intended to define or limit the
scope of any provision of this Agreement.
23. Review of CounseL The parties acknowledge that each party and its counsel have
reviewed and revised this Agreement and that the normal rules of construction to the effect that any
ambiguities are to be resolved against the drafting party shall not be employed in the interpretation of this
Agreement or E�ibits A, B, and C.
24. Amendments / Modifications / Extensions. No amendment, modifcation, or extension
of this Agreement shall be binding upon a party hereto unless set forth in a written instrument, which is
executed by an authorized representative of each party.
25. Entiretv of A�reement. This Agreement, including E�ibits A, B and C, contains the
entire understanding and agreement between City and Vendor, their assigns and successors in interest, as
to the matters contained herein. Any prior or contemporaneous oral or written agreement is hereby declared
null and void to the extent in conflict with any provision of this Agreement.
26. Counternarts. This Agreement may be executed in one or more counterparts and each
counterpart shall, for all purposes, be deemed an original, but all such counterparts shall together constitute
one and the same instrument.
27. Warrantv of Services. Vendor warrants that its services will be of a high quality and
conform to generally prevailing industry standards. City must give written notice of any breach of this
warranty within thirty (30) days from the date that the services are completed. In such event, at Vendor's
option, Vendor shall either (a) use commercially reasonable efforts to re-perform the services in a manner
that conforms with the warranty, or (b) refund the fees paid by City to Vendor for the nonconforming
services.
28. Immi�ration Nationalitv Act. Vendor shall verify the identity and employment eligibility
of its employees who perform work under this Agreement, including completing the Employment
Eligibility Verification Form (I-9). Upon request by City, Vendor shall provide City with copies of all I-9
forms and supporting eligibility documentation for each employee who performs work under this
Agreement. Vendor shall adhere to all Federal and State laws as well as establish appropriate procedures
and controls so that no services will be performed by any Vendor employee who is not legally eligible to
perform such services. VENDOR SHALL INDEMNIFY CITY AND HOLD CITY HARMLESS
FROM ANY PENALTIES, LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS
PARAGRAPH BY VENDOR, VENDOR'S EMPLOYEES, SUBCONTRACTORS, AGENTS, OR
LICENSEES. City, upon written notice to Vendor, shall have the right to immediately terminate this
Agreement for violations of this provision by Vendor.
29. Ownershiu of Work Product. City shall be the sole and exclusive owner of all reports,
work papers, procedures, guides, and documentation, created, published, displayed, and/or produced in
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conjunction with the services provided under this Agreement (collectively, "Work Product"). Further, City
shall be the sole and exclusive owner of all copyright, patent, trademark, trade secret and other proprietary
rights in and to the Work Product. Ownership of the Work Product shall inure to the benefit of City from
the date of conception, creation or fixation of the Work Product in a tangible medium of expression
(whichever occurs first). Each copyrightable aspect of the Work Product shall be considered a"work-made-
for-hire" within the meaning of the Copyright Act of 1976, as amended. If and to the extent such Work
Product, or any part thereof, is not considered a"work-made-for-hire" within the meaning of the Copyright
Act of 1976, as amended, Vendor hereby eXpressly assigns to City all eXclusive right, title and interest in
and to the Work Product, and all copies thereof, and in and to the copyright, patent, trademark, trade secret,
and all other proprietary rights therein, that City may have or obtain, without further consideration, free
from any claim, lien for balance due, or rights of retention thereto on the part of City.
30. Si�nature Authoritv. The person signing this Agreement hereby warrants that he/she has
the legal authority to execute this Agreement on behalf of the respective party, and that such binding
authority has been granted by proper order, resolution, ordinance or other authorization of the entity. This
Agreement and any amendment hereto, may be executed by any authorized representative of Vendor whose
name, title and signature is affxed on the Verification of Signature Authority Form, which is attached
hereto as Exhibit "C". Each party is fully entitled to rely on these warranties and representations in entering
into this Agreement or any amendment hereto.
31. Chan�e in Companv Name or Ownership. Vendor shall notify City's Purchasing
Manager, in writing, of a company name, ownership, or address change for the purpose of maintaining
updated City records. The president of Vendor or authorized official must sign the letter. A letter indicating
changes in a company name or ownership must be accompanied with supporting legal documentation such
as an updated W-9, documents filed with the state indicating such change, copy of the board of director's
resolution approving the action, or an executed merger or acquisition agreement. Failure to provide the
specified documentation so may adversely impact future invoice payments.
32. No Bovcott of Israel. If Vendor has fewer than 10 employees or this Agreement is for
less than $100,000, this section does not apply. Vendor acknowledges that in accordance with Chapter
2270 of the Texas Government Code, the City is prohibited from entering into a contract with a company
for goods or services unless the contract contains a written verification from the company that it: (1) does
not boycott Israel; and (2) will not boycott Israel during the term of the contract. The terms "boycott Israel"
and "company" shall have the meanings ascribed to those terms in Section 808.001 of the Texas
Government Code. By signing this contract, Vendor certi�es that Vendor's signature provides written
verification to the City that Vendor: (1) does not boycott Israel; and (2) will not boycott Israel during
the term of the contract.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement in multiples.
(signature page follows)
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ACCEPTED AND AGREED:
CITY OF FORT WORTH
By:
Name: William Johnson
Title: Assistant City Manager
Date: __ N_o_v_1_s,_2_0_2 _4 __ _
APPROVAL RECOMMENDED:
By:
Name: Robert A. Alldredge, Jr.
Title: Executive Assistant Chief
ATTEST:
By:
Name: Jannette Goodall
Title: City Secretary
Cindy Dickason d/b/a PSYCHSCREENING
By: �D�Jt,,
Name: Cindyickason
Title: Owner
Vendor Services Agreement
City Secretary Contract No. ____ _
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.
;(;a:t:lh,,,ffe A �-D-,w-By: J (I
Name: Loraine Coleman
Title: Administrative Services Manager
APPROVED AS TO FORM AND
LEGALITY:
A ;na,,,,,,a, � By:
Name: Amama Muhammad
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C: (None Required)
Date Approved:
Form 1295 Certification No.: NIA
Page 10 of26
EXHIBIT A
Ps chScreenin
Y g
7801 Oakmont Blvd, Ste
101 Fort Worth TX 76132
Phone:817-900-0218
SCOPE OF WORK
1. INTRODUCTION
This Statement of Work (SOV� outlines the requirements and expectations for the provision of
psychological testing services for the City of Fort Worth. These services aim to assess the
psychological fitness of candidates seeking to become telecommunicators and ensure they
possess the mental and emotional stability necessary for effective job performance.
2.BACKGROUND
Law enforcement agencies require a thorough understanding of the psychological profiles of their
potential hires to maintain public safety, ensure employee well-being, and reduce instances of
misconduct. Psychological testing is a critical component of the recruitment and selection
process.
3. OBJECTIVES
The objectives of this SOW are to:
A. Provide comprehensive psychological assessment services for candidates applying
to the City of Fort Worth Police Department.
B. Ensure assessments are conducted in accordance with legal and ethical standards.
C. Deliver reports with assessment outcomes and recommendations for each candidate.
4. SCOPE OF WORK
The psychological testing services will include, but are not limited to:
A. Administer standardized psychological tests to candidates.
B. Conduct structured clinical interviews.
C. Evaluate candidates' psychological history and current functioning.
Evaluation Reporting:
A. Provide a written report summarizing the assessment findings, including:
1) Strengths and weaknesses relevant to law enforcement duties.
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2) Recommendations for suitability for the position.
Follow-Up Consultation:
A. Provide interpretation of results and recommendations for future support, if necessary.
5. DELIVERABLES
A. Completion of evaluations and reports will occur within 48 hours of candidate
assessments.
B. All reports will be provided by email to the human resources director or her/his designee.
6. ROLES AND RESPONSIBILITIES
Provider Responsibilities:
A. Psychscreening will only employ psychologists/psychiatrists licensed in the
state of Texas, with appropriate knowledge of law enforcement methods
and procedures.
B. Conduct psychological testing in a professional and confidential manner.
C. Ensure compliance with all applicable laws and regulations related to
psychological testing and data protection.
D. Submit invoices for work completed at the end of each month.
Agency Responsibilities:
A. Provide access to candidate information as necessary for the assessment.
B. Pay vendor for services rendered after submission of invoice from vendor.
7. CONFIDENTIALITY
A. All candidate information and assessment results will remain confidential and will
only be shared with authorized agency personnel, in accordance with applicable
confidentiality laws and regulations.
8. RATES
A. Psychscreening will charge an agreed fee of $220 per applicant with the option to review
and revise pricing annually 60 days prior to contract renewal.
9. AMENDMENTS AND TERMINATION
A. Any amendments to this SOW must be made in writing and agreed upon by both
parties. Either party may terminate the agreement with 60 days written notice.
Vendor Services Agreement Page 12 of 26
City Secretary Contract No.
Appendix A
City of Fort Worth, Texas
Job Description
Classification Title Public Safety Communicator I
Job Code:
Pay Grade
FLSA Status
PS5130
509
Nonexempt
GENERAL SUMMARY
Job Family: Public Safety
Date Reviewed: 06/28/15
Date Revised: � 4/09/22
PerForms dispatch services for emergency and non-emergency calls. Processes calls by
entering pertinent information gathered from citizens into TriTech CAD. Routes calls to
appropriate emergency services.
ESSENTIAL DUTIES 8� RESPONSIBILITIES
The intenf of this job description is fo provide a representafive summary of the major duties and
responsibilities performed by incumbents of this job. lncumbents may be requested to perform
job-relafed tasks other than those speci�cally presented in this description.
1. Receives and prioritizes emergency and non-emergency calls and situations; locates
area of emergency situation using a variety of technical systems and routes calls to the
appropriate department. Monitors Omega alarm system for City.
2. Enters all pertinent computer data relating to dispatch incidents and other important
information. Retrieves information from Computer Aided Dispatch (CAD) system and
routes to dispatchers.
3. Monitors Omega City alarm systems and monitors security of various municipal
buildings. Identifies needed emergency responses and routes calls to dispatchers.
4. Responds to calls received from hearing impaired machines on various hotlines
including crime stoppers and drug enforcement hotlines.
5. Testifies in court as required.
6. Verifies private residence and business active alarm permits.
7. Verifies stolen vehicles have not been towed or repossessed. Verifies license plate or
VIN of stolen vehicles and sends to citywide broadcasts.
8. PerForms correction and submission of timesheets.
9. Facilitates citizens filing Narcotics complaint forms.
10. PerForms other elated duties as required.
11. Adheres to assigned work schedule as outlined in the Department and City attendance
policies and procedures; ensures all behaviors comply with the City's Personnel Rules
and Regulations.
Page 1 of 3
Vendor Services Agreement Page 13 of 26
City Secretary Contract No.
KNOWLEDGE, SKILLS 8 ABILITIES
. Knowledge of:
➢ Modem office procedures, methods and computer equipment.
➢ Principles and procedures of record keeping.
➢ Pertinent federal, state and local laws and ordinances.
➢ Computer aided dispatch, 79 call signals, and various databases and systems
related to 911 operations.
➢ Police Information Mining Portal.
➢ General Orders for Fort Worth Police Department.
• Skill in:
➢ Planning and prioritizing.
➢ Observation and decision-making.
➢ Organization, time management, and multi-tasking.
➢ Problem solving.
• Ability to:
➢ Communicate clearly and effectively, both orally and in writing.
➢ Learn methods and techniques of emergency dispatching.
➢ Learn to process information and make sound decisions in emergency situations.
➢ Learn the geography and surrounding area of the City and interpret City maps and
geog raphi cal locations.
➢ Respond to emergency and non-emergency situations from the general public.
➢ Type at a speed necessary for successful job performance.
➢ Establish and maintain effective working relationships.
➢ Trace cell sources.
➢ Remain calm and manage stress.
➢ Maintain confidentiality.
MINIMUM JOB REQUIREMENTS
High school diploma/GED and no experience required.
OTHER REQUIREMENTS
Must meet TCOLE and CJIS requirements.
WORKING CONDITIONS
The woric environment characferisfics described here ane represenfafive of fhose an employee
encounters while performing the essential functions of this job. Reasonable accommodations may
be made to enable individuals with disabilities to perform the essentia! functions.
Depending on assignment, positions in this class typically require touching, talking,
hearing, seeing, grasping, standing, walking and repetitive motions.
PHYSICAL DEMANDS
The physical demands described here are represenfaiive of those fhat must be met 6y an
employee to successfully perform the essential funcfions of this job. Reasona6le accommodations
may be made to enable individuals with disabilities fo perfo►m fhe essential functions.
Page 2 of 3
Vendor Services Agreement Page 14 of 26
City Secretary Contract No.
Sedentary Work — Depending on assignment, positions in this class typically exert up to
10 pounds of force occasionally, a negligible amount of force frequently, and/or or
constantly having to lift, carry, push, pull or otherwise move objects. Sedentary work
involves sitting most of the time. Jobs are sedentary if walking and standing are required
only occasionally and all other sedentary criteria are met.
Page S of 3
Vendor Services Agreement Page 15 of 26
City Secretary Contract No.
City of Fort Worth, Texas
Job Description
Classification Title Public Safety Communicator II
Job Code: PS5140 Job Family: Public Safety
Pay Grade 510 Date Reviewed: � 06/28/15
FLSA Status I Nonexempt Date Revised: � 4/9/22
GENERALSUMMARY
Performs answering and dispatch services for emergency and non-emergency calls for
police, fire and medical response. Performs duties in support of the Police Information
Center and a variety of technical tasks. Ensures the safety and effectiveness when routing
calls to appropriate City services.
ESSENTIAL DUTIES 8� RESPONSIBILITIES
Tl�e intent of this job description is to provide a representative summary of the major duties and
responsibilities performed by incumbents of this job. Incumbents may be requested to perform
job-related tasks other than fhose speci�cally presented in this description.
1. Receives and prooesses emergency and non-emergency calls using Computer Aided
Dispatch System (CAD) and various electronic devices. Dispatches calls to patrol units
and receives and communicates information pertaining to the incident. Monitors Omega
alarm system for City.
2. Retrieves all pertinent computer data relating to dispatch incidents, special requests
from officers and other important information.
3. Determines the correct emergency response, correctly prioritizing and collecting data
that is now evidence in crimes.
4. Enters information into CAD system for call processing from caller information or use of
automatic number identifier (ANI) and automatic location identifier (ALI) received from
phone system.
5. Uses power map to locate callers and noti�es other employees, supervisors and field
units.
6. Updates and monitors unit status and transmits officer requests for emengency services.
7, Verifies and inputs data as requested by officers in the field.
S. Notifies wrecker services, fire department, medical investigator or other entities as
requested.
9. PerForms other related duties as required.
10. Adheres to assigned work schedule as outlined in the Department and City attendance
policies and procedures; ensures all behaviors comply with the City's Personnel Rules
and Regulations.
Page 7 of 3
Vendor Services Agreement Page 16 of 26
City Secretary Contract No.
When Assis�ned to Police Information Center:
1. Enters all pertinent computer data relating to dispatch incidents and other important
information. Retrieves information from Computer Aided Dispatch {CAD) system and
routes to dispatchers.
2. Perfortns criminal history checks. Inputs information into oompletes case infortnation
and incident reports into computer soflware.
3. Receives and sends information to other agencies using teletype program.
4. PerForms timely entry of accurate information into National Crime Information Center
(NCIC) and Texas Crime Information Center (TCIC).
5. Trains new employees as required.
6. PerForms related duties as required.
KNOWLEDGE, SKILLS & ABILITIES
. Knowledge of:
➢ Modem office procedures, methods and computer equipment.
➢ Principles and procedures of record keeping.
➢ Pertinent federal, state and local laws and ordinances.
➢ Computer aided dispatch, 79 call signals, and various databases and systems
related to 911 operations.
➢ Police Information Mining Portal.
➢ General Orciers for Fort Worth Police Department.
• Skill in:
➢ Planning and prioritizing.
➢ Observation and decision-making.
➢ Organization, time management, and multi-tasking.
➢ Customer service.
• Ability to:
➢ Communicate clearly and effectively, both orally and in writing.
➢ Learn methods and techniques of emergency dispatching.
➢ Learn to process information and make sound decisions in emergency situations.
➢ Learn the geography and surrounding area of the City.
➢ Learn to interpret City maps and geographical locations.
➢ Respond to emergency and non�mergency situations from the general public.
➢ Type at a speed necessary for successful job perFormance.
➢ Establish and maintain effective working relationships.
➢ Comprehend radio traffic and dispatch critical information.
MINIMUM JOB REQUIREMENTS
High school diploma/GED and one (1) year of public safety call taking/dispatch
experience.
Page 2 of 3
Vendor Services Agreement Page 17 of 26
City Secretary Contract No.
OTHER REQUIREMENTS
Must have successfully completed Dispatcher Training at time of job offer.
Must possess the prerequisites of the Basic Telecommunicator Proficiency Certification
requirements per Texas Commission on Law Enforcement (TCOLE).
Must meet TCOLE and CJIS requirements.
WORKING CONDITIONS
The wor1� environment characteristics described here arie represenfafive of those an employee
encounters while performing the essenfial functions of this job. Reasonable accommodations may
be made to enable individuals with disabilities to perform the essentia! funcfions.
Depending on assignment, positions in this class typically require touching, talking,
hearing, seeing, grasping, standing, walking and repetitive motions.
PHYSICAL DEMANDS
The physical demands described here are represenfaiive of those fhat must be met 6y an
employee to successfully perform the essenfia/ functions of fhis job. Reasonable accommodafions
may be made to enable individuals with disabilities fo perform fhe essential functions.
Sedentary Work — Depending on assignment, positions in this class typically exert up to
10 pounds of force occasionally, a negligible amount of force frequently, and/or or
constantly having to lift, carry, push, pull or otherwise move objects. Sedentary work
involves sitting most of the time. Jobs are sedentary if walking and standing are required
only occasionally and all other sedentary criteria are met.
Page 3 of 3
Vendor Services Agreement Page 18 of 26
City Secretary Contract No.
c�ty of Fort wortn, Texas
Job Description
Classification Title Public Safety Communicator III
Job Code: PS5250 I Job Family: Public Safety
Pay Grade 511 Date Reviewed: 11/13/2019
FLSA Status Nonexempt Date Revised: 4/9/2022
GENERAL SUMMARY
Provides communication and dispatch services for emergency and non-emergency calls
for police, fire and medical response. Supports the Police Information Center and a
variety of technical tasks. Ensures the safety and efFectiveness when routing calls to
appropriate City services.
ESSENTIAL DUTIES � RESPONSIBILITIES
The intent of this job description is fo provide a roepresentative summary of the major duties and
responsibilities performed by incumbents of this job. Incum6ents may be requesfed to perform
job-related tasks other than fhose speci�cally presenfed in tf►is description.
1. Properly receives and processes emergency, non-emergency, and administrative
phone calls from citizens and other public safety agencies according to policies and
procedures.
2. Provides life-safety information during responses; analyzes oonflicting and/or limited
location information to direct first responders to the scene; negotiates with suicidal
callers or hostage takers; and deploys to the scene of planned events, major
emergencies, or ongoing incidents.
3. Monitors and controls the movement of field units and provides appropriate and
effective coverage in response to public safety emergencies.
4. Identifies critical situations to ensure the prompt and appropriate response to unusual
situations.
5. Perf'orms various computer checks, input, and retrieval of information to assist
emergency services staff.
6. Retrieves all pertinent computer data relating to dispatch incidents, special requests
from officers and other important information.
7. Determines the correct emergency response, correctly prioritizing and collecting data
that is now evidence in crimes.
8. Enters information into CAD system for call processing from caller information or use
of automatic number identifier (ANI) and automatic location identifier (ALI) received
from phone system.
9. Uses power map to locate callers and notifies other employees, supervisors and field
units.
Page 1 of 4
Vendor Services Agreement Page 19 of 26
City Secretary Contract No.
10. Updates and monitors unit status and transmits officer requests for emergency
services.
11.Verifies and inputs data as requested by offioers in the field.
12. Notifies wrecker services, fire department, medical investigator or other entities as
requested.
13. PerForms other related duties as required.
14.Adheres to assigned work schedule as outlined in the Department and City attendance
policies and procedures; ensures all behaviors complywith the City's Personnel Rules
and Regulations.
When Assi4ned to Police Information Center:
1. Receives and processes a variety of time sensitive data and information in assigned
area of responsibility.
2. Collects data and responds to request for statistics, telephone recording and other
pertinent information.
3. Enters all pertinent computer data relating to dispatch incidents and other important
information. Retrieves information from Computer Aided Dispatch (CAD) system and
routes to dispatchers.
4. PerForms criminal history checks. Inputs information into completes case information
and incident reports into computer software.
5. Receives and sends information to other agencies using teletype program.
6. PerForms timely entry of accurate information into National Crime Information Center
(NCIC) and Texas Crime Information Center (TCIC).
7. Trains new employees as required.
8. PerForms other related duties as required.
KNOWLEDGE, SKILLS 8 ABILITIES
• Knowledge of:
➢ Modern office procedures, methods and computer equipment.
➢ Principles and procedures of record keeping.
➢ Pertinent federal, state and local laws and ordinances.
➢ Computer aided dispatch, 79 call signals, and various databases and systems
related to 911 operations.
➢ Police Information Mining Portal.
➢ General Orders for Fort Worth Police Department.
➢ Methods and techniques of police records research and file retrieval.
• Skill in:
➢ Attention to detail.
➢ Active listener with excellent communication skills.
➢ Critical Thinking and Problem Solving.
➢ Observation and decision-making.
➢ Organization and time management.
Page 2 of 4
Vendor Services Agreement Page 20 of 26
City Secretary Contract No.
➢ Monitoring assigned activities and operations.
➢ Operating assigned equipment.
➢ Making sound decisions and using good judgment.
➢ Prioritizing work activities.
nu�i�ty to:
➢ Operate the computer aided dispatch (CAD) system and various other computer
terminals.
➢ Provide training and technical guidance to lower level personnel.
➢ Respond to emergency and non-emergency situations from the general public.
➢ Process information and make sound decisions in emergency situations.
➢ Interpret City maps and geographical locations.
➢ Dispatch staff to emergency scenes as appropriate.
➢ PerForm various duties in support of the Police Information Center.
➢ Access various criminal and crime history information.
➢ Operate various emergency recording and dispatching equipment under stress in
an efFicient manner.
➢ Maintain and update a variety of detailed reoords and reports.
➢ Type at a speed necessary for successful job performance.
➢ Communicate clearly and concisely, both orally and in writing.
➢ Establish and maintain effective working relationships.
➢ Demonstrate understanding of ASL (American Sign Language) and use of
interpreters.
➢ Demonstrate emergency management for people with disabilities.
MINIMUM JOB REQUIREMENTS
HS diploma/GED and iwo (2) years of emergency or public safety dispatch experience;
40 hours of approved or equivalent Telecommunicator training; and, full access and
training on Texas Crime Information Center (TCIC) / National Crime Information Center
(NCIC).
OTHER REQUIREMENTS
Must have an active TCOLE Basic Telecommunicator license and Communications
Training Officer Certificate (CTO) at time of job offer.
Must have completed the Telecommunications Device for the Deaf (TDD) / Teletypewriter
(TTY) for Telecommunicators within the last six (6) months from time of hire; or, TDDlTTY
D.E, Traditional Service (TRS) and Emergency Technology, Deaf Culture, Crimes P�qainst
People with Disabilities, Effective TTY Call Processing, or ADA Law and Regulations
within the last six (6) months from time of jab offer.
Must meet TCOLE and CJIS requirements.
Page S of 4
Vendor Services Agreement Page 21 of 26
City Secretary Contract No.
WORKING CONDITIONS
The work environment characteristics described hene arie represenfative of those an employee
encounters while performing the essenfial functions of fhis job. Reasonable accommodations may
be made to enable individuals with disabilities to perform the essentia! funcfions.
Depending on assignment, positions in this class typically require touching, talking,
hearing, seeing, grasping, standing, walking and repetitive motions.
PHYSICAL DEMANDS
The physical demands described here are represenfaiive of those fhat must he met 6y an
employee to successfully perform the essential funcfions of this job. Reasonable accommodations
may be made to enable individuals wifh disabilities fo perfo►m fhe essential functions.
Sedentary Work — Depending on assignment, positions in this class typically exert up to
10 pounds of force occasionally, a negligible amount of force frequently, and/or or
constantly having to lift, carry, push, pull or otherwise move objects. Sedentary work
involves sitting most of the time. Jobs are sedentary if walking and standing are required
only occasionally and all other sedentary criteria are met.
Page 4 of 4
Vendor Services Agreement Page 22 of 26
City Secretary Contract No.
Appendix B
TEXAS COMMISSION ON LAW ENFORCEMENT
6330 E. Highway 290, STE. 200
Austin, Texas 78723-1035
Phone: (512) 936-7700
h1.jJS: % jVv4L �N.tGC?€c, 1:2X 3�.:iOV
LICENSEE PSYCHOLOGICALAND EMOTIONAL HEALTH DECLARATION (L-3)
Occupations Code § 1701.306; Commission Rules §§ 217.1, 217.7, 221.35, 227.4
INDIVIDUAL INFORMATION TO BE COMPLETED BY ACADEMY OR AGENCY
1. TCOLE PID 2. INDIVIDUAL LAST NAME 3. INDIVIDUAL FIRST NAME 4. M.I. 5. SUFFIX Jf., BfC.
6. HOME MAILING ADDRESS 7. CIN 8. STATE 9. ZIP CODE 10. EMAIL
11 . LICENSE TVPE SOUGHT (FOR STUDENT SEEKING ENROLLMENT IN ACADEMV - DO NOT CHECK IF SEEKING APPOINTMENT�
❑ PEACE OFFICER ❑ COUNTY JAILER ❑ TELECOMMUNICATOR ❑ SCHOOL MARSHAL
❑ PEACE OFFICER ❑ RESERVE OFFICER ❑ COUNTY JAILER 8 TELECOMMUNICATOR
❑ SCHOOL MARSHAL ❑ PUBLIC SECURITY OFFICER ❑ JUVENILE PROBATION OFFICER
ACADEMY OR AGENCY INFORMATION (TO BE COMPLETED BY ACADEMY OR AGENCY)
TX 439214 I FORT WORTH POLICE DEPT
505 W FELIX I FORT WORTH I �% I 76115 I 817382-4258
INDIVIDUAL ACKNOWLEDGEMENT AND RELEASE (TO BE COMPLETED BY INDIVIDUAL)
21. I hereby authorize the release of my Personal History Statement and any other background investigation
documents to the examining practitioner. I also hereby authorize the release of the results of this psychological
examination and any other relevant information to the above requesting academy or law enforcement agency
and the Texas Commission on Law Enforcement.
Attention Requesting Academy or Agency and Examining Practitioner: State Law and Commission Rules require that a
psychological examination be performed by a psychologist or psychiatrist licensed in Texas, except in exceptional
circumstances when, upon prior apprwal by TCOLE, it may be performed by a qualified physician licensed in Texas. The chief
administrator of the requesting agency must request prior approval in writing and must receive written approval from TCOLE
before a psychological examination performed by a physician is acceptable.
Requesting Academy or Agency: After the above sections are completed, submit this form along with a description of job
duties for the license or appointment sought, a copy of the individual's Personal History Statement, and any background
investigation documents (if applicable) by mail or email to the practitioner selected by the academy or agency.
Examining Practitioner: The psychological examination must be conducted pursuant to professionally recognized standards
and methods. The examination process must consist of a review of the description of job duties for the license or appointment
sought, a review of the Personal History Statement, and a review of any background investigation documents (if applicable).
The examination must consist of at least two instruments, one which measures personality traits and one which measures
psychopathology, and a face-to-face interview conducted after the instruments have been scored. Given the nature of law
enforcement and the potential consequences to the agency, the individual, and the public, the purpose of the psychological
examination is to determine whether the individual is in satisfactory psychological and emotional health to serve as the type of
law enforcement officer for which the license or appointment is sought.
L-3 Form 9.1.2024 Page 1 of 2
Vendor Services Agreement Page 23 of 26
City Secretary Contract No.
PSYCHOLOGICAL AND EMOTIONAL HEALTH EXAMINATION TO BE COMPLETED BY PRACTITIONER
22. PRACTITIONER LICENSE TYPE
❑ PHYSICIAN ❑ PSYCHOLOGIST ❑ PSYCHIATRIST
23. PRACTITIONER LAST NAME 24. PR4CTITIONER FIRST NAME 25. LICENSE NUMBER 26. EMAIL
27. MAILING ADDRESS 28. CITY 29. STATE 30. ZIP CODE 31 . PHONE NUMBER
32. DESCRIPTION OF TESTS OR METHODOLOGIES PERFORMED AND CONCLUSIONS, INCLUDING ANV EXISTING CONDITIONS (ATTACH ADDITIONAL
PAGES AS NEEDED
33. DATE PSYCHOLOGICAL EXAMINATION PERFORMED:
34. I certify that I have completed a psychological and emotional health examination of the above-named
individual pursuant to professionally recognized standards and methods. I have concluded that the individual:
❑ ❑
IS IS NOT
in satisfactory psychological and emotional in satisfactory psychological and emotional
health to serve as the type of licensee for the health to serve as the type of licensee for the
license or appointment sought. license or appointment sought.
PRACTITIONER NAME (TYPE OR PRINT) PRACTITIONER SIGNATURE DATE
STATE LAW AND COMMISSION RULES REQUIRE THAT A PSYCHOLOGICAL EXAMINATION BE PERFORMED BY A
PSYCHOLOGIST OR PSYCHIATRIST LICENSED IN TEXAS, OR BY A QUALIFIED PHYSICIAN LICENSED IN TEXAS WITH
PRIOR APPROVAL FROM TCOLE. THIS FORM IS ONLY VALID IF SIGNED BY THE APPROPRIATE PRACTITIONER.
Examining Practitioner: After completing the above examination section, return this form and any additional documents by
mail or email to the requesting academy or law enforcement agency. If the individual is determined to not be in satisfactory
psychological or emotional health to serve, please submit this form to TCOLE at fitfordutv(a�tcole.texas.aov.
Requesting Academy or Agency: If the individual is determined to not be in satisfactory psychological or emotional health
to serve, submit this form to TCOLE at fitfordutvCa�tcole.texas.qov within 30 days of the examination.
For school marshal applicants and licensees, this L-3 Form remains valid for 90 days from the date signed by the practitioner,
unless withdrawn or invalidated. For all other applicants and licensees, this L-3 Form remains valid for 180 days from the
individual's graduation date from the academy, if accepted by the appointing agency, or is valid for 180 days from the date
signed by the practitioner, unless withdrawn or invalidated.
THIS DOCUMENT IS CONFIDENTIAL AND NOT SUBJECT TO DISCLOSURE
UNDER THE PUBLIC INFORMATION ACT, GOVERNMENT CODE CHAPTER 552.
L-3 Form 9.1.2024
Page 2 of 2
Vendor Services Agreement Page 24 of 26
City Secretary Contract No.
Appendix C
Texas Administrative Code
TITLE 37
PART 7
CHAPTER 217
RULE §217.1
PUBLIC SAFETY AND CORRECTIONS
TEXAS COMMISSION ON LAW ENFORCEMENT
ENROLLMENT, LICENSING, APPOINTMENT, AND
SEPARATION
Minimum Standards for Enrollment and Initial Licensure
(b) The commission shall issue a license to an applicant who meets the following
standards:
(12) examined by a psychologist, selected by the appointing, employing agency, or
the academy, who is licensed by the Texas State Board of Examiners of
Psychologists. This examination may also be conducted by a psychiatrist licensed
by the Texas Medical Board. The psychologist or psychiatrist must be familiar
with the duties appropriate to the type of license sought. The individual must be
declared by that professional, on a form prescribed by the commission, to be in
satisfactory psychological and emotional health to serve as the type of officer for
which the license is sought. The examination must be conducted pursuant to
professionally recognized standards and methods. The examination process must
consist of a review of a job description for the position sought; review of any
personal history statements; review of any background documents; at least two
instruments, one which measures personality traits and one which measures
psychopathology; and a face to face interview conducted after the instruments have
been scored. The appointee must be declared by that professional, on a form
prescribed by the commission, within 180 days before the date of the appointment
by the agency;
Vendor Services Agreement Page 25 of 26
City Secr�ary CaatractNo.
EXHEBIT B
VERTFICATION 4F SiGNATURE AUTRORITY
Cindy Dic3cason
PsychScree�ing, �nc., Owner
7801 �akmont Bl�d, Ste i41
Fort Worth, Teacas 76t32
Execution of thes Signatarc Verifkat�ioa Fotm ("Form") h�eby Ceriifies tha# the following
individuals a�d/or �ositionS have the authority to legally bind Vendor and to ex�cute any agreement,
amendment ar change arder nn behalf oi Ve�dor. 3uch binding authority has be�n gramed by proper order,
resoiution, ordi�a�e or a�l�er ��ethorization of Ve�dor. City is fu1�y sntitkd to rely on tbe waaanty and
represet�ation set forth in this FoRn in eM�ing iirto any a�t or amer�neTrt with Yenc�or. Vendor
will submit an update� Form withi�► tean {1�) business days if there are any �hanges to the signatory
authori#y. City is entitled ta rely pn any �urrerrt enecuted Form ur�tii it receives a revised Form that has be�;n
properly exec�ted by Ver�dor.
�. N�: Jennifer Brovm
Assis#ar�t
2. N�.me:
Positeon:
Signature
3. Nat�ae:
Pasiteon:
Sign�ture
Name:
i�,t�',,�aQ.e�
Signa of Presiclent / CEO
Other Title: �ner
�: 13 No�►ember 20'1�
Vendor Sc�vices Agreer�et Page 26 of 2�