HomeMy WebLinkAboutContract 64108CITY OF FORT WORTH
Agreement for High ImpACT Physician Assistant Services - ACCLAIM Page 1 of 22
AGREEMENT BETWEEN THE CITY OF FORT WORTH AND ACCLAIM
PHYSICIAN GROUP, INC. FOR HIGH IMPACT PHYSICIAN ASSISTANT SERVICES
This AGREEMENT for physician assistant services (“Agreement”) is made and entered into by
and between the CITY OF FORT WORTH, a Texas home rule municipality (“City”), and
ACCLAIM PHYSICIAN GROUP, INC., DBA Acclaim Health JPS Physician Health
Network, a non-profit healthcare organization certified by the Texas Medical Board under the
Texas Health and Safety Code and as an affiliate of the Tarrant County Hospital District
(“Agency”). City and Agency are referred to individually as a “Party” and sometimes collectively
referred to as the “Parties.”
RECITALS:
WHEREAS, concentrations of homelessness are reported by citizens in various parts of
the City;
WHEREAS, some people experiencing homelessness also have mental and physical
health care needs;
WHEREAS, the City conducted a 17-month pilot program, High ImpACT, to see if
unsheltered referrals from target areas could be housed and if so, could sustain housing;
WHEREAS, after 12 months of the pilot the results indicated a very high percentage of
those referrals accepted housing and maintained that housing;
WHEREAS, the City Council voted to continue High ImpACT past its pilot stage;
WHEREAS, the Agency is familiar with the High ImpACT program through its work as
a subcontractor for My Health, My Resources of Tarrant County to provide physician assistant
services for the High ImpACT pilot;
WHEREAS, the Parties believe that these services will further the goal of the High
ImpACT program and desire to enter into this Agreement in order to set out the terms, goals and
responsibilities of each party;
NOW THEREFORE, the Parties for the mutual consideration included herein agree to enter into
the following Agreement.
AGREEMENT DOCUMENTS:
The Agreement documents shall include the following:
1.This Agreement for Advanced Practice Provider or Physician Assistant Services;
2.Exhibit “A” – Scope of Services
3.Exhibit “B” – Budget
4.Exhibit “C” – Reimbursement Request Form
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5.Exhibit “D” -- Request for Budget Modification Form
Exhibits “A,” “B,” “C,” and “D”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 Exhibits “A,” “B,” “C,” and “D”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.
1.1 Agency shall provide City with advanced practice provider or physician assistant
services for the High ImpACT program to those referred to the program (“Services”), which are
more particularly described in Exhibit “A” – Scope of Services.
1.2 Program Performance.
1.2.1 Agency agrees to maintain full documentation supporting the performance of the
work and fulfillment of the objectives set forth in Exhibit “A.”
1.2.2 Agency agrees to provide a monthly report to the High ImpACT program manager
to document the performance of the work described in Exhibit “A.”
1.2.3 Agency agrees to provide a quarterly report to the High ImpACT program
manager to document the performance of the work described in Exhibit “A.”
1.2.2 Agency agrees that the Reimbursement Request Form and monthly report will be
submitted to City no later than the 15th day after the end of each month. Agency agrees that at the
end of each quarter (December, March, June, September) Agency shall also provide a quarterly
report with the aggregate information requested therein along with its monthly report and
reimbursement request. Should Agency not be able to meet these requirements in a given month,
the Agency shall provide written notification prior to the deadline that details the expected date of
submission. If no notification is received before the 15th day, the City may document for future
corrective action. If, by the last day of the same month, Agency has not submitted the required
reports, City may send a non-compliance letter notifying Agency’s duly authorized representative
of a possible suspension of program funding.
1.2.3 Agency agrees to complete a Corrective Action Plan (CAP) in the event of three
(3) consecutive months or six (6) non-consecutive months with incomplete or incorrect
submissions of a Reimbursement Request Form or report. Agency also agrees to complete a CAP
for recurring late submissions of a Reimbursement Request Form or report. City may elect to allow
Agency to correct minor errors in submissions without requiring a CAP, but reserves the right to
require a CAP upon the above stated conditions.
2.TERM.
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This Agreement shall begin on October 1, 2025 (“Effective Date”) and shall expire on
September 30, 2026 (“Expiration Date”), unless terminated earlier in accordance with this
Agreement (“Initial Term”). City shall have the option, in its sole discretion, to renew this
Agreement under the same terms and conditions, except for the compensation amount which shall
be provided at the time of the renewal, for 3 additional 1-year terms. Execution of this Agreement
after the Effective Date shall have no bearing on the enforceability of the Agreement.
3. COMPENSATION.
3.1 City shall pay Agency in accordance with the provisions of this Agreement and Exhibit
“B” – Budget. Total payment made by City under this Agreement for the Initial Term shall not
exceed One Hundred Ninety-Two Thousand and Three Hundred Twenty Dollars
($192,320.00) (“Program Funds”), and shall be paid to Agency on a reimbursement basis.
Agency shall not perform any additional services 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 incurred by Agency not specified by this Agreement unless City first
approves such expenses in writing. If City determines in its sole discretion that this Agreement
should be renewed as provided under Section 2 of this Agreement, the City shall provide an
updated Exhibit “B”, which shall include the not to exceed amount to be paid to Agency on a
reimbursement basis during the renewal term.
3.2 Payment of the Program Funds from City to Agency shall be made on a cost-
reimbursement basis following receipt by City from Agency of a signed Reimbursement Request
Form (“RRF”) as described in Exhibit “C” along with copies of all receipts and other supporting
documentation. The RRF shall be submitted to City no later than the 15th day following the end
of the month. Agency will submit RRFs through the City’s designated reporting portal. Homeless
Strategies staff will provide agency access to necessary portal/program(s) to upload RRFs. Unless
advance written permission from City is provided to Agency, Submittal of a monthly RRF is
required even if services are not provided.
3.3 The monthly RRF should be sequentially numbered and include expense
documentation that is detailed, clear and concise. All invoices should be sent electronically to the
Homeless Strategies coordinator and manager.
The invoice must contain the following information:
Supplier Name and Address;
Remit to Supplier Name and Address, if different;
Applicable City Department business unit# (i.e. FW002)
Complete City of Fort Worth PO number (i.e. the PO number
must contain all preceding zeros);
Invoice number;
Invoice date; and
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Invoices to be submitted after delivery of the goods or services.
Reimbursements will not be made until after receipt of an acceptable and approved RRF
and monthly report as required. Reimbursements shall be made within 30 days receipt of said
documents. Incomplete or incorrect submissions will be returned to the Agency for resubmission,
restarting the 30-day reimbursement schedule.
3.4 Any modifications in the original approved budget that exceed 5% must have prior
written permission from City before the modifications are made. The Request for Budget
Modification Form (Exhibit “D”) must be submitted, and request must be approved by City before
any money is moved to the line-item. Once the Request for Budget Modification is approved, the
modified budget will take effect on the first day of the following month. The new modified budget
shall not exceed the total amount of Program Funds. Agency shall be solely responsible for any
money spent in excess of the not to exceed amount included in this Agreement for the then-current
term.
3.5 Agency will document cost allocations for all budgeted expenses throughout the
entirety of the Agreement and will be responsible for having a policy and procedure in place for
this documentation. Specifically, Agency will document how all shared costs, personnel time, or
equipment that was fully or partially paid for using City funds, were used in furtherance of the
program activities described in this Agreement. Documentation of these cost allocations, as well
as a copy of the Agency’s policy and procedures for the documentation of the cost allocations shall
be made available to the City upon request.
3.6 The City reserves the right to reject any budget modification that the City believes, in
its sole discretion, is not clearly aligned with the program activities and any requests for
reimbursement expenses that the City believes, in its sole discretion, are not specified in Exhibit
“B”of this Agreement or an approved budget modification form.
3.7 Requests for Budget Modifications shall be submitted via email to
Tara.Perez@fortworthtexas.gov.
4. TERMINATION.
4.1. Written Notice. City or Agency may terminate this Agreement at any time and for
any reason by providing the other Party with 60 days’ written notice of termination.
4.2 Duties and Obligations of the Parties. In the event that this Agreement is terminated
prior to the Expiration Date, City shall pay Agency for services actually rendered up to the
effective date of termination and Agency 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, Agency shall provide City with copies of all
completed or partially completed documents prepared under this Agreement. In the event Agency
has received access to City data as a requirement to perform services hereunder, Agency shall
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return all City-provided data to City in a machine-readable format or other format deemed
acceptable to City.
4.3 Non-appropriation 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 Agency
within 3 business days 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.
5. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION.
5.1 Disclosure of Conflicts. Agency hereby represents and warrants to City that
Agency has made full disclosure in writing of any existing or potential conflicts of interest related
to Agency's services under this Agreement. In the event that any conflicts of interest arise after
the Effective Date of this Agreement, Agency hereby agrees to make full disclosure of such
conflict of interest to City immediately in writing.
5.2 Confidential Information. Agency, for itself and its officers, agents and employees,
agrees that it shall treat all information provided to it (i) by City (“City Information”) as
confidential and shall not disclose any such information to a third party without City’s prior written
approval, and (ii) shall abide by all of the standards of confidentiality of clientinformation (“Client
Information”) in its performance of its duties and obligations under this Agreement including but
not limited to those standards, rules and regulations regarding confidentiality required by HMIS
and the HMIS Lead/System Administrator. “Client Information” is defined for the purposes of
this Agreement as personal, demographic, or treatment data about the individuals being served by
the program.
5.3 Unauthorized Access. Agency shall store and maintain CityInformation and Client
Information in a secure manner and shall not allow unauthorized users to access, modify, delete or
otherwise corrupt City Information or Client Information in any way. Agency shall notify City
immediately if the security or integrity of any City Information or Client Information has been
compromised or is believed to have been compromised, in which event, Agency 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 or Client Information from further unauthorized disclosure.
6.RIGHT TO AUDIT.
Agency agrees that City shall, until the expiration of 3 years after final payment under this
Agreement, or the final conclusion of any audit commenced during the said 3 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 Agency involving transactions
relating to this Agreement at no additional cost to City. Agency agrees that City shall have access
during normal working hours to all necessary Agency facilities and shall be provided adequate and
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appropriate work space in order to conduct audits in compliance with the provisions of this section.
City shall give Agency reasonable advance notice of intended audits.
This provision shall survive the expiration or termination of this Agreement.
7. INDEPENDENT CONTRACTOR.
It is expressly understood and agreed that Agency 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, Agency 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, consultants and sub vendors. Agency acknowledges that the doctrine of
respondeat superior shall not apply as between City, its officers, agents, servants and employees,
and Agency, its officers, agents, employees, servants, vendors and sub vendors. Agency further
agrees that nothing herein shall be construed as the creation of a partnership or joint enterprise
between City and Agency. It is further understood that City shall in no way be considered a Co-
employer or a Joint employer of Agency or any officers, agents, servants, employees or sub vendor
of Agency. Neither Agency, nor any officers, agents, servants, employees or sub vendor of Agency
shall be entitled to any employment benefits from City. Agency shall be responsible and liable for
any and all payment and reporting of taxes on behalf of itself, and any of its officers, agents,
servants, employees or sub vendors.
8. LIABILITY AND INDEMNIFICATION.
8.1 LIABILITY – TO THE EXTENT PERMITTED BY THE TEXAS
CONSTITUTION AND LAWS OF THE STATE OF TEXAS, AGENCY SHALL BE LIABLE
AND RESPONSIBLE FOR ANY AND ALL PROPERTY LOSS, PROPERTY DAMAGE
AND/OR PERSONAL INJURY, INCLUDING 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 AGENCY, ITS OFFICERS, AGENTS, SERVANTS OR
EMPLOYEES.
8.2 GENERAL INDEMNIFICATION – TO THE EXTENT PERMITTED BY THE
TEXAS CONSTITUTION AND LAWS OF THE STATE OF TEXAS, AGENCY HEREBY
COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS AND DEFEND CITY,
ITS OFFICERS, AGENTS, SERVANTS AND EMPLOYEES, FROM AND AGAINST ANY
AND ALL CLAIMS OR LAWSUITS OF ANY KIND OR CHARACTER, WHETHER REAL
OR ASSERTED, FOR EITHER PROPERTY DAMAGE OR LOSS (INCLUDING ALLEGED
DAMAGE OR LOSS TO AGENCY'S BUSINESS AND ANY RESULTING LOST PROFITS)
AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS,
ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT, TO THE EXTENT
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CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OR MALFEASANCE OF AGENCY,
ITS OFFICERS, AGENTS, SERVANTS OR EMPLOYEES.
This section shall survive the expiration or termination of this Agreement.
9. ASSIGNMENT AND SUBCONTRACTING.
9.1 Assignment. Agency 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 Agency under which
the assignee agrees to be bound by the duties and obligations of Agency under this Agreement.
Agency and Assignee shall be jointly liable for all obligations of Agency under this Agreement
prior to the effective date of the assignment.
9.2 Subcontract. If City grants consent to a subcontract, subcontractor shall execute a
written agreement with Agency referencing this Agreement under which subcontractor shall agree
to be bound by the duties and obligations of Agency under this Agreement as such duties and
obligations may apply. Agency shall provide City with a fully executed copy of any such
subcontract.
10.INSURANCE.
Agency represents and warrants that it is a governmental unit as defined by the Texas Tort
Claims Act.
Agency shall maintain at all times during this Agreement:
10.1 Coverage and Limits
(a) Self-insurance with combined limits of not less than $100,000 per person
and $300,000 per occurrence for bodily injury (in keeping with the terms of the Texas Tort
Claims Act);
(b) Self-insurance with combined limits of not less than $100,000 per
occurrence for property damage (in keeping with the terms of the Texas Tort Claims Act);
(c) Worker’s Compensation or worker’s compensation self-insurance up to
Statutory limits according to the Texas Workers’ Compensation Act or any other state
workers’ compensation laws where the work is being performed
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11. COMPLIANCE WITH LAWS, ORDINANCES, RULES AND REGULATIONS.
Agency 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 Agency of any violation of such laws,
ordinances, rules or regulations, Agency shall immediately desist from and correct the violation.
12. NON-DISCRIMINATION COVENANT.
Agency, for itself, its personal representatives, assigns, sub vendors and successors in
interest, as part of the consideration herein, agrees that in the performance of Agency’s duties and
obligations hereunder, 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 AGENCY,
ITS PERSONAL REPRESENTATIVES, ASSIGNS, SUB VENDORS OR SUCCESSORS
IN INTEREST, AGENCY AGREES TO ASSUME SUCH LIABILITY AND TO
INDEMNIFY AND DEFEND CITY AND HOLD CITY HARMLESS FROM SUCH
CLAIM.
This section shall survive the expiration or termination of this Agreement.
13. 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 email with confirmation of receipt by the
receiving party, or (3) received by the other Party by United States Mail, registered, return receipt
requested, addressed as follows:
To City:
City of Fort Worth
City Manager’s Office
Attn: Tara Perez, Homeless Strategies
Manager
100 Fort Worth Trail
Fort Worth, TX 76102
Phone: (817) 392- 2235
Email: Tara.Perez@fortworthtexas.gov
With copy to City Attorney’s Office at same
address
To Agency:
Acclaim Physician Group, Inc.
Attn: Sunny Jaryga
Acclaim Multi-Specialty Group
200 W. Magnolia Avenue, Suite 201
Fort Worth TX 76104
Phone: (817) 702-0178
Email: SJaryga@jpshealth.org
With copy to Thomas Cocke, Assistant
General Counsel – Acclaim at same address
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14. SOLICITATION OF EMPLOYEES.
Neither City nor Agency shall, during the term of this Agreement and additionally for a
period of 1 year after its termination, solicit for employment or employ, whether as employee or
independent contractor, any person who is or has provided services to the other Party 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.
15. GOVERNMENTAL POWERS.
It is understood and agreed that by execution of this Agreement, neither the City nor the
Agency waives or surrenders any of their governmental powers or immunities. Notwithstanding
the forgoing, Agency agrees that if Agency is a charitable or nonprofit organization and has or
claims an immunity or exemption (statutory or otherwise) from and against liability for damages
or injury, including death, to persons or property, Agency hereby expressing waives its rights to
plead defensively such immunity or exemption as against the City. This section shall not be
constructed to affect a governmental entity’s immunities under constitutional, statutory or common
law plead against any other entity other than the City.
16. NO WAIVER.
The failure of City or Agency 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
Agency’s respective right to insist upon appropriate performance or to assert any such right on any
future occasion.
17. GOVERNING 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.
18. SEVERABILITY.
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.
19. FORCE MAJEURE.
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City and Agency 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, epidemics or pandemics,
material or labor restrictions by any governmental authority, transportation problems, restraints or
prohibitions by any court, board, department, commission, or agency of the United States or of
any States, civil disturbances, other national or regional emergencies, and/or any other similar
cause not enumerated herein but which is beyond the reasonable control of the Party whose
performance is affected (collectively “Force Majeure Event”). The performance of any such
obligation is suspended during the period of, and only to the extent of, such prevention or
hindrance, provided the affected Party provides notice of the Force Majeure Event, and an
explanation as to how it hinders the party’s performance, as soon as reasonably possible, as
determined in the City’s discretion, after the occurrence of the Force Majeure Event. The form of
notice required by this section shall be the same as section 13 above.
20. HEADINGS NOT CONTROLLING.
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.
21. 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 Exhibits “A,” “B,” “C,” and “D”.
22. AMENDMENTS/ MODIFICATIONS/ EXTENSIONS.
No amendment, modification, 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.
23. ENTIRETY OF AGREEMENT.
This Agreement, including Exhibits “A,” “B,” “C,” and “D”contains the entire
understanding and agreement between City and Agency, 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.
24. COUNTERPARTS AND ELECTRONIC SIGNATURES.
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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. This Agreement may be executed by electronic signature, which will be
considered as an original signature for all purposes and have the same force and effect as an
original signature. For these purposes, “electronic signature” means electronically scanned and
transmitted versions (e.g. via PDF or facsimile transmission) of an original signature, or signatures
electronically inserted via software such as Adobe Sign.
25. WARRANTY OF SERVICES.
Agency warrants that its services will be of a professional quality and conform to generally
prevailing industry standards. City must give written notice of any breach of this warranty within
30 days from the date that the services are completed. In such event, at Agency’s option, Agency
shall either (a) use commercially reasonable efforts to re-perform the services in a manner that
conforms to the warranty, or (b) refund the fees paid by City to Agency for the nonconforming
services.
26. IMMIGRATION NATIONALITY ACT.
Agency shall verify the identity and employment eligibility of its employees who perform
working under this Agreement, including completing the Employment Eligibility Verification
Form (I-9). Upon request by City, Agency shall provide City with copies of all I-9 forms and
supporting eligibility documentation for each employee who perform work under this Agreement.
Agency 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. AGENCY SHALL, TO THE EXTENT ALLOWED BY LAW,
INDEMNIFY CITY AND HOLD CITY HARMLESS FROM ANY PENALTIES, LIABILITIES,
OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAGH BY AGENCY, AGENCY’S
EMPLOYEES, SUBCONTRACTORS, AGENCTS, OR LICENSEES. City, upon written notice
to Agency, shall have the right to immediately terminate this Agreement for violations of this
provision by Agency.
27. OWNERSHIP 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 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-
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hire" within the meaning of the Copyright Act of 1976, as amended, Agency 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.
28.CHANGE IN COMPANY NAME OR OWNERSHIP
Agency shall notify City’s Assistant City Manager, in writing, of a company name,
ownership, or address change for the purpose of maintaining updated city records. The chief
executive officer of Agency 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.
29. SIGNATURES.
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 Agency. Each
Party is fully entitled to rely on these warranties and representations in entering into this
Agreement or any amendment hereto.
30.PROHIBITION ON CONTRACTING WITH COMPANIES THAT BOYCOTT
ISRAEL
If Agency has fewer than 10 employees or this Agreement is for less than $100,000.00
this section does not apply. Agency acknowledges that in accordance with Chapter 2271 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” have the meanings ascribed to those terms in Chapter 2271 of the
Texas Government Code. By signing this Agreement, Agency certifies that Agency’s signature
provides the written verification to the City that Agency: (1) does not boycott Israel; and (2)
will not boycott Israel during the term of this Agreement.
31. PROHIBITION ON BOYCOTTING ENERGY COMPANIES
Agency acknowledges that in accordance with Chapter 2276 of the Texas Government
Code, City is prohibited from entering into a contract for goods or services that has a value of
$100,000 or more that is to be paid wholly or partly from public funds of the City with a company
with 10 or more full-time employees unless the contract contains a written verification from the
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company that it: (1) does not boycott energy companies; and (2) will not boycott energy companies
during the term of the contract. The terms “boycott energy company” and “company” have the
meaning ascribed to those terms by Chapter 2276 of the Texas Government Code. To the extent
that Chapter 2276 of the Government Code is applicable to this Agreement, by signing this
Agreement, Agency certifies that Agency’s signature provides written verification to the City
that Agency: (1) does not boycott energy companies; and (2) will not boycott energy
companies during the term of this Agreement.
32. PROHIBITION ON DISCRIMINATION AGAINST FIREARM AND
AMMUNITION INDUSTRIES
Agency acknowledges that except as otherwise provided by Chapter 2274 of the Texas
Government Code, the City is prohibited from entering into a contract for goods or services that
has a value of $100,000 or more that is to be paid wholly or partly from public funds of the City
with a company with 10 or more full-time employees unless the contract contains a written
verification from the company that it: (1) does not have a practice, policy, guidance, or directive
that discriminates against a firearm entity or firearm trade association; and (2) will not discriminate
during the term of the contract against a firearm entity or firearm trade association. The terms
“discriminate,” “firearm entity” and “firearm trade association” have the meaning ascribed to those
terms by Chapter 2274 of the Texas Government Code. To the extent that Chapter 2274 of the
Government Code is applicable to this Agreement, by signing this Agreement, Agency
certifies that Agency’s signature provides written verification to the City that Agency: (1)
does not have a practice, policy, guidance, or directive that discriminates against a firearm
entity or firearm trade association; and (2) will not discriminate against a firearm entity or
firearm trade association during the term of this Agreement.
33. CONFIDENTIAL INFORMATION
Agency acknowledges that the City is a governmental entity and is subject to the Texas
Public Information Act (“Act”). By executing this agreement, Agency acknowledges that this
Agreement will be publicly available on the City’s website, and Agency is therefore waiving any
claim of confidentiality, whether based in statute or the common law, to any and all materials
contained as part of this Agreement including all documents and information referenced herein or
attached hereto.
[SIGNATURE PAGE TO FOLLOW]
CITY OF FORT WORTH
Agreement for High ImpACT APP/Physician Assistant Services – ACCLAIM Page 14 of 22
IN WITNESS WHEREOF, the Parties hereto have executed this Agreement in multiple
originals on the date written below their respective signatures to be effective on the Effective
Date.
ACCEPTED AND AGREED:
CITY OF FORT WORTH:
By: ___________________________
Name: Dianna Giordano
Title: Assistant City Manager
Date: ___________________________
APPROVAL RECOMMENDED:
By: ______________________________
Name: Bethany Warner
Title: Intergovernmental Relations
Manager
ATTEST:
By: ______________________________
Name: Jannette S. 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: Tara Perez
Title: Homeless Strategies Manager
APPROVED AS TO FORM AND LEGALITY:
By: ______________________________
Name: Gavin Midgley
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C:
1295:
AGENCY:
ACCLAIM PHYSICIAN GROUP, INC.:
By:
Name: Sunny Jaryga
Title: Senior Vice President
Date: ____________________________
CITY OF FORT WORTH
Agreement for High ImpACT APP/Physician Assistant Services – ACCLAIM Page 15 of 22
EXHIBIT “A”
SCOPE OF SERVICES
ADVANCED PRACTICE PROVIDER/PHYSICIAN ASSISTANT SERVICES FOR
HIGH IMPACT
ACCLAIM will do the following:
Agency shall provide staffing for An advanced practice provider or physician assistant for the
Assertive Community Treatment Team of the High ImpACT program:
A. In General
Eligible households are individuals in the City of Fort Worth who are on the High ImpACT
Cohort in Partnership Home’s Homeless Management Information System;
B. Definitions
A general Assertive Community Treatment Team (“ACT Team”) is a well-documented
community mental health program for treating those with severe mental disorders. A
multidisciplinary team which delivers a full range of medical, psychosocial and rehabilitative
services to clients in a community setting (as opposed to treatment in an institution). The team
provides support in community that is modeled after the staffing patterns on inpatient psychiatric
units. The “hospital without walls” consists of people from multiple disciplines who work together,
meet daily and coordinate care for clients.
Key features of an ACT Team:
Interdisciplinary staffing that includes expertise in psychiatry, nursing, social work,
vocational functioning and substance use treatment
Team approach (shared caseloads and daily team meetings)
Low staff-client ratios (1:10)
Locus of contact in the community
Intensive and frequent contacts with clients
Assertive outreach
24 hour availability
Time unlimited services
High Impact Cohort – The list of individuals who have been referred to the High Impact Program.
High Impact Program – City funded program to focus additional housing and mental health
resources on individuals experiencing homelessness in seven target areas:
CITY OF FORT WORTH
Agreement for High ImpACT APP/Physician Assistant Services – ACCLAIM Page 16 of 22
Camp Bowie West/Las Vegas Trail (CD 3)
Seminary/La Gran Plaza/Hemphill (CD 9, 11)
Downtown (CD 9)
Near Southside (CD 9)
Historic Southside/Near Eastside (CD 8)
Northside/Stockyards (CD 2)
Beach Street intersections – from E. Lancaster to N. Tarrant Parkway (CD 2, 4, 8, 11)
The program will also include City-wide HOPE referrals.
Referrals will be made based on being located in these target areas and either having been in the
location over two years or are suspected of having severe mental illness. Referrals for the High
Impact Cohort will be made by neighborhood patrol officers, the Homeless Outreach Program and
Enforcement (HOPE) Team of the City’s Police Department and street outreach teams.
While the expectation of the High ImpACT team as a whole is to be responsive 24/7 as needed,
there is not a responsibility or expectation for the advanced practice provider/physician assistant to
be part of the on-call response.
There is not an expectation the advanced practice provider or physician assistant or Agency
purchase medical supplies needed by clients on the High ImpACT program.
C. Agency Responsibilities:
Agency will:
o Provide an Advanced Practice Provider (APP) or physician assistant (PA) to provide
medical services for the Assertive Community Treatment Team as part of the High
ImpACT program;
o The City acknowledges and agrees that in the event Agency needs to replace the APP
or PA assigned to provide services hereunder that the Agency must identify, recruit,
and hire an APP or PA and that Agency shall not be liable for any delay or failure to
perform its obligations under this Agreement due to difficulties in hiring or staffing,
provided that Agency has made reasonable and documented efforts to secure the
necessary personnel. In the event Agency is unable to staff the ACT Team with a
qualified provider, the City’s sole remedy shall be to terminate the agreement pursuant
to Section 4 of the Agreement.
The APP or PA will:
- Attend and actively engage in daily High ImpACT morning meetings and weekly case
review conferences.
- Deliver comprehensive, holistic primary care services, which include conducting physical
examinations, formulating diagnoses, and managing both acute and chronic conditions.
CITY OF FORT WORTH
Agreement for High ImpACT APP/Physician Assistant Services – ACCLAIM Page 17 of 22
Responsibilities may also involve prescribing medications, monitoring pharmacological
treatments, and performing initial health assessments during home visits.
- Recognize that many clients have limited interaction with medical professionals and may
be hesitant to seek care, the APP/PA will tailor treatment plans and scheduling to align
with each individual's comfort level and specific needs. A flexible, client-centered
approach will be central to their practice.
- Visit all High ImpACT clients willing to receive medical services;
- Beyond the Acclaim Family Medicine/Community Medicine Core Procedure list, the
APP/PA will offer nutritional counseling and facilitate smoking cessation programs
- As needed, organize groups and/or coordinate peer support groups for clients facing similar
health challenges, fostering a sense of community and shared progress.
- Report monthly to High ImpACT program manager the names of clients visited and the
number of times visited
D. City Responsibilities
- The City will include a provision in the City’s contract with My Health, My Resources of
Tarrant County that requires another team member to accompany the advanced practice
provider or physician assistant on all client visits.
- The City is responsible for ensuring that needed medical supplies are purchased for the
advanced practice provider or physician assistant through a provision in the City’s contract
with My Health, My Resources of Tarrant County that requires MHMR to purchase needed
medical supplies for the High ImpACT team.
- The City will include a provision in the City’s contract with My Health, My Resources of
Tarrant County that requires MHMR to provide transportation from MHMR offices for the
advanced provider or physician assistant when making client visits.
Evaluation:
Evaluation meetings will be held with Homeless Strategies staff to continually evaluate program
and Agency shall comply as necessary and in good faith.
Financial reporting:
Reimbursement Requests and any necessary supporting documentation and reports will be
submitted by the 15th of every month in format of Exhibit “C”.
CITY OF FORT WORTH
Agreement for High ImpACT APP/Physician Assistant Services – ACCLAIM Page 18 of 22
EXHIBIT “B”
BUDGET
Agency will submit invoice for reimbursement by the 15th of the month following the month
services were provided.
This report shall itemize each monthly expense requested for reimbursement by the Agency and
shall be included in Budget submitted.In order for this report to be complete the following must
be submitted:
Paystub must include pay period, date paid, amount and expenses (salary, FICA,
benefits etc). If pay stubs are unavailable, payroll registries with applicable expenses
highlighted and labeled will suffice. Agency may not submit payroll expenses dated
60 calendar days prior to the date of the Reimbursement Request with the exception of
the first Reimbursement Request which may include items from the Effective Date of
the Agreement to the end of the reporting month or with written permission from
Homeless Strategies staff so long as such changes are otherwise in accordance with the
Agreement.
For non-payroll expenses, invoices for each expense listed. Agency may not submit
invoices dated 60 calendar days prior to the date of the Reimbursement Request with
the exception of the first Reimbursement Request which may include items from the
Effective Date of the Agreement to the end of the reporting month or with written
permission from Homeless Strategies staff so long as such changes are otherwise in
accordance with the Agreement.
Proof that each expense was paid by the Agency, which proof can be satisfied by
cancelled checks. If a cancelled check is not possible, a bank statement with the expense
highlighted and labeled will suffice.
If allocations percentages are used, all documentation must be submitted with the first
month’s invoice and if changes are made, new allocation documentation submitted with
invoice.
For the audit, bank statements showing payments, Form 941s and allocation
documentation will be reviewed.
CITY OF FORT WORTH
Agreement for Physician Assistant Services - ACCLAIM
Page 19 of 22
PROGRAM COSTS Total
$192,320.00
A. SALARIES (By title)
APP/Physician Assistant
Physician Assistant
SALARIES TOTAL: $161,496.00
B. FRINGE BENEFITS
Physician Assistant Benefits
FRINGE BENEFITS TOTAL: $30,824.00
C. MILEAGE
MILEAGE TOTAL:
D. CELL PHONES/EQUIPMENT
CELL PHONES/EQUIPMENT TOTAL:
E. CLIENT EXPENSES
CLIENT EXPENSES TOTAL:
F. OTHER APPROVED
OTHER APPROVED TOTAL:
TOTAL PROGRAM COST:$192,320.00
CITY OF FORT WORTH
Agreement for High ImpACT APP/Physician Assistant Services – ACCLAIM Page 20 of 22
EXHIBIT “C”
REIMBURSEMENT REQUEST FORM
Expenses Name of employee or
client
Amount
Invoiced
Date Check
No.
Expense: Personnel
Salary
Salary
Salary
Salary Total:
FICA (Medicare/Social Security)
FICA (Medicare/Social Security)
FICA (Medicare/Social Security)
Health Insurance
Health Insurance
Health Insurance
Dental Insurance
Dental Insurance
Dental Insurance
Life Insurance
Life Insurance
Life Insurance
Disability Insurance
Disability Insurance
Disability Insurance
Retirement
Retirement
Retirement
Unemployment Insurance
Unemployment Insurance
Unemployment Insurance
Workers Compensation
Workers Compensation
Workers Compensation
Total of all Benefits:
Mileage
Mileage
Mileage
Mileage Total:
CITY OF FORT WORTH
Agreement for High ImpACT APP/Physician Assistant Services – ACCLAIM Page 21 of 22
Cell phone
Cell phone
Cell phone
Cell Phone Total:
Type of Client
Expense/Vendor
Client Expense Total:
Operations/Vendor:
Operations Total:
Other
Other Total:
Total Invoiced Amount
Attestation
Contractor:
Program:
Name of Person submitting
report:
Date Range Covered by this
report:
I have reviewed this report and
certify that it is a complete,
accurate, and up-to-date
reflection of the services
rendered under the terms of our
Agreement with the City of Fort
Worth.
Signature:
Total
A B C D E
Budget Category
Budget
Amount
Total Previous
Reimbursements
Requested
This
Month’s
Request
Total Request
to Date (B+D)
Remaining
Balance Available
(A-D)
Salaries
Fringe Benefits
Mileage
Cell
phone/Equipment
Client Costs
Other
Total
CITY OF FORT WORTH
Agreement for High ImpACT APP/Physician Assistant Services – ACCLAIM Page 22 of 22
EXHIBIT “D”
REQUEST FOR BUDGET MODIFICATION
Up to 5% of any budgeted line-item does not need prior approval but form must be sent
to City with monthly RFR
More than 5% of any budgeted line-item must have prior City approval
An increase in a zero line-item must have prior City approval
I have reviewed this request and certify that the listed modifications are correct.
__________________________________________ ________________________________
___________
Authorized Signatory Signatory Title
Date
STAFF USE ONLY
Modification Approved Modification NOT Approved
__________________________________________________________________________
Staff Signature Date
PROGRAM COSTS
Budget Category Approved Budget Change Requested Revised Budget
Salaries
Fringe Benefits
Mileage
Cell Phones/Equipment
Client Costs
Other Approved
Indirect or Administration
Total Costs
Modification Narrative (describe in detail what change is for)
Date
Submitting Agency
Contact Name
Phone Number and Email
Remit Address
City of Fort Worth,
Mayor and
Texas
Council Communication
DATE: 08/12/25 M&C FILE NUMBER: M&C 25-0658
LOG NAME: 02CONTINUATIONHIGHIMPACTPROGRAM
SUBJECT
(CD 2, CD 3, CD 4, CD 8, CD 9 and CD 11) Authorize Execution of Agreements with Listed Service Agencies for High ImpACT Program
Services in an Amount Up to $2,178,303.00 and Authorize Three Annual Renewal Options in a Combined Amount Up to $6,534,909.00
RECOMMENDATION:
It is recommended that the City Council:
1. Authorize the City Manager or his designee to execute agreements with agencies listed below in a combined amount up to $2,178,303.00
for a term commencing October 1, 2025 and terminating September 30, 2026 for High ImpACT Program services;
2. Authorize the City Manager or his designee to renew the agreements for Fiscal Years 2027, 2028 and 2029 with the agencies listed below in
a combined amount of up to $6,534,909.00 for High ImpACT Program services dependent on funds being appropriated for Homeless
Strategies;
3. Authorize the City Manager or his designee to amend the agreements if necessary to achieve program goals provided that the amendment
is within the scope of the program and in compliance with City policies and applicable laws and regulations; and
4. Find that such contract renewals and any amendments thereto serve a public purpose of reducing homelessness and that adequate controls
are in place.
DISCUSSION:
On March 19, 2024, the City Council approved Mayor & Council Communication (M&C) 24-0200 to fund the first five months of a 17-month High
ImpACT Pilot Program in the amount of $1,096,847.00. On December 10, 2024, the City Council approved M&C 24-1032 to
allocate $2,178,304.00 to fund the remaining 12 months of the 17-month pilot.
While many areas of Fort Worth have seen an uptick in unsheltered homelessness and the issues associated with it, there are seven areas that
have been hit especially hard. The High ImpACT Program aims to direct mental health and housing resources to reduce issues related to
unsheltered homelessness in those seven areas:
• Camp Bowie West/Las Vegas Trail (CD 3)
• Seminary/La Gran Plaza/Hemphill (CD 9 and 11)
• Downtown (CD 9)
• Near Southside (CD 9)
• Historic Southside/Near Eastside (CD 8)
• Northside/Stockyards (CD 2)
• Beach Street Intersections — from East Lancaster to North Tarrant Parkway (CD 2, 4, 8 and 11)
• City-wide HOPE referrals are also considered
This unique program houses the "hardest to house" clients who frequently interact with law enforcement and are highly visible to businesses and
neighborhoods.
The High ImpACT Program has finro components and associated goals for the first 17 months of the pilot:
1. Housing Assistance: Housing assistance for at least 40 eligible High ImpACT clients. Leverage existing housing vouchers with a goal of
providing housing assistance for up to 40 more people.
2. Housing First Assertive Community Treatment Team (Housing First ACT Team): Services for at least 80 severely mentally ill unsheltered and
housed clients by a mobile, high-level team, including psychiatric and medical professionals.
More than 70% of clients for the program were referred by Neighborhood Police Officers in the target areas based on considerations of both
the length of time someone has been unsheltered in that target area or if he or she is an unsheltered individual who may have severe mental
illness.
As stated in M&C 24-0200, the 17-month pilot program's perFormance measures will be that at least 70% of those offered housing enter housing
within six months and after one year of entering housing, at least 70% are still housed (can be different unit, but must be housed).
After one year of the pilot, the program is showing success in meeting pertormance objectives.
Goals by Sept. 30, 2025 Progress as of April
30, 2025
ACT Team services provided to 80 ACT Team services
clients provided to 79 clients
House 40 clients with High ImpACT Housed 41 clients with
assistance High ImpACT
assistance
At least 70% of those offered 89%
housing accept within 6 months housing acceptance
rate
At least 70% still housed after one 92% still housed after
year one year
Based on the success so far, it is recommended that the City Council continue funding the program in order to provide medical, psychiatric and
case management services as well as housing assistance. These intensive services combined with housing assistance have enabled many
unsheltered individuals with severe mental illness in target areas to obtain and retain housing.
The City contracted with My Health, My Resources of Tarrant County (MHMR) to provide High ImpACT services. MHMR contracted with
Partnership Home (formerly Tarrant County Homeless Coalition) and Acclaim Health to provide master lease/landlord engagement services and
physician assistant services.
For Fiscal Year 2026, the proposal is for the City contract directly with all three agencies as follows.
Agency Services Annual Contracted Amount
My Health, My Resources of Provision of psychiatric $1,269,005.00
Tarrant County services, therapy, housing
case management, client
costs etc
Acclaim Health Provision of physician $201,094.00
assistant services
Partnership Home Master leasing and landlord $708,204.00
engagement services
TOTAL $2,178,303.00
Funding will be budgeted within the General Fund for the City Managers office for Fiscal Year 2026.
This project was approved for a waiver per the Chapter 252 exemption, for Professional Services by the Legal Department.
FISCAL INFORMATION / CERTIFICATION:
The Director of Finance certifies that upon approval of the above recommendations and adoption of the Fiscal Year 2026 Budget by the City
Council, funds will be available in the Fiscal Year 2026 operating budget, as appropriated, in the General Fund. Prior to an expenditure being
incurred, the City Manager's Office has the responsibility to validate the availability of funds.
Submitted for City Manager's Office b� Dianna Giordano 7783
Originating Business Unit Head: Bethany Warner 6121
Additional Information Contact: Tara Perez 2235
City Secretary’s Office
Contract Routing & Transmittal Slip
*Indicates the information is required and if the information is not provided, the contract will be
returned to the department.
Contractor’s Name:
Subject of the Agreement:
M&C Approved by the Council? *Yes No
If so, the M&C must be attached to the contract.
Is this an Amendment to an Existing contract? Yes No
If so, provide the original contract number and the amendment number.
Is the Contract “Permanent”? *Yes No
If unsure, see back page for permanent contract listing.
Is this entire contract Confidential?*Yes No If only specific information is
Confidential, please list what information is Confidential and the page it is located.
Effective Date: Expiration Date:
If different from the approval date. If applicable.
Is a 1295 Form required?* Yes No
*If so, please ensure it is attached to the approving M&C or attached to the contract.
Project Number:If applicable.
*Did you include a Text field on the contract to add the City Secretary Contract (CSC)
number? Yes No
Contracts need to be routed for CSO processing in the following order:
(Approver)
Jannette S. Goodall (Signer)
Allison Tidwell (Form Filler)