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HomeMy WebLinkAbout065282 - General - Contract - Fort Worth ISDDocusign Envelope ID: 76EB893D-6852-4B3D-9AEE-A892479DFD9C CSC No. 65282 CITY OF FORT WORTH CLINICAL AFFILIATION AGREEMENT This Clinical Affiliation Agreement ("Agreement") is made between the City of Fort Worth ("Fort Worth"), a home -rule municipal corporation organized under the laws of the state of Texas, and the Fort Worth Independent School District, a political subdivision of the state of Texas and a legally constituted independent school district located in Tarrant County, Texas ("School"). Fort Worth and School are each a "Party" and collectively the "Parties" to this Agreement. WHEREAS, Fort Worth, by and through the Fort Worth Fire Department, provides regulated prehospital emergency medical services ("EMS") and emergency ambulance transportation ("EMS System") to the public within its jurisdiction and those jurisdictions that have executed an EMS Interlocal Agreement with Fort Worth; WHEREAS, School has an EMS Program ("Program") that provides its students ("Students" or "Student") with academic and clinical experiences; WHEREAS, School desires for Fort Worth, as a licensed EMS Provider, to provide the Students with suitable clinical experience consistent with School's curriculum and assist with clinical teaching and supervision of Students in the Program; WHEREAS, the purpose of this Agreement is to state the terms and conditions under which Fort Worth will cooperate with School to promote the success of the Program and provide clinical experiences for the Students; NOW THEREFORE, known by all these present, Fort Worth and School, acting herein by, and through, their duly authorized representatives, agree to the following terms: I. RESPONSIBILITIES OF SCHOOL School shall: 1.1 Plan the educational activities for the Student's clinical experience at Fort Worth after consultation with and approval by Fort Worth's Medical Director, or their designee (the "Medical Director"). 1.2 Provide qualified teachers from School to teach the pre -requisite core curriculum and support courses in the Program; 1.3 Provide administrative functions for each Student in the Program. 1.4 Provide a faculty member to be available for consultation at all times Students are at Fort Worth, and to supervise Students participating in the Program. 1.5 Instruct Students to abide by Fort Worth's patient care policies and guidelines. Information regarding Fort Worth's applicable policies and guidelines will be available at the time of student OFFICIAL RECORD Clinical Affiliation Agreement Page. 1 of 8 CITY SECRETARY FT. WORTH, TX Docusign Envelope ID: 76EB893D-6852-4B3D-9AEE-A892479DFD9C orientation at Fort Worth. 1.6 If applicable, provide Fort Worth with the appropriate forms to be used in evaluating the performance of Students in the Program. 1.7 Require Students to comply with the regulatory and accreditation standards provided by Fort Worth at the time of student orientation at Fort Worth. 1.8 Ensure each student has current immunizations, including: Influenza, Hepatitis B, MMR, TDAP, Varicella (or titer), and provide Fort Worth proof if requested. 1.9 Confirm that Students have been tested for tuberculosis within one (1) year of commencement of the Program and are tested at least annually while participating in the Program, and provide evidence of such testing and the results to Fort Worth prior to commencement of the Program or upon request of Fort Worth thereafter. 1.10 Confirm Students have been instructed in Standard Precautions, as recommended and defined by the Centers for Disease Control and Prevention (CDC), and completed a Basic Life Support cardiopulmonary resuscitation course prior to the beginning of the Program and provide evidence of such confirmation to Fort Worth prior to commencement of the Program or upon request of Fort Worth thereafter. 1.11 Confirm that Students have been instructed in HIPAA privacy law standards and have successfully completed any training required by Fort Worth prior to participating in clinical experiences at Fort Worth. 1.12 Provide to Fort Worth, at least two (2) weeks prior to commencement of the Program, a letter outlining the needs of Students, days and hours Students will be on patient units or service areas, names of Students and supervising faculty members, length, and dates of clinical experience. 1.13 Consider promptly any complaints made by Fort Worth against a Student and participate in joint problem solving. Patient safety and welfare shall be the primary concern. Student issues will be documented by Fort Worth and provided to the designated Faculty member and/or other representative of School. The Medical Director, in their sole discretion, may require permanent withdrawal of any Student from Fort Worth at any time for cause. 1.14 Comply with Fort Worth's substance abuse policies, and, at Fort Worth's request, remove any Student or faculty member from the Program if there is reasonable suspicion that the Student or faculty member has violated Fort Worth's substance abuse policies. 1.15 Verify that a background evaluation, including a criminal background history in all fifty (50) states, has been performed on each Student, and verify that there are no negative findings for each Student prior to commencing any assignment at Fort Worth. For purposes of this Agreement, a criminal background history shall include any felony conviction within the last ten (10) years. For purposes of this Agreement, a background evaluation shall include the last ten (10) years and all counties (in Texas and outside of Texas) in which the Student has been a resident of or Clinical Affiliation Agreement Page 2 of 8 Docusign Envelope ID: 76EB893D-6852-4B3D-9AEE-A892479DFD9C employed in. 1.16 Ensure that each Student and faculty member at all times while at Fort Worth wears a name tag, badge, or other identifying label that clearly states the Student or faculty member's identity and the name of the School. II. RESPONSIBILITIES OF FORT WORTH Fort Worth shall: 2.1 Provide reasonable cooperation to promote the success of the Program. 2.2 Provide equipment and supplies that are necessary for clinical care by Fort Worth, unless otherwise specified in writing for a special requirement such as personal protective equipment. 2.3 Provide suitable clinical experience situations as prescribed by the curriculum provided by School. 2.4 Assist with clinical teaching and supervision of an agreed -upon number of Students in the Program. 2.5 Upon request by School, formally evaluate the performance of Students in the Program using the form provided by School; 2.6 Retain responsibility for patient care; 2.7 Reserve the right to determine the manner in which its equipment shall be operated; 2.8 To the extent allowed by law, assume no professional or financial liability for injury to Students or faculty except that which might occur as a member of the public, unless due to Fort Worth's sole negligence or gross misconduct; and 2.9 Provide access to acute emergency care at Student's expense in the event of an accident or injury to a student on Fort Worth's property. III. RESPONSIBILITIES OF FORT WORTH AND SCHOOL Fort Worth and School shall: 3.1 Agree upon the number of Students to be placed with Fort Worth for clinical rotations prior to the beginning of each School semester in which Students are assigned to and accepted by Fort Worth; 3.2 Agree on a schedule and provide an orientation of faculty and Students to Fort Worth and assigned units. Clinical Affiliation Agreement Page 3 of 8 Docusign Envelope ID: 76EB893D-6852-4B3D-9AEE-A892479DFD9C 3.3 Comply with all applicable federal, state, and local laws, rules, regulations, and ordinances. IV. TERM 4.1 This Agreement will be effective upon execution by Fort Worth's Assistant City Manager and will expire on September 30 of the next fiscal year of Fort Worth, unless terminated earlier in accordance with the terms and conditions of this Agreement. This Agreement may be renewed by the written, mutual agreement of the Parties for an unlimited number of one-year renewals, each a "Renewal Term." V. TERMINATION 5.1 Convenience. Either Fort Worth or School may terminate this Agreement at any time and for any reason by providing the other party with 30 days written notice of termination. 5.2 Breach. If either party commits a material breach of this Agreement, the non -breaching Party must give written notice to the breaching party that describes the breach in reasonable detail. The breaching parry must cure the breach ten (10) calendar days after receipt of notice from the non -breaching party, or other time frame as agreed by the parties. If the breaching parry fails to cure the breach within the stated period, the non -breaching parry may, in its sole discretion, and without prejudice to any other right under this Agreement, law, or equity, immediately terminate this Agreement by giving written notice to the breaching party. 5.3 Duties and Obligations of the Parties. Upon termination of this Agreement for any reason, School shall provide Fort Worth with copies of all completed or partially completed documents prepared under this Agreement. In the event that School has received access to Fort Worth information or data as a requirement to perform services hereunder, School shall return all Fort Worth provided data to Fort Worth in a machine-readable format or other format deemed acceptable to Fort Worth. VI. HIPAA 6.1 It is the intent of the parties to comply fully with the Health Insurance Portability and Accountability Act, Texas Health and Safety Code Chapter 181, and implementing regulations issued pursuant thereto (collectively "HIPAA" herein). The parties agree that protected health information (hereinafter referred to as "Protected Health Information" or "PHI") is subject to protection under HIPAA, and it is the intent of the parties to be in full compliance with, state and federal law, including applicable provisions of HIPAA, the Health Information Technology for Economic and Clinical Health Act ("HITECH") its related regulations, and all applicable state privacy and security laws related to access of PHI by the Parties. To the extent that the services performed under this Agreement are determined to be performing a transaction subject to HIPAA or the HITECH Act, the Business Associate Agreement shall control. 6.2 To the extent applicable, each party shall implement and maintain such safeguards as are necessary to ensure that the PHI is not used or disclosed except as is provided in this Agreement and any referenced documents, including the Business Associate Agreement. Clinical Affiliation Agreement Page 4 of 8 Docusign Envelope ID: 76EB893D-6852-4B3D-9AEE-A892479DFD9C VH. STATUS OF STUDENTS 7.1 School and Fort Worth understand and agree that while faculty and Students are participating in the Program, faculty and students are not employees of Fort Worth. Accordingly, faculty and Students are not entitled to any of the rights or benefits established for Fort Worth's employees, such as salary, vacation, sick leave with pay, paid holidays, insurance, and/or workers' compensation coverage. Further, nothing herein shall be construed as creating a partnership or joint venture between School and Fort Worth, its officers, agents, employees, and subcontractors, and doctrine of respondeat superior has no application as between the School and Fort Worth. 8.1 [Reserved] 8.2 [Reserved] VIIL INDEMNIFICATION IX. NOTICE 9.1 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; or (2) received by the other party by United States Mail, registered, return receipt requested, addressed as follows: FORT WORTH: City of Fort Worth Attn: Medical Director 100 Fort Worth Trail Fort Worth TX 76102 ith Copy to the City Attorney same address [Reserved] SCHOOL: ort Worth Independent School District .ttn: Robert Wright 060 Camp Bowie Blvd. ort Worth, TX 76116 ith Copy to the Office of Legal Services at same address X. INSURANCE XI. GENERAL PROVISIONS 11.1 Governmental Powers. It is understood and agreed that by execution of this Agreement, Fort Worth and School do not waive or surrender any of their governmental powers or immunities. 11.2 No Waiver. The failure of Fort Worth or School to insist upon the performance of any term or provision of this Agreement or to exercise any right granted herein shall not constitute a Clinical Affiliation Agreement Page 5 of 8 Docusign Envelope ID: 76EB893D-6852-4B3D-9AEE-A892479DFD9C waiver of Fort Worth's or School's respective right to insist upon appropriate performance or to assert any such right on any future occasion. 11.3 Governing Law and 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 on the basis of 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. 11.4 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. 11.5 Force Majeure. Fort Worth and School 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 parry's performance, as soon as reasonably possible, as determined in the Fort Worth'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. 11.6 Headings Not Controlling. Headings and titles used in this Agreement are for reference purposes only and shall not be deemed a part of this Agreement. 11.7 Review of Counsel. The parties acknowledge that each party and its counsel have reviewed 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 hereto. 11.8 Amendments. No amendment of this Agreement shall be binding upon a parry hereto unless such amendment is set forth in a written instrument and duly executed by an authorized representative of each party. 11.9 Entirety of Agreement. This Agreement, including any exhibits attached hereto and any documents incorporated herein by reference, contains the entire understanding and agreement between Fort Worth and School, 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. Clinical Affiliation Agreement Page 6 of 8 Docusign Envelope ID: 76EB893D-6852-4B3D-9AEE-A892479DFD9C 11.10 Counterparts. 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. An executed Agreement, modification, amendment, or separate signature page shall constitute a duplicate if it is transmitted through electronic means, such as fax or e-mail, and reflects the signing of the document by any party. Duplicates are valid and binding even if an original paper document bearing each party's original signature is not delivered. 11.11 Signature Authority. 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. Each party is fully entitled to rely on these warranties and representations in entering into this Agreement or any amendment hereto. 11.12 Electronic Signatures. This Agreement maybe 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 file or facsimile transmission) of an original signature, or signatures electronically inserted via software such as Adobe Sign. [Signature Page Follows] Clinical Affiliation Agreement Page 7 of 8 Docusign Envelope ID: 76EB893D-6852-4B3D-9AEE-A892479DFD9C ACCEPTED AND AGREED: FORT WORTH: zj Q By: Name: Title: Date: Assistant City Manager APPROVAL RECOMMENDED: By: Name: Title: Date: ATTEST: By: Name: Jannette Goodall Title: City Secretary Date: a n a0 ........ R* .00 Od oo aaQnn�45Qa Fort Worth Independent School District: By: 011. ti C. �- Name: Karjn C. Molina Title: Fort Worth ISD Superintendent Date: 11 /3/2025 `8129C81585BB455... By: Mohammed Choudhury Deputy Superintendent Date: 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: Harold Rogers (Nov 12, 202510:12:14 CST) Name: Title: Date: APPROVED AS TO FORM AND LEGALITY: By: Name: Title: Date: Taylor Paris Assistant City Attorney CONTRACT AUTHORIZATION: M&C: Approved to Form and Legality By: Date: 10/3 2025 8/25/2025 OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Clinical Affiliation Agreement Page 8 of 8 FORM D CRIMINAL BACKGROUND CHECK AND FELONY CONVICTION NOTIFICATION (a) CRIMINAL BACKGROUND CHECK The Contractor listed below will obtain history record information that relates to an employee, applicant for employment, or agent of the Contractor ("servant") if the servant has or will have continuing duties related to the contracted services and the duties are or will be performed on school property, or at another location where students are regularly present. The Contractor certifies to FWISD that before beginning work, and at least once per year thereafter, criminal history record information will be obtained. The Contractor shall assume all expenses associated with the background checks and shall immediately remove any servant who was convicted of any felony, or a misdemeanor involving moral turpitude, as defined by Texas law, from FWISD's property or other location where students are regularly present. FWISD shall be the final decider of what constitutes a "location where students are regularly present." Contractor's violation of this section shall constitute a substantial failure. If the Contractor is the person, owner, or operator of the business entity, Contractor may not self -certify regarding the criminal history record information and its review and must submit original evidence acceptable to the District with this Agreement showing compliance. (b) FELONY CONVICTION NOTIFICATION Section 44.034(a) of the Texas Education Code states, "a person or business entity that enters into a contract with a school district must give advance notice to the District if the person or owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony." Subsection (b) further provides, "a school district may terminate a contract with a person or business entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for services performed before the termination of the contract." THE FELONY CONVICTION NOTICE IS NOT REQUIRED OF A PUBLICLY HELD CORPORATION If the Contractor is a publicly held corporation, proceed to Section A, below. I, the undersigned agent for the Contractor named below, certify that: (1) the information concerning criminal background check and notification of felony convictions has been reviewed by me; (2) the following information furnished is true to the best of my knowledge; and (3) I acknowledge compliance with this section`. Contractor's Name:(--©�'`�CG- Authorized Company Official's Name: A. The Contractor is a publicly held corpora ' • erefore, this reporting requirement is not applicable: I Company Official's Signature: Date: �/ M / a B. The Contractor is not owned nor operate b nyone who has been convicted of a felony: Company Official's Signature: Date: b/% /q /4s7 C. The Contractor is owned or operated by the following individual(s) who has/have been convicted of a felony: Name of Felon(s): Details of Conviction(s): Company Official's Signature: Date: Note: Name & Signature of Company Official should be the same as on the Affidavit (Form C) Contractor is responsible for the performance of the persons, employees, and sub -contractors Contractor assigns to provide services for the Fort Worth ISD pursuant to this RFP on any and all Fort Worth ISD campuses or facilities. Contractor will not assign individuals to provide services at a Fort Worth ISD campus or facility who have a felony conviction or a history of violent, unacceptable, or grossly negligent behavior, without the prior written consent of the Fort Worth ISD Purchasing Department. Model SB 9 Contractor Certification Form Criminal History Record Information Review of Certain Contract Employees Introduction: Chapter 22 of the Texas Education Code requires service contractors to obtain criminal history record information regarding covered employees and to certify to the District that they have done so. Covered employees with disqualifying convictions are prohibited from serving at a school district. Definitions: Covered employees: Includes all employees of a contractor (including subcontractors and independent contractors) who have or will have continuing duties related to the service to be performed at the District and have or will have direct contact with students. The District will be the final arbiter of what constitutes direct contact with students. Disqualifying conviction: One of the following offenses, if at the time of the offense: (a) a felony offense under Title 5, Texas Penal Code; (b) an offense for which a defendant is required to register as a sex offender under Chapter 62, Texas Code of Criminal Procedure; or (c) an equivalent offense under federal law or the laws of another state. On behalf of Contractor's Name, I, with the contact information provided below: Individual's Full Name: Individual's Full Name Street Address: Individual's Street Address, City, State, ZIP Code Telephone Number: Individual's Telephone Number Fax Number: Individual's Fax Number E-Mail Address: Individual's E-Mail Address Certify that (check one of the following): rLl None of Contractor's employees are covered employees, as defined above; OR ❑ Some or all of the Contractor's employees are covered employees. If this box is selected, I further testify that: • Contractor has obtained all required criminal history record information, through the Texas Department of Public Safety, regarding its covered employees. • None of the covered employees has a disqualifying conviction. • Contractor has taken reasonable steps to ensure that its employees who are not covered employees do not have continuing duties related to the contract services or direct contact with students. If Contractor receives information that a covered employee has a disqualifying conviction, Contractor will immediately remove the covered employee from contract duties and notify the District in writing within three (3) business days. Upon request, Contractor will make available for the District's inspection the criminal history record information of any covered employee. If the District objects to the assignment of a covered employee on the basis of the covered employee's criminal history record information, Contractor agrees to discontinue using that covered employee to provide services at the District. The District reserves the right to conduct its own criminal background check of Contractor and its covered employees. Noncomplian the Contractor with this certification may be grounds for contract termination. Signature Date FORT WORTH. City Secretary's Office Contract Routing & Transmittal Slip Contractor's Name: CFW Clinical Affiliation Agreement Subject of the Agreement: provides regulated prehospital er medical services M&C Approved by the Council? * Yes ❑ No M If so, the M&C must be attached to the contract. Is this an Amendment to an Existing contract? Yes ❑ No 0 If so, provide the original contract number and the amendment number. Is the Contract "Permanent"? *Yes 0 No ❑ If unsure, see backpage for permanent contract listing. Is this entire contract Confidential? *Yes ❑ No 0 If only specific information is Confidential, please list what information is Confidential and the page it is located. Effective Date: If different from the approval date. Expiration Date: unlimited renewals 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 0 No ❑ Contracts need to be routed for CSO processing in the followingorder: rder: 1. Katherine Cenicola (Approver) 2. Jannette S. Goodall (Signer) 3. Allison Tidwell (Form Filler) *Indicates the information is required and if the information is not provided, the contract will be returned to the department.