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Home My WebLink AboutContract 46006 CITY SECW o DD CONTRACT NO. -- MOBILE SCREENING AGREEMENT THIS MOBILE SCREENING AGREEMENT (the "Agreement") is effective on September 12, 2014 (the "Reservation Date") and is by and between TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH ("Hospital"), a Texas non-profit corporation,and City of Fort Worth ("Customer"). RECITALS WHEREAS, Hospital is in the business of providing health services; and WHEREAS, Customer desires for Hospital to provide health services to its employees, and Hospital is willing to provide such services. NOW,THEREFORE, for and in consideration of the mutual covenants herein contained and other good and valuable consideration, the receipt of which is hereby acknowledged, the parties agree as follows: 1. Services to be Provided. Hospital hereby agrees to provide to Customer with the Wellness for Life Mobile Screening Event(the "Event")scheduled as follows: 1.1 Event Date: October 6, 7, 8, 9, 10, 2014 Time: 8:00 a.m.—4:00 p.m. 1.2 Organization or business name: City of Fort Worth 1.3 Target audience: Employees 1.4 Service street addresses: October 6, 7, 8, 10 2014: City Hall, 1000 Throckmorton; Fort Worth, Texas 76101 and October 9, 2014: Will Rogers Memorial Coliseum, Round Up Inn, 3401 W. Lancaster, Fort Worth,Texas, 76107. 1.5 Contact name and phone number: Ellen Pearce, 817-392-7753 A reservation is not confirmed until the Agreement is signed by both parties. 2. Cancellation Policy. 2.1 Hospital Cancellation. Hospital may cancel, postpone, or reschedule the Event within two (2) days of the Event Date upon written notice (via certified mail, e-mail, or facsimile) without penalty. a. Force Maieure. Hospital also reserves the right to cancel the Event due to low participation, inclement weather, or technical difficulties. Should Hospital cancel the Event, Customer's contact person will be notified and an alternate date will be arranged. Hospital will notify all scheduled participants. _n/a_ 2.2 Customer Cancellation. Customer agrees to provide written notice (via certified mail, (Initial if applies) e-mail, or facsimile) to Hospital of any intention to cancel its Event within three (3) business days of the M C11) Event Date. If Hospital does not receive cancellation within three (3) business days of the Event Date, M Customer agrees to pay Hospital Five Hundred Dollars ($500) for loss of provider revenue ("Cancellation M Fee"). v o OFFICIAL RECORD o CITY SECRETARY N FT.WORTH,TX 0 3. Customer's Responsibilities. Customer is responsible for adhering to the requirements set forth in sections 3.1, 3.2 and 3.3 or Customer will be subject to forfeiture of the unit for service on the Event Date and will be charged a Cancellation Fee. Upon arriving at the Event site, the mobile unit driver is responsible for determining whether all conditions are met. If the unit driver determines there is not appropriate parking or an alternative site is not available and/or acceptable, the driver has sole discretion to cancel the Event. 3.1 Parking. Customer agrees to provide appropriate parking for Hospital's mobile screening unit. Appropriate parking is defined as a seventy (70) foot paved level parking surface, designated and reserved for the mobile unit with access as early as 6:00 a.m. on the Event Date. 3.2 Restrooms. Customer must provide clean, operable, restroom facilities for mobile unit staff during screening hours. 3.3 Perimeter. For pedestrian safety, Customer must maintain a ten (10) foot security perimeter around the screening unit at all times while the screening unit is in service. 4. Minimum Event Requirements. The Hospital requires the following minimum number of screening participants for each mobile screening event: 4.1 Mammography = 22 participants 4.2 Skin cancer screenings = 19 participants 4.3 Well-woman examinations= 10 participants 4.4 Prostate examinations= 19 participants 4.5 Bone density screenings = 19 participants 4.6 Colon screenings = 19 participants The minimum participant numbers must be scheduled at least three (3) days prior to the Event Date or the Event will be cancelled and rescheduled. 5. Appointment Scheduling. Participants should call 1-855-318-7696 to schedule their individual appointments. 6. Publications/Advertising. Customer will present to Hospital all promotional materials, publications, articles, press releases, scripts and statements intended to publicize, communicate or display the Event PRIOR TO PRINTING, at least ten (10) days in advance of the planned publication/release date for Hospital's review and approval, which will not be unreasonably withheld. 7. Event Day. 7.1 Participants. Participants are responsible for providing two (2) forms of identification (a valid picture ID or Texas issued drivers license and a utility bill, phone bill or some type of correspondence with the participant's name and correct address to establish proof of residency). Results of screenings are mailed to the participant's home address. 7.2 Primary Care Physician. Each participant will be asked to identify his/her primary care physician. A primary care physician is required for patient follow-up. If the participant does not have a primary care physician, Hospital will assign Dr. Kathleen Crowley to be the participant's primary care physician for receipt of screening results. 8. Compensation. Screenings will be paid for by participant insurance or other funding sources. Please check Hospital's insurance link for coverage at: http://www.texashealth.org Hospital will also require the contact information for a representative from Customer's benefits/human resources department to verify coverage. Customer agrees to provide the name and telephone number of the appropriate person at least three (3) days prior to the Event Date. 8.1 Other Funding Sources. Funding for screening may be available from other sources including federal, state, the Susan G. Komen Breast Cancer Foundation, Doris Kupferle Woman's Health Boards, and Bernard C. Alger Fund for qualified participants without private insurance. Should a participant not present an insurance card at the time of screening and be determined later to be covered,the insurance company will be billed for the full amount. 9. Notices. Any notice, request or other communication required under this Agreement shall be in writing and shall be deemed to have been given or made if delivered via certified mail, e-mail, or facsimile to the parties at the following addresses, or at such other addresses as shall be specified in writing by either of the parties to the other in accordance with the terms and conditions of this subsection: If to Hospital: Texas Health Fort Worth Attn: Lillie Biggins, FACHE, President 1300 Pennsylvania Avenue Fort Worth,Texas 76104 Copy to: Wellness for Life Mobile Screening Attn: Rosemary Galdiano, RN, MPH,OCN 1300 West Terrell Avenue Fort Worth,Texas 76104 Phone Number: 817-820-4910 Facsimile Number: 817-887-5266 OFFICIAL RECORD If to Customer: City of Fort Worth CITY SECRETARY Attn: Susan Alanis,Assistant City Manager FT.WORTH,TX 1000 Throckmorton Fort Worth,Texas 76101 Phone Number:817-392-8180 10. Relationship of Parties. Nothing in this Agreement shall be construed to constitute either party as a partner, employee or agent of the other, it being intended that Customer shall be an independent Customer of Hospital under this Agreement and solely responsible for its own actions. No employee or agent of one party hereto shall be considered an employee or agent pf the of r_party. N er Customer nor Hospital has the right to bind the other party hereto. t� }/'' IN WITNESS WHEREOF,on the dates set forth herein below. MMY IlGyser, City Secr anti TEXAS HEA H HARRIS METHODIST CITY OF FORT WORTH a�� ®oo ®�►��a IP,ITAI FCI T W TH �p�►o° Nommo Com s Date S n Alanis Date Vice President AssiA"N& 'AC TO �a4 a 0000000* CI Approved As To Form Only: FOP AN D LEG ALITy; ��a�U Terri A.DeSio Assistant General Counsel ASSIST AT CITY ATT(]RNFv