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HomeMy WebLinkAboutC2026-064 - 5/19/2026 - Approved Portions of this contract may contain CONFIDENTIAL , PROPRIETARY, and /or TRADE SECRET INFORMATION (This contract with Front Line Mobile Health, PLLC, contains a confidentiality clause which may be applicable to, but is not limited to, confidential, proprietary, and trade secret information of Front Line Mobile Health, PLLC, and is the core subject of this contract.) Contact the Legal Department Prior to Release (Add cover sheet to top of contract when saving in City files) PROFESSIONAL SERVICES AGREEMENT The following Terms of the Professional Service Agreement("Agreement")are entered into and made effective on the date of final execution of this Agreement by both Parties. BETWEEN: FRONT LINE MOBILE HEALTH, PLLC, ("Service Provider"),a professional limited liability company organized and existing under the laws of Texas,with its principal office located at 4749 Williams Drive,Suite 304,Georgetown,TX 78633, info@frontlinemobilehealth.com; AND: City of Corpus Christi,Texas("Contracting Agency"),for the benefit of Corpus Christi Fire Department and the Airport Department,governmental agencies organized and existing under the laws of Texas,with its principal office located at 1201 Leopard Street,Corpus Christi,Texas 78401,which may be contacted at: Point of Contact: Daniel Valdez, Deputy Fire Chief of Administration Phone Number: (361)826-3936 E-Mail Address: r) nieh Caocorpuschristitx.gov Alternate Point of Contact:Thao Natterer, Business Manager Alternate Point of Contact Phone Number: (361)826-3965 Alternate Point of Contact E-Mail Address: haoNC&corpuschristitx.gov Service Provider and Contracting Agency may be referred to herein individually as"Party,"or collectively as"Parties." WHEREAS Service Provider is in the business of providing professional medical services relating to Annual Medical Evaluations, Candidate Medical Evaluations, Fitness-for-Duty Medical Evaluations,Candidate Psychological Evaluations, Fitness for Duty Psychological Evaluations, Promotional Psychological Evaluations,Special Tactics Team Selection Psychological Evaluations,and Professional Consulting Services;and WHEREAS,Contracting Agency will provide such services to Contracting Agency's Incumbent Firefighter personnel, Candidate Firefighter personnel, Candidate Fire Academy personnel, Incumbent Sworn Peace Officer personnel, Candidate Sworn Peace Officer personnel,Candidate Peace Officer Academy personnel,Incumbent Emergency Communications Personnel, Candidate Emergency Communications Personnel, Other Incumbent Personnel,or Other Candidate Personnel, identified by the Contracting Agency who volunteer to undergo these evaluations. NOW,THEREFORE,in consideration of the mutual covenants and agreements herein contained,the Parties hereto, intending to be legally bound, agree as follows: AGREEMENT 1. ENTIRE AGREEMENT frontlinemobilehealth.com i This Agreement, recitals,and attachments represent the entire understanding and Agreement between Service Provider and Contracting Agency, and supersede all other negotiations,proposals, understandings,and representations (written or oral) made by and between Service Provider and Contracting Agency.This Agreement includes the following attachments which are incorporated herein: 1.1 Exhibit A,"Minimum Billing Amount". 1.2 Exhibit B,"Scope of Services and Fee Schedule for Annual Medical Evaluations". 1.3 Exhibit C,"Scope of Services and Fee Schedule for Candidate Medical Evaluations". 1.4 Exhibit D,"Scope of Services and Fee Schedule for Fitness-for-Duty Medical Evaluations". 1.5 Exhibit E,"Scope of Services and Fee Schedule for Candidate Psychological Evaluations". 1.6 Exhibit F,"Scope of Services and Fee Schedule for Fitness-for-Duty Psychological Evaluations". 1.7 Exhibit G,"Scope of Services and Fee Schedule for Promotional Psychological Evaluations". 1.8 Exhibit H,"Scope of Services and Fee Schedule for Special Tactics Team Selection Psychological Evaluations". 1.7 Exhibit I,"Examinee Waiver for Medical Evaluation". 1.8 Exhibit J,"Examinee Waiver for Fitness-for-Duty Medical Evaluation". 1.9 Exhibit K,"Post-Offer Psychological Evaluation: Disclosure and Informed Consent". 1.10 Exhibit L,"Fitness-for-Duty Psychological Evaluation: Disclosure and Informed Consent". 1.11 Exhibit M,"Promotional Psychological Evaluation: Disclosure and Informed Consent". 1.12 Exhibit N,"Special Tactics Team Selection Psychological Evaluation: Disclosure and Informed Consent". 1.13 Exhibit O,"Requirements for Firefighters". 1.14 Exhibit P,"Medical Recommendation Form". 1.15 Exhibit Q,"Work Limitations Form". 1.16 Exhibit R,"HIPAA Business Associate Agreement". 2. TERM 2.1 The initial term of this Agreement shall begin on the date of final execution by the Parties(the"Effective Date")and shall expire on September 30,2027(the"Expiration Date"), unless terminated earlier in accordance with this Agreement ("Initial Term").After the Initial Term,the Contracting Agency may renew this Agreement under the same terms and conditions,subject to any price adjustments in accordance with Section 2.2,for up to four(4)additional one-year terms. Each renewal shall be initiated by,and subject to the Service Provider's written agreement,which shall not be unreasonably withheld,and shall be mutually confirmed by both Parties in writing no later than ninety(90)days prior to the expiration of the Initial Term,or no later than ninety(90)days prior to the expiration of each subsequent Renewal Term. 2.2 Service Provider may,at its discretion, increase the price for those services identified in Exhibit B through Exhibit H (Section 1.2 through Section 1.8)of this Agreement a maximum of five percent(5%)at the start of each Renewal Term the Agreement is in effect. frontlinemobilehealth.com 2 Service Tier Initial Term 1 st Option Year 2nd Option Year 3rd Option Year 4th Option Year Partnership $ 925.00 $ 971.25 $ 1,019.81 $ 1,070.80 $ 1,124.34 Annual Medical Evaluations Essentials Cancer $ 655.00 $ 687.75 $ 722.14 $ 758.24 $ 796.16 Essentials Cardiovascular $ 655.00 $ 687.75 $ 722.14 $ 758.24 $ 796.16 Partnership $ 1,600.00 $ 1,680.00 $ 1,764.00 $ 1,852.20 $ 1,944.81 Candidate Medical Evaluations Essentials $ 1,200.00 $ 1,260.00 $ 1,323.00 $ 1,389.15 $ 1,458.61 Foundations $ 800.00 $ 840.00 $ 882.00 $ 926.10 $ 972.41 Service Assessment Initial Term 1st Option Year 2nd Option Year 3rd Option Year 4th Option Year Candidate Psychological Evaluations(Fire Fighter) $ 425.00 $ 446.25 $ 468.56 $ 491.99 $ 516.59 Candidate Non-Suitability Appeal(Fire Fighter) $ 725.00 $ 761.25 $ 799.31 $ 839.28 $ 881.24 Candidate Psychological Evaluations(Law Enforcement) $ 800.00 $ 840.00 $ 882.00 $ 926.10 $ 972.41 Psychological Evaluations Candidate Non-Suitability Appeal(Law Enforcement) $ 975.00 $ 1,023.75 $ 1,074.94 $ 1,128.68 $ 1,185.12 Fitness-for-Duty Psychological Evaluations $ 1,600.00 $ 1,680.00 $ 1,764.00 $ 1,852.20 $ 1,944.81 Promotional Psychological Evaluations $ 800.00 $ 840.00 $ 882.00 $ 926.10 $ 972.41 Special Tactics Team Selection Psychological Evaluations $ 800.00 $ 840.00 $ 882.00 $ 926.10 $ 972.41 The amounts reflected in the table above constitute the agreed-upon pricing for each Term,subject to renewal by the Parties in accordance with Section 2.1. 3. DEFINITIONS The terms used in this Agreement shall have the following meaning: "Authority Having Jurisdiction"("AHJ")shall mean and refer to Contracting Agency's Authority Having Jurisdiction (as that term is defined in NFPA 1580 Section 3.2.2)as an organization,office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials,an installation or a procedure.The AHJ for Contracting Agency is the Fire Chief. "Annual Medical Evaluation"shall mean and refer to the analysis of information for the purpose of making a determination of medical certification of Incumbent Firefighter personnel,Incumbent Sworn Peace Officer personnel, Incumbent Emergency Telecommunications personnel,and Incumbent Other personnel(the"Participant")identified by the Contracting Agency who volunteer to undergo these evaluations of each one's ability to meet the appropriate standards regarding Firefighter, Peace Officer, Emergency Telecommunications,or Other applicable duty fitness,as well as to identify areas of the Participant's medical status that may indicate the possibility of future health issues and/or impact that Participant's ability to carry out the essentialjob tasks or duties associated with his or her position. "Candidate Firefighter,Candidate Fire Academy Personnel,Candidate Sworn Peace Officer,Candidate Peace Officer Academy personnel,Candidate Emergency Telecommunications,or Candidate Other personnel"shall mean and refer to a Participantwho has notyetbeen hired by the Contracting Agency,or who has been given a conditional offer of employment by the Contracting Agency. "Candidate Medical Evaluation"shall mean and refer to the analysis of baseline information for the purpose of making a determination of medical certification of Candidate Firefighter personnel,Candidate Fire Academy personnel,Candidate Sworn Peace Officer personnel,Candidate Peace Officer Academy personnel, Candidate Emergency Telecommunications personnel or Candidate Other Personnel(the"Candidate")identified by the Contracting Agency who volunteer to undergo these evaluations of each one's ability to meet the appropriate standards regarding Firefighter, Peace Officer, Emergency Telecommunications,or Other applicable duty fitness,as well as to identify areas of the Candidate's medical status that may indicate the possibility of future health issues and/or impact that Candidate's ability to carry out the essentialjob tasks or duties associated with his or her position. "Candidate Psychological Evaluation"shall mean and refer to the analysis of baseline information for the purpose of making a determination of psychological certification of Candidate Firefighter personnel, Candidate Fire Academy personnel, Candidate Sworn Peace Officer personnel,Candidate Peace Officer Academy personnel, Candidate Emergency frontlinemobilehealth.com 3 Telecommunications personnel or Candidate Other Personnel(the"Candidate")identified by the Contracting Agency who volunteer to undergo these evaluations of each one's ability to meet the appropriate standards regarding Firefighter, Peace Officer, Emergency Telecommunications,or Other applicable duty fitness,as well as to identify areas of the Candidate's psychological status that may indicate the possibility of poor suitability and/or impact that Candidate's ability to carry out the essential job tasks or duties associated with his or her position. "Confidential Information"shall mean and refer to all information or material that has or could have commercial value or other utility in a disclosing party's business,and that is disclosed by one Party to this Agreement to the other in connection with or incidental to a Party's performance under this Agreement.Confidential Information shall include,without limitation, trade secrets, proprietary know-how,technical and non-technical data,formulas, programs,devices,methods, techniques, processes,financial data, pricing,client lists,and any other information that derives economic value,actual or potential,from not being generally known to or readily ascertainable by persons who can obtain economic value from its disclosure or use. "Essential Job Task"shall mean and refer to a task or assigned duty that is critical to successful performance of the job (as that term is defined in NFPA 1580 Section 3.3.29)and described in Exhibit L"Requirements for Firefighters". "Final BillingAmount"shall mean and refer to the total amount the Contracting Agency will be invoiced for, based on the final roster of Participants provided to the Service Provider,which is required no later than thirty(30)days before the Introductory E-Mail is sent to the Participants,and any Participants added to the roster by the Contracting Agency in coordination with Service Provider,and the amounts specified for services performed in Exhibit B through Exhibit H (Section 1.2 through Section 1.8)of this Agreement. If additional Participants are added by Contracting Agency after submission of the final roster to Service Provider,the Final Billing Amount will be greater than the Minimum Billing Amount (please see Definition of"Minimum Billing Amount"). "Fitness for Duty"shall mean and refer to an assessment of the correlation between a Participant's capabilities and their assigned duties,and the ability of a Participant to perform their assigned duties completely and effectively. "Fixed Facility Third Parry Services"shall mean any screening, laboratory, imaging, or other medical service included within the scope of this Agreement that is performed by a third-party provider at a fixed-site medical facility rather than at a mobile or on-site event conducted by Service Provider. Fixed-Facility Third-Party Services may include,without limitation, full-body magnetic resonance imaging(MRI),laboratory specimen collection performed at a patient service center,follow- up or make-up phlebotomy,or any other service delivered at a third-party facility due to participant unavailability, departmental election,clinical indication,or operational necessity. "Human Performance Assessment"shall mean and referto a series of self-reported standardized behavioral health assessments that measure the Participant's condition regarding behavioral health attributes that Service Provider has determined impact the Participant's personal and work performance. "Incumbent Firefighter,Incumbent Sworn Peace Officer,Incumbent Emergency Telecommunications,or Incumbent Other personnel"shall mean and refer to a Participantwho has been hired and is no Longer Candidate Firefighter, Candidate Fire Academy personnel, Candidate Sworn Peace Officer,Candidate Peace Officer Academy personnel, Candidate Emergency Telecommunications,or Candidate Other personnel. "Make-Up Medical Evaluation"shall mean and refer to an Annual Medical Evaluation conducted outside the scheduled timeframe of the Contracting Agency's medical evaluation event for a Participant who was unable to attend during the scheduled event due to a known absence communicated in advance or an unexpected absence occurring during the scheduled event. "Medical Recommendation Form"shall mean and refer to Exhibit J,"Medical Recommendation Form"which refers to the ability of Contracting Agency Incumbent Firefighter,Candidate Firefighter, or Candidate Fire Academy personnel to perform any and/or all of the 15 Essential Job Tasks from the National Fire Protection Association (NFPA)standard,titled"2025 frontlinemobilehealth.com 4 NFPA 1580 Standard for Emergency Responder Occupational Health and Wellness", Chapter 10 Occupational Medical: Essential Job Tasks(NFPA 1582),found in Exhibit L,"Requirements for Firefighters". "Minimum Billing Amount"shall mean and refer to the minimum amount the Contracting Agencywill be invoiced for, based on the final roster of Participants provided to the Service Provider,which is required no later than thirty(30)days before the Introductory E-Mail is sent to the Participants,and the amounts specified for services performed in Exhibit B through Exhibit H (Section 1.2 through Section 1.8)of this Agreement. Any additional Participants added to the roster by the Contracting Agency in coordination with Service Provider will be added to the Final Billing Amount(please see Definition of"Final Billing Amount"). "NFPA 1580"shall mean and refer to the National Fire Protection Association standard titled"2025 NFPA 1580 Standard for Emergency Responder Occupational Health and Wellness",as effective as of the Effective Date of this Agreement. "NFPA 1582"shall mean and refer to the National Fire Protection Association standard titled"2022 NFPA 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments",as effective as of the Effective Date of this Agreement. "NFPA 1583"shall mean and refer to the National Fire Protection Association standard titled"2022 NFPA 1583 Standard on Health-Related Fitness Programs for Fire Department Members",as effective as of the Effective Date of this Agreement. "Participant"shall mean and refer to candidate or incumbent personnel, identified by the Contracting Agency,who will or have undergo/undergone an evaluation performed by Service Provider. "Protected Health Information"or"PHI"shall have the meaning set forth in the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations,as amended from time to time("HIPAX),including all information that identifies an individual and relates to: 1 The individual's past, present, or future physical or mental health or condition; 2 The provision of health care to the individual;or 3 The past, present,or future payment for the provision of health care to the individual. 4. COMPENSATION 4.1 During the Initial Term of this Agreement,Contracting Agency will compensate Service Provider for services performed in the amount specified in Exhibit B through Exhibit H (Section 1.2 through Section 1.8)of this Agreement. Subsequent Renewal Terms will be subject to the price escalation described in Section 2.2 of this Agreement. 4.2 Contracting Agency will compensate Service Provider based on the information contained in Exhibit A,"Minimum Billing Amount". To determine final resource and staffing levels for the physicals,Service Provider requires Contracting Agency to submit a final roster of Annual Medical Evaluation Participants no later than thirty(30)days before the Introductory E-Mail is sent to the Participants.The number of Participants listed on the roster will be the minimum number of physicals billed.Contracting Agency may continue to add Participants in coordination with Service Provider.The charges for these additional Participants will be added to the Final Billing Amount. 5. PAYMENT 5.1 Service Provider will invoice Contracting Agency for services completed in accordance with Exhibit B,"Scope of Services and Fee Schedule for Annual Medical Evaluations"of this Agreement. 5.1.1 Service Provider will invoice Contracting Agency for fifty percent(50%)of the Minimum Billing Amount or fifty percent(50%)of the Final Billing Amount,whichever is greater,following the completion of Step 2 of Annual Medical frontlinemobilehealth.com 5 Evaluations. The Service Provider will invoice the Contracting Agency for the remaining balance of the Minimum Billing Amount or Final Billing Amount,whichever is greater,following the completion of Step 4 of Annual Medical Evaluations,to include any Participants re-scheduled as make-up evaluations. The Annual Medical Evaluation operational steps are as follows: (a) Step 1: Introductory E-Mails sent to Participants. (b) Step 2: Laboratory specimen collection, processing,and completion. (c) Step 3: Screening tests are completed. (d) Step 4: Physical Examination and Provider Consultation is completed. 5.1.2 If a Participant's Annual Medical Evaluation is re-scheduled as a make-up through a request initiated by Contracting Agency,invoicing will still take place for services rendered in accordance with Exhibit B,"Scope of Services and Fee Schedule for Annual Medical Evaluations",of this Agreement. 5.1.3 If Service Provider initiates the re-scheduling of a Participant's Annual Medical Evaluation as a make-up,then Service Provider shall delay issuing an invoice for the re-scheduled evaluation until the evaluation is complete. 5.2 Service Provider will invoice Contracting Agency for services completed in accordance with Exhibit C,"Scope of Services and Fee Schedule for Candidate Medical Evaluations",of this Agreement. 5.2.1 Service Provider will invoice Contracting Agency for one hundred percent(100%)of the Final Billing Amount,following completion of Step 4 of an individual Participant's Candidate Medical Evaluation. 5.2.2 Service Provider will invoice Contracting Agency for one hundred percent(100%) of the Minimum Billing Amount or one hundred percent(100%)of the Final Billing Amount,whichever is greater,following completion of Step 4 of a group of Participants'Candidate Medical Evaluations where completion of all Steps occurs within a period of fewer than thirty(30) days. 5.2.3 Service Providerwill invoice Contracting Agency for fifty percent(50%)of the Minimum BillingAmount orfifty percent (50%) of the Final Billing Amount, whichever is greater, following the completion of Step 2 of a group of Participants' Candidate Medical Evaluations where completion of all Steps occurs in a period of thirty(30) days or greater. The Service Provider will invoice the Contracting Agency for the remaining balance of the Minimum Billing Amount or Final Billing Amount,whichever is greater,following the completion of Step 4 of a group of Participants'Candidate Medical Evaluations, to include any Participants re-scheduled as make-up evaluations. The Candidate Medical Evaluation Steps are the same as the Annual Medical Evaluation Steps. 5.2.4 Service Provider will invoice Contracting Agency for partial services completed by a Participant whose Candidate Medical Evaluation was discontinued prior to the completion of Step 4, either by the Participant's withdrawal from the hiring process,or due to a withdrawal of a conditional offer of employment by the Contracting Agency. (a) If up to and including Step 1 Services are completed,Service Provider will invoice Contracting Agency for twenty five percent(25%)of the total cost of the service tier selected for the Candidate Medical Evaluation. (b) If up to and including Step 2 Services are completed,Service Provider will invoice Contracting Agency for fifty percent(50%)of the total cost of the service tier selected for the Candidate Medical Evaluation. frontlinemobilehealth.com 6 (c) If up to and including Step 3 Services are completed,Service Provider will invoice Contracting Agency for seventy five percent(75%)of the total cost of the service tier selected for the Candidate Medical Evaluation. 5.2.5 If a scheduled Participant fails to attend a confirmed screening and/or physical evaluation without providing at least twenty-four(24)hours'prior notice of cancellation to Service Provider,Service Provider may invoice the Contracting Agency a missed appointment fee of one hundred dollars ($100.00) per incident. The parties acknowledge that this amount represents a reasonable estimate of costs incurred due to the reservation of clinical time, personnel scheduling, and logistical resources that cannot reasonably be reassigned within that timeframe. 5.3 Service Provider will invoice Contracting Agency for services completed in accordance with Exhibit D,"Scope of Services and Fee Schedule for Fitness-for-Duty Medical Evaluations",Exhibit F,and"Scope of Services and Fee Schedule for Fitness- for-Duty Psychological Evaluations",of this Agreement. 5.3.1 Service Provider will invoice Contracting Agency for one hundred percent(100%)of the Final Billing Amount,following completion of an individual Participant's Fitness-for-Duty Medical Evaluation or an individual Participant's Fitness-for-Duty Psychological Evaluation. 5.4 Service Provider will invoice Contracting Agency for services completed in accordance with Exhibit E,"Scope of Services and Fee Schedule for Candidate Psychological Evaluations',of this Agreement. 5.4.1 Service Provider will invoice Contracting Agency for one hundred percent(100%)of the Final Billing Amount,following completion of an individual Participant's Candidate Psychological Evaluation, an individual Participant's Promotional Psychological Evaluation,or an individual Participant's Special Tactics Team Selection Psychological Evaluations. 5.4.2 Service Provider will invoice Contracting Agency for one hundred percent(100%) of the Minimum Billing Amount or one hundred percent (100%) of the Final Billing Amount, whichever is greater, following completion of a group of Participants' Candidate Psychological Evaluations, a group of Participants' Promotional Psychological Evaluations, or a group of Participants' Special Tactics Team Selection Psychological Evaluations, where completion of all Steps occurs within a period of fewer than thirty(30)days. 5.4.3 Service Provider will invoice Contracting Agency for fifty percent(50%)of the Minimum Billing Amount orfifty percent (50%) of the Final Billing Amount, whichever is greater, following the completion of Step 2 of a group of Participants' Candidate Psychological Evaluations, a group of Participants' Promotional Psychological Evaluations, or a group of Participants'Special Tactics Team Selection Psychological Evaluations where completion of all Steps occurs in a period of thirty (30) days or greater. The Service Provider will invoice the Contracting Agency for the remaining balance of the Minimum Billing Amount or Final Billing Amount, whichever is greater, following the completion of Step 3 of a group of Participants' Candidate Psychological Evaluations, a group of Participants' Promotional Psychological Evaluations, or a group of Participants'Special Tactics Team Selection Psychological Evaluations,to include any Participants re-scheduled as make-up evaluations. The operational steps for Candidate Psychological Evaluations, Fitness-for-Duty Psychological Evaluations, Promotional Psychological Evaluations,and Special Tactics Team Selection Psychological Evaluations are as follows: (a) Step 1: Demographic information for Participants and supplementary information, as applicable (Personal History Statements, background investigation reports, polygraph reports, etc.), is provided to Service Provider by Contracting Agency. Introductory E-Mails sent to Participants with information and instructions concerning Step 2 and Step 3. frontlinemobilehealth.com 7 (b) Step 2: Psychological test battery is completed in accordance with Exhibit E,"Scope of Services and Fee Schedule for Candidate Psychological Evaluations'; Exhibit F,"Scope of Services and Fee Schedule for Fitness-for-Duty Psychological Evaluations'; Exhibit G, "Scope of Services and Fee Schedule for Promotional Psychological Evaluations", and Exhibit H, "Scope of Services and Fee Schedule for Special Tactics Team Selection Psychological Evaluations';of this Agreement. (c) Step 3: Psychological interview is conducted, and narrative report is completed with recommendation for suitability. 5.4.4 Service Provider will invoice Contracting Agency for partial services completed by a Participant whose Candidate Psychological Evaluation, Promotional Psychological Evaluation, or Special Tactics Team Selection Psychological Evaluation was discontinued prior to the completion of Step 3, either by the Participant's withdrawal from the hiring, promotion,or selection process,or due to a withdrawal of a conditional offer of employment,promotional eligibility,or special tactics team eligibility by the Contracting Agency. (a) If up to and including Step 1 Services are completed,Service Provider will invoice Contracting Agency for twenty five percent(25%)of the total cost of the service tier selected for the Candidate Medical Evaluation. (b) If up to and including Step 2 Services are completed,Service Provider will invoice Contracting Agency for fifty percent(50%)of the total cost of the service tier selected for the Candidate Medical Evaluation. 5.4.5 If a scheduled Participant fails to attend a confirmed test proctoring and/or psychological interview without providing at least three(3)business days prior notice of cancellation to Service Provider,Service Provider may invoice the Contracting Agency a missed appointment fee of one hundred dollars ($100.00) per incident. The parties acknowledge that this amount represents a reasonable estimate of costs incurred due to the reservation of clinical time, personnel scheduling, and logistical resources that cannot reasonably be reassigned within that timeframe. 5.5 Where Contracting Agency has requested more than one service to occur concurrently, Service Provider will invoice Contracting Agency for services completed in accordance with Exhibit Bthrough Exhibit H(Section 1.2through Section 1.8) of this Agreement, whichever are applicable. An example of a concurrent service request is performance of both a Candidate Medical Evaluation and a Candidate Psychological Evaluation, or performance of both a Fitness-for-Duty Medical Evaluation and a Fitness-for-Duty Psychological Evaluation. 5.5.1 Service Provider will invoice Contracting Agency for one hundred percent(100%)of the Final BillingAmount,following completion of concurrent services for an individual. 5.5.2 Service Provider will invoice Contracting Agency for one hundred percent(100%) of the Minimum Billing Amount or one hundred percent(100%)of the Final Billing Amount,whichever is greater,following completion of concurrent services for a group of Participants where completion occurs within a period of fewer than thirty(30)days. 5.5.3 Service Provider will invoice Contracting Agency for fifty percent(50%)of the Minimum BillingAmount or fifty percent (50%)of the Final BillingAmount,whichever is greater,following the completion of Step 2 of concurrent services for a group of Participants where completion of all Steps occurs in a period of thirty (30) days or greater. The Service Provider will invoice the Contracting Agency for the remaining balance of the Minimum Billing Amount or Final Billing Amount,whichever is greater,following the completion of Step 3(in the case of psychological evaluation)and/or Step 4(in the case of medical evaluation)of a group of Participants,to include any Participants re-scheduled as make-up evaluations. 6. NON-APPROPRIATION frontlinemobilehealth.com 8 6.1 The Parties acknowledge and agree that Exhibit B through Exhibit H (Section 1.2 through Section 1.8) set forth in this Agreement is based upon Contracting Agency's current appropriated revenues. 6.2 It is understood and agreed that Contracting Agency shall have the right to request amendment of this Agreement at the end of any Contracting Agency fiscal year if the governing body of the Contracting Agency does not appropriate funds sufficient to compensate for the services, by providing prompt written notice to Service Provider of the non-appropriation. Amendments may include modification of Exhibit B through Exhibit H (Section 1.2 through Section 1.8) set forth in this Agreement to allow for continued performance of the Professional Services by Service Provider within the margins of the funds appropriated by the governing body of the Contracting Agency. 6.3 It is understood and agreed that Contracting Agency shall have the right to terminate this Agreement at the end of any Contracting Agency fiscal year if the governing body of the Contracting Agency does not appropriate funds sufficient to compensate for the services. When terminating this Agreement for non-appropriation of funds or non-appropriation of sufficient funds,the Contracting Agency should endeavor to provide notification of intent to terminate at least one hundred twenty(120)days prior to the initiation of Step 1 of their scheduled event. When notification of intent to terminate at Least one hundred twenty(120)days prior to the initiation of Step 1 of their scheduled event is not possible,Contracting Agency shall provide prompt notification at the earliest date the Contracting Agency becomes aware of the non-appropriation of funds or non-appropriation of sufficient funds. 7. PROFESSIONAL SERVICES TO BE PROVIDED 7.1 Service Provider shall apply and use the standards found in the latest version of NFPA 1580 and any State statutes which regulate the standards for Firefighter personnel evaluations,medical and/or psychological. Service Provider shall apply and use the latest version of the standards dictated by the State Law Enforcement commission,applicable Technical Bulletins, and any State statutes which regulate the standards for Sworn Peace Officer personnel or Emergency Communications personnel evaluations, medical and/or psychological. Service Provider shall use the applicable standards of duty fitness, Contracting Agency duty description, or Contracting Agency required abilities for Other personnel evaluations, medical and/or psychological. 7.2 Contracting Agency acknowledges and agrees that Service Provider does not and shall not provide advice or recommendations regarding, or make, direct, encourage, or otherwise take responsibility for employment decisions, including but not limited to Contracting Agency's employment-related decisions regarding whether Contracting Agency hires,terminates,promotes,demotes,increases or decreases pay,adjusts or restricts personnel assignments orjob duties, ortakes any other potentially adverse employment action against Contracting Agency's personnel and employees. For the avoidance of doubt, Contracting Agency shall be solely Liable for all employment decisions made in connection with any Participant. 8. LIMITED SCOPE OF EVALUATIONS 8.1 Medical evaluations conducted by Service Provider as part of a benefit program,whether participation is voluntary or mandatory by the Contracting Agency, are intended solely to provide Participants with information and education regarding their current health status. Such evaluations are not occupational medical fitness-for-duty evaluations and are not conducted for the purpose of determining the Participant's ability to perform essential job functions. Accordingly, the occupational medical standards referenced in this Agreement, including but not limited to NFPA 1580, State Law Enforcement Commission standards,or other duty-related standards,shall not be applied to benefit medical evaluations. 8.1.1 The Contracting Agency shall provide Service Provider,in advance of the evaluations,withal[information reasonably necessaryfor Service Provider to understand the scope,purpose,and structure of the applicable benefit program,including but not limited to program objectives, eligibility criteria, participation requirements,applicable policies,and any limitations frontlinemobilehealth.com 9 on the use or disclosure of evaluation results. Service Provider shall be entitled to rely on the information provided by the Contracting Agency in structuring and conducting the benefit medical evaluations, and Service Provider shall not be responsible for any misunderstanding of program scope or requirements resulting from incomplete or inaccurate information supplied by the Contracting Agency. 8.2 Service Provider standards for a mandatory requirement Medical Evaluation of Incumbent Firefighter personnel, Candidate Firefighter personnel, Candidate Fire Academy personnel, Incumbent Sworn Peace Officer personnel, Candidate Sworn Peace Officer personnel, Candidate Peace Officer Academy personnel, Incumbent Emergency Communications personnel,Candidate Emergency Communications personnel,Incumbent Other personnel,or Candidate Other Personnel are found in Sections 8.2.1 through 8.2.6. 8.2.1 Service Provider's Medical Evaluation of Incumbent Firefighter personnel, Candidate Firefighter personnel, or Candidate Fire Academy personnel is limited to only those services specified in Exhibit B, "Scope of Services and Fee Schedule for Annual Medical Evaluations", and Exhibit C, "Scope of Services and Fee Schedule for Candidate Medical Evaluations", of this Agreement, in consultation with Exhibit O, "Requirements for Firefighters", and in compliance with Contracting Agency medical and/or fitness policies, a Memorandum of Understanding executed between the Parties,the standards found in the latest version of NFPA 1580, and/or any State statutes, and Service Provider shall perform all evaluations in accordance with applicable updated,adopted,and accepted medical industry standards. 8.2.2 Service Provider shall apply and use Exhibit P,"Medical Recommendation Form",to declare any applicable medical clearance or limitations for the Incumbent Firefighter personnel, Candidate Firefighter personnel, or Candidate Fire Academy personnel,when appropriate. 8.2.3 Service Provider's Medical Evaluation of Incumbent Sworn Peace Officer personnel,Candidate Sworn Peace Officer personnel,Candidate Peace Officer Academy personnel,Incumbent Emergency Communications personnel,or Candidate Emergency Communications personnel is limited to only those services specified in Exhibit B,"Scope of Services and Fee Schedule for Annual Medical Evaluations", and Exhibit C, "Scope of Services and Fee Schedule for Candidate Medical Evaluations', of this Agreement, and in compliance with Contracting Agency medical and/or fitness policies, a Memorandum of Understanding executed between the Parties,the latestversion of the standards dictated bythe State Law Enforcement Commission, applicable Technical Bulletins, and/or any State statutes which regulate the standards for medical evaluations of Incumbent Sworn Peace Officer personnel, Candidate Sworn Peace Officer Personnel, Candidate Peace Officer Academy personnel, Incumbent Emergency Telecommunications personnel, or Candidate Emergency Telecommunications personnel. 8.2.4 Service Provider shall apply and use required documentation for licensee medical declaration in accordance with the State Law Enforcement Commission standards, applicable Technical Bulletins, and any State statutes which regulate the standards for medical evaluations for Incumbent Sworn Peace Officer personnel, Candidate Sworn Peace Officer Personnel, Candidate Peace Officer Academy personnel, Incumbent Emergency Telecommunications personnel, or Candidate Emergency Telecommunications personnel. 8.2.5 Service Provider's Medical Evaluation of Incumbent Other personnel or Candidate Other personnel is limited to only those services specified in Exhibit B,"Scope of Services and Fee Schedule for Annual Medical Evaluations",and Exhibit C, "Scope of Services and Fee Schedule for Candidate Medical Evaluations", of this Agreement, and in compliance with the applicable standards of duty fitness, Contracting Agency duty description, or Contracting Agency required abilities for medical evaluations of Incumbent Other personnel or Candidate Other personnel. 8.2.6 Service Provider shall apply and use a Memorandum of Record for medical declaration documentation of Incumbent Other personnel or Candidate Other personnel. frontlinemobilehealth.com 10 8.3 Service Provider standards for Fitness-for-Duty Medical Evaluations of Incumbent Firefighter personnel, Incumbent Sworn Peace Officer personnel, Incumbent Emergency Communications personnel, or Incumbent Other personnel are found in Sections 8.3.1 through 8.3.6. 8.3.1 Service Provider's Fitness-for-Duty Medical Evaluation of Incumbent Firefighter personnel is limited to only those services specified in Exhibit D, "Scope of Services and Fee Schedule for Fitness-for-Duty Medical Evaluations", of this Agreement, in consultation with Exhibit O, "Requirements for Firefighters", and in compliance with Contracting Agency medical and/or fitness policies,the Contracting Agency's duty description and physical requirements,the standards found in the latest version of NFPA 1580, and/or any State statutes which regulate the standards for fitness-for-duty medical evaluations for Incumbent Firefighter personnel, and Service Provider shall perform all evaluations in accordance with applicable updated,adopted,and accepted medical industry standards. 8.3.2 Service Provider shall apply and use Exhibit P,"Medical Recommendation Form",to declare any applicable medical clearance or limitations forthe Incumbent Firefighter personnel,when appropriate. When necessary,Service Provider shall apply and use a Memorandum of Record for fitness-for-duty medical declaration documentation of Incumbent Firefighter personnel. Additionally, Service Provider shall apply, and use required documentation for medical fitness-for-duty declaration in accordance with applicable Technical Bulletins, and any State statutes which regulate the standards for fitness-for-duty medical evaluations for Incumbent Firefighter personnel. 8.3.3 Service Provider's Fitness-for-Duty Medical Evaluation of Incumbent Sworn Peace Officer personnel or Incumbent Emergency Communications personnel is limited to only those services specified in Exhibit D,"Scope of Services and Fee Schedule for Fitness-for-Duty Medical Evaluations",of this Agreement,and in compliance with Contracting Agency medical and/or fitness policies,the Contracting Agency's duty description and physical requirements,the State Law Enforcement Commission standards,applicable Technical Bulletins,and any State statutes which regulate the standards forfitness-for- duty medical evaluations for Incumbent Sworn Peace Officer personnel or Incumbent Emergency Communications personnel, and Service Provider shall perform all evaluations in accordance with applicable updated, adopted, and accepted medical industry standards. 8.3.4 Service Provider shall apply, and use required documentation for licensee medical fitness-for-duty declaration in accordance with the State Law Enforcement Commission standards,applicable Technical Bulletins,and any State statutes which regulate the standards for fitness-for-duty medical evaluations for Incumbent Sworn Peace Officer personnel or Incumbent Emergency Communications personnel. When necessary,Service Provider shall apply and use a Memorandum of Record for fitness-for-duty medical declaration documentation of Incumbent Sworn Peace Officer personnel or Incumbent Emergency Communications personnel. 8.3.5 Service Provider's Fitness-for-Duty Medical Evaluation of Incumbent Other personnel is limited to onlythose services specified in Exhibit D,"Scope of Services and Fee Schedule for Fitness-for-Duty Medical Evaluations'; of this Agreement, and in compliance with Contracting Agency medical and/or fitness policies,the Contracting Agency's duty description and physical requirements, and/ or other duty-related standards required for medical evaluations of Incumbent Other personnel. 8.3.6 Service Provider shall apply and use a Memorandum of Record for fitness-for-duty medical declaration documentation of Incumbent Other personnel. 8.4 Service Provider standards for Candidate Psychological Evaluations of Candidate Firefighter personnel,Candidate Fire Academy personnel, Candidate Sworn Peace Officer personnel, Candidate Peace Officer Academy personnel, Candidate Emergency Communications personnel, or Candidate Other personnel, are found in Sections 8.4.1 through 8.4.6 and Service Provider shall perform all evaluations in accordance with applicable updated,adopted,and accepted psychological industry standards. frontlinemobilehealth.com i 8.4.1 Service Provider's Candidate Psychological Evaluation of Candidate Firefighter personnel and Candidate Fire Academy personnel is limited to only those services specified in Exhibit E, "Scope of Services and Fee Schedule for Candidate Psychological Evaluations", of this Agreement, in consultation with Exhibit O, "Requirements for Firefighters", and in compliance with Contracting Agency medical and/or fitness policies, a Memorandum of Understanding executed between the Parties,the standards found in the latest version of NFPA 1580,the Contracting Agency's duty description and psychological requirements, and/or any State statutes which regulate the standards for psychological evaluations of Candidate Firefighter personnel and Candidate Fire Academy personnel. 8.4.2 Service Provider shall provide Contracting Agency with a psychological narrative report that summarizes the key interview findings and pertinent background history, test results, and a clear hiring recommendation and/or suitability for the position sought. Candidate will be rated on a level of risk (i.e., low, medium, high) based upon the best professional judgment of the psychologist,job profile analysis,testing battery results,and clinical interview. 8.4.3 Service Provider's Candidate Psychological Evaluation of Candidate Sworn Peace Officer personnel, Candidate Peace Officer Academy personnel, Candidate Emergency Communications personnel, is limited to only those services specified in Exhibit E,"Scope of Services and Fee Schedule for Candidate Psychological Evaluations", of this Agreement, and in compliance with Contracting Agency medical and/or fitness policies, a Memorandum of Understanding executed between the Parties, the Contracting Agency's duty description and psychological requirements, the State Law Enforcement Commission standards, applicable Technical Bulletins, and any State statutes which regulate the standards for psychological evaluations of Candidate Sworn Peace Officer personnel,Candidate Peace Officer Academy personnel, Candidate Emergency Communications personnel. 8.4.4 Service Provider shall provide Contracting Agency with a psychological narrative report that summarizes the key interview findings and pertinent background history, test results, and a clear hiring recommendation and/or suitability for the position sought. Candidate will be rated on a level of risk(i.e., low, medium, high) based upon the best professional judgment of the psychologist, job profile analysis, testing battery results, and clinical interview. Additionally, Service Provider shall apply, and use required documentation for licensee mental and emotional health declaration in accordance with the State Law Enforcement Commission standards, applicable Technical Bulletins, and any State statutes which regulate the standards for psychological evaluations for Candidate Sworn Peace Officer personnel, Candidate Peace Officer Academy personnel, Candidate Emergency Communications personnel. 8.4.5 Service Provider's Candidate Psychological Evaluation of Candidate Other personnel,is limited to only those services specified in Exhibit E,"Scope of Services and Fee Schedule for Candidate Psychological Evaluations", of this Agreement, and in compliance with Contracting Agency medical and/or fitness policies, a Memorandum of Understanding executed between the Parties, the applicable duty-related standards of psychological fitness, the Contracting Agency's duty description and psychological requirements, and/or any State statutes which regulate the standards for psychological evaluations of Candidate Other personnel. 8.4.6 Service Provider shall provide Contracting Agency with a psychological narrative report that summarizes the key interview findings and pertinent background history, test results, and a clear hiring recommendation and/or suitability for the position sought. Candidate will be rated on a level of risk(i.e., low, medium, high) based upon the best professional judgment of the psychologist,job profile analysis,testing battery results,and clinical interview. 8.5 Service Provider standards for Fitness-for-Duty Psychological Evaluations of Incumbent Firefighter personnel, Incumbent Sworn Peace Officer personnel, Incumbent Emergency Communications personnel, or Incumbent Other personnel, are found in Sections 8.5.1 through 8.5.6 and Service Provider shall perform all evaluations in accordance with applicable updated,adopted,and accepted psychological industry standards. 8.5.1 Service Provider's Fitness-for-Duty Psychological Evaluation of Incumbent Firefighter personnel is limited to only frontlinemobilehealth.com 12 those services specified in Exhibit F,"Scope of Services and Fee Schedule for Fitness-for-Duty Psychological Evaluations", of this Agreement, in consultation with Exhibit O, "Requirements for Firefighters", and in compliance with Contracting Agency medical and/or fitness policies, a Memorandum of Understanding executed between the Parties, the standards found in the latestversion of NFPA 1580,the Contracting Agency's duty description and psychological requirements,and/or any State statutes which regulate the standards for psychological fitness-for-duty evaluations of Incumbent Firefighter personnel. 8.5.2 Service Provider shall provide Contracting Agency with a psychological narrative report that summarizes the key interview findings and pertinent background history, test results, and a clear fitness-for-duty recommendation and/or psychological suitability for their position. Incumbent Firefighter personnel will be rated on a level of risk(i.e.,low,medium, high)based upon the best professional judgment of the psychologist,job profile analysis,testing battery results,and clinical interview. 8.5.3 Service Provider's Fitness-for-Duty Psychological Evaluation of Incumbent Sworn Peace Officer personnel and Incumbent Emergency Communications personnel is limited to only those services specified in Exhibit F, "Scope of Services and Fee Schedule for Fitness-for-Duty Psychological Evaluations", of this Agreement, and in compliance with Contracting Agency medical and/or fitness policies, a Memorandum of Understanding executed between the Parties,the Contracting Agency's duty description and psychological requirements, the State Law Enforcement Commission standards, applicable Technical Bulletins, and any State statutes which regulate the standards for psychological fitness- for-duty evaluations of Incumbent Sworn Peace Officer personnel and Incumbent Emergency Communications personnel. 8.5.4 Service Provider shall provide Contracting Agency with a psychological narrative report that summarizes the key interview findings and pertinent background history, test results, and a clear fitness-for-duty recommendation and/or psychological suitability for their position. Incumbent Sworn Peace Officer personnel and Incumbent Emergency Communications personnel will be rated on a level of risk (i.e., low, medium, high) based upon the best professional judgment of the psychologist, job profile analysis, testing battery results, and clinical interview. Additionally, Service Provider shall apply, and use required documentation for licensee mental and emotional health declaration in accordance with the State Law Enforcement Commission standards, applicable Technical Bulletins, and any State statutes which regulate the standards for psychological fitness-for-duty evaluations for Incumbent Sworn Peace Officer personnel and Incumbent Emergency Communications personnel. 8.5.5 Service Provider's Fitness-for-Duty Psychological Evaluation of Incumbent Other personnel is limited to only those services specified in Exhibit F,"Scope of Services and Fee Schedule for Fitness-for-Duty Psychological Evaluations';of this Agreement,and in compliance with Contracting Agency medical and/or fitness policies, a Memorandum of Understanding executed between the Parties, the applicable duty-related standards of psychological fitness, the Contracting Agency's duty description and psychological requirements,and/or any State statutes which regulate the standards for psychological evaluations of for psychological fitness-for-duty evaluations of Incumbent Other personnel. 8.5.6 Service Provider shall provide Contracting Agency with a psychological narrative report that summarizes the key interview findings and pertinent background history, test results, and a clear fitness-for-duty recommendation and/or psychological suitability for their position. Incumbent Other personnel will berated on a level of risk(i.e.,low,medium,high) based upon the best professional judgment of the psychologist, job profile analysis, testing battery results, and clinical interview. 8.6 Service Provider standards for Promotional Psychological Evaluations of Incumbent Firefighter personnel, Incumbent Sworn Peace Officer personnel, Incumbent Emergency Communications personnel, or Incumbent Other personnel are found in Sections 8.6.1 through 8.6.2 and Service Provider shall perform all evaluations in accordance with applicable updated,adopted,and accepted psychological industry standards. frontlinemobilehealth.com 13 8.6.1 Service Provider's Promotional Psychological Evaluation of Incumbent Firefighter personnel,Incumbent Sworn Peace Officer personnel, Incumbent Emergency Communications personnel, or Incumbent Other personnel are Limited to only those services specified in Exhibit G,"Scope of Services and Fee Schedule for Promotional Psychological Evaluations", of this Agreement. 8.6.2 Service Provider shall provide Contracting Agency with a psychological narrative report that summarizes the key interview findings and pertinent background history, test results, and a clear recommendation and/or psychological suitability for promotion to a position of higher responsibility. Incumbent Firefighter personnel, Incumbent Sworn Peace Officer personnel, Incumbent Emergency Communications personnel, or Incumbent Other personnel will be rated on a Level of overall risk to the organization based upon the best prof essionaljudgment of the psychologist,job profile analysis, testing battery results,and clinical interview. 8.7 Service Provider standards for Special Tactics Team Selection Psychological Evaluations of Incumbent Firefighter personnel, Incumbent Sworn Peace Officer personnel, Incumbent Emergency Communications personnel, or Incumbent Other personnel are found in Sections 8.7.1 through 8.7.2,and Service Provider shall perform aLL evaluations in accordance with applicable updated,adopted,and accepted psychological industry standards. 8.7.1 Service Provider's Special Tactics Team Selection Psychological Evaluation of Incumbent Firefighter personnel, Incumbent Sworn Peace Officer personnel, Incumbent Emergency Communications personnel, or Incumbent Other personnel are limited to only those services specified in Exhibit H,"Scope of Services and Fee Schedule for Special Tactics Team Selection Psychological Evaluations",of this Agreement. 8.7.2 Service Provider shall provide Contracting Agency with a psychological narrative report that summarizes the key interview findings and pertinent background history, test results, and a clear recommendation and/or psychological suitability for selection to a position as a member of a special tactics team. Incumbent Firefighter personnel, Incumbent Sworn Peace Officer personnel, Incumbent Emergency Communications personnel, or Incumbent Other personnel will be rated on a Level of overall riskto the organization based upon the best professional judgment of the psychologist,job profile analysis,testing battery results,and clinical interview. 9. DISPUTED RESULTS 9.1 This Agreement is between Contracting Agency and Service Provider only.SERVICE PROVIDER SHALL NOT HAVE AN AGREEMENT WITH THE PARTICIPANT(S) TESTED other than the waivers, disclosures, and consents set forth in the following Exhibits: Exhibit I, "Examinee Waiver for Medical Evaluation", Exhibit J, "Examinee Waiver for Fitness-for-Duty Medical Evaluation",Exhibit K,"Post-Offer Psychological Evaluation:Disclosure and Informed Consent",Exhibit L,"Fitness- for-Duty Psychological Evaluation: Disclosure and Informed Consent", Exhibit M,"Promotional Psychological Evaluation: Disclosure and Informed Consent", and Exhibit N, "Special Tactics Team Selection Psychological Evaluation: Disclosure and Informed Consent", further define the Limited relationship between Participant and Front Line Mobile Health in the context of the evaluations Front Line Mobile Health performs at the request of the Contracting Agency,and within the scope of the specified evaluation,defined in Section 8 of this Agreement. 9.2 In the event a Participant disputes the recommendation submitted by Service Provider to Contracting Agency during a mandatory requirement evaluation, the resolution of such dispute will be accomplished through the process established by Service Provider and Contracting Agency. 9.3 Contracting Agency shall be responsible for all expenses incurred for Service Provider's re-testing or re-evaluation of a Participant. 10. EVALUATIONS PROVIDED frontlinemobilehealth.com 14 10.1 Service Provider will provide Annual Medical Evaluations for Participants identified by Contracting Agency,asset forth in the attached Exhibit B,"Scope of Services and Fee Schedule for Annual Medical Evaluations",of this Agreement. 10.2 Service Provider will provide Candidate Medical Evaluations for Participants identified by Contracting Agency, as set forth in the attached Exhibit C,"Scope of Services and Fee Schedule for Candidate Medical Evaluations",of this Agreement. 10.3 Service Provider will provide Fitness-for-Duty Medical Evaluations for Participants identified by Contracting Agency,as set forth in the attached Exhibit D,"Scope of Services and Fee Schedule for Fitness-for-Duty Medical Evaluations", of this Agreement. 10.4 Service Provider will provide Candidate Psychological Evaluations for Participants identified by Contracting Agency,as set forth in the attached Exhibit E,"Scope of Services and Fee Schedule for Candidate Psychological Evaluations", of this Agreement. 10.5 Service Provider will provide Fitness-for-Duty Psychological Evaluations for Participants identified by Contracting Agency, as set forth in the attached Exhibit F, "Scope of Services and Fee Schedule for Fitness-for-Duty Psychological Evaluations",of this Agreement. 10.6 Service Provider will provide Promotional Psychological Evaluations for Participants identified by Contracting Agency, as set forth in the attached Exhibit G,"Scope of Services and Fee Schedule for Promotional Psychological Evaluations", of this Agreement. 10.7 Service Provider will provide Special Tactics Team Selection Psychological Evaluations for Participants identified by Contracting Agency, as set forth in the attached Exhibit H,"Scope of Services and Fee Schedule for Special Tactics Team Selection Psychological Evaluations", of this Agreement. 10. Contracting Agency may initiate a written change order to add additional lab tests and other offerings provided by Service Provider at Service Provider's then-current pricing,or as may be negotiated by the Parties. 11. LOCATION AND SCHEDULE OF SERVICES TO BE PROVIDED 11.1 Annual Medical Evaluations. Annual Medical Evaluations will be conducted by Service Provider at a location mutually agreeable to the Parties. These evaluations will be provided on a schedule that is mutually agreeable to the Parties, with the understanding that all Annual Medical Evaluations must be completed by the end of the Agreement Term. 11.2 Candidate Medical Evaluations. Candidate Medical Evaluations will be conducted by Service Provider at a location mutually agreeable to Service Provider and Participant.These evaluations will be provided on a schedule that is mutually agreeable to Service Provider and Participant, with the understanding that the evaluation must be completed by the deadline established between the Parties,and that all Candidate Medical Evaluations must be completed by the end of the Agreement Term. 11.3 Fitness-for-Duty Medical Evaluations. Fitness-for-Duty Medical Evaluations will be conducted by Service Provider at a location mutually agreeable to Service Provider and Participant.These evaluations will be provided on a schedule that is mutually agreeable to Service Provider and Participant,with the understanding that the evaluation must be completed by the deadline established between the Parties,and that all Fitness-for-Duty Medical Evaluations must be completed by the end of the Agreement Term. 11.4 Candidate Psychological Evaluations. Candidate Psychological Evaluations will be conducted by the Service Provider virtually using HIPAA-compliant platforms on a schedule that is mutually agreeable to Service Provider and frontlinemobilehealth.com 15 Participant,with the understanding that the evaluation must be completed by the deadline established between the Parties, and that all Candidate Psychological Evaluations must be completed by the end of the Agreement Term. 11.5 Fitness-for-Duty Psychological Evaluations. Fitness-for-Duty Psychological Evaluations will be conducted by the Service Provider virtually using HIPAA-compliant platforms on a schedule that is mutually agreeable to Service Provider and Participant,with the understanding that the evaluation must be completed by the deadline established between the Parties, and that all Fitness-for-Duty Psychological Evaluations must be completed by the end of the Agreement Term. 11.6 Promotional Psychological Evaluations. Promotional Psychological Evaluations will be conducted by the Service Provider virtually using HIPAA-compliant platforms on a schedule that is mutually agreeable to Service Provider and Participant,with the understanding that the evaluation must be completed by the deadline established between the Parties, and that all Promotional Psychological Evaluations must be completed by the end of the Agreement Term. 11.7 Special Tactics Team Selection Psychological Evaluations. Special Tactics Team Selection Psychological Evaluations will be conducted by the Service Provider virtually using HIPAA-compliant platforms on a schedule that is mutually agreeable to Service Provider and Participant,with the understanding that the evaluation must be completed by the deadline established between the Parties, and that all Special Tactics Team Selection Psychological Evaluations must be completed by the end of the Agreement Term. 11.8 Fixed-Facility Third-Party Services. Services performed by third-party providers at fixed medical facilities are subject exclusively to applicable state and federal laws and regulations,the scheduling capacity, operational constraints, and geographic footprint of such providers.Service Provider makes no representation or warranty regarding proximity,timing of appointment availability,or scheduling priority. Fixed-Facility Third-Party Services shall not be deemed mobile services or services under the exclusive operational control of Service Provider. Contracting Agency shall be solely responsible for managing participant scheduling,staffing adjustments,overtime,travel, mileage,or other operational impacts associated with attendance at such facilities. Under no circumstances shall Service Provider be liable for indirect costs incurred by Contracting Agency related to third-party facility scheduling or travel requirements. 11.9. Make-Up Medical Evaluations. Make-Up Medical Evaluations will be conducted by Service Provider at a Location designated by Service Provider where the equipment, personnel, and other resources necessary to perform the applicable evaluation services are available. Service Provider may make reasonable efforts to schedule the Make-Up Medical Evaluation at a date, time, and location convenient for the Participant when practicable. Service Provider will make reasonable efforts to contact the Participant and schedule the Make-Up Medical Evaluation for a period not to exceed thirty (30) days following the originally scheduled evaluation event. If the Participant does not schedule or complete the Make- Up Medical Evaluation within this thirty (30) day period despite reasonable contact attempts, including engagement of Contracting Agency leadership for assistance,Service Provider shall have no further obligation to pursue scheduling of the Make-Up Medical Evaluation. Contracting Agency shall be solely responsible for managing staffing adjustments, overtime, travel, mileage, or other operational impacts associated with attendance of a Participant or Participants at a Make-Up Medical Evaluation.Under no circumstances shall Service Provider be liable for indirect costs incurred by Contracting Agency related to Make-Up Medical Evaluation scheduling or travel requirements. 11.10 Make-Up Medical Evaluation Events. Service Provider shall not be obligated to return to the Contracting Agency's Location or conduct a separate on-site event for the purpose of completing Make-Up Medical Evaluations unless mutually agreed to in writing by the parties.Any such mutually agreed upon return event may be subject to additional fees associated with reserving calendar availability, redeploying equipment and personnel,and any applicable travel or logistical costs. frontlinemobilehealth.com 16 12. RESPONSIBILITIES OF CONTRACTING AGENCY 12.1 Cooperation and Good Faith Participation. Contracting Agency shall cooperate in good faith with Service Provider and shall provide all information,access,coordination,and administrative support reasonably necessary for Service Provider to perform the services described in this Agreement in a timely and efficient manner. 12.2 Participant Roster and Demographic Information. Contracting Agency shall provide Service Provider with a complete and accurate roster of Participants in accordance with the deadlines specified in this Agreement and the applicable Exhibits.The roster shall include all demographic and identifying information reasonably necessary for Service Provider to perform the services, including,as applicable,full legal name,date of birth,job classification,and contact information. 12.2.1 Where services require scheduling coordination,follow-up communication, results notification,or coordination of Fixed-Facility Third-Party Services,Contracting Agency shall provide accurate, participant-specific direct contact information, including a personal mobile or direct telephone number for each Participant. 12.2.2 General station telephone numbers, administrative office numbers,shared departmental contact numbers, or other non-participant-specific contact information shall not be deemed sufficient where direct participant communication is reasonably necessary for performance of services under this Agreement. 12.2.3 Contracting Agency acknowledges that accurate and complete participant contact information is a material requirement for Service Provider's ability to coordinate scheduling,communicate clinical information,and complete services in a timely manner. 12.2.4 Service Provider shall not be responsible for delays in scheduling, missed appointments,inability to communicate results, incomplete service delivery,or other impacts arising from incomplete, inaccurate,outdated,or non-participant- specific contact information provided by Contracting Agency. 12.3 Participant Availability and Scheduling Cooperation. Contracting Agency shall ensure that Participants are made reasonably available for scheduled services and shall cooperate in facilitating Participant attendance at on-site events, virtual evaluations,or Fixed-Facility Third-Party Services,as applicable. 12.4 Operational Impacts of Fixed-Facility Third-Party Services. Contracting Agency acknowledges that Fixed-Facility Third-Party Services are subject to the scheduling capacity and operational constraints of third-party providers. Contracting Agency shall be solely responsible for managing internal staffing adjustments,overtime,travel time, mileage, backfill, or other operational impacts associated with Participant attendance at such facilities.Service Provider shall not be liable for any such indirect costs. 12.5 Employment Decisions. Contracting Agency acknowledges and agrees that Contracting Agency shall retain sole responsibility for all employment-related decisions made in connection with any Participant, including but not limited to hiring,promotion,demotion,reassignment,adjustment or restriction to job duties,compensation adjustments,disciplinary action, termination, or other potentially adverse employment action. Nothing in this Agreement shall be construed as delegating such authority to Service Provider. Service Provider does not and shall not provide advice or recommendations regarding, or make, direct, encourage, or otherwise take responsibility for employment decisions made by Contracting Agency. 13. ADDITIONAL SERVICES frontlinemobilehealth.com 17 13.1 To receive any additional professional services not provided for under this Agreement, Contracting Agency must separately contract with Service Provider under a written change order.No services other than those specifically identified under this Agreement will be provided without a change order. 13.2 Additional services may be requested by Contracting Agency at any time and will be consistent with the services and fees set forth in Exhibit B through Exhibit H (Section 1.2 through Section 1.8)of this Agreement. ADDITIONAL TERMS AND CONDITIONS 14. TERMINATION 14.1 Contracting Agency may terminate this Agreement for non-appropriation of funds or non-appropriation of sufficient funds as setforth in Section 6.2 and 6.3 of this Agreement. When terminatingthis Agreement for non-appropriation of funds or non-appropriation of sufficient funds, the Contracting Agency should endeavor to provide notification of intent to terminate at least one hundred twenty(120)days prior to the initiation of Step 1 of their scheduled event. When notification of intent to terminate at least one hundred twenty(120)days prior to the initiation of Step 1 of their scheduled event is not possible,Contracting Agency shall provide prompt notification at the earliest date the Contracting Agency becomes aware of the non-appropriation of funds or non-appropriation of sufficient funds. 14.2 If either Party materially breaches any covenant under this Agreement,the other Party may notify the breaching Party in writing and,if the breach is not cured within thirty(30)days,the non-breaching Party may terminate this Agreement. 14.3 Service Provider may immediately suspend services if it reasonably believes continued service would violate State or Federal law or violate applicable rules of professional conduct.Service Provider shall provide prior notice to Contracting Agency of suspension of services. 14.3.1 In the event of a suspension under Section 14.3,the Parties shall work in good faith to address the condition(s)giving rise to the suspension. Service Provider may reinitiate services once such condition(s) have been sufficiently remedied or resolved such that, in the reasonable professional judgment of the Service Provider,continuation of services would no longer result in a violation of applicable State or Federal law or applicable rules of professional conduct. Contracting Agency agrees to provide reasonable cooperation and, upon request, any documentation or information necessary for Service Provider to evaluate whether such condition(s) have been resolved. Service Provider shall not be obligated to resume services until it has reasonably determined that the risk of legal or professional non-compliance has been adequately mitigated. 14.4 Either Party may terminate this Agreement for any reason upon one hundred and twenty(120)days'written notice to the other Party. 14.5 In the event that this Agreement is terminated prior to the Expiration Date, Contracting Agency shall pay Service Provider for all services actually rendered up to the effective date of termination and Service Provider shall continue to provide Contracting Agency with services requested by ContractingAgencyand in accordance with thisAgreement up to the date of termination. Upon termination of this Agreement for any reason,Service Provider shall provide Contracting Agency with copies of all completed or partially completed documents prepared under this Agreement. In the event Service Provider has received access to Contracting Agency's information or data as a requirement to perform services hereunder, Service Provider shall return all Contracting Agency provided data to Contracting Agency in a machine-readable format or frontlinemobilehealth.com 18 other format deemed acceptable by Contracting Agency or destroy at the Contracting Agency's request some or all records, notes, notebooks, or the like, relating to Contracting Agency's operations, products, or business made or received by it during the term of this Agreement and delete all information or data from Service Provider's systems. 14.6 Written notice of termination by either the Contracting Agency or the Service Provider will be communicated in accordance with Section 2.1. Any notice or communication permitted or required by this Agreement shall be deemed effective onthethird businessdaywhen personally delivered or deposited,postage prepaid, in the first-class mail of the United States properly,or sent via electronic means, addressed to the appropriate primary and alternate contacts at the address set forth in the identification of Parties section of this Agreement. 15. INDEPENDENT CONTRACTING AGENCY 15.1 The Agreement shall not be construed as creating an employer/employee relationship,a partnership,orjoint venture. Service Provider's services shall be those of an independent contracting agency. 15.2 Service Provider agrees and understands that the Agreement does not grant any rights or privileges established for employees of Contracting Agency. 15.3 Service Provider shall not be within protection or coverage of Contracting Agency's Worker Compensation Insurance, Health Insurance, Liability Insurance, or any other insurance that Contracting Agency,from time to time, may have in force for its existing employees. 16. NON-DISCLOSURE AND CONFIDENTIALITY 16.1 Subject to the provisions of applicable laws, Contracting Agency acknowledges and agrees that, in the course of the Parties' performance under this Agreement, Contracting Agency may receive or have access to Confidential Information, proprietary information, and/or trade secrets belonging to Service Provider in the course of the Parties' respective performance under this Agreement.Contracting Agency understands that: (i)Confidential Information is commercially and competitivelyvaluable to Service Provider and that it and its protection is vitalto the success of Service Provider's business; (ii) the use or disclosure of Confidential Information by Contracting Agency, except in accordance with this Agreement, would cause irreparable harm to Service Provider;and(iii)nothing contained inthisAgreement shall prohibit Service Provider from pursuing any remedies,whether at law or in equity, available to Service Provider for a breach or threatened breach of this Agreement,including the recovery of damages from,and injunctive relief against Contracting Agency and its members, both appointed or elected. 16.2 During the term of this Agreement and following the termination thereof, Contracting Agency,to the extent permitted by law,will not use or disclose, directly or indirectly, any Confidential Information in any manner or for any purpose not in accordance with this Agreement or applicable law. Subject to the provisions of the local statutes and regulations governing the retention of records by Contracting Agency, upon termination of this Agreement,or at any time upon Service Provider's request, Contracting Agency agrees to surrender to Service Provider, or destroy at Service Provider's request, some or all records, notes, notebooks, or the like, relating to Service Provider's operations, products, or business made or received by it during the term of this Agreement.Upon termination of this Agreement,Contracting Agency will return all other Service Provider's property in its custody,and shall be bound by the non-disclosure and confidentiality clause of section 16. 16.3 Notwithstanding the foregoing, Contracting Agency may disclose Confidential Information to the extent required by Law.As required by applicable laws,Contracting Agency will notify Service Provider in the event a public information request made to Contracting Agency encompasses any information protected bythis Agreement.As authorized by applicable laws, Service Provider may submit arguments against disclosure of the requested information directlyto the Office of the Attorney General.Contracting Agency will only release the requested information if required to do so by the Office of the Attorney frontlinemobilehealth.com 19 General. 17. HIPAACOMPLIANCE 17.1 Service Provider is currently compliant and will remain compliant with all security measures required by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and the Health Information Technology for Economic and Clinical Health Act of 2009("HITECH"). 17.2 Contracting Agency acknowledges that once Service Provider has delivered a medical or psychological evaluation recommendation, as outlined in this Agreement, it is Contracting Agency's responsibility to maintain these reports and protect this information as outlined by HIPAA and HITECH. Each party shall comply with all applicable requirements of HIPAA and any state privacy laws with respect to any PHI received, created, maintained,or transmitted in connection with this Agreement. 17.3 Both Parties shall: a) Keep all PHI strictly confidential and use or disclose PHI only as necessary to carry out the purpose of this Agreement or as required by applicable law; b) Implement and maintain appropriate administrative, physical,and technical safeguards to ensure the security and confidentiality of PHI; c) Protect against reasonably anticipated threats or hazards to the security or integrity of PHI; d) Prevent unauthorized access to or use of PHI;and e) Ensure that any representatives who have access to PHI agree to the same restrictions and conditions that apply to Recipient. f) Discloser reserves the right to review Recipient's and its representatives'applicable policies and procedures used to maintain the security and confidentiality of PHI. 17.4 Breach Notification Recipient shall immediately notify Discloser in writing of: a) Any use or disclosure of PHI by Recipient or its representatives in breach of this Agreement; b) Any security incident of which Recipient becomes aware;or c) Any unauthorized access, use, or disclosure of PHI. 17.5 Precedence If HIPAA or any applicable state or federal law or regulation in effect imposes a higher standard of confidentiality or security with respect to PHI than the standard set forth in this Agreement,such higher standard shall prevail. 18. INSURANCE 18.1 Service Provider shall keep in full force and effect insurance coverage during the term of this Agreement, including without limitation statutory workers' compensation insurance; employer's liability and commercial general liability insurance;comprehensive automobile liability insurance if Service Provider has its own vehicles;and professional liability insurance. 18.2 The insurance certificate shall name Contracting Agency, its agents, officers, servants, and employees as additional insureds underthe commercial general liability and automobile\policies with respect to the operations and work performed frontlinemobilehealth.com 20 by the named insured as required by written contract. 18.3 The General Liability policy is Primary&Non-Contributory. 18.4 Waiver of Subrogation applies under the General Liability and Workers' Compensation policies. The commercial general liability insurance minimum coverage shall be at least one million dollars ($1,000,000) per incident, claim or occurrence,and one million dollars($1,000,000)aggregate.The Automobile Liability insurance minimum coverage shall be at least three hundred and fifty thousand dollars ($350,000) covering all owned, non-owned, and hired vehicles. The certificate shall provide that there will be no cancellation,termination,or non-renewal of the insurance coverage without a minimum thirty (30) days written notice to Contracting Agency, except in the case of cancellation for non-payment of premium,which shall be at leastten(10)days'written notice. 19. LIABILITY AND INDEMNIFICATION 19.1 SERVICE PROVIDER SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL PROPERTY LOSS, PROPERTY DAMAGE,AND/OR PERSONAL INJURY 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 SERVICE PROVIDER, ITS OFFICERS,AGENTS,SERVANTS,OR EMPLOYEES. 19.2 FURTHERMORE,SERVICE PROVIDER HEREBY COVENANTS AND AGREES TO INDEMNIFY,HOLD HARMLESS,AND DEFEND CONTRACTING AGENCY,ITS OFFICERS,AGENTS,SERVANTS,AND EMPLOYEES FROMANDAGAINSTANYAND ALL CLAIMS OR LAWSUITS OF ANY KIND OR CHARACTER,WHETHER REAL OR ASSERTED,IN CONTRACTOR TORT,FOR EITHER PROPERTY DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO SERVICE PROVIDER'S BUSINESS AND ANY RESULTING LOST PROFITS)AND/OR PERSONAL INJURY TO ANY AND ALL PERSONS ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT, TO THE EXTENT CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS, MALFEASANCE, OR INTENTIONAL MISCONDUCT OF SERVICE PROVIDER, ITS OFFICERS, AGENTS, SERVANTS, OR EMPLOYEES. 19.3 FURTHERMORE,TO THE EXTENT PERMITTED BY APPLICABLE LAWS AND WITHOUT WAIVING ANY IMMUNITY OR ANY LIMITATION OF LIABILITY PROVIDED BY THE CONSTITUTION OR LAWS OF THE STATE OF TEXAS OR BY THE CHARTER OF THE CITY OF CORPUS CHRISTI, CONTRACTING AGENCY HEREBY COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS, AND DEFEND SERVICE PROVIDER, ITS OFFICERS, AGENTS, SERVANTS, AND EMPLOYEES,FROM AND AGAINST ANY AND ALL CLAIMS OR LAWSUITS OF ANY KIND OR CHARACTER,WHETHER REAL ORASSERTED,IN CONTRACTORTORT, FOR EITHER PROPERTY DAMAGE OR LOSS(INCLUDING ALLEGED DAMAGE OR LOSS TO CONTRACTING AGENCY'S BUSINESS AND ANY RESULTING COSTS), PERSONAL INJURY TO ANY AND ALL PERSONS ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT, TO THE EXTENT CAUSED BY THE SOLE NEGLIGENTACTS OR OMISSIONS OR MALFEASANCE OF CONTRACTING AGENCY,ITS OFFICERS,AGENTS,SERVANTS, OR EMPLOYEES, AND/OR EMPLOYMENT-RELATED CLAIMS ARISING OUT OF ALLEGED ADVERSE EMPLOYMENT ACTION, INCLUDING BUT NOT LIMITED TO CLAIMS ARISING UDER TITLE VII OF THE CIVIL RIGHTS ACT OF 1964, AS AMENDED, THE AMERICANS WITH DISABILITIES ACT, THE OLDER WORKER BENEFIT PROTECTION ACT, AND THE TEXAS LABOR CODE WHEN SUCH FAULT IS UNMIXED WITH THE NEGLIGENTACTS OR OMISSIONS OR MALFEASANCE OF ANY ENTITY, PERSON,OR INDIVIDUAL. 20. FORCE MAJEURE 20.1 Neither Party shall be liable hereunder for anyfailure or delay in the performance of its obligations underthis Agreement if such failure or delay is on account of causes beyond its reasonable control, including civil commotion,war,fires, floods, accident, earthquakes, inclement weather, telecommunications line failures, electrical outages, network failures, governmental regulations or controls, casualty, strikes or labor disputes, terrorism, pandemics, epidemics, local disease frontlinemobilehealth.com 21 outbreaks, public health emergencies, acts of God, or other similar or different occurrences, for so long as such force majeure event is in effect. Each Party shall use reasonable efforts to notify the other Party of the occurrence of such an event within five(5) business days of its occurrence. 21. CONFLICTS OF INTEREST 21.1 Where local statute or regulation requires the disclosure of certain matters bycontractingagencies doing business with or proposing to do business with local governmental agencies such as Contracting Agency.Service Provider,if it is required to do so,will disclose such matters within seven (7) days of the date of submitting this Agreement to Contracting Agency, or within seven(7)days of becoming aware of a matter that requires disclosure,whichever is applicable. 22. NON-BOYCOTT VERIFICATION The Service Provider agrees to comply with all applicable federal, Texas, and City laws in the performance of this Agreement. The applicable law for any legal disputes arising out of this Agreement is the law of the State of Texas,and the venue for such disputes is the appropriate district or county court in Nueces County, Texas. In accordance with Chapter 2271, Texas Government Code ("Government Code"), if this Agreement has a value of$100,000 or more paid wholly or partly from public funds and the Service Provider has 10 or more full-time employees,the Service Provider verifies that it does not boycott Israel and will not boycott Israel during the term of this Agreement. In accordance with Chapter 2274, Government Code,if this Agreement has a value of$100,000 or more paid wholly or partly from public funds and the Service Provider has 10 or more full-time employees,the Service Provider verifies that it does not have a practice,policy,guidance, or directive that discriminates against a firearm entity or firearm trade association and will not discriminate during the term of this Agreement against a firearm entity or firearm trade association. In accordance with Chapter 2276, Government Code, if this Agreement has a value of$100,000 or more paid wholly or partly from public funds and the Service Provider has 10 or more full-time employees, the Service Provider verifies that it does not boycott energy companies and will not boycott energy companies during the term of this Agreement. 23. NO BUSINESS WITH FOREIGN TERRORIST VERIFICATION Pursuant to Chapter 2252, Government Code, Service Provider, as a"company"defined in Texas law,verifies that it does not have any contracts with or provide supplies or services to a foreign terrorist organization including, but not limited to, Iran, Sudan, or any company identified on a list prepared and maintained by the Texas Comptroller pursuant to Chapter 2252,as amended. 24. NO WAIVER 24.1 The waiver by either Party of a breach or violation of any provision of this Agreement shall not operate as or be construed as a waiver of any subsequent breach hereof. 25. NON-DISCRIMINATION 25.1 Service Provider,with regard to the work performed by it after award and prior to completion of this Agreement,shall not discriminate on the basis of race, color, sex, or national origin, including procurements of materials and leases of equipment. Service Provider shall not participate either directly or indirectly in the discrimination prohibited by any Federal, State,or local law. 25.2 IF ANY CLAIM ARISES FROM AN ALLEGED VIOLATION OF THIS NON-DISCRIMINATION COVENANT BY SERVICE PROVIDER,ITS PERSONAL REPRESENTATIVES,ASSIGNS,OR SUCCESSORS IN INTEREST,SERVICE PROVIDER AGREES TO ASSUME SUCH LIABILITY AND TO INDEMNIFY AND DEFEND CONTRACTING AGENCY AND HOLD CONTRACTING frontlinemobilehealth.com 22 AGENCY HARMLESS FROM SUCH CLAIM. 26. NOTICES 26.1 Any notice or communication permitted or required by this Agreement shall be deemed effective onthethird businessday when personally delivered or deposited, postage prepaid, in the first-class mail of the United States properly, or sent via electronic means,addressed to the appropriate primary and alternate contacts at the address set forth in the identification of Parties section of this Agreement. 27. CONSTRUCTION 27.1 The captions or headings in this Agreement are for convenience only and do not define,limit,or otherwise describe the scope or intent of any provision or section of this Agreement. References to the singular include the plural and vice versa. 28. SEVERABILITY 28.1 If any provision of this Agreement is found to be contraryto law by a court of competent jurisdiction,such provision shall be of no force or effect; but the remainder of this Agreement shall continue in full force and effect. 29. PUBLIC INFORMATION ACT REQUIREMENTS The requirements of Subchapter J,Chapter 552,Government Code,may applyto this contract and the contractor orvendor agrees that the contract can be terminated if the contractor or vendor knowingly or intentionally fails to comply with a requirement of that subchapter. This paragraph applies only to agreements that have a stated expenditure of at least $1,000,000 in public funds or that result in the expenditure of at least$1,000,000 in public funds by the Contracting Agency in a fiscal year. If it applies,the Service Provider must:(1) preserve all contracting information related to this Agreement as provided bythe records retention requirements applicable to the Contracting Agency for the duration of the Agreement; (2) promptly provide to the Contracting Agency any contracting information related to this Agreement that is in the custody or possession of the Service Provider upon request of the Contracting Agency; and (3) upon completion of the Agreement, either: (A) provide at no cost to the Contracting Agency all contracting information related to the Agreement that is in the custody or possession of the Service Provider; or (B) preserve the contracting information related to this Agreement as provided by the records retention requirements applicable to the Contracting Agency. Notwithstanding any conflicting Language contained within this Agreement,the provisions of this paragraph and Subchapter J supersede and control in the event of a conflict. 30. COMPLETE AGREEMENT 30.1 This Agreement supersedes all prior oral or written Agreements and understandings between the Parties respecting the subject matter thereof, and constitutes the entire Agreement between the Parties, and cannot be changed unless mutually agreed upon in writing by both Parties. 31. GOVERNING LAW: SUCCESSORS AND ASSIGNS 31.1 This Agreement and all matters or issues directly or collaterally relating thereto shall be interpreted by, governed in accordance with, and construed pursuant to the laws of the State of Texas without regard to its conflict of laws and rules, and both Parties agree to submit to jurisdiction in Texas. 31.2 Further, any action arising out of or relating to the performance of the parties hereunder, or the interpretation of this Agreement shall be brought exclusively in a court of competent jurisdiction located in Nueces County,Texas. frontlinemobilehealth.com 23 31.3 This Agreement shall be binding upon and inure to the benefit of the Parties hereto and their respective permitted successors and assigns. 32. COUNTERPARTS 32.1 This Agreement maybe 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. [Signature Page Follows] frontlinemobilehealth.com 24 SIGNATURES "Contracting Agency" "Service Provider" City of Corpus Christi for Corpus Christi Fire Department and Airport Department Front Line Mobile Health, PLLC 1201 Leopard Street 4749 Williams Drive,Suite 304 Corpus Christi,Texas 78401 Georgetown,Texas 78633 (361)826-3227 (512)688-6112 By: Swgio VGCarana By: Chelsea Connor Sergio Villasana(May 22,2026 11:43:54 CD I Chelsea Conner(May 22,2026 13:10:27 MDT) Sergio Villasana Chelsea K.Conner, MPAS,APA-C Director, Finance&Procurement Chief of Sales 05/22/2026 05/22/2026 Date Signed Date Signed By. Clayyton cCl.n sr Smith(May 20,2026 09:44:56 CDT) Clayton Smith Contracts Manager 05/20/2026 Date Signed Approved as to Form ReS.033935 �e�_irh��ri::erl 5Fw By: Efizciboth RLmdlox Elizabeth Hundley(May 21,2026 21:05:31 CDT) Elizabeth Hundley C OLHICil 5/19/2026 Assistant City Attorney RHHS13 05/21/2026 iss Date Signed ATTEST. ize &aC,a f a'-rEu, Rebecca Huerta(May 22,2026 13:42:27 CDT) Rebecca Huerta City Secretary frontlinemobilehealth.com 25 EXHIBIT A: Minimum Billing Amount To determine final resource and staffing levels forthe physicals,Service Provider requires Contracting Agency to submit a final roster of participants, accompanied by a memorandum which shall be signed by the Authority Having Jurisdiction, the Director of Finance & Procurement, and the Director of the Office of Management&Budget,no later than thirty(30)days beforethe Introductory E-mail is sent to the Participants. The number of Participants listed on the final roster will be the minimum number of physicals billed. Contracting Agency may continue to add Participants in coordination with Service Provider. The charges for these additional Participants will be added to the Final Billing Amount. frontlinemobilehealth.com 26 EXHIBIT B: Scope of Services and Fee Schedule for Annual Medical Evaluations Contracting Agency has the option to choose the "Partnership" level of services for its Annual Medical Evaluations from Service Providerfor a price of nine hundred twenty-five dollars($925)per Participant for the contract period and is subjectto change in subsequent years as provided in this Agreement. For the contract period, the general scope of services to be performed by Service Provider for the Annual Medical Evaluation for Contracting Agency includes, but is not limited to,the following*: *Service Provider reserves the right,upon prior notice to Contracting Agency,to modify the list of services in this Exhibit in the event better results can be obtained by using different lab tests or methodologies.Cost will not change without the approval of the Contracting Agency. COMPONENT LIST FOR PARTNERSHIPTIER FOR ANNUAL PHYSICALS LAB TESTS Comprehensive Metabolic Panel Complete Blood Count Lipid Panel Urinalysis with Reflex Microscopic Evaluation Hemoglobin Al c C-Reactive Protein Uric Acid Lipoprotein (a) Apolipoprotein B TSH Reflex to Free T4 PSA,Total (Men Only) CA-125 (Women Only) Fecal Occult Blood Cortisol,AM Testosterone Free/Total with SHBG (Men Only) Estradiol (Women Only) EXAMS Personalized Risk Assessment Health Questionnaire and Screening Body Composition Analysis Vision Screening Audiogram Human Performance Assessment Resting EKG Cardiopulmonary Exercise Test Chest X-Ray Cancer Screening Ultrasound:Thyroid, Liver, Gallbladder, Spleen, Pancreas, Kidneys, Proximal Abdominal Aorta, Bladder,Testes (Men Only), Ovaries (Women Only) Physical Examination and Consultation with Medical Provider Operational Threat Brief Organizational Climate Assessment frontlinemobilehealth.com 27 EXHIBIT B: Scope of Services and Fee Schedule for Annual Medical Evaluations Contracting Agency has the option to choose the "Essentials Cancer" level of services for its Annual Medical Evaluations from Service Provider for a price of six hundred and fifty five dollars ($655) per Participant for the contract period and is subject to change in subsequent years as provided in this Agreement. For the contract period,the general scope of services to be performed by Service Provider for the Annual Medical Evaluation for Contracting Agency includes,but is not limited to, the following*: *Service Provider reserves the right,upon prior notice to Contracting Agency,to modify the list of services in this Exhibit in the event better results can be obtained by using different lab tests or methodologies.Cost will not change without the approval of the Contracting Agency. COMPONENT LIST FOR ESSENTIALS CANCER TIER FOR ANNUAL PHYSICALS LAB TESTS Comprehensive Metabolic Panel Complete Blood Count Lipid Panel Urinalysis with Reflex Microscopic Evaluation Hemoglobin Al c TSH Reflex to Free T4 PSA,Total(Men Only) CA-125 (Women Only) Fecal Occult Blood EXAMS Personalized Risk Assessment Health Questionnaire and Screening Body Composition Analysis Vision Screening Audiogram Human Performance Assessment Chest X-Ray Cancer Screening Ultrasound:Thyroid, Liver, Gallbladder, Spleen, Pancreas, Kidneys, Proximal Abdominal Aorta, Bladder,Testes(Men Only), Ovaries (Women Only) Physical Examination and Consultation with Medical Provider Operational Threat Brief Or anizationalClimateAssessment frontlinemobilehealth.com 28 EXHIBIT B: Scope of Services and Fee Schedule for Annual Medical Evaluations Contracting Agency has the option to choose the "Essentials Cardiovascular" level of services for its Annual Medical Evaluations from Service Provider fora price of six hundred and fifty five dollars($655)per Participant for the contract period and is subject to change in subsequent years as provided in this Agreement. For the contract period,the general scope of services to be performed by Service Provider for the Annual Medical Evaluation for Contracting Agency includes, but is not Limited to,the following*: *Service Provider reserves the right,upon prior notice to Contracting Agency,to modify the list of services in this Exhibit in the event better results can be obtained by using different lab tests or methodologies.Cost will not change without the approval of the Contracting Agency. COMPONENT LIST FOR ESSENTIALS CARDIOVASCULAR TIER FOR ANNUAL PHYSICALS LAB TESTS Comprehensive Metabolic Panel Complete Blood Count Lipid Panel Urinalysis with Reflex Microscopic Evaluation Hemoglobin Al c C-Reactive Protein Uric Acid Lipoprotein (a) Apolipoprotein B EXAMS Personalized Risk Assessment Health Questionnaire and Screening Body Composition Analysis Vision Screening Audiogram Human Performance Assessment Resting EKG Cardiopulmonary Exercise Test Physical Examination and Consultation with Medical Provider Operational Threat Brief Organizational Climate Assessment frontlinemobilehealth.com 29 EXHIBIT B: Scope of Services and Fee Schedule for Annual Medical Evaluations Contracting Agency has the option to choose the alternating"Essentials Cancer" and "Essentials Cardiovascular" level of services for its Annual Medical Evaluations from Service Provider for a price of six hundred and fifty five dollars ($655) per Participant for the contract period and is subject to change in subsequent years as provided in this Agreement. For the contract period, the general scope of services to be performed by Service Provider for the Annual Medical Evaluation for Contracting Agency includes, but is not limited to,the following*: *Service Provider reserves the right,upon prior notice to Contracting Agency,to modify the list of services in this Exhibit in the event better results can be obtained by using different lab tests or methodologies.Cost will not change without the approval of the Contracting Agency. COMPONENT LIST FOR ESSENTIALS COMPONENT LIST FOR ESSENTIALS CANCER TIER FOR ANNUAL PHYSICALS CARDIOVASCULAR TIER FOR ANNUAL PHYSICALS LAB TESTS LAB TESTS Comprehensive Metabolic Panel Comprehensive Metabolic Panel Complete Blood Count Complete Blood Count Lipid Panel Lipid Panel Urinalysis with Reflex Microscopic Evaluation Urinalysis with Reflex Microscopic Evaluation Hemoglobin Al c Hemoglobin Al c TSH Reflex to Free T4 C-Reactive Protein PSA,Total(Men Only) Uric Acid CA-125 (Women Only) Lipoprotein (a) Fecal Occult Blood A oli o rotein B EXAMS EXAMS Personalized Risk Assessment Personalized Risk Assessment Health Questionnaire and Screening Health Questionnaire and Screening Body Composition Analysis Body Composition Analysis Vision Screening Vision Screening Audiogram Audiogram Human Performance Assessment Human Performance Assessment Chest X-Ray Resting EKG Cancer Screening Ultrasound:Thyroid, Liver, Gallbladder, Cardiopulmonary Exercise Test Spleen, Pancreas, Kidneys, Proximal Abdominal Aorta, Physical Examination and Consultation with Medical Bladder,Testes (Men Only), Ovaries (Women Only) Operational Threat Brief Organizational Climate Assessment Physical Examination and Consultation with Medical Operational Threat Brief Or anizational Climate Assessment frontlinemobilehealth.com 30 EXHIBIT C: Scope of Services and Fee Schedule for Candidate Medical Evaluations Contracting Agency has the option to choose the"Partnership"level of services for its Candidate Medical Evaluations from Service Provider for a price of one thousand six hundred dollars and 00/100($1,600.00)per Participant. This fee schedule is applicable during the Initial Term and is subject to change in subsequent Renewal Terms,as provided in this Agreement. For the Initial Term of the Agreement,the general scope of services to be performed by Service Provider for the Candidate Medical Evaluation for Contracting Agency includes,but is not limited to,the following*: *Service Provider reserves the right,upon prior notice to Contracting Agency,to modify the list of services in this Exhibit in the event better results can be obtained by using different lab tests or methodologies.Cost will not change without the approval of the Contracting Agency. COMPONENT LIST FOR PARTNERSHIPTIER FOR CANDIDATE PHYSICALS LAB TESTS Comprehensive Metabolic Panel CA-125 Women Only) Complete Blood Count Fecal Occult Blood Lipid Panel QuantiFERON Gold (Tuberculosis) Urinalysis with Reflex Microscopic Evaluation Hepatitis A and B Immunization Titer Hemoglobin Al c MMR and Varicella Immunization Titer Drug Screening Tetanus Immunization Titer C-Reactive Protein Blood Type ABO and Rh Type) Uric Acid Hepatitis C Infection Screening Lipoprotein (a) Coagulation Studies A olio rotein B Heavy Metal Screening(Lead,Arsenic, Mercury) TSH Reflex to Free T4 Cholinesterase PSA Total Men Only) EXAMS Personalized Risk Assessment Human Performance Assessment Health Questionnaire and Screening Cardiopulmonary Exercise Test Body Composition Analysis Chest X-Ray Vision Screening Spinal X-Ras Cervical,Thoracic, Lumbar Audio ram Physical Examination and Consultation with Medical frontlinemobilehealth.com 31 EXHIBIT C: Scope of Services and Fee Schedule for Candidate Medical Evaluations Contracting Agency has the option to choose the"Essentials"level of services for its Candidate Medical Evaluations from Service Provider for a price of one thousand two hundred dollars($1,200)per Participant for the contract period and is subject to change in subsequent years as provided in this Agreement. For the contract period,the general scope of services to be performed by Service Provider for the Candidate Medical Evaluation for Contracting Agency includes,but is not limited to,the following*: *Service Provider reserves the right,upon prior notice to Contracting Agency,to modify the list of services in this Exhibit in the event better results can be obtained by using different lab tests or methodologies.Cost will not change without the approval of the Contracting Agency. COMPONENT LIST FOR ESSENTIALS TIER FOR CANDIDATE PHYSICALS LAB TESTS Comprehensive Metabolic Panel Complete Blood Count Lipid Panel Urinalysis with Reflex Microscopic Evaluation Hemoglobin Al c Drug Screening C-Reactive Protein Uric Acid Lipoprotein (a) Apolipoprotein B TSH Reflex to Free T4 PSA,Total (Men Only) CA-125 (Women Only) Fecal Occult Blood QuantiFERON Gold (Tuberculosis) Hepatitis A and B Immunization Titer MMR and Varicella Immunization Titer Tetanus Immunization Titer Blood Type(ABO and Rh Type) Hepatitis C Infection Screening EXAMS Personalized Risk Assessment Health Questionnaire and Screening Body Composition Analysis Vision Screening Audiogram Human Performance Assessment Cardiopulmonary Exercise Test Chest X-Ray Physical Examination and Consultation with Medical Provider frontlinemobilehealth.com 32 EXHIBIT C: Scope of Services and Fee Schedule for Candidate Medical Evaluations Contracting Agency has the option to choose the"Foundations"level of services for its Candidate Medical Evaluations from Service Provider for a price of eighth und red dollars and 00/100($800.00)per Participant.This fee schedule is applicable during the Initial Term and is subject to change in subsequent Renewal Terms,as provided in this Agreement. For the Initial Term of the Agreement,the general scope of services to be performed by Service Provider for the Candidate Medical Evaluation for Contracting Agency includes, but is not limited to,the following*: *Service Provider reserves the right,upon prior notice to Contracting Agency,to modify the list of services in this Exhibit in the event better results can be obtained by using different lab tests or methodologies.Cost will not change without the approval of the Contracting Agency. COMPONENT LIST FOR FOUNDATIONS TIER FOR CANDIDATE PHYSICALS LAB TESTS Comprehensive Metabolic Panel Complete Blood Count Lipid Panel Urinalysis with Reflex Microscopic Evaluation Hemoglobin Al c Drug Screenin EXAMS Personalized Risk Assessment Health Questionnaire and Screening Body Composition Analysis Vision Screening Audiogram Human Performance Assessment Cardiopulmonary Exercise Test Physical Examination and Consultation with Medical Provider frontlinemobilehealth.com 33 EXHIBIT D: Scope of Services and Fee Schedule for Fitness-for-Duty Medical Evaluations Contracting Agency has the option to choose Fitness-for-Duty Medical Evaluation services for its Incumbent Members on an as-needed basis from Service Provider for a base price*of two thousand dollars($2,000)per Participant for the contract period and is subject to change in subsequent years as provided in this Agreement. For the contract period,the general scope of services to be performed by Service Provider for the Fitness-for-Duty Medical Evaluations for Contracting Agency includes,but is not limited to,the following**: MINIMUM COMPONENT LIST FOR FITNESS-FOR-DUTY MEDICAL EVALUATIONS LAB TESTS As Indicated, Based on Condition, Disease,or Potentially Disqualifying Defect EXAMS Health Questionnaire and Screening Review of Relevant Medical Records Review of Relevant Personnel Records Diagnostic Tests,As Indicated, Based on Condition, Disease,or Potentially Disqualifying Defect Physical Examination and Consultation with Medical Provider *Because all situations and individuals are unique,every Fitness-for-Duty Medical Evaluation is performed based on the needs and nature of the condition,disease or potentially disqualifying defect,taking into consideration the job duties and description provided by the Contracting Agency.Because these exams are conducted in a manner which is meant to be legally defensible,the level of detail and time required to complete the narrative evaluation is extensive.In situations where the diagnostics required to adequately assess an individual is expected to exceed the base cost,Service Provider will consult with the Contracting Agency prior to performance of the evaluation. **Service Provider reserves the right,upon prior notice to Contracting Agency,to modify the list of services in this Exhibit in the event better results can be obtained by using different lab tests or methodologies.Cost will not change without the approval of the Contracting Agency. ))) frontlinemobilehealth.com 34 EXHIBIT E: Scope of Services and Fee Schedule for Candidate Psychological Evaluations Contracting Agency has the option to choose Candidate Psychological Evaluation services for its Candidates on an as-needed basis from Service Provider for the price listed below,based on the type of evaluation requested(Fire,Peace Officer,and/or Emergency Communications)per Participant for the contract period and is subject to change in subsequent years as provided in this Agreement. For the contract period,the general scope of services to be performed by Service Provider for the Candidate Psychological Evaluations for Contracting Agency includes,but is not limited to,the following: COMPONENT LIST FOR FIREFIGHTER OR SINGLE-ROLE PARAMEDIC APPLICANTS SERVICES INCLUDED Personality Assessment I nventory(PAI) Virtual Face-to-Face Interview with Psychologist Psychological Narrative Report Opinion for Suitability for Position PersonPer $ 425 COMPONENT LIST FOR PEACE OFFICER CANDIDATE PSYCHOLOGICAL EVALUATIONS SERVICES INCLUDED Personality Assessment Inventory(PAI) California Personality Inventory(CPI) ------------------------------------------------------------------------------------------------------------------------------- Psychological History Questionnaire(PsyQ) State-Trait Anger Expression Inventory-II (STAXI-II) Raven's 2 Progressive Matrices Face-to-Face Interview with Psychologist ------------------------------------------------------------------------------------------------------------------------------- Psychological Narrative Report Opinion for Suitability for Position PersonPer $ 800 frontlinemobilehealth.com 35 EXHIBIT E: Scope of Services and Fee Schedule for Candidate Psychological Evaluations Contracting Agency has the option to choose Candidate Psychological Evaluation services for its Candidates on an as-needed basis from Service Provider for the price listed below,based on the type of evaluation requested(Fire,Peace Officer,and/or Emergency Communications)per Participant for the contract period and is subject to change in subsequent years as provided in this Agreement. For the contract period,the general scope of services to be performed by Service Provider for the Candidate Psychological Evaluations for Contracting Agency includes,but is not limited to,the following: FIREFIGHTER OR SINGLE-ROLE PARAMEDIC APPLICANTS PSYCHOLOGICAL NON SUITABILITY APPEAL SERVICES INCLUDED Review of Testing Battery Data and Reports Review of Initial Psychological Narrative Report Virtual Face-to-Face Interview with Psychologist Psychological Narrative Report Opinion for Suitability for Position PersonPer $ 725 LAW ENFORCEMENT OFFICER AND SCHOOL RESOURCE OFFICER APPLICANTS PSYCHOLOGICAL NON SUITABILITY APPEAL SERVICES INCLUDED Review of Testing Battery Data and Reports Review of Initial Psychological Narrative Report Virtual Face-to-Face Interview with Psychologist Psychological Narrative Report Opinion for Suitability for Position PersonPer $ 975 frontlinemobilehealth.com 36 EXHIBIT F: Scope of Services and Fee Schedule for Fitness-for-Duty Psychological Evaluations Contracting Agency has the option to choose Fitness-for-Duty Psychological Evaluation services for its Incumbent Members on an as- needed basis from Service Provider for the price of one thousand six hundred dollars($1,600)per Participant for the contract period and is subject to change in subsequent years as provided in this Agreement. For the contract period,the general scope of services to be performed by Service Provider for the Fitness-for-Duty Psychological Evaluations for Contracting Agency includes,but is not limited to,the following: COMPONENT LIST FOR FITNESS-FOR-DUTY PSYCHOLOGICAL EVALUATIONS SERVICES INCLUDED Personality Assessment Inventory(PAI) Minnesota Multiphasic Personality I nventory-2-Restructu red Form (MMPI-2-RF) ............................................................................................................................... Other Tests,As Appropriate Face-to-Face Interview with Psychologist Psychological Narrative Report Opinion for Psychological Fitness for Duty PersonPer $ 1,600 frontlinemobilehealth.com 37 EXHIBIT G: Scope of Services and Fee Schedule for Promotional Psychological Evaluations Contracting Agency has the option to choose Promotional Psychological Evaluation services for its Incumbent Members on an as- needed basis from Service Provider for the price of eight hundred dollars and 00/100($800.00)per Participant. This fee schedule is applicable during the Initial Term and is subject to change in subsequent Renewal Terms,as provided in this Agreement. For the Initial Term of the Agreement,the general scope of services to be performed by Service Provider for the Promotional Psychological Evaluations for Contracting Agency includes,but is not limited to,the following: COMPONENT LIST FOR PROMOTIONAL PSYCHOLOGICAL EVALUATIONS SERVICES INCLUDED Jackson Personality Inventory(JPI) NEO Personality Inventory ------------------------------------------------------------------------------------------------------------------------------- Raven's 2 Progressive Matrices Face-to-Face Interview with Psychologist Psychological Narrative Report Opinion for Suitability for Promotion Per Person Cost $ 800 frontlinemobilehealth.com 38 EXHIBIT H: Scope of Services and Fee Schedule for Special Tactics Team Selection Psychological Evaluations Contracting Agency has the option to choose Special Tactics Team Selection Psychological Evaluation services for its Incumbent Members on an as-needed basis from Service Provider forth e price of eight hundred dollars and 00/100($800.00)per Participant.This fee schedule is applicable during the Initial Term and is subject to change in subsequent Renewal Terms,as provided in this Agreement. For the Initial Term of the Agreement,the general scope of services to be performed by Service Provider for the Special Tactics Team Selection Psychological Evaluations for Contracting Agency includes,but is not limited to,the following: COMPONENT LIST FOR SPECIALTACTICS TEAM SELECTION PSYCHOLOGICAL EVALUATIONS SERVICES INCLUDED Personality Assessment Inventory(PAI) Raven's 2 Progressive Matrices ............................................................................................................................... Hogan Personality Inventory Situational Judgment Test ............................................................................................................................... Face-to-Face Interview with Psychologist Psychological Narrative Report ......................................... ..................................................................................... Opinion for Suitabilityfor Special Tactics Team Selection Per Person Cost $ 800 frontlinemobilehealth.com 39 EXHIBIT I: Examinee Waiver for Medical Evaluation Fire Service Annual Occupational Medical Evaluation (Benefit) By signing below, I acknowledge that I understand the scope of the medical services I receive today are being provided solely as a benefit to you and funded by your department. This program,and your participation, is voluntary and is NOT meant to determine if I am physically and mentally capable of performing myjob duties. acknowledge and understand that Front Line Mobile Health, PLLC is not establishing a patient-provider relationship. This evaluation is performed pursuant to a Professional Services Agreement between Front Line Mobile Health, PLLC,and your department,and/or Texas Local Government Code, Chapter 143(if applicable), and/or your department's Labor/management agreement(if applicable). This evaluation does not replace those evaluations or health care treatment plans recommended by your primary healthcare provider or other specialty providers. I will discuss any abnormal findings or results with my primary healthcare provider for a comprehensive diagnosis and treatment plan. Please note that due to the sensitivity of the testing equipment and lab procedures used by Front Line Mobile Health, PLLC, abnormal results and findings,along with revaccination or intervention after certain exposures, may be detected that are of insignificant physiological importance. However,they maywarrant a recommended referral to your primary care provider. You are encouraged to discuss these abnormal results and findings with them. Please note that Front Line Mobile Health, PLLC will not reimburse you or your department for the cost of any appointments, additional examinations, or testing you and your primary health care provider choose to undertake. This independent medical evaluation consists of an examination of major body systems,the analysis of laboratory results, radiographic studies,online questionnaires and various other screenings as required by the employer. Findings and results are strictly confidential and will be provided only to me unless I provide a separate written consent for their release. Non-identifiable aggregated medical and health information gathered from this and other co-workers'medical examinations will be used to monitor acute and long-term effects of the working environment;detect patterns of disease in the workforce; provide quantifiable medical information on the entire workplace; inform others in the workforce of the occupational hazards of your occupation;and for research studies which will be used to identify patterns, make correlations, and drive positive change in your chosen profession. Lastly,I acknowledge that the Fire Chief, his/her designee,or the Authority Having Jurisdiction (AHJ) makes the final determination on employment,work restrictions and adherence to medical recommendations. Front Line Mobile Health, PLLC and its medical director have no authority orjurisdiction as it relates to my work status. frontlinemobilehealth.com 40 EXHIBIT I: Examinee Waiver for Medical Evaluation Law Enforcement Annual Occupational Medical Evaluation (Benefit) By signing below, I acknowledge that I understand the scope of the medical services I receive today are being provided solely as a benefit to you and funded by your department. This program,and your participation, is voluntary and is NOT meant to determine if I am physically and mentally capable of performing myjob duties. acknowledge and understand that Front Line Mobile Health, PLLC is not establishing a patient-provider relationship. This evaluation is performed pursuant to a Professional Services Agreement between Front Line Mobile Health, PLLC,and your department,and/or your department's labor/management agreement(if applicable). This evaluation does not replace those evaluations or health care treatment plans recommended by your primary healthcare provider or other specialty providers. I will discuss any abnormal findings or results with my primary healthcare provider for a comprehensive diagnosis and treatment plan. Please note that due to the sensitivity of the testing equipment and lab procedures used by Front Line Mobile Health, PLLC, abnormal results and findings,along with revaccination or intervention after certain exposures, may be detected that are of insignificant physiological importance. However,they maywarrant a recommended referral to your primary care provider. You are encouraged to discuss these abnormal results and findings with them. Please note that Front Line Mobile Health, PLLC will not reimburse you or your department for the cost of any appointments, additional examinations, or testing you and your primary health care provider choose to undertake. This independent medical evaluation consists of an examination of major body systems,the analysis of laboratory results, radiographic studies,online questionnaires and various other screenings as outlined in the Professional Services Agreement with your department. My individual findings and results are strictly confidential and will be provided only tome unless I provide a separate written consent for their release. Non-identifiable aggregated medical and health information gathered from this and other co-workers'medical examinations will be used to monitor acute and long-term effects of the working environment;detect patterns of disease in the workforce; provide quantifiable medical information on the entire workplace; inform others in the workforce of the occupational hazards of your occupation;and for research studies which will be used to identify patterns, make correlations, and drive positive change in your chosen profession. Lastly,I acknowledge that the Front Line Mobile Health, PLLC and its medical director have no authority orjurisdiction as it relates to my work status,they only make recommendations and will provide an assessment of risk based on the clinical findings to you. frontlinemobilehealth.com 41 EXHIBIT I: Examinee Waiver for Medical Evaluation Law Enforcement Annual Occupational Medical Evaluation (Mandatory) By signing below, I acknowledge that I understand the scope of the medical services I receive today are solely to identify whether I am physically and mentally able to continue to perform my essential job tasks without undue risk of harm to myself or others. This medical evaluation uses the job description and/or the department's local policy regarding fitness for duty when making medical recommendations. acknowledge and understand that Front Line Mobile Health, PLLC is not establishing a patient-provider relationship. This evaluation is performed pursuant to a Professional Services Agreement between Front Line Mobile Health, PLLC,and your department,and/or Texas Local Government Code, Chapter 143(if applicable), and/or your department's Labor/management agreement(if applicable). This evaluation does not replace those evaluations or health care treatment plans recommended by your primary healthcare provider or other specialty providers. I will discuss any abnormal findings or results with my primary healthcare provider for a comprehensive diagnosis and treatment plan. Please note that due to the sensitivity of the testing equipment and lab procedures used by Front Line Mobile Health, PLLC, abnormal results and findings,along with revaccination or intervention after certain exposures, may be detected that are of insignificant physiological importance concerning your ability to perform your duties. However,they may warrant a recommended referral to your primary care provider. You are encouraged to discuss these abnormal results and findings with them. Please note that Front Line Mobile Health, PLLC will not reimburse you or your department for the cost of any appointments,additional examinations, or testing you and your primary health care provider choose to undertake. This independent medical evaluation consists of an examination of major body systems,the analysis of laboratory results, radiographic studies, online questionnaires and various other screenings as required by the employer. Findings and results are strictly confidential and will be provided only to me unless I provide a separate written consent for their release. However, I fully understand and acknowledge that specific information, results,and findings from this independent medical examination,evaluation, laboratory results,and medical findings,will form the basis of the Medical Director's recommendation to the department regarding your continued fitness for duty. Non-identifiable aggregated medical and health information gathered from this and other co-workers'medical examinations will be used to monitor acute and long-term effects of the working environment;detect patterns of disease in the workforce; provide quantifiable medical information on the entire workplace; inform others in the workforce of the occupational hazards of your occupation;and for research studies which will be used to identify patterns, make correlations, and drive positive change in your chosen profession. Lastly,I acknowledge that the Police Chief, his/her designee, or the Authority Having Jurisdiction(AHJ)makes the final determination on employment,work restrictions and adherence to medical recommendations. Front Line Mobile Health, PLLC and its medical director have no authority orjurisdiction as it relates to my work status,they only make recommendations and provide an assessment of risk based on the clinical findings. frontlinemobilehealth.com 42 EXHIBIT J: Examinee Waiver for Fitness-for-Duty Medical Evaluation Fire Service Fitness-for-Duty Medical Evaluation By signing below, I acknowledge that I understand the scope of the medical services I receive today are solely to identify whether I am physically and mentally able to perform the essential job tasks as a firefighter without undue risk of harm to myself or others, in accordance with the standards established under the National Fire Protection Association 1582 and/or the policy provided to Front Line Mobile Health, PLLC by my employer. understand that Front Line Mobile Health, PLLC, is not establishing a patient-provider relationship.This evaluation is performed under a Professional Services Agreement between Front Line Mobile Health, PLLC and my employer.This evaluation does not replace evaluations or health care treatment plans recommended by my primary care physician or other specialty providers. Due to the sensitivity of the testing equipment and lab procedures used by Front Line Mobile Health, PLLC,abnormal results and findings may be detected that are of insignificant physiological importance concerning my ability to perform my duties. However,they maywarrant a recommended referral to my primary healthcare provider for additional evaluation or treatment.I am encouraged to discuss all results and findings with them. Please note that Front Line Mobile Health, PLLC will not reimburse me or my employer for the cost of any appointments, additional examinations, or testing I and my primary healthcare provider, or specialty provider choose to undertake. am agreeing to undergo this independent medical examination consisting of an evaluation of major body systems,the analysis of laboratory results, and various other screenings.All findings and results are strictly confidential and will only be shared with the Authority Having Jurisdiction (AHJ), in this case the Fire Chief and/or my employer's Human Resources administrator, if a condition is discovered that would call into question my ability to safely perform the essentialjob tasks. acknowledge that the Fire Chief,their designee,or the Authority Having Jurisdiction(AHJ) makes the final determination on employment,work restrictions,and adherence to medical recommendations. fully understand and acknowledge that the specific information,results,and findings from this independent medical examination,evaluation, laboratory results,and medical findings,will form the basis of the Medical Director's recommendation to my employer regarding myfitness for duty. Non-identifiable aggregated medical and health information gathered from this and other co-workers'medical examinations will be used to monitor acute and long-term effects of the working environment;detect patterns of disease in the workforce; provide quantifiable medical information on the entire workplace; inform others in the workforce of occupational hazards;and for research studies to identify patterns, make correlations, and drive positive change. Finally,I acknowledge that the Fire Chief,their designee, or the Authority Having Jurisdiction (AHJ) makes the final determination on employment,work restrictions,and adherence to medical recommendations.I understand Front Line Mobile Health, PLLC and its Medical Director have no authority orjurisdiction as it relates to my work status,and this rests solely with my employer. frontlinemobilehealth.com 43 EXHIBIT J: Examinee Waiver for Fitness-for-Duty Medical Evaluation Law Enforcement Fitness-for-Duty Medical Evaluation By signing below, I acknowledge that I understand the scope of the medical services I receive today are solely to identify whether I am physically and mentally able to perform the duties of a law enforcement officer without undue risk of harm to myself or others. This medical evaluation uses the job description and/or the department's local policy regarding fitness for duty when making medical recommendations. understand that Front Line Mobile Health, PLLC, is not establishing a patient-provider relationship.This evaluation is performed under a Professional Services Agreement between Front Line Mobile Health, PLLC and my employer.This evaluation does not replace evaluations or health care treatment plans recommended by my primary care physician or other specialty providers. Due to the sensitivity of the testing equipment and lab procedures used by Front Line Mobile Health, PLLC,abnormal results and findings may be detected that are of insignificant physiological importance concerning my ability to perform my duties. However,they maywarrant a recommended referral to my primary healthcare provider for additional evaluation or treatment.I am encouraged to discuss all results and findings with them. Please note that Front Line Mobile Health, PLLC will not reimburse me or my employer for the cost of any appointments, additional examinations, or testing I and my primary healthcare provider,or specialty provider choose to undertake. am agreeing to undergo this independent medical examination consisting of an evaluation of major body systems,the analysis of laboratory results, and various other screenings.All findings and results are strictly confidential and will only be shared with the Authority Having Jurisdiction (AHJ), in this case the Police Chief and/or my employer's Human Resources administrator, if a condition is discovered that would call into question my ability to safely perform the essentialjob tasks. acknowledge that the Police Chief,their designee,or the Authority Having Jurisdiction (AHJ)makes the final determination on employment,work restrictions, and adherence to medical recommendations. fully understand and acknowledge that the specific information, results, and findings from this independent medical examination,evaluation, laboratory results,and medical findings,will form the basis of the Medical Director's recommendation to my employer regarding myfitness for duty. Non-identifiable aggregated medical and health information gathered from this and other co-workers'medical examinations will be used to monitor acute and long-term effects of the working environment;detect patterns of disease in the workforce; provide quantifiable medical information on the entire workplace; inform others in the workforce of occupational hazards;and for research studies to identify patterns, make correlations, and drive positive change. Finally,I acknowledge that the Police Chief,their designee,or the Authority Having Jurisdiction (AHJ)makes the final determination on employment,work restrictions,and adherence to medical recommendations.I understand Front Line Mobile Health, PLLC and its Medical Director have no authority orjurisdiction as it relates to my work status,and this rests solely with my employer. frontlinemobilehealth.com 44 EXHIBIT K: Post-Offer Psychological Evaluation: Disclosure and Informed Consent POSTJHR PSYCHOLOGICAL EVALUATION: FRONT LINE DISCLOSURE AND INFORMED CONSENT MODI LE H EALT H The agency that referred you h ere lof assessment(herein after referred to a8'th a hi ring agef5cy'j has g Ivan you an offer of erefpWyrltent conditierled,in part,on the results oT a job-retsted psyeho4agicat essessmant Dr.NAME OF PSYCHOLOGIST is a Licensed peycltblogltlt�herdnatterrefcrred to as"psyohotogtef')expeflenredin conducting auchassessmehts and&dLperrorm thepsychoL4*caL evaLuation_ The assessment wiR consist of mandardizeKd wtitten psychological resting,an orat interview,and a review of cotlateraL or third-parry inforrn8 Lion rrtaada available by the hiring agency or byyou_This.may Include information gathered during the background Irwestigation you authorieed the rr ring agency to Conduct. The asseesrnant witL also Includa a review of prior ease aaments if a psychologist pradausly evacuated you_Both the written inquiries and interview wiltprobe public aril private aspects of your Lire.These inquiries are necessary to adequateLyassess whether yeur paydtolo&at treitsand abiLitlre satisfy the fequiramentsof the position you have been coMltlonaLly offered- If atarryllmByou xMsh t8 ask about tote relevance of any question saked In the Intcrvlew—which will be Scheduled sometime after completion of the wrMenteating--please ask and you wilt recaive ark expLsnation as to why the rerxueatad information isrkeeded.As with ary job application pratedure,you have the right to tarrltinate the baseasrnent at any 1i n4a. -------------------------------------------------------------------------------------------------------------------------------------- Attho ugh the h W ng agency Is the psychologist's cltertt,n all you,the psychologist f*verthetesa WILL be mindful of hiaMar duty to conduct the evaLuation with fairneas and objectivity_You specifically unde retand and agree that you are not reeaiwing treatment or hesdth care from the psychologist and that the psychologist does not consider hWherseif to be treatingyou. You understand that you are rut beingexamined for any purpose relsiingto your personal.treatment or to your personalhealth care. Becausethe psychOLOgiaxis rohdurting this evaluation at the request of ttse hairtg agency and for reasons hawing nothing to do with treatrneratar health care,ru do NOT have doctor-patent or psychotherapist•petieni prtviLege In your communications with hinVher_ Therefore.you understand a ndagree that anything you Tray❑r do during at in connection width the evaluation Is.entitled to d tacLosure,If relevant to the evaluation,and mayor will bed isc lased to others involved in the setatedo n peo cesa who have a need to know it_The hiring agency refruirea a rap6rt of pertinent 16ndings brad conckrsiots,indudY�a detealmlrlatiorr of ynw aultebiLlty for t3tia poeiititn, foLlowingthe completion of the assaersament_ The hiring anger"may authoriza reLea se oithe racards associated vAth this assessment,inc lulling any written report,to"other qualified professional_Clrrumstances LeadliV to such an au horlxatlan may include a rnandetovy fitness-far-duty evaluation,dlaabNltp claim,or other me6catevaLuetYOn_SLaie Law aLso may require dietLOeure Of Otherw ae COnMarld&l informaton for reasons associated with,that not llmlted to,fisk of chill]abuse,a threat Of serious Nffn tO yaufse l Of Others,Or rourt order. Saxme or aLL of the Information you provide mayba used for psychotogical raseaarch cone arning test validaiiori,recruitment,aalettinn, end pe rforrrme nce of pubL io salety emgrloye e6_In the event bnfo rimatian from your a wal.uabon as used lot research pu rplYses,pr oc edur ea WILI be put in place to help ensure that your idamity is not ravealad. -------------------------------------------------------------------------------------..__ Reputi of Findings and Gwd u:a tilts FoUnwingtheromfAetlonoftheexamination,thepsychologistWILL�tvethehirlfz agency anoralandwrittenrepatofrelevantfindiNs.and conclusions relating to their opinion atautyour suitability for this position,purauant to tha attached authorization_These reports are necessary to rutriLithe purpose for whlch you have been refer red_The reports necessary WIILcontein priveta information,but the psychologist wi It make a gaad4sith effort tO restrict the dlatLosute of private i nforYnetion to the minimum necessary 14D sati elk the Purpose of teaeraminati nand vosupporthisfher find ings,eancknion%and recommendations.Ittorsfindrngs,eorrctusions,op pions, ofretommendstidns are thatkutged in an 8dkuditative roruen,the psychologisr may make fuLLdistloazure of all infOrrnatiOn asmay be 016bMa8ry Or required by Law- PO far M;rrtDmTl i ffOffL�Ilf3lrCbiflraalHLCofn 5121MM 5itT5 MI EXHIBIT K: Post-Offer Psychological Evaluation: Disclosure and Informed Consent POST-OFFER PSYCHOLOGICAL EVALUATION: FRONT LINE DISCLOSURE AND iN FORMED CONSENT M ON LE H EALT H waiver of Amm to Repot and Recce Thi a aseessrrrern is conducted sOLely to aid the hlri tg agencyr in daterm:ining your qualification for Mira.You wlu not he proW ded a copy of sny report the perhoLogist provides the hiring agency conemming;your suftaNklty.9ecause the hiringagency is the ctiern,yourauthofizatlenvALNOTpermlt the psycho;ogm to fe:ease or dlsctosathereporttoyou oranythlyd party- You spec)ficatly waive any and aLl etau,tory r fights to access and review pe rs orrat has Lth care or airy othe r i nformation a s it pertain s WINS ex8rr[ir16LiOn,it any,whethef arising under state or federal statutory,regulatory or common law.Including but not Limited to, the Health Insurance Portability4&nd,4ocountability Acr of 19%,the Texas Labor Code,and the Texas Code oT Regulation,artd therefore have NE)rights to access of taVlew the notes,reports,tests,anaLyae s or other informa tion generated in connection smith this evaluation of your au RabtTityfor emproywent.Evan i r some of the inrormation contained or produced in this assessment might Otherwise be accessibletayautftisiMormationieinextricabty intermvavenwith otttierconridentiat data to which you otherwise would not be-entitled. Therefara,you agree W eWnerata,release,and discharge psyc9ralogistarid the hi i irvw agency,its officers,ageatts,or assigns,f rom a[ry claim Or damages,whether in Lewor in equity,on bahalf of yourself,your heirs,agents,or assigns,for their rehiialtosnake availatmte shy and au infryrrYiatiari con[ainad in this sacs[-offer psyehaylog gal avaluatiorl other than the Tinai de[arminawn�Le-, quaLiriedor unquali ed)- -----------------------------------------------------------------------------------------------------------------------------------_. } P*mml for Sormims The hiring agency is compen ssting the psychologistfor serAce.However,the psycholoostwill ramaln objective and neutral_Ps such,the payehologis[will have sole Corrtr4l over iha examina[ibn and their ras:ultingopi pions,tonctusions,and retommer.dat;ons. PoleoGai Wcorue and Uses of the Examinahm Results Asa resuttor this exami nation,tl*psyuhoingis[may oOrrtlsrrd8 that you are{1}payrthologiealLy qualified for this position,or[2} payehologically unquiatifiedfor Chia position.The hiring agency hasdetermined the standards and degree of suitabiLity'iteequ[ras for qualification-RegartMess ai theconclusions the psychologist reaches and communicates in their report,[he hiring agency may choose not to laLy on their findings and recommendations,In whole or In part,when deciding on your status.A ternativaly,the htting agency may rely entireLy on their report.Th us,depending on their ultimate cone W slona and recommendationa concerning your sultabdity,and depending on the hiring agency s;consideration of their conclusions and racom mer Ida Lions,the rasults ofthis examination may have a significant impee[on you-,�and id". Tha pspthorogf st's opinfon toncarrtMg your psych odogitdt gvalffiCatlon or mW imbiJity far this position is NOT&statom*nt or opinion abo Lit your generef psyohotogiref hea rth or amotfanaf staWdry,nor is it a staa[ar"not about pour suitabr'lJ[y far this position with.2 d fl OAW fancy nr for�differentposirion WItn I"some.2genCy,iRZther,Of fs.2 SUfoment onlyabou[Uta degfee to which[ha furl range ofassassman[information avadrabre to them provides evidance atMis[ima of the psychotogicar traors and tarnpetancies requirad for the poshdon. ................................................................................................... > RepdingYaur Freedom to Be**to NrWpah You are free to dcc line panic)psion In this examination-However,your decision not to participate in the examination wlLI result in the revocation of the hiring agency's conditional.offer of ernpLoyment. - --------------------- ---------------------------------------------------------------- ------------------------------------------ FVar m Date This authadLellon maybe revoked at any time,except when action has teen taken In ralianca on this authorlmHon.Unless revoked earlier,this aulh orimribn witL expire one year from the date of signingor*41,remain In affee[for the period rtasonably needed to compfata Eris ae3essment- i,�� lt1g�1��1X� }}) ititttiiisis• m4,* �.'� .`r S@�� EXHIBIT K: Post-Offer Psychological Evaluation: Disclosure and Informed Consent POST-OFFERPS'YCHOLOGICAL EVALUATION- FRONTza. LIME DI CLOSUREAND INFORMED C016trd MOBILE HEALTH > RediWewre The peyChologFstwilladvisetha hiring ageneytoMainitin thewritten report in aconfidentiat rttedical Tile separate[rom other personnel Inrormetlon and that the information should tic made available only to a pemon(s)who have a bona tide need to loiKyrr the information included in the sport_ NewerNYeless,by signi rid the autiuuizatlon attached hereto as ExhIINt A(Authorization to Use and disclose Protected HeaUh Ilmorlmdon)and autho"the psych otoglat to release this information to the hiring agency,there is the possibility that the hirine agency could retlisclose this nafarmatlon.By aIgning the authorization you will expressly releMe psycttoingistIrorn any Uahiltty for the dlsclasure- -------------------------------------------------------------------------------------------------------------------------------------- > emetic k1fol 1 atio. Tha Genetic Information f l0rrdiaGriryfinetloA Oct Of 2MB{GINAJ prohibits employers end other antities cowered bk GINA,Tint II,Tram requeetingOr requiring genetic irtformationOf anirltlividualaefamily memberofthe inclMdual,arrcept&aapecificaUy allowed by this Law-Te canksly oolth this taw,we are ash that you not provide any&4k4ic Information Men reaporrding to any request for medical information."Genetic information,'as defined by GINA,Includes an Individual'a fami ly medical.history,the results of an i ndividual's or farmiLy memtkr's genetic tests,the fact that an Ind viduaL cc an ledhridual'a family member sought or received genetic setvlces,an3d ganetic information Of a fetus carried by an individual Oran indididuat's family member Oran embryo lawfully held by an individual or familymember receivingasaistive raproduretiwe services- -------------------------------—------------ -------------------------------- PA Nrding andfur Phologlaphing during the Eaalualion You are NOT authorised or perntrttedto pho[nc;ipy,photupraph,reoordorcapture any portion ofthe evaluation,In VMole or In part, including but not limited to written tasting,pemonal history q uastionnaires,Oral,interviaw,arwtl conversations with trio psychologist, whether in-person or by telephone.Thia prohibition applies io all for me of necordirtg,whether digtal or analogue- Ely agreeing to proceed wiih this rumination,you agree tO accapt this prohibition and a rnr civil and+or criminateoneequances for violating it- [ORM AND SIGNAiUK OF AM Notes If you do not have adequate time to review this form,you do not understand It,or It you require additional time to consult with an attorney or other advisor,you may rescheduta this examination for a later ti me by checking the box below,initialing it,arrd immediately inforrningtha psychologjst or the administrativeassistant. --------------------------------------------------------------------------------------------------------------------------------------- I require addtlonal dme to eansutt Will rrV atom"or other h^hieI c dy Peau ttj Are addhiaral th-dV.)cansultwhl advisor.Iunderstandtrial INS rosy require resehaduGrtgmy your atlornayUrrnherarry r. exa-flvalan for a later dabs- 1 have t cad,understand,and agree to the terms of Me iltformed cottaent"ernerdarld waNwof myaccras Initial only if you N Not r6quite additional tirtre. rights.I Wrlotrequre addltlonaLtlmetoconautiwitlt my attorney or other advisor. --------------------------------------------------------------------------------------------------------------------------------------- Name Un}ad3 Sigwiture Taday's fate I'f saga uhnu a ;7fl nffrlmkfi38IdL"J7ftt :1:.c.�'.W 50.7l.C19139 EXHIBIT K: Post-Offer Psychological Evaluation: Disclosure and Informed Consent FRONT LIFE AUTHORIZATION TO i_ISEAND DISCLOSE PROTECTED HEALTH IHFCRMAITION M 0 H I L E H E A. L T H -=j[.L ucepaychil'Loglstt,0 Use and ditcL sotN_-ir1�ndInesandopInIons err-e-rlirr,2mypast.prese tit ortoLICpi.OkSLcrmenUlhesun or c:onditrb n,as well as their corchiskm.opinions,and racorrtMendatians as to my psychological quablicatlon and aWtaN ft for the pc si'rcri h-y,!applied rsr,tU the agencythMreferred il]e for¢his examination the►eln sit erieferred to ae the-hI"agency',.This aulfi,o xatlondoe9netauthorizeawyofmyPfi_orcirfrenkhealthcareptowidemtodiscLaaeperaonaLhealthcarerecbrrdstopaych6tftfntar my prospeelve empLoyerwlthout separsla andapedloc v tl"en aulh<v iLwdun.oxcopt wS petnvdtted by Law. MEKFALffALTH1N:3FJfTK1K You u7utirda1 tisikn-fin: mnimtartibecoilr'ed N.GALCM Wi TWA1ND f,OR RffffR4L1F0R� 'i cmLr—igUthcft5n�xb mffmubmkibecm&Eted J rrratlersfand tear wis psyi:Jaora"wm frlake a goad-farrll eflarr to resfrict fhe dJsailasure ofprJLvate Wdrmain'an to Me rrMnkntim necessary faaati;l the purposed!meexamination and to support theMridino,eanrMians.and recornmendati6ris.CZ09isfentm1htrayprorisians of stare and dedera t fa w,Junderstan d that the hi"agency wJJI be advised to mainra in a ny wntren report provided to iY by doe psycbologfs r in a c oni4dendaJ med ezI Me separate from odw pamonnef Mform adon and rhat Me Jn konatlilan sJaoufd be made zw2 Jabfa only to persauas who have a bnrta We need to k'naw doe inrarmarton fneroded in the report 1 have been k)f mmd that J»YJr not receiLe a copy ofthe wrJrten repnrt,nor F►lilr f be able to aufnonee Its release to-any otherpersort f r party.r specJJJileafJy waMe any sra[trtnry rl h[s ro aceess and review' personaf heofM Care ArarWmaton as Kpertaine to fhfs examinabl9n. 1 ac rkw wfedga dear the prsychologisf has no confro f over how rite hiring agancy"Bag the repartonoe it Facehres K.J u nders rand Mar tree Wormad on used or ftclased pursuant to tnfs autfrarJzarJarn may be TW ylact to redis6os we and no merger proreead under federal law_ J erpressly release psyebwogisf Rrom dabirOtiy For dear redisebwre-Ho wetaer,J also Juade'rsfand Mar federaf or state faw may fesWer nadfSdO sure of M-enr2l JaeaJd4 Anfbrma fi i7,'I and drugla fcon al dJagnoWs,tree tn}era[ar ref erraf rnfo f li7arJ on. ---------------------------------------------------------------------------------------------------------------------------------------- SIMATURE OF APPUMIT YOU do notneed toaignthla authortzatlbn.Hrowewer,your refllaaLwlLLnlcan lhattl'm reffuired peycholagicaleveLirationwillnnt take pLatb_Thi a will rBault I n tha with rnwal of the conditional.alfar 61 empLbymant. You may revoke this authorization In wrttlna m any tirrie.Uyou revoke yout authorisation,the Infomu®tlon dcsc tlbed atova may no longarhausedordiacto edforthepurpo sat diner hiedin this writtenauthorixaSiorl.Artyusaardlaeloauraal*cedymadewiChy6ur permission cannot be undone_ Ta reVbkeVtlR�,plcaac send a wtittelY notice.hlatJn�tJlatgbu arc rcv.lkYtpthla�,to: FrantUriv MabKoHealth,PLIC,130 Box 12e8,Granhury,TX 7$048 1 have read lhls authorizatlon end 1 underswnd it Unless revoked,this authoriziotJbn explrcaenc year from the date b.-Low. ---------------------------------------------------------------------------------------------------------------------------------------' Name(Pfinted) Sioature Today's Date r'0 Eac 2M lrm:ury TXMW l xrd Marty-WE"A orn c-M.W ]IcFU»a EXHIBIT U Fitness-for-Duty Psychological Evaluation: Disclosure and Informed Consent FITNESS FOR DUTY PSYCHOLOGICAL EVALUATION: FRONT LINE DISCLOSUREAND INFORMEDCONSENT MODI LE H EALT H Overview of EyaluaUon The agency that ref erred you h err for assessment(herdnefter re rerred to as-the depattment-)hag requested a F Itne as far duty Ewa Wadon (FFDE).A FFDE bs Jndlcated whenever there Isom objecthra and reasanshk basis for beLieAre that an employer,as a result arm psychoLaekaLconditionof intpalrrttent.(1)May unable toperWfflone or inoroaaeahttaL job itancbeoa or(21 poses adlrectthfeatto himlherst llor others- Dr.NAME OF PSYCHOLOGIST Fs a licensed psychodndkst(h-relnalter referred to as'psycn4Lo��t"}experienced In conducttrV such assessments and will perform the psychological evakiiation. The assessment.witl consist Of eta nd Ord ized written psychotogieal tenting,Sri Oral interView,and a review of collateral or third party i nforr'nS Lion meade avaitable by the department or by you.This may intriude medical arwlfof personnel records. -------------------------------------------------------------------------------------------------------------------------------------- } WitS 9f C8ffWeFWty AlthouO the deperanent lathe psychologiat's cllant,not you,the psyd)oLogiat navanhelass WE tee mindfuL of hLsfher duty'to conduct the evaLuation with fairness and objectivity.You specifically unde rst.and and agree that you are not receiving treatment Or rw&Lth care from the psyehotogist and that the psychologist does not Consider hi mrherself to be treating you. You understand that you are riot beir�gexamined for any purpose reLatingto your pe rsonat treatment or tO your;ersonalheaLth care. Seca use the psychologiettis cofKduc Ling this evaluation at the request of the department and for reasons having NAN%to do with Vastmeatt or health care,yau do HOT have doctor-patient Of psychotherapist-patient privilege In}rout communkatlons with hi"ar- Therefore.you understand and agree that anything you say w do during or in connection with the evaLuetfan Is andtlyd to d isclosure,if relevant to the evaluation.and may or will bed isciosad to others involved in the FFDE decision process who have a need to knOwit- The department requi ras a report of pertinent findings and conclusions,Including a determination or your fitness rot duty,follOWUV the completloitefthe assessment. The department may authorize Minoan of the records associated with this assessment,iricLud ing any written report,to any other quallfied profesaicmrd-Clrcumstances leading to such an auttwrizatlon may include a second opinion fitness-for-duty avaluation, disabilitycLaimrorothermedcalavaluation-State Law Stan rriay require diselosureof Otherwise confidentiatinformation for reasons associated with.but not limited to,risk,of child abuse.a threat of serious ham to yotnsall or others,or court order. Some or ell of the Information you provide may be used for psychologgng research concerning teat validation,recruitme nt,salection, and performance or public safety em ploye es-In the event Information from your a vaLustlon is used for research purposes,procedures wilt be put In place to beep ensure that your idanuly is not raveafad. ------------------------------------------------------------------------------------------------------— Repaliof Findings and Cafe ants FoLlowingtheCompletionoftheexaminstlonrthepsychologlstMI.gfvethedepartmentanorwandwrttten€eportofrelavantfindings and Conclusions relating to their Opinion aboutyour fitness fo r dutyr pursuant 10 the anteChed authorization.These reports are neta3eary to futnLlthe purpose for which you have been referred-The reports necessary wKeOntaln pr,vats infor motion,but the psyehok).gial will make a good-faith effort to restrictthediselo&ureof private infOrma[ionto the minimum necessarytosatisfythe purpose or the araminetlanand to Support Weimer finding,conctuaionsr and recommendations-It the 5rbding%conctusions,opinions,or recommendstione are challenged in anadjiuditsitineforum.the perychoLogist may make full disclosure of all ioformelon as may be rkecessaryor regtlired by law. FLU Esc M;rrtDmTf i !rOtr�I1HIr��rB LCprl MIMM 51tT5 MI EXHIBIT L: Fitness-for-Duty Psychological Evaluation: Disclosure and Informed Consent FITNESS FOR DLITY PSYCHOLOGICAL EVALUATI ON: FR O M T LINE DISCLOSUREAND 1RFORMEDCON ENT M 0131 LE H EALT H Wafter 4f Access tD ReW Blvd RIols & Th _,,T:srape.k uorlductedsoLelytoaidttiedepartmentindetarminingyourficnessfordury-Youwittnotbeprovidedatopy of aeny report the piychotogiat protridet the department canocerrdngyaurfltnest for duty.Because the deparvnenc is the ellent,yaw a uthoWation will HOT permit the psycho iO&M to raters se or dlacloas the report to you Ora fly third parry- You spec ilicatly we ive any and 8 Ll 9tatutoryr rights to access and review personal hea Lth c are ac any other information as it pertains to this aaarnineti an,if any,whether arising under state or fader aL statutory,regulatory or common taw,Including but.not limited to, the Health Insurance%nabilityand Aocountabitity Act of 19%.the Texas Labor Code,and the Texas Code of ReguLationa,and thera f ore have NO fights to Sc cesa of raV6e W the rfotea,raparts,tests,analyses of other IrTwma tlon gerwated in co nn action worth this evaluation of your suitability for empb3Vment.Even if name of the information contained or predueed in this assessment migtrt otherwise be aceessibtatoyouthisinfarmatidrtisinastricabty interwoven with etherconridentiat data to which you Otherwise would not be entitled. Tltetefofa,you agree to exonerala,f elea se,and discharge Paydtnlogi st and the department,Its officers,agents,at sssig-m%from any claim or damages,whether in Law OF in equity,on behalf Of .yturself,your he irs,agents,of assigns,for their refusalto Mak* aveitebta any and all information edriminad in this Frtness for Dr rty PsychoLcrgcaL Evaluation other than the final d8t8rntinat tan Ri.e-,fit for duty or unfit for duty}- -------------------------------------------------------------------------------------------------------------------------------------- > Prpmenl for Smicas The depa rtmant Is carnpansatirg the psychoto4lat for service.However,the Psychologist veil remain objective and neutral.As such,the psycho log at MLI have sotecontrat aver 1h0ex8mi natianand lNeir r8sulting api nuns,eonetuaiaons,and recommendations. Palenhad Nicufm and Uses of the Exaninfim Rests As a result or this exarni nation.the psyuhoWgisc may corrciu d8 that you 8r8{l}psychotogicatly fit for duty,or f2}psychologically unfit for duty-Tha departmant has determined the standards and dagrea of psychological fired m it requires for duty-Re g&rdLe ns of the carrdusion s the psychologist re aches and com n'sunicat8 s in their report,the de p8rtment mayc house not to re ly on their nlndirtps and recommersdahonft,In whNa or in part,when deciding on your status.Alternatively.the department may rely entirely on otait repon-Thue,daWdingon their uLtinmaconduslons and rxomrixgdstionsconcerNngyomVness for duty,anddepending on the daps rtment's consid era tlon of their COncluaians and raeon}mendatlons,the resuLts afthisexaminadon may have a slgnifrcant impact on your status- 7ftapsythofogfst'sopiniancanternin�ryo-urpsyofrolagiee {ar8ssforducyisHOTastaremmntoropfnfonaboucyour generalpsythafogtalhsalrh or emozh3nffr-%t&b fly,front its stater►rent abouryourfirotass FordutyMM a dFfarernf agency or fOfa diffarrui!peTsftrbr7 Mdth the szma agsncy.Rather,itris a Statement aftyabout Wedagfee to which the Furl range of assessment;nformatfon avaiJabJa to them provides evkfonceae chit rirrte crape p.syehafogdt-arrraits and Carr7per6ncJ&l required for theposfiion. -----------------------------------------------------...----..........---...._...----.........----... RW(Iiing)rour Freedom to Uedirm to hr4apate You spa free to decline participation to this aramination. ----------------------------------- -- -------------------- ) [*M ion 011re This authafizat;on may be revcriced au arty tone,ekcept w4trn action has bean taken In ral.4aike an this authorization.Uniess revoked earlier,thin authorization wffi&xpire one year from the date of signing-or witi.remain in affeet for the period reasonably needed to cemptare this hmaa+.rmertt- 9 m8nim mb"U7n Txrdtiem:okt--A&xm "` Et3$ 512 T5.-JO9 EXHIBIT L: Fitness-for-Duty Psychological Evaluation: Disclosure and Informed Consent FITNESS FOR DIRTY PSYCHOLOGICAL EVALUATION: FRONT LINE DISCLOSUREAND INFORMED CONSENT r49 0 b I L E H E A L T H Redisdosure .he psyx:;Iuk gi 9I will a uu::1 idc;'Li:]S:-1C J,:,jt I.is_spur a re from Other personnel Information and that the information should be made evallable ontyto a persons]who haves bona f lda need to know the information included in the report- Nevertheless,by Mgni rid the authorizatlan attached hereto asEirhi bit A(Authorization to Use and disclose Protected Health Information)and authoWlift thepsy`hologiatto release this information to thedepartment,there Is the possiblllty thatthe department could redisclose this infornlatlan.By signing the authorization you will atrpresaly,release psychologist from any liability for the disclosure. -------------------------------------------------------------------------------------------------------------------------------------- } GA ic kiformaition The Genetic Information Nondiscrimination Act of 2DD13{GINA}prohibits emptoyers and other entities covered by GINA,TitLe II,from requestingor requiring genetic Information of an indlviduaLor TamiLy member of the i nd'evidual,except as epee irrcatly aLlowed by this Law-TocomplywdththisLaw,weereasIdiV that you not prffvkJe any Information wMenfesponding to mViegunt for medical. information.-Genetic information,-as defined byGINA,irr tudasanindividuaUa;familymedit-.aLItistory,the resultsofaniodividual's or family member's genetic tests,the fact that an UrdlvidusL or an Indivldual.'a family member sought or received genetic senrlces,and gametic inlor ration of a fetus carried by an individual Ora n individus I'a ramily mernber Oran ambryo Lawfully held by an individual OF ramilyrne^fiber receiving ass is tive reproductive services. .............................................................................................. Rem ding aridior Pholvglaphing During We brAaGdo You are NOT authorized or permutedto photocopy,photograph,record or capture any portlryn of the eveluaticm,In whale or In part, including but not limited to written testin&persaneLhistory questi©nneires,areL interYiew,and conversations with the payrchologist, whether in-person or by telephone.This prohibition applies to all.forms of recording,whether digital or analogue. By egr&aing to proceed with this examination,you agree to accept this prohibition and any civil andlor crimirialconaequancee for vioLatingit- CORM AND SIGNATURT OF APPIM Mete:Iryou do not have adequatetlme to review this Form,you do not understand It,or a you require additional.I]me to consuLtv.ith an anorney or other advisor,you may reschedule Lhis exerni nation for a Later ti me by cheekirtg the box below,i nitialing iL,sobd immedisrely inrorm ingthe psychologist or the administrative assistant. ........................._....----........----...--------.........---...----..._....---.........---•-•---------...-----•---••----•---- I raqulre additional time to consult with my erLorney or ether Ir hie only If you require&ddltioraal timid to emai trhtllt advbor-I understand that this may requke rescheduling my your adomeyor atlteradritar- exer ilnd6on I&a later dale. I have read,understand,and agree to the terms oT the InTermed consent staterrtent and wd rroTrrryacce s Initial.ordyif you NNoirequireadditionaltirtre_ rlorts.I do not require addltionaLtimctoconsvtt with mlr attorney or other advisor. Name rhmtO sumbre To 's Date PO Eac OM rnourrTV.30M `Anerrra-idtrdtltmP TLMM 512,9752M EXHIBIT L: Fitness-for-Duty Psychological Evaluation: Disclosure and Informed Consent FRONT LIFE AUTHORIZATION TO USE MD DISCLOSE PROTECTED HEALTH INFORMATION MOBI LE H E A. L T H laud:uuzepsyeh~st tin uananddiscLasetheirllndIngsandopInlonsconcerningmy past.present orruturephysksLarmantalhealth or condition,as weLL as titdr concLuslions,opinions,and recommendations as to my psyc hological 1ltrrss for duty,to the agency that rere ri-L d ne forth is examination(hereinafter referred to as t he'departm ant").This stMO Mza 1landxs not a ulhairize ally of any prier Mawent tact tth c are provltl cl't to dldGkaSe prroArML he Bath Gate f abbe tla t a psyeitolraglat or my pt WL--U we employe r without ae part to tntl SpcG Ifrc writteh autho rizertlo n,cxoc pt a s permitte d try 18w. MMALFEXHUfOfNTO Youlur irnaltA—ri-rte--uminatarbbewiiu ed [lF�'�LC�LOA(�6k�1F€AiAB1f,OR4L�IRlf�i�11�11 'ialmlovilrtialttieit�(rthea�llil�m�6elalt�d Jrendersrand[fearrho affarrto restrict thedJeclesuraofprJvatoJ%bnrnaUon[aOrenWnkn rnnecessary tosatfsfy the pwpaseOfMeex2miinatAw and to gappor[Mis Ondfn eorretueians,andretxsmrnarrdatfana.CapeMavatwrth thepuuv)s� ofeta[ear?drederaflaw,fvndeMandarse[the depa#men["fbaadvisedramafntafnanywrartannspartpf0Vk% srofrbydrap&WWro&tin a conWengaJ mecVcaJ JFJe separate from ul7aer persanner rnf0rmarJan aM that[fie JrrfOM?aMfon sJiward be m26e avafJ2bra only to-parsarm wft0 hone a ba1a Ode mead to know 0Me fr"nria[ion intruded fn Cie report l have treen 0Fanred[natJvMr not receNe a copy oFthe w Man fe part,r"wig f tee able ro au[h0rf¢e ill release to any 0merpers0n ar party.f spe6ftarJy wa"any statutory rigfife ro aocess and nsWaw persona)heal[Yl care rr}JtNmaGan as rt'pertaine to this aXaminai50n. l aekr?OH4et7J,+e Nor the psycJaolay+Js[)pas n0 00rarro!aver haw Vie departr»er�r uses[he repart0rrce rT reeeJlrts rl•.f watleratand Nar the Mformabon used or diwJosed pursuant ray this aUrhonza rk o maybe sub ecr m redise7 osare and no Jangerpuorected under Federal Jaw lexpressly releasepsycheogAst from d2bAy for NarraWscroswe-Howev1er,JaJsotrrxiemf v?dNarfederalorsratofawmayresWer redf dasureafinenralheaJNJnlormabananddrug/bfc0hakdl2gnOWs,rreatmt-nreureFlerrafrnfbrmarJon. •----...---••----...----••----...----•----...-----••......................................................••-----...---••----...----••-- SIGNAlURE OF APPLICANT You do not need to align this authorization.Hawetier,your refusal wILL mean that the required psycholo&-&L evalustion wiLl not take plfita- You may revoke this authorization in wrltingat anytime.If you revoke your authorization,the Information described above may nor Langer be used or dispelosed for the purpo sas described in this written a urhoritaliorl.Arty use or discLU3ure already 1118de.wiry•your permi93i0r`tanrY2t be undOna. To revokethlaarM AWIM please Send a wrtten notice,atttingthaityou are rev6ltlngttW8MMarlra0fin,to: Front Line MibbiLe Haalth,PLLC,134 Odic 1208,Granbury,TX 76048 1 have read ihi t a uthurizr tJon find I uhdc hmhhd it Unless revoked,this authoHzatlo n explraR orte year f ra rn the date be Lbw. --------------------------------------------------------------------------------------------------------------------------------------• Name(Printed) Sigature Teday's Date EXHIBIT M: Promotional Psychological Evaluation: Disclosure and Informed Consent frontlinemobilehealth.com 53 PROMOTIONAL PSYCHOLOGICAL EVALUATION: FR 0 N T A LINE DISCLOSURE AND INFORMED CONSENT 1,4061LE HEALTH Overview of Evaluation Tlr i,-r ,V,a'r rf cr red you hefe for assessment(heranafter reletred toss-the department-)has requested a Pfomot►onst Psychotogkat 1 valuation. The goal of the PromoMnat Psychotogic ei I vatuation is to ensure that the department is promoting individuals who are the best fit for the position. Dr.NAME OF PSYCHOLOGIST is a licensed psychologist(hereinafter referred to as'psychotogiat7 experienced in conducting such assessments and vnll perform the psychological evaluation. The assessment will consist of standardized written psychological testing and an oral interview. > Imhof cmdWentiaro Although the department Is the psychologist's client,not you,the psychologist nevertheless wiu be mindlut of his/her duty to conduct the evaluation with fairness and objectivity.You specifically understand and agree that you are not receiving treatment or health care from the psychologist and that the psychologist does not consider hi mRiersetf to be treating you. You understand that you are not being examined for any purpose retating to your personal treatment or to your personal healthcare. Because the psychologist is conducting this evaluation at the request of the department and for reasons having nothing to fie with treatment or health care,you do NOT have doctor patient of psychotherapist patient privilege in your communications with hm/her. Therefore,you understand and agree that anything you say or do during or in connection with the evaluation is ontotted to disclosure,if relevant to the evaluation.and mayor witl be disclosed to others involved in the selection process who have a need to know it.The department requires a report Of pertnem findings and conclusions,including a determination of your suitability for this position, following the completion of the assessment. The department may authorize release of the records associated with this assessment,including any written report,to any other qualified prolessionaL Circumstances leading to such an authorization may include a mandatory fitness for duty evaluation,disabiiry claim,of other medreat evaluation.State taw also may require disclosure of otherwise confidential information for reasons associated with,but not URNted to,risk of chid abuse.a threat Of serious harm t0 yourself or Others,or court Order. Some or all of the information you provide may be used for psychological research concerning test validation,recruitment,selection, and performance of public safety employees.In the event nfofinetwn from your evaluation is used for research purposes.procedures will be put in place to help ensure that your identity is not revealed. Report of Findings and Conclusions i ol.owrng the c orrip,etion of the examination,the psychologist will give the department an oral and written report of relevant findings and conclusions relating to their opinion about your suitability for this position,pur suant to the attached authorization.These reports are necessary to fulfill the purpose lot which you have been referred.The reports necessary will contain private information,but the psychologist will make a good-faith effort to restr ict the disclosure of or ivate.nformation to the m,nimum necessary to satisfy the purpose of the examination and to support his/her findings.conclusions,and recommendations.If the find rigs,conclusions,opinions, or recommendations are challenged in an ad udicative forum,the psychologist may make full disclosure of all information as may be necessary or required by law. Waiver of Access to Repot and Records This assessment is conducted solely to aid the department indeterritiningyour qualification for promotion.You will not be provided a eopyof any report the peyohotoglat provides the department coneeminCyour sullabnity.Because the department is the client,your authorization will NOT porrrrt the psychologist to release or disclose the report to you or any third party. You spec ifk ally watvo any and all statutory rights to access and review personal health care or any other information as it pertains to this examination.it any.whether ansine under state or federal statutory,regulatory or common law,including but not limited to, the Health Insurance Portability and Accountability Act of 1996.the Texas Labor Code,and the Texas Code of Regulations,and therefore have NO fights to sc cess of rovicw the notes.reports,tests,analyses of other information generated in cormec tion with p 110110 a0rlr,gDOXW >>> r.r..�wef■ s»eaeoe s�9 D) frontlinemobilehealth.com 54 EXHIBIT M: Promotional Psychological Evaluation: Disclosure and Informed Consent frontlinemobilehealth.com 55 PROMOTIONAL PSYCHOLOGICAL EVALUATION: FRONT LINE DISCLOSURE AND INFORMED CONSENT M 0 B I L E H E A L T H this evatuatlon of your suitability for promotion.Even it some of the information contained or produced in this assessment might otherwise be accessible to you,this information is inextricably interwoven with other confidential data to which you otherwise would not be entitled. Therefore,you agree to exonerate,release,and drscharge psychologist and the department,its officers,agents,or assigns,from any claim or damages,whether in law or in equity,on behalf of yourself,your heirs,agents,or assigns,for their refusal to make available"and aft information contained in this post-offer psychological evaluation other than the linat determination(i.e., recommended or not recommended). Payment fot Services The ocpanmerit is compensating the psychologist for service.However.the psychologist wC reman objective and neutral.As such,the psychologist wit have sole cone,ol o•.rr the exam nation and their resulting opinions,conclusions.and recommendations. Potential Outcome and Uses of the Examination Resuits As a result of this examination.the psychologist may conclude that you are(t)below average.(2)tow average.(3)~op.(a) above average,or(5)superior in five separate categories of style of character,style of interaction,thinking ability,personality. and risk.The department has determined the standards and degree of suitability it requires for qualification.As"dlasa of the conclusions ter psychologist reaches and communicates in their report.the department may choose not to rely on their findings and recommendations.in wttote or in part,when deciding on your promotion status.AllematNoty.the department may rely entirely on thew report.Thus,depmdng on their ultimate conclusions and recommendations concerning your suitabtity.and depending on the department's consideration of their conclusions and recommendations.the results of this examination may have a significant impact on your candidacy for promotion. The psychologist's opinion concerning your psychological qualfication or suitability for this position is NOT a statement or opinion about your general psychological health or emotional stability,nor is it a statement about your suitability for this position with a different agency or for a different position with the same agency.Rather,It is a statement only about the degree to which the full range ofassessment information available to them provides evidence at this time of the psychological traits and competencies required for the position. Regarding Your freedom to Decine to Paftpate you arc rr,- �.-,1,ne panicrpat.on in this examination.(however,your decision not to participate in the evaluation may impact your prontobora.-tatus. > fi **u Date This authoniabon may be revoked at any time,except when action has been taken In reliance on this authorization.Unless revoked earlier,this authorization will expire after the promotional process has expired. Redisclosure The psychologist will advise the department to maintain the written report in a confidential medical file separate from other personnel information and that the information should be made available only to a person(s)who have a bona ride need to know the information ncluded in the report. `r_venhetess,by suthwilation attached hereto as l xhrbit A(Authorization to Use and Disclose Protected Health Information)and authorizing the psychologist to release this information to the department.there Is the possibibty that the department P00111[ cksa6tsTflf M tiaiViYailaw 512836M 5129)9m frontlinemobilehealth.com 56 EXHIBIT M: Promotional Psychological Evaluation: Disclosure and Informed Consent PROMOTIONAL PSYCHOLOGICAL EVALUATION: FR 0 N T A LINE DISCLOSURE AND INFORMED CONSENT 140611E HEATH could rediscto"this information in circumstances such as a mandatory fitness fa duty evaluation,dlsablUty claim,or other medical evaluation. State law may also require disclostRe of otherwise confidential information for reasons associated vAh,but not United to, risk of child abuse,a threat of senous harm to yoursett ot others,a court order. By signing the authorization you writ expressly release psychologist from any liability for the disclosure. > Gene(c Information The Genetic Information Nondisc rirrrnation Act of 2008(GIN/)proN bits employers and other entities covered by GINA,Title Il,from requesting or requiring genetic i nfor ms tion of an individual or family member of the i ndividuat,except as spec ifically allowed try this Low.To comply with this law,we sic asking that you not provide any genetic information when responding to any request for medical information."Genetic information,'as defined by GINA.includes an individual's family medical history,the results of an individual's or family member's genetic tests,the fact that an individual of an indrvldual's family member sought or recerved genetic services,and genetic information We fetus carried by an rndividusl or an individual's family member or en embryo tawfulty held by an individual or family me^iber receivng assistive reproductive services Rfleotdlag and/or Photographing During the Evaluation You ste NOT u_r orized or pew tted to a_, _;,., _.__f dph.record or capture any portion of the evaluation,In whole or in part. including but not timited to wi rtten testing,personal history questionnaires.Oral interview,and conversations with the psychologist, whether in-person or by telephone.This prohibition applies to all for ins of recording,whether digital or analogue. Sy agreeing to proceed with this examination,you agree to accept this prohibition and any civil arxVor cr,mir at consequences for vioisting it. CWff ff AM SIGNATURE OF WMCANT Note:If you do not have adequate time to review this form,you do rot understand It,or$you require additional brae to consult with an attorney or other advisor,you may reschedule this examination for sister time by checking the box below,initiating it,and immediately informing the psychologist or the administrative assistant. ..............................................................................._.........................._.........................._.. I requie adddmsl time tc ec"ut wtf•.my st1wr,"or:far i:Kial only If you require additional UrnebconsiA*0 adeYa.I Lvdefflard that W n risy•eyu rs rev.h k. rry your adorr»y or other adw110r. aeartiYwiori b a law data. I thaws road.underatand,and agree to the terms of the hbrmed consent ststexne nt and waiver of my access In"I only d you Do Not ragre addA anal ter. rttxs.I do not requre additional tine to consult with my attorney or other advisor. Nye pi" Signature Today's Date FOEm_N8 irCmTX7GW tydnanxWw 1L= 5t223LM 507SM frontlinemobilehealth.com 57 EXHIBIT M: Promotional Psychological Evaluation: Disclosure and Informed Consent FRONT ► LINE AUTHORIZATION TO USE AND DISCLOSE PROTECTED HEALTH INFORMATION MOBILE HEALTH euthrcrizc pyrchololgiat.0 use and disciose th n it fl ndinga auto opinkxta cancemYng my past,preaent or future phyeica condition,as well as theircoru.Auaiores-opiniorls,andrecemmerf estortrypsychological qua Hileatlonendmii.- to the agency that referred me for this eta vl oa tii n 1hercrn after refereed to as the'department"f.71tis atrrllortrr tlian lore rvat tiutHoriec tiny of"p"oral rrentheadh care provides to disclose peraanal health care rtwordat0 paycholoostor my prarpaGUmemplrtyerwlthotrt sep w ate and apcc111c wrlFhenautttarlratlan,except as permitted by law. MMALtFALMIHF7Po4 TO Yeunitirnal�li�ltrl-f$8'AIrR UfItObECOII(iILfE� UfWALI7M DdGlMTIFATMM,GR LiWtT Vt4TM You m t uiW tlis i n tx tfw etaf ni tlon to�e andEbd 1understandchar Via psyctaotaVatwAimakeagow—rairhef r[o restrict madrsedasUreofprJvareh?Wmabantoriserrlfn,Vrturrinacea� tb aati8fy the pufpdse Or the examMaVan and to sutrpon the findings.c aricMims,and reo®mrma ndat✓dns.CiMiSfeht WAM the prt7rd"WM ofstate and irederaf Lrrw,.lunderstand that the deportment"file advised ra maintain any wrhran report prcMded to It by the psyehofogmt fn a conWendal medJcal hie separate from Ocher pefsonnef inform atron and drat the Jnformahbn shoufd be mane availabfe on ry to pamom who have a Lana 6d a need to know the inlarma[ion incfuded in the report i have been Jnfarmed[hat r wkf not rece+re a copy of the xrhren repsrt,rox PwM f be abfe to au[horfia its rs2ease tb any obherperson df party.f speeirCafiy waive any sfatutbry rtLri[s to access and review parsonaJ health care information as itperbins to this axaminatfan. i ack oowWL+a Char tha psychedogAst has no oantral aver how the dapartmmr uses[he reportWCa it recehea it.i understand Char the mforma r7on used or diselasad pvrsuani rO this a uthoWa-Pon maybe sub ecr to redfeebosurs and no Jongei pvorected under federa2law. i axpres sty re!ease psyrhalogis[from tiab)(My for Mat reoFsefbswe-However.J also un CJers[a4d U7ar federal ar s rate few may rasrrirt redisctoswe ar n:e^r.a i!:+aalrh 1nfafmaG'on and drrrgJafcO f or dlagno&M,oreatmeor or refen'a f;nformarion. ---------------------------------------------------------------------------------------------------------------------------------------- SIGNATURE OFAPPLJM You da not nerd ttt sign thla autharlxatlen.HeweVmr,your refusaLwlLLmean that the required paycho'Lat"Levalust➢en wlLLnot take place-This will result In the withd rawatfrem the promotion consideration process. You may revoke this;autPorization in writing atanytYne.If you revoke your aulhon26!ibr,the Information descilbed abowemay no Longer be used or discloaed for the purposes described in this written a uthoriaatiurs.Ovey useOr diseLOsure already msdewith yrrur Permission cannot be undone- To revoke this authariudon,please send a Wrrltcr5 fYMlee,atetirtgthatyou arc retroltYtg title atMhoAratloq,to: Frontline MobiLc Health,PLLC,PO Box 1268,Granbury,TX 760M 1 have read this authorization and 1 understand it.Unless revoked,this auU oriuttlan expires one year from the date beLfmrr. --------------------------------------------------------------------------------------------------------------------------------------- Name(Printed) Sigature Today's Date POBa12%ym_ure W W i-Anernx-llhA& m r_mW 51ZP`i Jf frontlinemobilehealth.com 58 EXHIBIT N: Special Tactics Team Selection Psychological Evaluation: Disclosure and Informed Consent SPECIAL TACTICS TEAM SELECTION EVALUATION: FRONT IM LINE DISCLOSURE AND INFORMED CONSENT _ M 0 B 1 L E HEALTH Ovemew of Evalwhon The agency that referred you here for assessment(hereinafter referred to as'the department-)has requested a Special Tactics Team Setecton Psychological lvalusbon. The goal of the Special Tactics Team Selection Psyc hotogk al l valuation is to ensure that the department is promoting Individuals who are the best fit lot the position. Dr.NAME OF PSYCHOLOGIST is a licensed psychologlst (hereinafter referred to as'paychologgt-)experienced in conducting such assessments and VA perform the psychological evaluation. The assessment will consist of standardized written psychological testing and an oral interview. Lints of Confidentiality Altho�rh It,dcpannior,t is the psyc hologisYs client.not you.the psychologst nevertheless wkl be mindful of his/her duty to conduct the evaluation with fairness and objectivity.You specifically understand and agree that you are not receiving treatment or health ears from the psychologist and that the psychologist does not consider hrmfierself to be treating you. You understand that you are not being examined for any purpose relating to your personal treatment or to your personal health cafe. Because the psychologist is conduc ting this evaluation at the request of the department and lot reasons hating nothing to do wfth treatment or health care,you do NOT have doctor patient or psychotherapist patient privilege in your comnvinkstions with himther. Therefore,you understand and agree that anything you say or do during or in connection vvllh the evaluation Is entitled to disclosure,if relevant to the evaluation,and mayor will be disclosed to others involved in the selection process who have a rued to know it.The department requires a report of pertinent findings and conclusions,including a determination of your suitability for this position. following the completion of the assessment. The department may authorize release of the records associstedwith this assessment,including arty written report,to any other qualified professional.Circumstances teednig to such an authorization may include a mandatory fitness lot duty evaluation,drsabinty claim,or other medical evaluation.State taw also may require disclosure of otherwise confidential information for reasons associated wfth,but not United to,risk of chid abuse.a threat of serlous harm to youtself or others,or court order. Sonic or ell of the information you provide may be used for psychologycal research concerning test validation,recruitment,selection, and performance of public safety employees.In the event information from your evaluation is used for research purposes,procedures will be,pea in plsc_r to to:p enswe that your identity is not revealed. Repot of Findings and Candusions I o.., %:.,. . _ trun of the examltetion,the psychologist will give the department an orat and written report of relevant findings and conclusions rotating to their opinion aboutyour suitabilityfot selection to the special tactics team,pursuant to the attached authorization.These reports are necessary to fulfillthe purpose for which you have been referred.The reports necessary will contain private information,but the psychologist will make a good-faith effort to restrict the disclosure of private information to the minimum necessary to satisfy the purpose of the examination and to support his/her findings,conclusions,and recommendations.It the findings.conclusions,opinions,or recommendations are challenged in an adjudicatNe forum,the psychologist may make full disclosure of all information as may be necessary or required try law. Waiver of Access to Report and Records Th s assessment is cunducted sutety to a the department.n determining your quatilcation for selection to the special tactics team.You wIU not be provided a copy of any report the psychologbt provides the department concerning your sultabftity. Because the department is the client,your authorization will NOT permit the psychologist to release or disclose the report to you or any third party. You spec ific ally verve any and all statutory rights to access and review personal health care or any other information as it pertains to this examination.it any,whether ansine under state of federal statutory,regulatory or common taw.Including but not United to, the Health Insurance portability and Accountability Act of 1996.the Texas Labor Code.and the Texas Code of Regulation*,and therefore have 140 rights to access or review the notes,reports,tests,analyses or other information generated in connection with Po Bat t26H CtNbe TX'im W Iaimlridobw 5t2%3 X6 5123MM frontlinemobilehealth.com 59 EXHIBIT N: Special Tactics Team Selection Psychological Evaluation: Disclosure and Informed Consent SPECIALTACTICS TEAM SELECTIONEVALUATION: FRONT LINE DISCLOSURE AND INFORMED CONSENT MOBILE H EALT H (his eva9uatlOn Of y6ur au itSbility(Of promotion.Even iT9a ma of the IATotffiS VOn t6h 1a in ed Or produced i n this assessment might otherwise be accessibla Lo you.this ievrormation is ine,dr®cabily in ierwovan with aiher confidential Bete to which you Otherwise would not ba entitLed. TJLetefora,you agree biaexorfcfata,release.anddJscharga psychologist and the depanment,its orncere,agents,of sasigns,from any ctaiert or damage%whether in Law or in equity,on behalf ofyourseli,your heirs,agents,Or assigns,for thair refusatLo make awe itabla any and atr infomtatlon contained in this SpeciaL Tactics Team Rsychatagiea[Evaluation other than the Tinal detarrnination(Le.,recommended or not recommended). --------------------------------------------------------------------------------------------------------- } Papmeltt for Setviles The AepBflhtant IS cOrrrpensatin�the psychat%lat fat seMce.r bwmvar,the p"chb63j!lat vriLl rem-ain objective and newtral..As such,the psychoiogist will have sole can trot overt haexaminatian and their rasuLting opinions,conclusions,arts recommendations- ........... ........ ..............__.....---...............-----.............. ........... ? PoteltGal Utitmome and Uses of the Fxaminafian Rlistdts As a resutt of thie examination,the psychologist rosy conclude that you are r1}below avaraga,(2)low average,(3)average,(A} abave.averaga,or(5)superior in rive separate categories Of style or char attar,style or interaction,thinking abiLi(y,pemonaLity, and risk.Tha department hastletermined The Standards and degree of suitability it requires for quaLiflcaiian.Regard Less of the conclusions the psy+c hologist reachea and commu ni0ate9lh thair reoOrl,Lha dapa nmanl may Ohaosa rWt to rely an their findings and,racommendatkans,in whole cc in part,when deckling on your selection Sulu a.Alternatively,the department may rely entirety Orr their report_Thus,depennd&V On their ultYtrata conclusions and recommendations concamIng your sultsbiAlty,and depending on the department's consideration of their oonclusions and recammendatiorm the reeulm or this examination may have a significant impact on your carrdidacyr for promotion. The prythalogis isopinion-torrcerrtlrrg your psycho iogivaL gvatrFieeeran or suirobHiry far this position Js NO7a stafement or npJnlan abeuf yorrrgeneraT psyehotogicar hearth or arrrationdf stability,row is it a sratamant about your t"heabh1hy far thiaposrrlon wPth a drrrarentagancy-or fat adifrerantposlf0on wrath IhasaMeagency.R:nther,if is a Vzfament only about the degree rb which the full rangeofa"a39ntentinformari3naraAsbte to rhentprovrcres evidenca at this Irma ofthe psychniugical trahs and cumpetenciea required for the pasiriaro. ------------------------- --------- - > RepAngrour Freedom to Dwkw to Participate You are free to decline pen c4swtlan in this examhatlon_However,your decieIon not to participate in the evaluation may im pact your setection status. ------------------------------------------------------------------------------ -------------------------- ---------------------------- } N Date This authorization may be revoked st any time,except when action has bean taken In ralia:nce On this authwitetion.Unless revoked esdier,this authorization will.axpireafter the setaction peaces&has expired- --------------------------------- ----------------------------------------------------------------------------------------- RedWlusure The psyeWlogi 81 will advise the deps rlmant to mai ntai n the wr itten repOn in S.confidential medical Me separate from other peraonnal i rJormation and that the information should be made evalLable only to a pefson(s)who luvoL a irons fide need to know the information incLuded in the report_ —4-ve rttr_tress,by sientngr the authmizatlon Sttached hereto SS Elrhibit A(Authod2atibn to Use aM Disc lose protected Health rnTormationl and authorlring the psychcL_•,.-,11_rein ssathi�in'urmatlan to the depaftment,there is the possiblUty that the depertment FOFmtIn r3nmrrT(.30M T3rr flwrokh-::llttmn T:—.mM 512975M frontlinemobilehealth.com 60 EXHIBIT N: Special Tactics Team Selection Psychological Evaluation: Disclosure and Informed Consent SPECIAL TACTICS TEAM SELECTION EVALUATION: FRO SIT »M LINE DISCLOSURE AND INFORNIED CONSENT 14 0 B I L L H L ALT H could redisc Lose this info(motion in circumstances such as a mardatury fitness for duty eva."bun.disauuty claret,or other rnctLcar (!valuation. State law may also require disclosure of othemse c onfrdential information for reasons associated with.but not limited tc. nsk of c hgd st>use,a throat of serous harm to yourself or others,or court order. By sienift Me suailwization you wal expressly release psycholoefst from arty Liability for the disclosure. G11iR 100"M The Genetic Information Nondiscrimination Act of 2008(GINA)prohibits employers and other entities covered by G1NA.Trite 11.from requesting or requiring genetic information of an individual or family member of the individual.except as spec ifically allowed by this Low.To comply with this law.we are asking that you not provide any genetic infotmatlon when respondne to any request lot medical information.'Genetic information,'as defined by GINA.includes an individuat's family medical history.the results of an,ndMduat's or family member's Qenetrc tests.the fact that an ndMdual or an indMduat's family member sought or fec ervcd eenetic services.end genetic information of a fetus carried by an indviduat or an ind v�dual's family member or an embryo lawfully held by an,individual or family member receiving assistive reproductive services. ) Recording and/or Mologiaphing Owing the Evaluation You are NOT authorized or pernutted to photocopy.photoeraph.record or capture any poroon of the evaluation.in whole or h part. including but not limited to written testing,personal history questionnaires.oral interview,and conversations with the psychologist. wfnether in-person or by telephone.This prohibition applies to all forms of recording.whether dig-tat or analogue. 8y agreeing to proceed with this examination.you agree to accept this prohibition and any civil arxVor criminal consequences for violating it. MNMfT AM SIGN IM OF APPLICANT Note:ff you do not have adequate bete to review this form.you do not understand It.or if you require additional lime to consult wftft on attorney or other advisor,you may reschedule this examination fore Later time by checking the box below,initiating it,and immediately informing the psychologist or the administrative assistant. ..............................................................................._........................................................ f require addtlonal tune to co nsu.t wth my att grey or otter Ir Halo.*If you require addRiWM the toconr/twith advisor.I understand that this may require res.!.1_. , your rrnwnw or oa w duper. examination for a Meer data I have read,understand.and se ve to the terms of th- orm hMed consent stater mint and waNer of rry access Initial only d you pro Not requis additional tine. retts.1 do not require addrtnonal time to consul vwh my attorney or other adlwr ........................................................................................................................................ Name(Punted) StUtature Today's Date Poem in613ftlraTiXMW 50975M frontlinemobilehealth.com 61 EXHIBIT N: Special Tactics Team Selection Psychological Evaluation: Disclosure and Informed Consent FRONTS LINE AUTHORIZATION TO USE AND DISCLOSE PROTECTEDHEALTH INFORMATION M o BILE HEALTH lauthrurizcpo-ycJtvLQjmL:vusrsndJrscLosatJxif findings;andopinlonsconcemWigmypaaypraaentorftaihrraphyEWcaLor man ISLheaLth or conditon,as ydt-LL as their corsclusfions,opinions,and recommendations a3a to my paychelagicsi gLtaulicatlan and mWtabinty for pro moaion, to the atenr=y that referred nle fur this ex..a m ination Ihereinafter referred to as the'department-).This auWWftffW n doeiffnatautharlxc any of my priorerwrtandifealthDarepreWtlersmdiscloseperaanaLhealthrarerecetdatapeydhalniestarmypreape t1weempLoyerwlthout separate and apecltic written autharizetion,exceptaa permitted by Law. i MAMAM IIFUMT13 You urst iniU Un item krthe aminatiar to be omhc!ed MM40RDlAtMWTffA3Ef,0Rl M0iM 'iaumLmintiaitisit5nixb=rAfftiabmio eccrwc6ed i waderstand thar Ma psychafa0st MR make a 00d-faWl effort to restrict the dJsobasure ofphilate AnJwmabarn to Use min MUM necesury to t2ft y the purpose Of the eAamMatlan and to evfrr,DM the fJndings,bane Luiffns.and recommendatians.Consisfent with Coe proWsians art stare antl redefaf bow,!understand that the departmenfwiJrbe odVsed ro maintain any warren fepoftprcwJded ro it by the psychofogist in aeon fiderrtlaJ rile W cad file s eparate from oche.!person nef fnformarJo n and rhaf the Jn formation Ocufd be frmfle av2dab re onrk to pefsans wire nave a bona We need to know the bnrarm anon incfuded in the reporL Mavis a4e been Anfbmred tnat r w8r not receive a c opy of the warren report,AN W&I f be abbe to authorfre its release to any otherpersari of party.f specti'Tnea0y wa&e any sratutafy NLMfs to awfts and review personal health care information as itpeftains to this axamfnabdn. l an krxawdedgS that the PeYCh Joy+Jst has no oonrroJ over how the departmenr uses the report once it recehe's it.J vn dem9and Oar the rtMarmadon used or disclosed pursuant to this authadza-rJon may be sub)ecr to redisebosrme and no Jangerprorected under federal Jaw. J expressty reJeasa psye=oy+Ast from da-N tMy Iof char redis cfraswe_However,J also urxiers[and Na r faders(or s t,to faw may rawrJer redbsdostue al menra,heaJ th Anrarma flan and drupfafcohab diagnosis,rreatmen r or referrof hiform arJon. ---------------------------------------------------------------------------------------------------------------------------------------- SIGNATURE OF APPIJCM You do hint need 16aigra this autharlutlan.However,your refueal*ILL Me an that the required psyohaLogir-alevaLuatlon WAR net take pLaaa_This will resaLt I n tha witted rawalfrom tha speciaL tactics team saLaction process. You may revoke IN s authorisation in writing at any tin7a.Ir you reVOke your authUr12e111on,the Inforniatien described strove may no longer be used or disclosed for the purpo sins dee;cr ibed in this written 9 uth6ri2atiort.prey useardiaeleaurealready madewithyour permieaiarl Ganrvot be andona. To rewekethlsateihoAeatlar4 pieasc send a written native,statingthat you are rcvaklrapthla adM6dratlal,lo: Front Line Mobile Health,PLLC,P4 Box 1268,Gran burp,TX 7904a have read thisauthoi-lu lohand1understanditUnlessrevoked,thisauthorizationexpitesoneyearfromthedatebeLow. ---------------------------------------------------------------------------------------------------------- Home(Printed) Wwture Today's Date frontlinemobilehealth.com 62 EXHIBIT 0: Requirements for Firefighters National Fire Protection Association standard titled"2025 NFPA 1580 Standard for Emergency Responder Occupational Health and Wellness"and"2022 NFPA 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments"are not incorporated by reference due to the size of the documents. However,these fifteen (15)Essential Job Tasks are included for reference and can be superseded by the Contracting Agency's job descriptions, if provided to Service Provider. 1. Wearing personal protective equipment(PPE)and self-contained breathing apparatus(SCBA)while performing firefighting tasks(e.g., hose line operations,extensive crawling, lifting and carrying heavy objects,ventilating roofs or walls using power or hand tools,forcible entry), rescue operations, and other emergency response actions under stressful conditions,including working in extremely hot or cold environments for prolonged time periods. 2. Wearing the respirators required bythe jurisdiction (e.g., N-95, half-face elastomeric, PAPR,SCBA),which includes a demand-valve-type positive-pressure facepiece or filter respirator,achieving a successful fit-test and tolerating increased respiratory workloads. 3. Exposure to toxic fumes, irritants, particulates, biological(i.e., infectious)and nonbiological hazards,or heated gases, despite the use of PPE and SCBA. 4. Climbing at least six flights of stairs or walking a similarly strenuous distance and incline in jurisdictions without tall buildings while wearing PPE and SCBA, commonly weighing 40-50 lb. (18-23 kg)and carrying equipment/tools weighing an additional20-40 lb.(9-18 kg). 5. Wearing PPE and SCBA that is encapsulating and insulated,which will result in significant fluid loss that frequently progresses to clinical dehydration and can elevate core temperature to levels exceeding 102.20F(390C). 6. Working alone while wearing PPE and respirators required by the jurisdiction,searching,finding,and rescue-dragging or carrying victims to safety in hazardous conditions and low visibility. 7. While wearing PPE and SCBA,advancing water-filled hose lines up to 1 3/4 in.(45 mm) in diameter from fire apparatus to occupancy[approximately 150 ft(50 m)],which can involve negotiating multiple flights of stairs, ladders,and other obstacles. 8. While wearing PPE and SCBA,climbing ladders,operating from heights,walking or crawling in the dark along narrow and uneven surfaces that might be wet or icy, and operating in proximity to electrical power lines or other hazards. 9. Unpredictable, prolonged periods of extreme physical exertion as required by emergency operations without benefit of a warm-up period,scheduled rest periods, meals, access to medication(s),or hydration. 10. Operating fire apparatus or other vehicles in an emergency mode with emergency lights and sirens. 11. Critical,time-sensitive,complex problem solving during physical exertion in stressful, hazardous environments, including hot,dark,tightly enclosed spaces,that is further aggravated by fatigue,flashing lights,sirens,and other distractions. frontlinemobilehealth.com 63 EXHIBIT 0: Requirements for Firefighters 12. Ability to communicate(i.e.,give and comprehend written or verbal orders)while wearing PPE and respirators required by the jurisdiction under conditions of high background noise, poor visibility,and drenching from hose lines or fixed protection systems(e.g.,sprinklers). 13. Functioning as an integral component of a team,where sudden incapacitation of a member can result in mission failure or in risk of injury or death to members of the public or other team members. 14. Working in shifts, including during nighttime,that can extend beyond 12 hours. 15. Performing emergency medical service(EMS)tasks,such as cardiopulmonary resuscitation (CPR)or lifting or moving patients,while wearing PPE and respirators required bythe jurisdiction. frontlinemobilehealth.com 64 EXHIBIT P: Medical Recommendation Form (Full Recommendation) I:I10NI I I.INII: Medical Recommendation Form MOBILE HEALTH Hame D U.B Date of Evaluation. Department: Type of Evaluation: Does that specific department have a department health and nullness policy? Medical Standard:1582(New) The above named individuai is recommended for full OPOr2tiOnal Suppression duty without restrictions for:365 Days ONo fitness and/or medical condition(s)was/were found to be present during the evaluation that would limit the abovenamed individual from performing full duty without restrictions IAW the NFPA Essential Job Tasks and/or Department Policy. ....................................................................................................................................................................................................................................................................................................................................................... the above.named individual revealed specific limltation� The evaluation performed on the abovenamed individual revealed recommended limitations for performing one or more of the following NFPA Essential Job Tasks and/or Department Policy Requirements. Major system for the reason for the limited/no duty recommendation: THE MEDICAL RECOMMENDATION ISTILIFIREFORE LIMITED FROM PFRFORMiNG THE FOLLOWING FSSFNTIAL JOB TASKS�clheGkall that appiy) 1.Wearing personal protective equipment(PPE)and self-contained breathing apparatus(SCBA)while performing firefighting tasks(e.g.,hose line operations, extensive crawling,lifting and carrying heavy objects,ventilating roofs or walls using power or hand tools,forcible entry),rescue operations,and other emergency response actions under stressful conditions,including working in extremely hot or cold environmentsfor prolonged time period 2.Wearing the respirators required by the jurisdiction(e.g,,N-95,half-face 9.Exposure to toxic fumes,irritants,particulates,biological(i.e., clastomeric,PAPR,SCBA),which includes a demand-valve-type infectious)and nonbiological hazards.or heated gases,despite the use of positive-pressure facepiece or filter respirator,achieving a successful fit PPE and SCBA test and tolerating increased respiratory workloads 3,Climbing at least six flights of stairs or walking a similarly strenuous 10.Wearing PPE and SCBA that is encapsulating and insulated,which will distance and incline in jurisdictions without tall buildings while wearing result in significant Fluid loss that frequently progresses to clinical PPE and SCBA,commonly weighing 40-50 lb(18-23 kg)and carrying dehydration and can elevate core temperature to levels exceeding 102,2°F equipment/tools weighing an additional 20-40 lb(9-18 kg) (39°C) 4.Working alone while wearing PPE and respirators required by the 0 11.While wearing PPE and SCBA,advancing water-filled hose lines up to 1 jurisdiction,searching,finding,and rescue-dragong or carrying victims to Y4 in(45 mm)in diameter from fire apparatus to occupancy(approximately safety in hazardous conditions and low visibility 150 ft(50 m)),which can Involve negotiating multiple flights of stairs, ladders,and other obstacles 5.Whilc wearing PPE and SCBA,climbing ladders,operating from heights `^, 12.Unpredictable,prolonged periods of extreme physical exertion as walking or crawling in the dark along narrow and uneven surfaces that might required by emergency operations without benefit of a warm-up period, be wet or icy,and operating in proximity to electrical power lines or other scheduled rest periods,meals,access to medicatlon(s),or hydration. hazards 6.Operating fire apparatus or other vehicles in an emergency mode with 13.Critical,time-sensitive,complex problem solving during physical emergency lights and sirens exertion in stressful,hazardous environments,including hot,dark,tightly enclosed spaces,that is further aggravated by fatigue,flashing lights, sirens,and other distractions 7.Ability to communicate(i.e..give and comprehend written or verbal 14.Functloningas an Integral component of a team,where sudden orders)while wearing PPE and respirators required by the jurisdiction, incapacitation can result in mission failure or in risk of injury or death to under conditions of high background noise,poor visibllity,and drenching members of the public or otherteam members from hose lines or fixed protection systems(e.g.,sprinklers) 8.Working in shifts,including during nighttime,that can extend beyond 12 15.Performing EMS tasks,such as CPR or lifting or moving patients, hours while wearing PPE and respirators required bythejurisdiction )0 14 D) front IInemobilehealth,com 512.838.3808 Copyright 2025 0 Front Line Mobile Health 65 EXHIBIT P: Medical Recommendation Form (Non-Recommendation) F11011 T LIME Medical Recommendation Form MOBILE HEALTH Name: Date of Evaluation: Department: Typo of Evaluation: Does that specific dopartmcm havo a department health and wellness policy?No Medical Standard:1582(New) The above •d individual is recommended tar full operational surr • r duty withouto o Days No fitness and/or medical condition(s)was/were found to be present during the evaluation that would limit the abovenamed Individual from performing full duty without restrictions IAW the NFPA Essential Job Tasks and/or Department Policy, ................................................................................................................................................................................................................................................................................................................................................................ OThe evaluation performed an the abovenamed individual revealed recommended limitations for performing one or more of the fallowing NFPA Essential Job Tasks and/or Department Policy Requirements. Major system for the reason for the limited/no duty recommendation:Fitness 1MMFN DATIO N IS THFRFFDRI LIMITFE)FROM PFRFORMING1 1 , JOB TASKS(check all that aplply�� I 0 1.Wearing personal protective equipment(PPE)and self-contained breathing apparatus(SCBAJ while performing flreflghtingtasks(e.g.,huse line operations, extensive crawling,lifting and carrying heavy objects,ventilating roofs or walls using power or hand tools,forcible entry),rescue operations,and other emergency response actions under stressful conditions,including working in extremely hot or cold environments for prolonged time period 0 2.Wearing the respirators required by the Jurisdiction(e.g.,N-95, 9. Exposure to toxic fumes,irritants,particulates,biological(i.e„ half-face elastomeric,PAPR,SCBA),which includes a demand-valve-type infectious)and nonbioiogical hazards,or heated gases,despite the use of positive-pressure faeepiece or filter respirator,achieving a successful fit PPE and SCBA test and tolerating increased respiratory workloads 0 3. Climbing at least six flights of stairs or walking a similarly strenuous O 10.Wearing PPE and SCBA that is encapsulating and Insulated,which will distance and incline In jurisdictions without tall buildings while wearing PPE result In significant fluid loss that frequently progresses to clinical and SCBA,commonly weighing 40-50 lb(18-23 kg)and carrying dehydration and can elevate core temperature to levels exceeding 102.21 equipment/tools weighing an additional 20-40 Ib(9-18 kg) (39°C) O4.Working alone while wearing PPE and respirators required by the O 11.While wearing PPE and SCBA,advancing water-filled hose Imes up to 1 jurisdiction,searching,finding.and rescue-dragging or carrying victims to 34 In(45 mm)In diameter from fire apparatus to occupancy[approximately safety in hazardous conditions and low visibility 150 ft(50 m)],which can involve negotiating multiple flights of stairs, ladders,and other obstacles O5, While wearing PPE and SCBA,climbing ladders,operating from heights, 0 12, Unpredictable,prolonged periods of extreme physical exertion as walking or crawling in the dark along narrow and uneven surfaces that might required by emergency operations without benefit of a warm-up period, be wet or icy,and operating in proximity to electrical power lines or other scheduled rest periods,meals,access to medication(s),or hydration. hazards 6.Operating fire apparatus or other vehicles in an emergency mode with 13. Critical,time-sensitive,complex problem solving during physical emergency lights and sirens exertion in stressful,hazardous environments,including hot,dark,tightly enclosed spaces,that is further aggravated by fatigue,flashing lights, sirens,and other distractions I Ability to communicate(i.e.,give and comprehend written or verbal O 14 Functioning as an integral component of a team,where sudden orders)while wearing PPE and respirators required by the jurisdiction, incapacitation can result in mission failure or in risk of injury or death to under conditions of high background noise,poor visibility,and drenching members of the public or other team members from hose lines or fixed protection systems(e.g.,sprinklers) 8. Working In shifts,Including during nighttime,that can extend beyond 15.Performing EMS tasks,such as CPR or lifting or moving patients,while 12 hours ' wearing PPE and respirators required by the jurisdiction 56 EXHIBIT Q: Work Limitations Form WORK LVAITATIONS FORNI FRONT LINE E,mpL yeeName: datleoflnju MOBILE HEALTH Departmen Shift/Supenriso Evaluatonn data Overview of Evaluation Front Line Mobile Health has been contracted to perform'Department Physician Services"services to ensure that injured employees are receiving the appropriate clinical management in order to help them achieve the physical recovery neoessa ry to safely return to work.Any Limitation/restriction recommendations are based on a reviewof either clinical records,employee examination.employee interview,andlor other avai table information_ Front tine Mobile Health cannot guarantee that the employerwal have suitable work for the injured employee within the limitations outlined below,duringrecoveryperlod,and modified or light duty may not be feasible in all instances_ Medical Provider Statement:The above-named employee has been evaluated by me on: My diagnosis and recommendations are as follows: dlagnosi Employee teay return toworkwldmutrestrfctiam asuf. Employee may return toworkwleh-game restrictlom asat . Employee maynot return to work at this time.PernaVwreturnfawarkdate,perndngebaktationis-______ Recommended Restrictions RastHrmant P aline to M 00 (r Malian Rrstrictlbns'Ha ) I FurMtelr. [do-.Fa Ama. H;a.haur..pucr.ntwerk: HWHo nPrior. ll 2 d 6 a Othiel Roil-wrdA rlr. srarrrceuu StATNL-a:raivar pr war[Yq I Oeff e!laj Hus[wq splr J[ taftrk CkftWV0*wL sral klrel AfH •=rTrW Hlls[.36{Md45 n all 11l ampiw5auumns Ha crMnploprmngrawyacupnwnt w:tsrinm.rtm».Y fiwlElrL , -J WHI:. Can o0xdmautaaHlk:rrIL—Julor F�hlna Fuel I-sm. hklcnlnixywa la awUK PaaCMg Frca �9pn. Hus[xmpl-,uMarm slrrxatl ka,6aartl'Iplrg t5rrw ^x" Hus[kmpl-.uryarmrLrrJdly Phlslcal£wrrJsc Gassrt�[hrgm.nwm ryrwalk hN i1dn mnUdwt7_ Wwork Inwdn—hanYak.ffA r-s W wa*x hWVUnransm'roknng rbihrrr H I Gist--rleshicNars When Exrrclsl It>n' MaeHb—Per Czy G 2 4 d B 1 G9hc M.Ch U ..F,.DyjrAj 2 OPO Any Olhel 9ra-c�n w'akrg J.Wng KnmrnF,S<L.Wl6 FWnnrg Bardlnp5:lNpng elrng PvshlnVpLulra Elrpbcal tws-rg srnmrma POnmQ66.�IryT){7r�F?{ rfrrp�rcntcan 5CLB3B3809 5129i520Q9 IL EXHIBIT Q: Work Limitations Form L uni WORK LIMITATIONS FORM FRONT.A.., LINE EmaloyeefJame: 4abeaflnju MOBILE HEALTH Cepartmen Shi{t/Superviso Evaluaton Date Recommended Reslriclions(continued) UfuCarry aaarrlaloas(Marry) MedkAkn Rasulnlons(M nVI ]%,.—ngofPFE PAW—Rt, rra6cafons Go ra:mYarrotlka7crwhlha an shlR Nn%"ng of FFE s'al@M mlyb tlrt. M*=WSIWUh3K3 HwwAorsn MQvffa&CvfmS/ OTC ma ILMnSn10Nrallafr]atl NewsnnnRoIFFE>WU,: MW—n'r� th—b shoulars DD—drM YANWt"..dlc.Mo Avdd psolorv�eCl sun ey�u5ure 4e patlmrlR.nRtrans'n-k-p TarmUYrrx.x Ihs 6arpYsp't L a:hm nra:tlrUnr.;r an. }bmitationswill remain m effect until re-evaluation scheduled far= Endaisementand Acknowledgement I'iovlGs:r 51Cnaturc I>nrvlW!r Namc 6aaa Sipxai Employee Slphau.a ddellMunn-ateaou So--nature Employee Nnme ttee—Nerve Date Sicned Date SIC-d PD5x1268,GrarburyTX76W fw1nffroVEhuth.com 50338.38W 512975.2OD9 frontlinemobilehealth.com 68 EXHIBIT R: HIPAA BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement(the "Agreement") is entered into between Front Line Mobile Health, PLLC and City of Corpus Christi (the "Business Associate") and made effective on the date of final execution of this Agreement by both Parties(the"Effective Date"). 1. DEFINITIONS. Catch-all definitions: The following terms used in this Agreement shall have the same meaning as those terms in the HIPAA Rules: Breach, Breach Notification, Data Aggregation, Designated Record Set, De-Identified Information, Disclosure (Disclose), Electronic Protected Health Information, Electronic Transactions Rule, Enforcement Rule, Genetic Information, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required By Law, Sale, Secretary, Security Incident, Security Rule, Subcontractor, Transaction, Unsecured Protected Health Information,and Use. Specific definitions: (a) "Business Associate" shall generally have the same meaning as the term "Business Associate" at 45 C.F.R. § 160.103,and in reference to the party to this agreement,shall mean City of Corpus Christi. (b) "Covered Entity"shall generally have the same meaning as the term"Covered Entity"at 45 C.F.R.§160.103,and in reference to the party to this Agreement,shall mean Front Line Mobile Health, PLLC. (c) "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 C.F.R. Part 160 and Part 164. (d) "HITECH Act"shall mean the Health Information Technology for Economic and Clinical Health Act. 2. OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE. Business Associate agrees to: (a) Not Use or Disclose Protected Health Information other than as permitted or required by the Agreement or as Required by Law; (b) Use appropriate safeguards,and complywith Subpart C of 45 C.F.R.Part 164with respectto Electronic Protected Health Information, to prevent Use or Disclosure of Protected Health Information other than as provided for by the Agreement; (c) Report to Covered Entity any Use or Disclosure of Protected Health Information not provided for bythe Agreement of which it becomes aware, including Breaches of Unsecured Protected Health Information as required at 45 C.F.R.§ 164.410,and any Security Incident of which it becomes aware; (d) In accordance with 45 C.F.R.§§164.502(e)(1)(ii)and 164.308(b)(2),if applicable,ensure that any Subcontractors that create,receive,maintain,ortransmit Protected Health Information on behalf of the Business Associate agree to the same restrictions,conditions,and requirements that apply to the Business Associate with respect to such information; (e) Make available Protected Health Information in a Designated Record Set to Front Line Mobile Health, PLLC as necessary to satisfy Covered Entity's obligations under 45 C.F.R. § 164.524, including furnishing upon Covered Entity's request or direction an electronic copy of Protected Health Information that is maintained in a Designated Record Set; frontlinemobilehealth.com 69 (f) Make any amendment(s)to Protected Health Information in a Designated Record Set as directed or agreed to by the Covered Entity pursuant to 45 C.F.R. § 164.526, or take other measures as necessary to satisfy Covered Entity's obligations under 45 C.F.R.§ 164.526; (g) Maintain and make available the information required to provide an accounting of Disclosures to Front Line Mobile Health, PLLC as necessaryto satisfy Covered Entity's obligations under 45 C.F.R.§164.528. (h) To the extent the Business Associate is to carry out one or more of Covered Entity's obligation(s)under Subpart E of 45 C.F.R. Part 164 ("Privacy of Individually Identifiable Health Information"), comply with the requirements of such Subpart E that apply to the Covered Entity in the performance of such obligation(s); (i) Make its internal practices,books,and records available to the Secretary for purposes of determining compliance with the HIPAA Rules; (j) Not participate in any Sale of Protected Health Information; (k) Not Use or Disclose Genetic Information for underwriting purposes in violation of the HIPAA Rules; (l) Comply with the Electronic Transaction Rule and any applicable corresponding requirements adopted by HHS with respect to any Electronic Transactions conducted by Business Associate on behalf of Covered Entity in connection with the services provided under this Agreement. 3. REPRESENTATIONS OF BUSINESS ASSOCIATE. Business Associate agrees that it is directly liable under the HIPAA Rules and the HITECH Act and is subject to civil and, in some cases, criminal penalties for making Uses and Disclosures of Protected Health Information that are not authorized by this Agreement or Required by Law. Business Associate also acknowledges that it is liable and subject to civil penalties for failing to safeguard Electronic Protected Health Information in accordance with the HIPAA Security Rule. 4. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATE. Business Associate shall not Use or Disclose Protected Health Information relating to Covered Entity, except as expressly permitted under and consistent with this Section 4. (a) Business Associate may Use or Disclose Protected Health Information for the following permissible purposes: (i) Use or disclose PHI as necessaryto perform services under its contract with Front Line Mobile Health,PLLC ("Underlying Agreement"); (ii) Use or disclose PHI as required by law; (iii) Use PHI for proper management and administration or to fulfill legal responsibilities, provided that any disclosures are required by law or made with assurances of confidentiality and security; (iv) De-identify PHI or provide data aggregation services relating to Front Line Mobile Health,PLLC's healthcare operations,in accordance with 45 C.F.R.§164.514;and (v) Make requests for PHI consistent with the minimum necessary standard under 45 C.F.R.§164.502(b). (b) Business Associate agrees to make Uses and Disclosures and requests for Protected Health Information consistent with Covered Entity's Minimum Necessary policies and procedures, a copy of which has been furnished to Business Associate. (c) Business Associate may not Use or Disclose Protected Health Information in a mannerthatwould violate Subpart E of 45 C.F.R. Part 164 if done by Covered Entity. frontlinemobilehealth.com 70 5. PROVISIONS FOR COVERED ENTITY TO INFORM BUSINESS ASSOCIATE OF PRIVACY PRACTICES AND RESTRICTIONS. (a) Notification of Breach.If Business Associate discovers a Breach of Protected Health Information,the Business Associate shall,followingthe discovery of the Breach of Unsecured Protected Health Information, notify the Covered Entity of such breach in accordance with this Section 6. (i) A Breach is treated as discovered by Business Associate on the first day on which such breach is known to Business Associate or,by exercising reasonable diligence,would have been known to Business Associate. Business Associate shall be deemed to have knowledge of a Breach if the Breach is known, or by exercising reasonable diligence would have been known,to any person, other than the person committing the Breach,who is an employee,officer,or other agent of Business Associate. (ii) Business Associate shall provide the notification required under this Section 6 without unreasonable delay and in no case later than 60 calendar days after discovery of the Breach. (iii) The notification shall include,to the extent possible,the identification of each individual whose Unsecured Protected Health Information has been,or is reasonably believed by Business Associate to have been, accessed,acquired, used,or disclosed during the Breach. (iv) Business Associate shall provide the Covered Entity with any other available information that the Covered Entity is required to include in notification to the individual under 45 C.F.R.§164.404(c)at the time of the notification by Business Associate,and any information that is not then available promptly after such information becomes available.Information to be provided includes,to the extent possible: (A) A brief description of what happened, including the date of the Breach and the date of the discovery of the Breach, if known; (B) A description of the types of Unsecured Protected Health Information that were involved in the Breach (such as whether full name,social security number,date of birth, home address,account number,diagnosis, disability code,or other types of information were involved);and (C) A brief description of what Business Associate is doing to investigate the Breach,to mitigate harm to Individuals,and to protect against any further Breaches. 6. TERM AND TERMINATION. (a) Term. The Term of this Agreement shall be effective as of the Effective Date and shall terminate twelve (12) months following the Execution Date or on the date Covered Entity terminates for cause as authorized in paragraph (b)of this Section,whichever is sooner. (b) Termination for Cause.Business Associate authorizes termination of this Agreement by Covered Entity if Covered Entity reasonably determines in good faith that Business Associate has violated a material term of the Agreement. (c) Obligations of Business Associate Upon Termination. Except as set forth in Section, upon termination of this Agreement for any reason, Business Associate shall return to Covered Entity(or, if agreed to by Covered Entity, destroy)all Protected Health Information received from Covered Entity, or created, maintained,or received by Business Associate on behalf of Covered Entity,that the Business Associate still maintains in any form. Business associate shall retain no copies of the Protected Health Information. (d) Transmission of PHI.If so directed by Covered Entity, Business Associate will transmit any Protected Health Information received from Covered Entity,or created, maintained,or received by Business Associate on behalf of Covered Entity,to another Business Associate of Covered Entity at termination. (e) Business Associate Responsibility for Subcontractors. Business Associate shall be responsible for compliance with the obligations regarding Covered Entity's Protected Health Information with respect to frontlinemobilehealth.com 71 any applicable Protected Health Information created, received, or maintained by Subcontractors retained by Business Associate. (f) Survival.The obligations of Business Associate under this Section shall survive the termination of this Agreement. 7. MISCELLANEOUS. (a) Regulatory References. A reference in this Agreement to a section in the HIPAA Rules means the section as in effect or as amended. (b) Amendment.The parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law. Any amendment to this Agreement must be in writing and signed by both parties. (c) Interpretation.Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA Rules. (d) Governing Law.This Agreement shall be governed by the laws of Texas,except to the extent preempted byfederal law. (e) Counterparts.This Agreement may be executed in any number of counterparts, and may be signed via facsimile or e-mail (scan), and each such counterpart shall be deemed to be an original instrument, but all such counterparts shall constitute one agreement. (f) Severability.The provisions of this Agreement shall be severable,and the invalidity of any provision shall not affect the validity of other provisions. (g) Entire Agreement. This Agreement contains the entire agreement between the parties. This Agreement supersedes all prior agreements, understandings or writings,whether oral or written with regard to this subject matter. (h) Notice.Any notice required under this Agreement shall be in writing and shall be given by(i)delivery in person, (ii) by a nationally recognized next day courier service, (iii)by first class,registered or certified mail,postage prepaid, (iv)by electronic mail to the address of the party specified in this Agreement or such other address as either party may specify in writing. [Signature Page Follows] frontlinemobilehealth.com 72 SIGNATURES "Contracting Agency" "Service Provider" City of Corpus Christi for Corpus Christi Fire Department and Airport Department Front Line Mobile Health, PLLC 1201 Leopard Street 4749 Williams Drive,Suite 304 Corpus Christi,Texas 78401 Georgetown,Texas 78633 (361)826-3227 (512)688-6112 By. Sekgro ViUZana By. Chelsea Conner Sergio Villasane(May 22,2026 11:43:54 CDT) Chelsea Conner(May 22,2026 13:10:27 MDT) Sergio Villasana Chelsea K.Conner, MPAS,APA-C Director, Finance&Procurement Chief of Sales 05/22/2026 05/22/2026 Date Signed Date Signed By. Clayton Smith(May 20,2026 09:44:56 CDT) Clayton Smith Contracts Manager 05/20/2026 Date Signed Approved as to Form pY By EE�izabethlizabeth Hundley y 21,}�2026 21:5:31 CDT) Elizabeth Hundley Assistant City Attorney 05/21/2026 Date Signed frontlinemobilehealth.com 73