HomeMy WebLinkAboutC2016-192 - 4/19/2016 - Approved 400usctiw'4,
SERVICE AGREEMENT
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EMPLOYER-SPONSORED WELLNESS CLINIC �2 .F
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Contract No. 644
THIS Employer-Sponsored Wellness Clinic ("Agreement") is entered into by 1.1;n11411-1E1-5:27.11
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between Concentra Health Services, Inc., of Addison, Texas ("Contractor") and the City
of Corpus Christi, a Texas home-rule municipal corporation ("City"), by and through its
duly authorized City Manager or his designee ("City Manager"), effective for all
purposes upon execution by the City Manager.
WHEREAS, Contractor has proposed to provide management and operation of an
employer-sponsored wellness clinic services in response to the City's Request for
Proposals ("RFP Event No. 103");
WHEREAS, the City has determined Contractor to be the best valued respondent;
NOW, THEREFORE, Contractor and City enter into this Agreement and agree as follows:
1. Services. Contractor will provide management and operation of an employer-
sponsored wellness clinic ("Services") in accordance with Scope of Work
("Attachment A"), and as detailed in Contractor's Technical Proposal ("Attachment
B") which are Attached and Incorporated by Reference into this Agreement.
2. Compensation and Payment. The total amount to be paid under the initial term
of this agreement shall not exceed $1 ,338,536.00. Fees will be paid as outlined in
Attachment C "Fee Schedule" attached and Incorporated by Reference into this
agreement. Contractor shall submit monthly invoices for all services rendered in
accordance with this agreement. Payment will be made to Contractor within thirty (30)
days of receipt of proper invoice.
3. Term. This Agreement is for two years commencing on June 1 , 2016 and
continuing through May 31 , 2018. The term includes an option to extend for up to
three additional one-year periods subject to the approval of the Contractor and the
City Manager or designee.
4. Contract Administrator. The contract administrator designated by the City is
responsible for approval of all phases of performance and operations under this
Agreement including deductions for non-performance and authorizations for
payment. All of the Contractor's notices or communications regarding this
Agreement must be directed to the contract administrator, who is the Director of
Human Resource or designee ("Contract Administrator").
2016-192
4/19/16
Res. 030814 1
Concentra Health Services Inc. INDEXED
5. Independent Contractor. Contractor will perform the Services as an independent
contractor and will furnish such Services in its own manner and method, and under
no circumstances or conditions may any agent, servant or employee of the
Contractor be considered an employee of the City.
6. Insurance. Before activities can begin under this Agreement, the Contractor's
insurance company, or companies, must deliver a Certificate of Insurance, as proof
of the required insurance coverages, to the Contract Administrator and City's Risk
Manager. The Contractor's insurance requirements are attached to and
incorporated by reference into this Agreement as Attachment "D".
7. Assignment. No assignment of this Agreement or of any right or interest contained
in this Agreement by the Contractor is effective unless the City first gives its written
consent to such assignment. The performance of this Agreement by the Contractor
is of the essence of this Agreement, and the City's right to withhold consent to such
assignment is within the sole discretion of the City on any ground whatsoever.
8. Fiscal Year. All parties recognize that the continuation of any contract after the
close of any fiscal year of the City (the City's fiscal year ends on September 30th) is
subject to appropriations and budget approval providing for covering such contract
item as an expenditure in the budget. The City does not represent that said budget
item will be actually adopted, as that determination is within the sole discretion of
the City Council at the time of adoption of each budget.
9. Waiver. No waiver of any breach of any term or condition of this Agreement, or
the Consultant's response to RFP, which exhibit is incorporated into this Agreement,
waives any subsequent breach of the same.
10. Compliance with Laws. This Agreement is subject to all applicable federal, state
and local laws. All duties of the parties will be performed in the City of Corpus Christi,
Texas. The applicable law for any legal disputes arising out of this Agreement is the
law of Texas and such form and venue for such disputes is the appropriate district,
county or justice court in and for Nueces County, Texas.
11. Subcontractors. The Contractor may use subcontractors in connection with the
Services to be performed under this Agreement. When using subcontractors,
however, the Contractor must obtain prior written approval from the Contract
Administrator. In using subcontractors, the Contractor shall be responsible for all their
acts and omissions to the same extent as if the subcontractor and its employees
were employees of the Contractor. All requirements set forth as part of this
Agreement are applicable to all subcontractors and their employees to the same
extent as if the Contractor and its employees had performed the Services.
12. Amendments. This Agreement may be amended only in writing and upon
execution by authorized representatives of both parties.
13. Termination. The City Manager may terminate this Agreement for Contractor's
failure to perform the Services. Failure to keep all insurance policies in force for the
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entire term of this Agreement is grounds for termination. The Contract Administrator
must give the Contractor written notice of the breach and set out a reasonable
opportunity to cure. If the Contractor has not cured within the cure period, the City
Manager may terminate this Agreement immediately thereafter.
Alternatively, the City Manager may terminate this Agreement without cause upon
20 days' written notice to the Contractor. However, the City may terminate this
Agreement upon three days' written notice to the Contractor for Contractor's failure
to pay or provide proof of payment of taxes, as set out in this Agreement.
14. Taxes. The Contractor covenants to pay payroll taxes, Medicare taxes, FICA
taxes, unemployment taxes and all other related taxes in accordance with Circular
E, "Employer's Tax Guide", Publication 15, as it may be amended. Upon request, the
City Manager shall be provided proof of payment of one or more of these taxes
within 15 days of such request.
15. Notice. Notice may be given by hand delivery or certified mail, postage
prepaid, and is received on the day faxed or hand-delivered and on the third day
after deposit in the U.S. mail if sent certified mail. Notice shall be sent as follows:
IF TO CITY:
City of Corpus Christi
Attention: Human Resources - Benefits Administrator
1201 Leopard Street
Corpus Christi, Texas 78401
IF TO CONTRACTOR:
Contractor Name: Concentra Health Services, Inc.
Contact Person: Keith Newton, President and Chief Executive Officer
Address: 5080 Spectrum Drive, Suite 1200W
City, State, Zip: Addison, Texas 75001
16. Severability. Each provision of this Agreement shall be considered to be
severable and if, for any reason, any such provision or any part thereof, is
determined to be invalid and contrary to any existing or future applicable law, such
invalidity shall not impair the operation of or affect those portions of this Agreement
that are valid, and this Agreement shall be construed and enforced in all respects as
if the invalid or unenforceable provision or part thereof had been omitted.
17. Entire Agreement. This Agreement constitutes the entire agreement between
the parties concerning the subject matter of this Agreement and supersedes all prior
negotiations, arrangements, agreements and understandings, either oral or written,
between the parties.
18. Order of Precedence. In the event of conflicts or inconsistencies between this
Agreement and its exhibits or attachments, such conflicts or inconsistencies will be
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resolved by reference to the documents in the following order of priority: this
Agreement and its Attachments, the RFP documents including Addenda.
19. Certificate of Interested Parties. Contractor agrees to comply with Texas
Government Code Section 2252.908 and complete Form 1295 "Certificate of
Interested Parties" as part of this Agreement.
20. INDEMNIFICATION. CONTRACTOR SHALL INDEMNIFY, HOLD
HARMLESS AND DEFEND THE CITY OF CORPUS CHRISTI AND ITS OFFICERS,
EMPLOYEES AND AGENTS ("INDEMNITEES") FROM AND AGAINST ANY AND
ALL LIABILITY, LOSS, CLAIMS, DEMANDS, SUITS AND CAUSES OF ACTION OF
ANY NATURE ON ACCOUNT OF PERSONAL INJURIES, INCLUDING THOSE
RESULTING IN WORKERS' COMPENSATION CLAIMS OR DEATH, PROPERTY
LOSS OR DAMAGE, OR ANY OTHER KIND OF LOSS OR DAMAGE,
INCLUDING ALL EXPENSES OF LITIGATION, COURT COSTS, REASONABLE
ATTORNEYS' FEES AND EXPERT WITNESS FEES WHICH ARISE OR ARE
CLAIMED TO ARISE OUT OF CONTRACTOR'S PERFORMANCE OF THIS
AGREEMENT EXCEPT WHERE THE INJURIES, DEATH, LOSS, OR DAMAGES ARE
CAUSED OR ARE CLAIMED TO BE CAUSED BY THE NEGLIGENCE OR
INTERNTIONAL ACTS OR OMISSIONS OF INDEMNITEES. CONTRACTOR
MUST, AT ITS OWN EXPENSE, INVESTIGATE ALL NOTICES, CLAIMS, AND
DEMANDS, ATTEND TO THEIR SETTLEMENT OR OTHER DISPOSITION, DEFEND
ALL ACTIONS BASED THEREON WITH COUNSEL REASONABLY
SATISFACTORY TO THE CITY ATTORNEY, AND PAY ALL CHARGES OF
ATTORNEYS AND ALL OTHER COSTS AND EXPENSES OF ANY KIND ARISING
FROM ANY OF SAID LIABILITY, LOSS, CLAIMS, DEMANDS, SUITS, OR
ACTIONS. THE INDEMNIFICATION OBLIGATIONS OF CONTRACTOR UNDER
THIS SECTION SURVIVE THE EXPIRATION OR EARLIER TERMINATION OF THIS
AGREEMENT.
21. Conflict of Interest. Contractor agrees to comply with Chapter 176 of the
Texas Local Government Code and file Form CIQ with the City Secretary's Office, if
required. For more information and to determine if you need to file a Form CIQ,
please review the information on the City Secretary's website at
http://www.cctexas.com/government/city-secretary/conflict-disclosure/index
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CONTRACTOR:
Signature: U" • a, /64"-
Printed Name: W. Keith Newton
Title: President
Date: 4-I 115I i o
CITY OF CORPUS CHRISTI
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1.
Margie Rose ATTEST: `e.—Le-C_/e.,C,
Deputy City Manager REBECCA HUERTA -
CITY SECRETARY
For City Manager
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Date
APPROVED AS TO LEGAL FORM: as_pip;
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4.•41p
I ,4 -+ SECRETAR
Buck Brice
Assistant City Attorney
For City Attorney
Attached and Incorporated by Reference:
Attachment A: Scope of Work
Attachment B: Contractor's Technical Proposal
Attachment C: Fee Schedule
Attachment D: Insurance Requirements
Incorporated by Reference Only:
Exhibit A: Request for Proposals Event No. 103
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Attachment A: Scope of Work
The Contractor will provide services to operate a wellness clinic and offer full access to
primary care including, but not limited to: episodic care, disease management, and
wellness programs focused on health promotion and disease prevention to eligible
active employees, retirees and their eligible dependents and/or surviving spouses. The
wellness clinic's staff shall be properly sponsored and supervised as required by the
State of Texas. Neither the City nor its health benefits fund will assume any liability for
the practice of medicine.
The Contractor will oversee the operation of the clinic and be responsible for all
expenses incurred, such as but not limited to: staffing, supplies (both medical and
office), facilities, record maintenance, telephone, and any special needs regarding
waste removal or security. All services, data management and record keeping will be
HIPAA and HITECH compliant. Services will be performed as outlined in the Contractor's
Technical Proposal "Attachment B" to this Agreement.
• Clinic Location. 6th Floor of City Hall in Corpus Christi, TX
• Program Participants. 5,711 program participants including:
❑ Employees: 2,528
❑ Dependents: 2,971
❑ Retirees under 65: 134
❑ Retiree dependents: 78
• Hours of Operation. Monday through Friday, 7:00 a.m. to 7:00 p.m.
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Attachment B: Contractor's Technical Proposal
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Attachment C: Fee Schedule
PROGRAM FEES("FEES")
Onsite Center Program Costs
City of Corpus Christi
Startup Costs
One
. nr .,_ m ., , timeFee
•
Network Implementation $10,500
Technology/Software Licenses $16,000
Data Feed $7,000
Implementation Fees $26,000
TOTAL START-UP COSTS $59,500
Year Year Year Year Year
Labor Costs
One Two Three Four Five
Salary Benefits Coverage CME Licenses Training Total Total Total Total Total
Physician Oversight(0.16 FTE) $53,414 $12,285 $0 $300 $60 $500 $66,560 $69,888 $73,382 $77,051 $80,904
Midlevel Provider(0.8 FTE) $110,117 $25,327 $0 $1,500 $300 $2,500 $139,744 $146,731 $154,068 $161,771 $169,860
Midlevel Provider(0.8 FTE) $100,600 $23,138 $0 $1,500 $300 $2,500 $128,038 $134,440 $141,162 $148,220 $155,631
Medical Assistant(1.0 FTE) $28,600 $6,578 $4,290 $0 $0 $1,000 $40,468 $42,491 $44,616 $46,847 $49,189
Medical Assistant(1.0 FTE) $27,040 $6,219 $4,056 $0 $0 $1,000 $38,315 $40,231 $42,243 $44,355 $46,572
TOTAL LABOR COSTS $319,771 $73,547 $8,346 $3,300 $660 $7,500 $413,125 $433,781 $455,470 $478,244 $502,156
Year Year Year Year Year
Ongoing Fees
One Two Three Four Five
Network Connectivity $8,300 $8,715 $9,151 $9,608 $10,089
Equipment Lease $4,000 $4,200 $4,410 $4,631 $4,862
Technology Fee $16,000 $16,800 $17,640 $18,522 $19,448
Management Fee $80,500 $84,525 $88,751 $93,189 $97,848
TOTAL ONGOING FEES $108,800 $114,240 $119,952 $125,950 $132,247
Estimated Passthrough Costs Year Year Year Year Year
One Two Three Four Five
Estimated Medical Supplies $25,000 $25,750 $26,523 $27,318 $28,138
Estimated Laboratory $66,000 $67,980 $70,019 $72,120 $74,284
Estimated Office Supplies/Admin/Travel/Other $12,000 $12,360 $12,731 $13,113 $13,506
TOTAL ESTIMATED PASSTHROUGH COSTS $103,000 $106,090 $109,273 $112,551 $115,927
TOTAL ANNUAL COSTS $684,425 $654,111 $684,695 $716,744 $750,330
• Schedule above is based on current scope and volume
o Any scope or volume changes necessitated at the request of Client, or as a result of
Client's failure to comply with the identified, express terms of this Agreement, may
require additional fees
• Labor Costs above are the minimum amounts estimated based on incumbent staff rates as of
date of execution of this Agreement
o The Client acknowledges that incumbent staff rates may be significantly below
anticipated replacement rates based on market conditions
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o In the event of personnel changes, the parties shall cooperate in good faith to determine
new pricing based upon then-current market rates for replacement staff at the time of
hire, with such changes to be agreed upon in an amendment to this Agreement
o In the event that the parties are unable to agree to new pricing, any accompanying
staffing shortage or reduction in services shall not be considered a breach by Concentra
o If the parties cannot agree to new pricing within six months, either party may, without
penalty, terminate this Agreement upon sixty (60) days written notice to the other party.
o Client acknowledges that any new staff will require training and that Client will be
invoiced for training of the new staff, which training shall not exceed thirty (30) days.
• The technology fees subject to change as the number of staff changes
• Pass-through costs based on current volume estimates; as volume increases, pass-through
costs to fluctuate accordingly
• Includes standard quarterly stewardship reporting.
• Billing will include the monthly labor cost and the ongoing fixed fees at a rate of 1/12th the
annual fee and the pass-through items as incurred based on actual cost.
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• Glossary of Fees
•
Start Up Details
Each clinic will need to be on a dedicated line meeting Concentra's speed and capacity standards in order to optimally operate EMR and
Network Installation patient portal systems.This fee includes all network hardware(router,switch,etc.)as well as installation costs.
Data Feed Eligibility Feed Intake and set up
Start-up costs include software licensing for three providers,staff training,customized database construction,customization of forms and
Technology/Software Licenses patient portal.
Implementation Fee ✓ Execution of implementation plan
✓ Opening on-site clinic
✓ Developing work flow and clinical operating procedures for program stakeholders
✓ Internal/external implementation planning calls
✓ Joint team meetings to review scope and services
✓ Initial walk-through of Onsite
✓ Set up billing procedures(location set-up in system,TIN)
✓ Initiation of recruitment of personnel(determine of client desires to interview candidates)
✓ Credentialing of clinicians and HR orientation(on-boarding of employees)
✓ Supply/equipment review and orientation
✓ Concentra-specific training of Onsite policies/procedures
✓ Order uniforms
✓ Communication plan conceptualized with Client to increase clinic utilization
Labor Costs Details
Total cost includes salary,benefits,training,CME and is billed 1/12th monthly.Total medical oversight is prescribed to be 1/10th of the
Oversight midlevel time;therefore fee is subject to change if staff levels change
Total cost includes salary,benefits,training,CME and is billed by 1/12th monthly.Concentra will closely monitor the utilization of the center;
any requested adjustments to the on-site center hours of operation and/or staffing will be modified upon mutual agreement between the
parties and documented by an executed amendment to the agreement.In the event that additional hours are deemed temporarily necessary
for existing staff members that are not overtime hours,they will be billed at the rates listed above.In the event that overtime hours are
Mid-Level(s) deemed temporarily necessary,overtime hours will be billed at 1.5X the rates listed above.
Total cost includes salary,benefits,training,CME and is billed by 1/12th monthly.Concentra will closely monitor the utilization of the center;
any requested adjustments to the on-site center hours of operation and/or staffing will be modified upon mutual agreement between the
parties and documented by an executed amendment to the agreement.In the event that additional hours are deemed temporarily necessary
for existing staff members that are not overtime hours,they will be billed at the rates listed above.In the event that overtime hours are
Medical Assistants deemed temporaril necessary,overtime hours will be billed at 1.5X the rates listed above.
On•oin• Fees Details
Network Connectivity Ongoing support&cost for system connectivity
Includes hardware&accessories for 3 exam room/total 5 work stations including:computers,printer,scanner,copier.All maintenance of
Equipment Lease said equipment also included.
Technology Fee All licensing and hosting costs for EMR and patient portal as well as ongoing support and training
Management Fee ✓ Local,Regional,and national medical and operational oversight and support teams
✓ Dedicated Director of Strategic Accounts to support strategy
✓ Billing and collections
✓ Analytics
✓ HR support for colleagues
Estimated Pass-Through
Costs Details
Estimate was provided by City based on prior usage-This will be billed as incurred on the monthly invoice and will fluctuate based on
Estimated Medical Supplies*** utilization.
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Estimate was provided by City based on prior usage-This will be billed as incurred on the monthly invoice and will fluctuate based on
Estimated Laboratory"" utilization.
Estimated Office This will be billed as incurred on the monthly invoice and will fluctuate based on utilization.The preferred method for office supply ordering is
SupplieslAdminlTravel/Other"` for direct procurement by the City.
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Attachment D: Insurance Requirements
INSURANCE REQUIREMENTS
I. PROPOSER'S LIABILITY INSURANCE
A. Proposer must not commence work under this contract until all insurance required
has been obtained and such insurance has been approved by the City. Proposer
must not allow any subcontractor to commence work until all similar insurance
required of any subcontractor has been obtained.
B. Proposer must furnish to the City's Risk Manager and Director of Human Resources,
one (1) copy of Certificates of Insurance with applicable policy endorsements
showing the following minimum coverage by an insurance company(s) acceptable
to the City's Risk Manager. The City must be listed as an additional insured on the
General liability and Auto Liability policies by endorsement, and a waiver of
subrogation by endorsement is required on all applicable policies. Endorsements
must be provided with Certificate of Insurance. Project name and/or number must
be listed in Description Box of Certificate of Insurance.
TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE
30-day advance written notice of Bodily Injury and Property Damage
cancellation, non-renewal, material Per occurrence - aggregate
change or termination required on all
certificates and policies.
COMMERCIAL GENERAL LIABILITY $1,000,000 Per Occurrence
including: $2,000,000 Aggregate
1. Commercial Broad Form
2. Premises- Operations
3. Products/ Completed Operations
4. Contractual Liability
5. Independent Proposers
6. Personal Injury- Advertising Injury
MEDICAL PROFESSIONAL LIABILITY $1,000,000 per claim / $2,000,000
including: aggregate
Coverage provided shall cover all (Defense costs not included in Policy
physicians, nurses, assistants, officers, limits)
directors, employees and agents If claims made policy, retro date must
1. Medical Malpractice be prior to inception of agreement;
2. Errors and Omissions have extended reporting period
provisions and identify any limitations
regarding who is an Insured
AUTO LIABILITY (including) $500,000 Combined Single Limit
1. Owned
2. Hired and Non-Owned
3. Rented/Leased
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WORKERS'S COMPENSATION Statutory and complies with Part II of
(All States Endorsement if Company is not this
domiciled in Texas) Exhibit.
Employer's Liability
$500,000/$500,000/$500,000
C. In the event of accidents of any kind related to this contract, Proposer must furnish
the Risk Manager with copies of all reports of any accidents within 10 days of the
accident.
II. ADDITIONAL REQUIREMENTS
A. Applicable for paid employees, Proposer must obtain workers' compensation
coverage through a licensed insurance company. The coverage must be written on
a policy and endorsements approved by the Texas Department of Insurance. The
workers' compensation coverage provided must be in an amount sufficient to assure
that all workers' compensation obligations incurred by the Proposer will be promptly
met. An All States Endorsement shall be required if Proposer is not domiciled in the
State of Texas.
B. Proposer shall obtain and maintain in full force and effect for the duration of this
Contract, and any extension hereof, at Proposer's sole expense, insurance coverage
written on an occurrence basis by companies authorized and admitted to do
business in the State of Texas and with an A.M. Best's rating of no less than A- VII.
C. Proposer shall be required to submit a copy of the replacement Certificate of
Insurance to City at the address provided below within 10 days of any change made
by the Proposer or as requested by the City. Proposer shall pay any costs incurred
resulting from said changes. All notices under this Exhibit shall be given to City at the
following address:
City of Corpus Christi
Attn: Risk Manager
P.O. Box 9277
Corpus Christi, TX 78469-9277
D. Proposer agrees that, with respect to the above required insurance, all insurance
policies are to contain or be endorsed to contain the following required provisions:
• List the City and its officers, officials, employees, and volunteers, as additional
insureds by endorsement with regard to operations, completed operations, and
activities of or on behalf of the named insured performed under contract with the
City, with the exception of the workers' compensation policy;
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• Provide for an endorsement that the "other insurance" clause shall not apply to the
City of Corpus Christi where the City is an additional insured shown on the policy;
• Workers' compensation and employers' liability policies will provide a waiver of
subrogation in favor of the City; and
• Provide thirty (30) calendar days advance written notice directly to City of any,
cancellation, non-renewal, material change or termination in coverage and not less
than ten (10) calendar days advance written notice for nonpayment of premium.
E. Within five (5) calendar days of a cancellation, non-renewal, material change or
termination of coverage, Proposer shall provide a replacement Certificate of
Insurance and applicable endorsements to City. City shall have the option to
suspend Proposer's performance should there be a lapse in coverage at any time
during this contract. Failure to provide and to maintain the required insurance shall
constitute a material breach of this contract.
F. In addition to any other remedies the City may have upon Proposer's failure to
provide and maintain any insurance or policy endorsements to the extent and within
the time herein required, the City shall have the right to order Proposer to stop work
hereunder, and/or withhold any payment(s) which become due to Proposer
hereunder until Proposer demonstrates compliance with the requirements hereof.
G. Nothing herein contained shall be construed as limiting in any way the extent to
which Proposer may be held responsible for payments of damages to persons or
property resulting from Proposer's or its subcontractor's performance of the work
covered under this contract.
H. It is agreed that Proposer's insurance shall be deemed primary and non-contributory
with respect to any insurance or self insurance carried by the City of Corpus Christi for
liability arising out of operations under this contract.
I. It is understood and agreed that the insurance required is in addition to and
separate from any other obligation contained in this contract.
2016 Insurance Requirements
Human Resources.
Employer Sponsored Wellness Clinic Services Agreement
2/11/2016 ds Risk Management
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CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2016-21248
Concentra Health Services, Inc.
Addison,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 03/03/2016
being filed.
City of Corpus Christi Date cknowledged:/)--
2rThil--()UP3 Provide the identification number used by the governmental entity or state agency to track or identify the c ntrac,and provide a
description of the goods or services to be provided under the contract.
103
Employer-Sponsored Wellness Clinic
4 Nature of interest(check applicable)
Name of Interested Party City,State,Country(place of business)
Controlling Intermediary
5 Check only if there is NO Interested Party.
El
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6 Alda I swear,or affirm,under p-nalty of perjury, , at th' above disclosure is true
1
aprrect.
s DANIEL
My Commission Expires and
/October 29,2017
Kei Newt esident and Chief Executive Officer
Sign. re of authorized agent of con ting business entity
AFFIX NOTARY STAMP/SEAL ABOVE Ktith
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Sworn to and subscribed before me,by the said 71'61dt/it" 04-L ( y it,this the I0+ day of inAfat .
201 6 ,to certify which,witness my hand and seal of office. & llap-
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Signature of efiiccs administering oath Panted r ne of administering oath Title of effir�l administering oath
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.312