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HomeMy WebLinkAbout113033 GENERALCARE HEALTH SERVICES INC - CONTRACT - RFP - P1089 MEDICAL PROVIDER - WORKERS COMPENSATIONSERVICES AGREEMENT THIS AGREEMENT made and entered into the day and year set forth below by and between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter referred to as the "City" and GeneralCare Medical Clinic, hereinafter referred to as "Service Provider" WITNESSETH In consideration of the mutual covenants and obligations herein expressed, it is agreed by and between the parties hereto as follows 1 SccoE of Services The Service Provider agrees to provide services in accordance with the scope of services attached hereto as Exhibit "A", consisting of two (2) pages and incorporated herein by this reference 2 Contract Period This Agreement shall commence January 1, 2008, and shall continue in full force and effect until December 31, 2008, unless sooner terminated as herein provided In addition, at the option of the City, the Agreement may be extended for additional one year periods not to exceed four (4) additional one year periods Renewals and pricing changes shall be negotiated by and agreed to by both parties The Denver Boulder Greeley CPIU published by the Colorado State Planning and Budget Office will be used as a guide Written notice of renewal shall be provided to the Service Provider and mailed no later than nmely (90) days prior to contract end 3 Delgy If either party is prevented in whole or in part from performing its obligations by unforeseeable causes beyond its reasonable control and without its fault or negligence, then the party so prevented shall be excused from whatever performance is prevented by such cause To the extent that the performance is actually prevented, the Service Provider must provide written notice to the City of such condition within fifteen (15) days from the onset of such condition SA rev06/07 14 Conduct return to work (fitness for duty) examinations as requested by the City's TPA Claim Administrator, Risk Management or Human Resources department, and provide appropriate feedback to staff regarding employees' work restrictions vis-a-vis the employees' job duties 15 Employees may be given a "Patient Satisfaction Survey' upon completion of medical services or when they reach MMI The City of Fort Collins may conduct an in-house survey to assess services by the medical provider 16 Ensure medical and office staff is current with certifications pet DOT requirements and drug and alcohol testing regulations 17 Conduct Non -DOT and DOT drug screens and alcohol breath tests Perform DOT tests according to FMCSA and FTA regulations Work with CCOM, third party administrator and Risk Management and Human Resources departments 18 Perform DOT medical exams by a certified medical examiner as specified in Section 390 5 of the Federal Motor Carrier Safety regulations Medical examiner retains the examination form and if determines the driver is qualified, provides a certificate to the driver and one to the Risk Management department SA rE'v06/07 10 INSURANCE REQUIREMENTS 1 The Seance Provider will provide, from insurance companies acceptable to the City, the insurance coverage designated hereinafter and pay all costs Before commencing work under this bid, the Seance Provider shall furnish the City with certificates of insurance showing the type, amount, class of operations covered, effective dates and date of expiration of policies, and containing substantially the following statement "The insurance evidenced by this Certificate will not be canceWed or materially altered, except after ten (10) days written notice has been received by the City of Fort Collins " In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out and maintain, at the expense of the Service Provider, such insurance as the City may deem proper and may deduct the cost of such insurance from any monies which may be due or become due the Service Provider under this Agreement The City, its officers, agents and employees shall be named as additional insureds on the Service Provider's general liability and automobile liability insurance policies for any claims arising out of work performed under this, Agreement 2 Insurance- coverages shall be as follows A Workers' Compensation & Employer's Liability The Service Provider shall - maintain during the life of this Agreement for all of the Service Provider's employees engaged in work performed under this agreement Workers' Compensation insurance with statutory limits as required by Colorado law Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee B Commercial General & Vehicle Liability The Service Provider shall maintain during the life of this Agreement such commercial general liability and automobile liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement Coverage for property damage shall be on a "broad form" basis The amount of insurance for each coverage, Commercial General and Vehicle, shall not be less than $500,000 combined single limits for bodily injury and property damage In the event any work is performed by a subcontractor, the Service Provider shall be responsible: for any liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance SA rev06/07 11 EXHIBIT "C" FEE SCHEDULE Medical Care The City of Fort Collins will receive 5% off the Colorado Workers' Compensation fee schedule Non -Medical Services Per Hour Conferences $300 Depositions $325 Testimony $425 After Hour Urgent Care This is handled as a separate contract and is billed as a monthly fee depending upon the amount of exposure to the GeneralCare Providers after hours —usually much less than the cost of an emergency room visit In addition, there is a $3000 after-hours charge that will be billed if the provider meets a patient after hours at one of our clinics GENERALCARE MEDICAL CLINIC PHYSICAI EXAMINATION COMPONENTS/ PRICES-2007 EXAM SERVICES CHARGES COMPONENT RENDERED Oeneral Examination Hgt, wgt, vision, $60 00 urtmal sts vital signs Range of Motion Range of Motion $1500 Measurements Lumbar Spice Only Back Fit Evaluation Range of Motion $15 00 Measure Flexibility,and Strength Appropriate Range of Motion $20 00 ea Range of Motion Lumbar, Cervical, Shoulder, Wrist, Knee Testing (Per Company Selection) DOT Physical Exam Hgt wA vision, color vision $60 00 DOT card BP, pulse, exercise pulse, unnaiysis, audtorne Respuator Physical Eeam Hgt, wgt, vital signs, exam of specific body $50 00 as required by OSHAIMSHA systems stressed by use of a respirator OSHA RPP Questionnaire Review by medical provider $20 00 Spiromeir5 Pulmonary Function Test $30 00 Respirator Ft Testing Quantitative Fit Testing $40 00 Audiometry Heating Booth $25 00 On -site Testing OSHA/MSHA Compliant with HCP CAOtIC lesters Drug Screens Collection Only $15 00 Dnig Screens Chain of Custod} $30 00 CDL/DOT Certified Medical Review Officer (NIDA-5) DOT Certified Collectors Drug Screens InstaCheck Negative or $30 00 (NIDA-LIKE) Pending (sent to Certified Lab) Amphetim nee, Cocain Certified Medical Review Office Opiates, Martluana, PCp Certified Collectors Breath Alcohol Testing Life Loc PBA Cemfned Instrument and $15 00 Certified lesters 5A revOuiut 12 ACO_RD._ CERTIFICATE OF LI_AB_ILIT_Y INSURANCE 04'"'""""""Y' I I lznvo7 _ .MI5 GERIIF ICATf IS ISSp'cp AS A MATTER Or INFORMATON IRicll S Gatm111 Ir,"runoe ONLY ND GONERS NI ISIGATS UYONT;itl.i-RYIFIGArE 1 of Colorado L` D HOLDER Ili* ( FR I IHCATE DOES NOr ntfi EXl END UR 0 Box i35416 I ALTER THC COVCRFGE AFRUADED I3Y IyL-POVCI£S'BFLOW jcrE«)oy cc 00�73 INAP;U d70-36fi-9J�J bav >"Cv C'� $p 3'[ MWRI PS AFI OROINU 00VtrR41.L �PhbnO - _ _J INS V4lO rnI Hanford Casualty Insurance CompanV • General Care Health Services Inc '.•„RI N,I Plnnaco( Assurance ' I 602 S t-emay Ave„sul _ __ _ _ _ __ Fort Collins CO 80524 1 1 1 ' - - - r IhSUd P q :OVERAGtS 16f{'ptILIC'i Uh lNyUhnFfllhfEDOf LUVI+TVI'.kl ll••:,Vrp l01RC INSI11101.NAFJAL'(`Jllbfl _ (I1r Yl11 iLYI FRO( IN111•Ai rll IUlrl 'I6i/110114: ANY RVOIJIHI MI Nf'I NM or 1.04t IrION 01 A lY LUN11(n41 OR QJIIcH O.t UMI Nr N91n Iit'I'LLl'f, VAI IrH HIS CLI(FINLAq Mnv 6C 6tNU OR MAVr4!FIM1M TIIEINSUHANLFNFONUIUUY iII{I'ULM1IR OI Ef RIULLIICNC'N IS \II(1 (I Ti(`t1i,ME IT1(M: C,Rj 5101f,.1N)VNJV YlOW4 f1f 5VC11 vpl Y' f9 npONF('n rL UMP F SII1l'. MAY HAV i GCe N hFOJCGO d (°M U ! N6 MSR AODr _____1TOLICY Llll N+Slii TYPG IB INS!RAY FOU(YNUMHGr _^ I i rrM1VE'POJLVTARIRA NON LDATP LNkIDWYY) pAtE14WUblY� _ -__Run, _� IS 6ENtenI LIAWILIT I � I 1,60O,OOC I LAA J710R'471U 1 � ILIAbIi 4rvU _ X GOMNCHGITI CLRLRAL I InUIJTY I RNR_MI_FS LEA Lew«Iro) : 300,000 -I( LAME wnDF rX j ucuN' 34SBA'JI1965 - _ _I 03/22/07 03/22IOB I mao rxi RLM �Iro �,-w 6 10,000 J j 4FR9t` Al Y 1JV M1JUIiv �FN_NAL S_ 1,000,000 _ I A4CilCpA'E 2,000.000 - OI IJ/CCRlLA 1111MInr�IP4'1`. YFI, fl•f10001 iS 'OILCIUI'A-O 4I G_1 I 1 �)2,000000 _I I A 1 7 AIJ O"OOILL I IADIIIY —� t ONMIM I)SINO F LIMP ' �AAYAfO 1F+nrn) 1,000,000 _ !a L OVAJfOPU((19 34SBAU11965 PCIpII Y INA RY 03/22/07 03/22/08 S 1 I `Rrl CDJLtO AUI O� I If 1 ` _XInuiconuro. r_ _ - _—_ _ n00IL`N l'II,Y f j X�NON0NNEOAlnUS S�Nc Iwq b I,•RI.R(R,V OAMnn( 11 - J---{I�-� UAPnCC L14DILUY i I _^ _— 11Yu n�crMn f F1VT0 (TLi eI. ALIIpCNI lb _.-J� IN -MYP I (AML t � 1 �IJ'11�,LIAN _ _ /Uit pM1l" -_t ",DOD A FXCCS4IUM'tl<[Llrt c'11y1LNl j F ^vl ueL" I)I W ¢ d 0DV { x :n+L•.- 14SBAU11965 1000,00003/72/07 /08 'i I I Is ICIf, 4I111 I'MR II 1=41i Ar[,N 1 B lNCIK1,9S COMPS NSATION ANO �j._I'm1 1.11OYCOS IIAOaRY I 01/D1107 000110V I ILEA: N.L, 10U1_ y100,000 RAY I-ROPHR, KIIC PAPYNi IIIE M I I I I rrfr9FVIMDCPr\nuai N1 1369942 _ IU1l01708 I O1/01(09 �`x unresl FAr wLOYel� s 100,00D _ _ 1 uhl n•1 I•uuLT (IMN I s 500,000 I `r 1i—D(SCRIupCw p' prFHP NDN`/I DCA IdiN: •VET If1 tS lFXIF USgVS Af.ItM')Y r' Ix FML1u lSl f'Ihh'lPLYn'f" ' � --� City of Fort Collins is named as Additional Insured on the General Liability Policy per contract Or I l)-1GA Tr HOLDER City of Fort Collins P O Box 580 Fort Collins, CO 80522 1 i C A N_C CLLA f I UN ~_l _ ,dW1 UANY Of rN'AUU11.1-1rIENUAC'r.t(5 e/IAlto" LI U1Ft9Nh 1-10PRAIION UIJCUIIIFLOL pVISbUINb IN5URClkWLLONOtAVORIOMNL 1D_DAY4WRI11tti N0116CTU MELLHIUIC%TC,ID1DEA W{t9Tp TI6 _EF1 NIITFAlLUp,TOWhO5kALl IV ROSE NO ODI h'.r11CN OR UAOILI.Y OF ANY KIND URON pip INSURER, In ACCN (%OR RCPRESENTATIVhS AUTNOARGp NCPRh;rMTAtUc —� Shawn A Wolowev WIPORTANT If the certificate holfter IS an ADDII IONA1. INSURED the pollcy(ies) must be endorsed A statement on tnls cert,fieale ooc, not comer rlgnts to III, oc1110rate holder In lieu of such endorsementis) It 806ROGAPON IS VVAIVED, tiUbje�t to the tel.rrs and corcrluons of the policy certain Iwhues may 'equirL 2n eri(1u,,cn)cn t. slatomcn:Oil thi, CPrI1tca*F 00c, r,ot rrnrtpj rlyhts to the cert,flrAre rv]Irtef In IIPII Ot SUGh end OrPPnlrnt(S) DISCLAIMER The Ccrtlficotc ot'osuranre on the reverse side of th Is form does no' cmsMote a contract between the Issuing Insurer(s), at.rhomcd repmsentatl /o or producer, and the ce�lifcate holder, nor aoes It affirmatively or negatively amend extend or alter the coverage afforded by tha policies fisted thereon 25 (2001/03) 4 Early Termination by City/Notice Notwithstanding the time periods contained herein, the City may terminate this Agreement at any time without cause by providing written notice of termination to the Service Provider Such notice shall be delivered at least fifteen (15) days prior to the termination date contained in said notice unless otherwise agreed in writing by the parties All notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to the following addresses City - City of Fort Collins Attri Purchasing PO Box 580 Fort Collins, CO 80522 Service Provider: GeneralCare Medical Clinic Attn Lori Van Skike 620 South Lemay Forl Collins, CO 80524 In the event of early termination by the City, the Service Provider shall be paid for services rendered to the date of termination, subject only to the satisfactory performance of the Service Provider's obligations under this Agreement Such payment shall be the Service Provider's sole right and remedy for such termination 5 Compensation In consideration of the services to be performed pursuant to this Agreement, the City agrees to pay Professional according to Exhibit "C" Fee Schedule consisting of one (1) page and incorporated herein by this reference Monthly partial payments based upon the Professional's billings and itemized statements are permissible The amounts of all such partial payments shall be based upon the Professional's City -verified progress in completing the services to be performed pursuant hereto and upon the City's approval of the Professional's actual reimbursable expenses Final payment shall be made following acceptance of the work by the City Upon final payment, all designs, plans, reports, specifications, drawings, and other services rendered by the Professional shall become the sole property of the City 6 City Representative The City will designate, prior to commencement of the work, its representative who shall make, within the scope of his or her authority, all necessary 2 SA rev06/07 and proper decisions with reference to the services provided under this agreement All requests concerning this agreement shall be directed to the City Representative 7 Independent Service provider The services to be performed by Service Provider are those of an independent service provider and not of an employee of the City of Fort Collins The City shall not be responsible for withholding any portion of Service Provider's compensation hereunder for the payment of FICA, Workmen's Compensation or other taxes or benefits or for any other purpose 8 Personal Services It is understood that the City enters into the Agreement based on the special abilities of the Service Provider and that this Agreement shall be considered as an agreement for personal services Accordingly, the Service Provider shall neither assign any responsibilities nor delegate any duties arising under the Agreement without the prior written consent of the City 9 Acceptance Not Waiver The City's approval or acceptance of, or payment for any of the services shall not be construed to operate as a waiver of any rights or benefits provided to the C+y under this Agreement or cause of action arising out of performance of this Agreement 10 Warranty (a) Service Provider warrants that all work performed hereunder shall be performed with the highest degree of competence and care in accordance with accepted standards for work of a similar nature (b) Unless otherwise provided in the Agreement, all materials and equipment incorporated into any work shall be new and, where not specified, of the most suitable grade of their respective kinds for their intended use, and all workmanship shall be acceptable to City (c) Service Provider warrants all equipment, materials, labor and other work, provided under this Agreement, except City -furnished materials, equipment and labor, against defects and nonconformances in design, materials and workmanship/workwomanship for a period beginning with the start of the work and ending twelve (12) months from and after final acceptance under the Agreement, regardless whether the same were furnished or performed by Service Provider or by any of its subcontractors of any tier Upon receipt of written notice from City of any such defect or nonconformances, the affected item or part thereof shall be redesigned, 3 SA rev06/07 repaired or replaced by Service Provider in a manner and at a time acceptable to City 11 Default Each and every term and condition hereof shall be deemed to be a material element of this Agreement In the event either party should fail or refuse to perform according to the terms of this agreement, such party may be declared in default thereof 12 Remedies In the event a party has been declared in default, such defaulting party shall be allowed a period of ten (10) days within which to cure said default In the event the default remains uncorrected, the party declaring default may elect to (a) terminate the Agreement and seek damages, (b) treat the Agreement as continuing and require specific performance, or (c) avail himself of any other remedy at law or equity If the non -defaulting party commences legal or equitable actions against the defaulting party, the defaulting party shall be liable to the non defaulting party for the non -defaulting party's reasonable attorney fees and costs incurred because of the default 13 Binding Effect This writing, together with the exhibits hereto, constitutes the entue agreement between the parties and shall be binding upon said parties, their officers, employees, agents and assigns and shall inure to the benefit of the respective survivors, heirs, personal representatives, successors and assigns of said parties 14 Indemnity/Insurance a The Service Provider agrees to indemnify and save harmless the City, its officers, agents and employees against and from any and all actions, suits, claims, demands or liability of any character whatsoever brought or asserted for injuries to or death of any person or persons, or damages to property arising out of, result from or occurring in connection with the performance of any service hereunder b The Service Provider shall take all necessary precautions in performing the work hereunder to prevent injury to persons and property 4 SA rev06/07 c Without limiting any of the Service Provider's obligations hereunder, the Service Provider shall provide and maintain insurance coverage naming the City as an additional insured under this Agreement of the type and with the limits specified within Exhibit B, consisting of one (1) page, attached hereto and incorporated herein by this reference The Service Provider before commencing services hereunder, shall deliver to the City's Director of Purchasing and Risk Management, P 0 Box 580 Fort Collins, Colorado 80522 one copy of a certificate evidencing the insurance coverage required from an insurance company acceptable to the City 15 Entire Agreement This Agreement, along with all Exhibits and other documents incorporated herein, shall constitute the entire Agreement of the parties Covenants or representations not contained in this Agreement shall not be binding on the parties 16 Law/Severabrlrty The laws of the State of Colorado shall govern the construction interpretation, execution and enforcement of this Agreement In the event any provision of this Agreement shall be held invalid or unenforceable by any court of competent jurisdiction, such holding shall not invalidate or render unenforceable any other provision of this Agreement 17 Prohibition Against Employing Illegal Aliens This paragraph shall apply to all Contractors whose: performance of work under this Agreement does not involve the delivery of a specific end product other than reports that are merely incidental to the performance of said work Pursuant to Section 8-17 5-101, C.R S., et seq , Contractor represents and agrees that a As of the date of this Agreement 1 Contractor does not knowingly employ or contract with an illegal alien, and 2 Contractor has participated or attempted to participate in the basic pilot employment verification program created in Public Law 208, 104th Congress, as amended, and expanded in Public Law 156, 108th Congress, as amended, administered by the United States Department of Homeland Security (the 'Basic SA reY06/07 Pilot Program") in order to confirm the employment eligibility of all newly hired employees b Contractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or knowingly enter into a contract with a subcontractor that knowingly employs or contracts with an illegal alien to perform work under this Agreement c Contractor shall continue to apply to participate in the Basic Pilot Program and shall in writing verify same every three (3) calendar months thereafter, until Contractor is accepted or the public contract for services has been completed, whichever is earlier The requirements of this section shall not be required or effective if the Basic Pilot Program is discontinued d Contractor is prohibited from using Basic Pilot Program procedures to undertake pre -employment screening of job applicants while this Agreement is being performed e If Contractor obtains actual knowledge that a subcontractor performing work under this Agreement knowingly employs or contracts with an illegal alien, Contractor shall 1 Notify such subcontractor and the City within three days that Contractor has actual knowledge that the subcontractor is employing or contracting with an illegal alien, and 2 Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to this section the subcontractor does not cease employing or contracting with the illegal alien, except that Contractor shall not lerminate the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien SA rev06/07 f Contractor shall comply with any reasonable request by the Colorado Department of Labor and Employment (the "Department") made in the course of an investigation that the Department undertakes or is undertaking pursuant to the authority established in Subsection 8-17 5-102 (5), C R g If Contractor violates any provision of this Agreement pertaining to the duties imposed by Subsection 8-17 5-102, C R S the City may terminate this Agreement If this Agreement is so terminated, Contractor shall be liable for actual and consequential damages to the City arising out of Contractor's violation of Subsection 8-17 5-102, CRS h The City will notify the Office of the Secretary of State if Contractor violates this provision of this Agreement and the City terminates the Agreement for such breach 7 SA rev06107 CITY OF FORT COLLINS, COLORADO a municipal corporation plllNg Y *%5 Jame B 'Neill II, CPPO, FNIGP ;p Director ofJPurchasing and Risk Management :o •••..... _•��� Date Z17�4 I GeneralCare Medical inic i BY PRINT NAME CORPORATE PRESIDENT OR VICE PRESIDENT Date /-I- /U-O 7 ATTEST (Corporate Seal) CORPORATE SECRETARY SA rev06/07 EXHIBIT A SCOPE OF WORK 1 Provide appropriate medical care and case management at a minimum of five (5) days a week from 8 00 a m to 5 00 p m , for City of Fort Collins employees that have injuries or illnesses alleged to have occurred as a result of their employment 2 Provide medical opinion to assess work relatedness in each case to diminish the possibility of fraudulent claims 3 Maintain accurate medical records for every City employee receiving medical care Individual patient records and reporting systems necessary to carry out program administrative, planning, and legal requirements will be established and maintained 4 Notify City TPA and Risk Management after medical treatment is rendered The report will include information on the accident/exposuie, work restncWns, and prognosis for return to work This information should be transmitted to the city's electronic mail system or Risk Management fax If electronic notification is not available as of January 1, 2008, it shall be available by June 1, 2008 5 Notify Risk Management or City TPA for approval prior to referral of employee from your facility to another physician, or upon admission to a hospital or other facility All information for on -going treatment shall be sent promptly to the receiving physician, hospital or other facility 6 Provide employee with written "status" report outlining work restrictions, if any, for every visit 7 Provide a written dictation / summary report within TWO (2) days of initial treatment to Risk Management and TPA claim administrator 8 Provide specialty services as requested such as physical examinations, audiograms, x- rays, EKG's, immunizations, physical therapy, drug and alcohol testing, DOT physicals, pre -employment physicals and other medical services as may be deemed beneficial to City employees and the employer 9 Be familial with Workers' Compensation laws and provide hearing testimony when needed 10 City employees shall be treated only by Level II accredited physicians on weekdays and upon entry with appointment and follow-up visits post walk-in Examinations and treatments by PA are acceptable for minor first aid and other insignificant procedures 11 Cooperate with the City's TPA claim administrator and risk management staff in submitting information upon request in a timely manner 12 Participate in consultations with employer and TPA claim administrator as requested to discuss specific cases and procedures 13 Provide a written medical treatment plan when requested