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Providence Occupational Medical Group ~ C180007 City of Tigard CONTRACT CHANGE ORDER/ 13125 SW Hall Blvd. AMENDMENT SUMMARY Tigard,Ore n 97one_(503j223 639-4171 7223 FIELD CHANGE ORDER FORM Fax-(503) 684-7297 0 ww-W.u Project Title: Physical Capacities Testing Project Manager:Brandi Leos Contractor: Providence Occupational Med. Grp O ' al Contract#: C180007 Effective Dates: 07/27/2017— 12/31/2020 Chane Order/Amendment Amount: Accounting S Amendment PercentaZe Running Total: % , AMENDMENT DETAILS Extend End Date to: Deeeffiber 31,2019 uecember S1,GUZU CHANGE ORDER DETAILS UNIT QTY UNIT$ TOTAL$ REASONING FOR CHANGE ORDER/AMENDMENT BUDGET IMPACT AND REQUIRED ACTIONS REQUESTING PROJECT MANAGER L APPROVING CITY STAFF Signature Signature Date Date Contractor is hereby authorized by the City of Tigard to perform CONTRACTOR the additional work described below in accordance with the terms and conditions detailed in the original contract along with all applicable rules,regulations,and laws that may be in effect for the Signature work. The unit pricing in the original contract shall apply to all additional work. A copy of this form, once completed, is to be forwarded to the Purchasing Office to ensure all changes to the encumbrances are met. Remember— the cumulative total of Amendments cannot exceed theproject's FY budget. Date �Iv CITY OF TIGARD,OREGON AMENDMENT TO CONTRACT PHYSICAL CAPACITIES TESTING C180007 AMENDMENT #1 The Agreement between the City of Tigard,a municipal corporation of the State of Oregon,hereinafter called City,and Providence Health&Services-Oregon,dba Providence Occupational Medicine,hereinafter referred to as Contractor,entered into on the 27th day of July,2017,is hereby amended as follows: 1. EFFECTIVE DATE AND DURATION Contractor shall initiate services upon receipt of City's notice to proceed,together with an executed copy of this Agreement. This Agreement shall become effective upon the date of execution and shall expire, unless otherwise terminated or extended,on Deeember 31,-241-9 December 31,2020. All services shall be completed prior to the expiration of this Agreement. IN WITNESS WHEREOF, City has caused this Amendment to be executed by its duly authorized undersigned officer and Contractor has executed this Amendment upon signature and date listed below. CITY OF TIGARD PROVIDENCE OCCUPATIONAL MED.GRP j' Signature Signature X I r4u Printed Name Printed Name — Date Date CITY OF TIGARD,OREGON AMENDMENT TO CONTRACT PHYSICAL CAPACITIES TESTING C180007 AMENDMENT #1 The Agreement between the City of Tigard,a municipal corporation of the State of Oregon,hereinafter called City, and Providence Health&Services -Oregon,dba Providence Occupational Medicine,hereinafter referred to as Contractor, entered into on the 27th day of July, 2017,is hereby amended as follows: 1. EFFECTIVE DATE AND DURATION Contractor shall initiate services upon receipt of City's notice to proceed,together with an executed copy of this Agreement. This Agreement shall become effective upon the date of execution and shall expire, unless otherwise terminated or extended,on Deeember-31z0-1.9 December 31,2020. All services shall be completed prior to the expiration of this Agreement. IN WITNESS WHEREOF, City has caused this Amendment to be executed by its duly authorized undersigned officer and Contractor has executed this Amendment upon signature and date listed below. CITY OF TIGARD PROVIDENCE OCCUPATIONAL MED.GRP L I%� `R { Signature Signature Printed Name Printed Name Com • / Zo/ ll - Zq--t�' Date Date CITY OF TIGARD,OREGON-CONTRACT SUMMARY FORM ("PHIS FORMMUST ACCOMPANY EVERY CONTRACT �__ _.�- Contract Title: Physical Capacity Testing Number: M Contractor: Providence Occupational Medical Group Contract Total: $50,000.00 Contract Overview: Covers pre-employment physical capacities and drug testing for a variety of City of Tigmd positions. Initial Risk Level: ❑ Extreme ❑ High &Moderate ❑ Low Risk Reduction Steps: Risk Comments: Risk Signature: Contract Manager: Brandi Leos Ext: 2407 Department: HR Type: ❑ Purchase Agreement ® Personal Service ❑ General Service ❑ Public Improvement ❑ IGA ❑ Other: Start Date:-&A4' l'r End Date: 12/31/2019 Quotes/Bids/Proposal: FIRM AMOUNT/SCORE Account String: Fund-Division-Account Work Order—Activit;Tyke Amount FY YYl v +16�12. A m -S FY FY FY FY 412rovals - LCRB Date: Department Comments: Department Signature: Purchasing Comments: Purchasing Signature: City Manager Comments: City Manager Signature: After securing all required approvals,forward original copy to the Contracting and Purchasing Office along with a completed Contract Checklist. Contract # 6 CI'T'Y OF TIGARD, OREGON AGREEMENT FOR SERVICES RELATED TO PHYSICAL,CAPACITIES TESTING THIS AGREEMENT made and entered into this 27`x' day of July, 2017 by and between the City of Tigard,a municipal corporation of the State of Oregon, hereinafter called "City", and Providence Health & Services — Oregon, dba Providence Occupational Medicine, hereinafter called "Contractor", collectively known as the "Parties." RECITALS WHEREAS, Contractor has submitted a bid or proposal to City to provide specific services; and WHEREAS, Contractor is in the business of providing specific services and is aware of the purposes for which City requires the services;and WHEREAS, City and Contractor wish to enter into a contract under which City shall purchase the services described in Contractor's bid or proposal; THEREFORE,The Parties agree as follows: 1. SERVICES TO BE PROVIDED Contractor agrees to provide services related to pre-employment testing as detailed in Exhibit A—Scope of Services and by this reference made a part hereof. 2. EFFECTIVE DATE AND DURATION Contractor shall initiate services upon receipt of City's notice to proceed,together with an executed copy of this Agreement. This Agreement shall become effective upon the date of execution and shall expire, unless otherwise terminated or extended,on December 31, 2019. All services shall be completed prior to the expimtio:a of this Agreement. 3. COMPENSATION City agrees to pay Contractor an amount not exceeding Fifty Thousand and No/100 Dollars($50,000.00) for performance of those services described herein, which payment shall be based upon the following applicable terms: A. Payment will be made in installments based on Contractor's invoice, subject to the approval by the City, and not more frequently than monthly. Payment shall be made only for work actually completed as of the date of invoice. B. Payment b, City shall release City from any further obligation For payment to Contractor, for services performed or expenses incurred as of the date of the invoice. Payment shall not be considered acceptance or approval of any work or waiver of any defects therein. C. Contractor shall make payments promptly, as due, to all persons supplying labor or materials for the prosecution of this work. D. Contractor shall not permit any lien or claim to be filed or prosecuted against the City on any account of any labor or material furnished. E. Contractor shall pay to the Department of Revenue all sums withheld from employees pursuant to ORS 316.167. F. If Contractor fails, neglects or refuses to make prompt payment of any claim for labor or services furnished to Contractor or a subcontractor by any person as such claim becomes due, City may pay such claim and charge the amount of the payment against funds due or to become due the Contractor. The payment of the claim in this manner shall not relieve Contractor or their surety from obligation with respect to any unpaid claims. G. Contractor shall pay employees at least time and a half pay for all overtime worked in excess of 40 hours in any one work week except for individuals under the contract who are excluded under ORS 653.010 to 653.261 or under. 29 USC sections 201 to 209 from receiving overtime. H. Contractor shall promptly, as due, make payment to any person, co-partnership, association or corporation, furnishing medical,surgical,hospital care or other needed care and attention incident to sickness or injury to the employees of Contractor or all sums which Contractor agrees to pay for such se;-vices and all moneys and sums which Contractor collected or deducted from the wages of employees pursuant to any law, contract or agreement for the purpose of providing or paying for such service. I. The City certifies that sufficient funds are available and authorized for expenditure to finance costs of this contract during the current fiscal year. Appropriations for future fiscal years shall be subject to budget approval by the City Council. 4. ASSIGNMENT/DELEGATION Neither party shall assign or transfer any interest in or duty under this Agreement without the written consent of the other and any attempted assignment or transfer without the written consent of the other party shall be invalid. 5. SUBMITTING BILLS AND MAKING PAYMENTS All notices and bills shall be made in writing and may be given by personal delivery,mail or fax. Payments may be made by personal delivery,mail, or electronic transfer. The following addresses shall be used to transmit notices,bills,payments,and other information: { T~ Ty ov TwAR.D: PROVIDE NCV OCCUPATIONAL Wb.GRV, Attn:Brandi Leos Attn: Laura Cook Address: 13125 SW Hall Boulevard Address:--1a3� "mac. Tigard, Oregon 97223 Lair.@ QswgFa, QR-974-15— �t'`�'� -3 Phone: (503) 718-2407 Phone: `jC`3 51`'13=1���� �`\e,, ,L�(i— �� Fax: (503) 6.39-6795 Fax: . - S-61S Email: brandi r..Rigard-or.grov Email: laura.cool::a),1,rovidence.org 6. TERMINATION The parties agree that any decision by either party to terminate this Agreement before the 31"day of December.,2019 shall be accompanied by thirty(30) days written notice to the other party prior to the date termination would take effect. There shall be no penalty for early termination. If City terminates the contract pursuant to this paragraph,it shall pay Contractor for services rendered prorated to the date of termination. 2 1 Par> e, 7. ACCESS TO 'RECORDS City shall have access to such books, documents, papers and records of Contractor as are directly pertinent to this Agreement for the purpose of making audit,examination,excerpts and transcripts. S. FORCE MAI]EURE Neither City nor Contractor shall be considered in default because of any delays in completion and responsibilities hereunder due to causes beyond the control and without fault or negligence on the part of the parties so disenabled, including but not restricted to, natural disaster, war, civil unrest, volcano, earthquake, fire, flood, epidemic, quarantine restriction, area-wide strike, freight embargo, unusually severe weather or delay of subcontractor or supplies due to such cause; provided that the parties so disenabled shall within ten (10) days from the beginning of such delay, notify the other party in writing of the cause of delay and its probable extent. Such notification shall not be the basis for a claim for additional compensation. Each party shall,however,make all reasonable efforts to remove or eliminate such a cause of delay or default and shall, upon cessation of the cause, diligently pursue performance of its obligation under the Agreement. 9. NON-DISCRIMINATION Contractor agrees to comply with all applicable requirements of federal and state civil lights and rehabilitation statues, rules, and regulations. Contractor also shall comply with the Americans with Disabilities Act of 1990,ORS 659A.142,and all regulations and administrative rules established pursuant to those laws. 10. INDEMNIT`c' Contractor agrees to and shall defend, indemnify and hold harmless City, City's officers, employees, agents and representatives from and against all liability, claims, costs, demands, judgments,penalties, and causes of action of any kind or character,or other costs or expenses incidental to the investigation and defense thereof,of whatever nature,resulting from or arising out of the activities of the Contractor or its subcontr;ictors,agents, or employees in performance of this contract, except,however, that the foregoing shall not apply to liability that arises out of the City's, its officers', employees', agents' and representatives' negligence. In cases in which negligence or liability is alleged against both parties, each party shall indemnify the other for its own negligence or liability. If any aspect of this indemnity shall be found to be illegal or invalid for any reason whatsoever, such illegality or invalidity shall not affect the remainder of this indemnification. 11. INSURANCE; Contractor shalt_ maintain insurance acceptable to City in full force and effect throughout the term of this contract. Such insurance shall cover risks arising directly or indirectly out of Contractor's activities or wort:hereunder. The policy or policies of insurance maintained by the Contractor shall provide at least the following limits and coverages: A. Cominercial General Liability Insurance Contractor shall obtain,at contractor's expense,and keep in effect during the term of this contract, Comprehensive General Liability Insurance covering Bodily injury and Property Damage. This coverage shall include Contractual Liability insurance for the indemnity provided under this contract. The following insurance will be carried: 3 1 T1agc Coverage Limit General Aggregate 3,000,000 Products-Completed Operations Aggregate 2,000,000 Persotn:al &Advertising Injury 1,000,000 Each Occurrence 2,000,000 Fire Damage (any one fire) 50,000 B. Commercial Automobile Insurance Contractor shall also obtain, at contractor's expense, and keep in effect during the term of the contract, Commercial Automobile Liability coverage including coverage for all owned, hired, and non-owned vehicles. The Combined Single Limit per occurrence shall not be less than$2,000,000. C. Workers' Compensation Insurance The contractor, its Subcontractors, if any, and all employers providing work, labor, or materials under this Contract that are subject employers under the Oregon Workers' Compensation Law shall comp:.y with ORS 656.017,which requires them to provide workers' compensation coverage that satisfies Oregon law for all their subject workers. Out-of-state employers must provide Oregon workers' compensation coverage for their workers who work at a single location within Oregon for more than 30 days in a calendar year. Contractors who perform work without the assistance or labor of any employee need not obtain workers' compensation coverage. All non- exempt employers shall provide Employer's Liability Insurance with coverage lit-nits of not less than $1,000,000 each accident. D. Additional Insured Provision All policies aforementioned, other than Workers' Compensation and Professional Liability, shall include the City its officers, employees, agents and representatives as additional insureds with respect to this contract. E. Self-Insurance The City understands that some Contractors may self-insure for business risks and the City will consider whether such self-insurance is acceptable if it meets the minimum insurance requirements for the type: of coverage required. If the Contractor is self-insured for commercial general liability or automobile liability insurance the Contractor must provide evidence of such self-insurance. The Contractor must provide a Certificate of Insurance showing evidence of the coverage amounts on a form acceptable to the City. The City reserves the right in its sole discretion to determine whether self-insurance is adequate, F. Certificates of Insurance As evidence of the insurance coverage required by the contract, the Contractor shall furnish a Certificate of Insurance to the City. No contract shall be effective until the required Certificates of Insurance have been received and approved by the City. The certificate will specify and document all provisions within this contract and include a copy of Additional Insured Endorsement. A renewal certificate will be sent to the below address prior to coverage expiration. G. Independent Contractor Status The service or services to be rendered under this contract are those of an independent contractor. Contractor is not an officer,employee or agent of the City as those terms are used in ORS 30.265. 4 II. Primary Coverage Clarification The parties agree that Contractor's coverage shall be primary to the extent permitted by law. The parties further agree that other insurance maintained by the City is excess and not contributory insurance vrith the insurance required in this section. I. Cross-Liability Clause A cross-lia:)ility clause or separation of insureds clause will be included in all general liability, professional liability,pollution and errors and omissions policies required by thus contract. A certificate in form satisfactory to the City certifying to the issuance of such insurance will be forwarded to: City of Tigard Attn: Contracts and Purchasing Office 13125 SSU I=Iall Blvd. "Tigard, Oregon 97223 Such policies or certificates must be delivered prior to commencement of the work. The procuring of such required insurance shall not be construed to limit contractor's liability hereunder. Notwithstanding said insurance, Contractor shall be obligated for the total amount of any damage,injury, or loss caused by negligence or neglect connected with this contract. 12. ATTORNEY'S FEES In case suit or action is instituted to enforce the provisions of this contract, the parties agree that the losing party shall pay such sum as the court may adjudge reasonable attorney fees and court costs, including witness fees (expert and non-expert),attorney's fees and court costs on appeal. 13. COMPLIANCE WITH STATE AND FEDERAL LAWS/RULES Contractor shall comply with all applicable federal, state and local laws, rules and regulations, including, but not limited to, the requirements concerning working hours, overtime, medical care, workers compensation insurance, health care payments, payments to employees and subcontractors and income tax withholding contained in ORS Chapters 279A, 279B, and 279C, the provisions of which are hereby made a part of this agreement. 14. CITY OF TIGARD BUSINESS LICENSE Contractor shall obtain,prior to the execution of any performance under this Agreement,a City of Tigard Business License. The Tigard Business License is based on a calendar year with a December 31st expiration date. New businesses operating in Tigard after June 30th of the current year will pay a pro- rated fee though the end of the calendar year. 15. CONFLICT BETWEEN TERMS It is further expressly agreed by and between the parties hereto that should there be any conflict between the terms of this instrument in the proposal of the contract, this instrument shall control and nothing herein shall be considered as an acceptance of the terms of proposal conflicting herewith. 16. SEVERABILITY In the event any provision or portion of this Agreement is held to be unenforceable or invalid by any court of competent jurisdiction, the validity of the remaining terms and provisions shall not be affected to the extent that it did not materially affect the intent of the parties when they entered into the agreement. 5 111aye. 17. COMPLETE AGREEMENT This Agreement,including the exhibits,is intended both as a final expression of the Agreement between the Parties and as a complete and exclusive statement of the terms. In the event of an inconsistency between a provision in the main body of the Agreement and a provision in the Exhibits,the provision in the main body of the Agreement shall control. In the event of an inconsistency between Exhibit A and Exhibit B,Exhibit A shall control. No waiver, consent, modification, or change of terms of this Agreement shall bind either party unless in writing and signed by both parties. Such waiver, consent, modification, or change if made, shall be effective only in specific instances and for the specific purpose given. There are no understandings, agreements, or representations, oral or written, not specified herein regarding this Agreement. Contractor,by the signature of its authorized representative,hereby acknowledges that he/she has read this Agreement,understands it and agrees to be bound by its terms and conditions. IN WITNESS WHEREOF,City has caused this Agreement to be executed by its duly authorized undersigned officer and Contractor has executed this Agreement on the date hereinabove first written, CITY OF TIGARD oQ PROVIDENCE OCCUPATIONAL MED GRP By:Authorized City Representative By: Program Bgroe*ar EA10 19-01-7 Date Date 6 1' age EXHIBIT A SCOPE OF SERVICES TEST ADMINISTRATION Scheduling Appointments The candidate/examinee shall: 1. Contact the Consultant agency by calling 503-216-7960 within three business days to arrange an appointment at a desired clinic location. Administering the Tesr. The consultant shall adhere to the following process: 1. Upon arrival at the clinic, the candidate/exarninee is registered by the front desk staff and directed to complete any recuired forms. 2. After registration, the candidate/examinee is then escorted to the back office where any necessary ancillary services are performed by a certified Medical Assistant or Technicians(i.e.height,weight,blood pressure,vision screens,hearing tests,lung function tests,etc.).A qualified medial provider will complete the additional aspects of the pre-screen medial evaluation,including administering a drug test and other medical tests as may be necessary. 3. After the pre-screen medical evaluation with the medical provider, the examinee is escorted to the to the physical capacity room where the remainder of the examination will be performed by a certified Medical Assistant. 4. The process typically takes 45 rninutes to one hour. 5. Upon completion of the appointment the front desk staff assists the examinee in "checking out". Reporting Examination Results The consultant shall: 1.. Following test completion,process records and reports and send results to the identified City of Tigard Human Resources designee. 2. Certify and provide results from the examination/evaluation to the City within two (2) business days or when lab and ancillary results are available. 3. Provide results to the City of Tigard in a one page report which indicates one of the following: a) Pre-screen medical and baseline test results: I. The individual may perform the job without restrictions. 11. Limitations are identified in this individual's ability to perform the job: (limitations noted) b) PCE test results: I. The examinee is cleared to perform the job without restriction/accommodations;or, II. Identification of limitations and accommodation(s); or, c) Determination Pending review of requested medical records Further evaluation is necessary,which may include additional testing, or review of requested medical records, 4. Restrict protected health information from the report provided to the City of Tigard. 5. NOT provide examinees a copy of the report, nor give information about the results, unless special instructions to do so are provided by the City of Tigard. 6. Make available providers and staff to answer questions the City of Tigard contact may have regarding the examinations,within the allowances of I APPA. 'rime Commitments The consultant shall: 1. Complete the conditional post-offer evaluation in one visit unless, based on a specific exaininee's medical history, additional medical information is needed. 711) age 2. Obtain the necessary release from the examinee and request records as appropriate. 3. Review records within one to two business days of receipt, and issue a final report of findings within two business day of review OR when required contact candidate/examinee to return to complete final testing phases. RECORDS ADMINISTItA'rION The consultant shall: 1. Maintain physical custody of all medical records and retain all records relating to Tigard business for at least 5 years after termination or cancellation of the Agreement or,if later,until any related pending proceeding or lit.gation has been closed, 2. Archive records per the State's record retention schedule. (Medical records may be maintained by the consultant electronically,provided the consultant has confirmed the format conforms to specifications required by City of Tigard for transfer of records.) 3. Warranty that consultant is knowledgeable of HIPAA and the protection of health information obtained, created, or exchanged as a part of a contract with the City,and shall abide by and implement I TPAA's statutory requirements. 4. Assist the City,when requested,in responding to claims/appeals that may be filed as a result of disqualification or conditional pass of an applicant/employee,including but not limited to: administrative hearings, courts of competent jurisdiction, quasi-legal,and quasi-judicial hearings. OTHER ON-SITE SERVICES The consultant may: 1. Provide on-site training as requested by the city in areas such as wellness program training and support, ergonomics, etc. 2. Provide other services such as ergonomic evaluations, or other related services as agreed upon by the consultant and the City of Tigard. 3. Provide services related to job task analysis and creation of future physical capacities tests as agreed upon by the consultant and the City of Tigard. FEE SCHEDULE The city shall remunerate the consultant agency as follows: DOT Medical Exams—New DOT Medical Exams—Recerfifications DOT Medical Exam-$95.00 DOT Medical Exam-$95.00 Audiogram-$25.00 Audiogram-$25.00 Accucheck-$17.00 Accucheck-$17.00 ECG-$65.00 ECG-$65.00 Record Review Brief-$25.00 Record Review Brief-$25.00 Record Review Extended-$50.00 Record Review Extended-$50.00 Exam Brief Follow-Up-$55.00 Exam Brief Follow-Up-$55.00 No Show DOT Exam Fee,-$95.00 No Show DOT Exam Fee-$95.00 8 Page: Customer Service Field Worker FBI Candidate Exam Pre-placement Exam-$85.00 Pre-placement Exam-$85.00 NON DOT Drug Screen Collection-this is billed TB Skin Test-$28.00 directly to BioMed ECG-$65.00 Record Review Brief-$25.00 ECG Stress Treadmill-$250.00 Record Review Extended-$50.00 Company Farms 1-5 pages-$15.00 Exam Brief Follow-Up-$55.00 Record Review Brief-$25.00 No Show Pre-placement Exam Fee-$85.00 Record Review Extended-$50.00 Exam Brief Follow-Up-$55.00 No Show Pre-placement Exam Fee-$85.00 Utility Worker-Parks Utility Worker-All Other Pre-placement Exam-$85.00 Pre-placement Exam-$85.00 PCT Standard-$63.00 PCT Standard-$63.00 Audiogram-$25.00 Audiogram-$25.00 DOT Qualification-$25 00 DOT Qualification-$25.00 DOT Drug Screen Collection-this is billed directly to DOT Drag Screen Collection-this is billed directly to BioMed BioMed Accucheck-$17.00 Accucheck-$17.00 ECG-$65.00 ECG-$65.00 Record Review Brief-$7.5.00 Record Review Brief-$25.00 Record Review Extended-$50.00 Record Review Extended-$50.00 Exam Brief Follow-Up-$55.00 Exam Brief Follow-Up-$55.00 No Show Pre-placement Exam Fee-$85.00 No Show Pre-placement Exam Fee-$85.00 Police Exam-DPSST Fitness for Duty/Return to Work Exam DPSST-$90.00 FFD/RTW Exam-$125.00 Audiogram-$25.00 Record Review Brief-$25.00 Spirometry-$36.00 Record Review Extended-$50.00 Titmus-$25.00 Exam Brief Follow-Up-$55.00 Ishihara-$10.00 No Show Pre-placement Exam Fee-$125.00 NON DOT Drug Screen Collection-this is billed directly to BioMed Venipuncture-$15.00 Comprehensive Metabolic Panel-$33.00 Blood Count-$22.00 Blood Typing ABO-$4"7.00 UA Dip-$20.00 UA Dip w/Micro-$20.01) Chest X-Ray-$95.00 Record Review Brief-$25.00 Record Review Extended-$50.00 Exam Brief Follow-Up- $55.00 No Show DPSST Exam Fee-$90.00 INVOICING The consultant shall: 1. Not transmit invoices or test results,which have date of birth and partial social security number,via electronic systems. 9 1 P ,.t g�