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Home My Public Portal About032-2017 - HR - Georgia's Pharmacy - Durable Medical EquipmentPROFESSIONAL SERVICES AGREEMENT THIS AGREEMENT made and entered into this Z"d day of kl'M , 2017, and referred to as Contract No. 32-2017, by and between the City of Richmond, Indiana, a municipal corporation acting by and through its Board of Public Works and Safety (hereinafter referred to as the "City") and George's Family Pharmacy, Inc., 1198 State Road 46E, Batesville, Indiana, 47006 (hereinafter referred to as the "Contractor"). SECTION I. STATEMENT AND SUBJECT OF WORK City hereby retains Contractor to be the Durable Medical Equipment ("DME") contract provider for the City of Richmond, Indiana for the 2017 calendar year. The proposal of Contractor is attached hereto as Exhibit "A", which Exhibit consists of six (6) pages, and is hereby incorporated by reference and made a part of this Agreement. Contractor shall perform all work and provide all services described on Exhibit "A." Should any provisions, terms, or conditions contained in any of the documents attached hereto as Exhibits, or in any of the documents incorporated by reference herein, conflict with any of the provisions, terms, or conditions of this Agreement, this Agreement shall be controlling. Contractor shall perform all work herein in a timely manner, conforming to all applicable professional standards. The Contractor shall furnish all labor, material, equipment, and services necessary for the proper completion of all work specified. No performance of services shall commence until the following has been met: 1. The City is in receipt of any required certificates of insurance; 2. The City is in receipt of any required affidavit signed by Contractor in accordance with Indiana Code 22-5-1.7-11(a)(2); and 3. A purchase order has been issued by the Purchasing Department. SECTION II. STATUS OF CONTRACTOR Contractor shall be deemed to be an independent contractor and is not an employee or agent of the City of Richmond. The Contractor shall provide, at its own expense, competent supervision of the work. Contract No. 32-2017 Page 1 of 6 SECTION III. COMPENSATION City shall pay Contractor at the rates set forth in the attached Exhibit A, and for the complete performance of all work described herein in a satisfactory and proper manner. Said cash pricing rates represent a twenty-five percent (25%) discount from the 2016 rates. Delivery and set up of any DME provided to employees pursuant to this Agreement shall be provided free of charge. SECTION IV. TERM OF AGREEMENT This Agreement shall be effective as of January 1, 2017, and shall continue in effect until December 31, 2017. Notwithstanding the term of this Agreement, City may terminate this Agreement in whole or in part, for cause, at any time by giving at least five (5) working days written notice specifying the effective date and the reasons for termination which shall include but not be limited to the following: a. failure, for any reason of the Contractor to fulfill in a timely manner its obligations under this Agreement; b. submission of a report, other work product, or advice, whether oral or written, by the Contractor to the City that is incorrect, incomplete, or does not meet reasonable professional standards in any material respect; c. ineffective or improper use of funds provided under this Agreement; d. suspension or termination of the grant funding to the City under which this Agreement is made; or e. unavailability of sufficient funds to make payment on this Agreement. In the event of such termination, the City shall be required to make payment for all work performed prior to the date this Agreement is terminated, but shall be relieved of any other responsibility herein. This Agreement may also be terminated, in whole or in part, by mutual Agreement of the parties by setting forth the reasons for such termination, the effective date, and in the case of partial termination, the portion to be terminated. SECTION V. INDEMNIFICATION AND INSURANCE Contractor agrees to obtain insurance and to indemnify the City for any damage or injury to person or property or any other claims which may arise from the Contractor's conduct or performance of this Agreement, either intentionally or negligently; provided, however, that nothing contained in this Agreement shall be construed as rendering the Contractor liable for acts Page 2 of 6 of the City, its officers, agents, or employees. Contractor shall as a prerequisite to this Agreement, purchase and thereafter maintain such insurance as will protect it from the claims set forth below which may arise out of or result from the Contractor's operations under this Agreement, whether such operations by the Contractor or by any sub -contractors or by anyone directly or indirectly employed by any of them, or by anyone for whose acts the Contractor may be held responsible. Coverage Limits A. Worker's Compensation & Disability Requirements Statutory B. Employer's Liability $100,000 C. Malpractice/Errors & Omissions Insurance $1,000,000 each occurrence $2,000,000 each aggregate SECTION VI. COMPLIANCE WITH WORKER'S COMPENSATION LAW Contractor shall comply with all provisions of the Indiana Worker's Compensation law, and shall, before commencing work under this Agreement, provide the City a certificate of insurance, or a certificate from the industrial board showing that the Contractor has complied with Indiana Code Sections 22-3-2-5, 22-3-5-1 and 22-3-5-2. If Contractor is an out of state employer and therefore subject to another state's worker's compensation law, Contractor may choose to comply with all provisions of its home state's worker's compensation law and provide the City proof of such compliance in lieu of complying with the provisions of the Indiana Worker's Compensation Law. SECTION VII. COMPLIANCE WITH INDIANA E-VERIFY PROGRAM REQUIREMENTS Pursuant to Indiana Code 22-5-1.7, Contractor is required to enroll in and verify the work eligibility status of all newly hired employees of the contractor through the Indiana E-Verify program. Contractor is not required to verify the work eligibility status of all newly hired employees of the contractor through the Indiana E-Verify program if the Indiana E-Verify program no longer exists. Prior to the performance of this Agreement, Contractor shall provide to the City its signed Affidavit affirming that Contractor does not knowingly employ an unauthorized alien in accordance with IC 22-5-1.7-11 (a) (2). In the event Contractor violates IC 22-5-1.7 the Contractor shall be required to remedy the violation not later than thirty (30) days after the City notifies the Contractor of the violation. If Contractor fails to remedy the violation within the thirty (30) day period provided above, the City shall consider the Contractor to be in breach of this Agreement and this Agreement will be terminated. If the City determines that terminating this Agreement would be detrimental to the public interest or public property, the City may allow this Agreement to remain in effect until the City procures a new contractor. If this Agreement is terminated under this section, then pursuant to IC 22-5-1.7-13 (c) the Contractor will remain liable to the City for actual damages. Page 3 of 6 SECTION VIII. IRAN INVESTMENT ACTIVITIES Pursuant to Indiana Code (IC) 5-22-16.5, Contractor certifies that Contractor is not engaged in investment activities in Iran. In the event City determines during the course of this Agreement that this certification is no longer valid, City shall notify Contractor in writing of said determination and shall give contractor ninety (90) days within which to respond to the written notice. In the event Contractor fails to demonstrate to the City that the Contractor has ceased investment activities in Iran within ninety (90) days after the written notice is given to the Contractor, the City may proceed with any remedies it may have pursuant to IC 5-22-16.5. In the event the City determines during the course of this Agreement that this certification is no longer valid and said determination is not refuted by Contractor in the manner set forth in IC 5- 22-16.5, the City reserves the right to consider the Contractor to be in breach of this Agreement and terminate the agreement upon the expiration of the ninety (90) day period set forth above. SECTION IX. PROHIBITION AGAINST DISCRIMINATION A. Pursuant to Indiana Code 22-9-1-10, Contractor, any sub -contractor, or any person acting on behalf of Contractor or any sub -contractor shall not discriminate against any employee or applicant for employment to be employed in the performance of this Agreement, with respect to hire, tenure, terms, conditions or privileges of employment or any matter directly or indirectly related to employment, because of race, religion, color, sex, disability, national origin, or ancestry. B. Pursuant to Indiana Code 5-16-6-1, the Contractor agrees: That in the hiring of employees for the performance of work under this Agreement of any subcontract hereunder, Contractor, any subcontractor, or any person acting on behalf of Contractor or any sub -contractor, shall not discriminate by reason of race, religion, color, sex, national origin or ancestry against any citizen of the State of Indiana who is qualified and available to perform the work to which the employment relates; 2. That Contractor, any sub -contractor, or any person action on behalf of Contractor or any sub -contractor shall in no manner discriminate against or intimidate any employee hired for the performance of work under this Agreement on account of race, religion, color, sex, national origin or ancestry; That there may be deducted from the amount payable to Contractor by the City under this Agreement, a penalty of five dollars ($5.00) for each person for each calendar day during which such person was discriminated against or intimidated in violation of the provisions of the Agreement; and Page 4 of 6 4. That this Agreement may be canceled or terminated by the City and all money due or to become due hereunder may be forfeited, for a second or any subsequent violation of the terms or conditions of this section of the Agreement. C. Violation of the terms or conditions of this Agreement relating to discrimination or intimidation shall be considered a material breach of this Agreement. SECTION X. RELEASE OF LIABILITY Contractor hereby agrees to release and hold harmless the City and all officers, employees, or agents of the same from all liability for negligence which may arise in the course of Contractor's performance of its obligations pursuant to this Agreement. SECTION XI. MISCELLANEOUS This Agreement is personal to the parties hereto and neither party may assign or delegate any of its rights or obligations hereunder without the prior written consent of the other party. Any such delegation or assignment, without the prior written consent of the other party, shall be null and void. This Agreement shall be controlled by and interpreted according to Indiana law and shall be binding upon the parties, their successors and assigns. This document constitutes the entire Agreement between the parties, although it may be altered or amended in whole or in part at any time by filing with the Agreement a written instrument setting forth such changes signed by both parties. By executing this Agreement the parties agree that this document supersedes any previous discussion, negotiation, or conversation relating to the subject matter contained herein. This Agreement may be simultaneously executed in several counterparts, each of which shall be an original and all of which shall constitute but one and the same instrument. The parties hereto submit to jurisdiction of the courts of Wayne County, Indiana, and any suit arising out of this Contract must be filed in said courts. The parties specifically agree that no arbitration or mediation shall be required prior to the commencement of legal proceedings in said Courts. By executing this Agreement, Contractor is estopped from bringing suit or any other action in any alternative forum, venue, or in front of any other tribunal, court, or administrative body other than the Circuit or Superior Courts of Wayne County, Indiana, regardless of any right Contractor may have to bring such suit in front of other tribunals or in other venues. Any person executing this Contract in a representative capacity hereby warrants that he/she has been duly authorized by his or her principal to execute this Contract. In the event of any breach of this Agreement by Contractor, and in addition to any other damages or remedies, Contractor shall be liable for all costs incurred by City in its efforts to enforce this Agreement, including but not limited to, City's reasonable attorney's fees. Page 5 of 6 In the event that an ambiguity, question of intent, or a need for interpretation of this Agreement arises, this Agreement shall be construed as if drafted jointly by the parties, and no presumption or burden of proof shall arise favoring or disfavoring any party by virtue of the authorship of any of the provisions of this Agreement. IN WITNESS WHEREOF, the parties have executed this Agreement at Richmond, Indiana, as of the day and year first written above, although signatures may be affixed on different dates. "CITY" THE CITY OF RICHMOND, INDIANA by and through its Board of Public Works and Safety By: zC�L�( / Vicki Robinson, President By: Richard Foore, Member M. Anthony L. Foster, II, Member Date: ✓ ' �� F.111 Date: I "CONTRACTOR" GEORGE'S FAMILY PHARMACY, INC. 1198 State Road 46E Batesville, IN 47006 Printed: Title: 0%0 n c A F d Date: 31 13'ZO i l Page 6 of 6 BROOKVILLE 480 Main St. Brookville, IN SUNMAN 308 N. Meridian St. VERSAILLES 326 S. Washington St. BRIGHT 24128 State Line Rd. MILAN BATESVILLE �0� 'C S 47012 F:765-647-6386 Sunman,23-6251 IN 47041 Versailles, IN 47042 Bright, IN 47025 124 W. Indian Trail Milan, IN 47031 1198 State Rd 46E Batesville, IN 47006 F:812-623-6252 F:812-689-0201 F:812-637-6386 F:812-664-6386 F:812-932-6386 City of Richmond Employees Durable Medical Equipment Contract January 1, 2017 1. To date, George's Family Pharmacy, Inc. is in network with the United Medical Resources/United Healthcare Networks. 2. Deductibles are as follows: Individual, via Network Providers: $1,000.00 Family, via Network Providers: $2,000.00 3. Out of Pocket Amounts are as follows: Individual, via Network Providers $ 3,000.00 Family, via Network Providers $6,000.00 4. The following Cash Price Options are available to the City of Richmond if they opt to purchase items for their employees directly through George's Family Pharmacy, Inc. with no insurance billing involved: CPAP, New, Machine Only $ 675.00 CPAP, New, Full Set Up $ 825.00 BIPAP, New, Machine Only $1,425.00 BIPAP, New, Full Set Up $1612.50 Nasal Mask with Headgear $ 90.00 Full Face Mask with Headgear $ 135.00 Headgear Only $ 22.50 Tubing, Standard $ 22.50 Tubing, Heated $ 45.00 Replacement Gel Cushion for Full Face Mask $ 33.75 Replacement Pillows for Nasal Mask $ 22.50 Filters $ 3.00 Chin Straps $ 15.00 Pagel of 3 BROOKVILLE 480 Main St. Br SUNMAN 308 N. Meridian St. VERSAILLES 326 S. Washington St. BRIGHT 24128 State Line Rd. MILAN 124 W. Indian Trail BATESVILLE 1198 State Rd 46E ookville, IN 47012 Weleorge's Sunman, 2 6251 F:812-623-6252 Versailles, IN 47042 Bright, 6 -6251 Milan, IN 46251 Batesville, IN 47006 F:765-647-6386 F:812-689-0201 F:812-637-6386 F:812-654-6386 F:812-932-6386 We carry a full line of Durable Medical Equipment (DME). Upon request, cash price options can be provided for any equipment not listed above. All prices include free delivery and set up. S. Employees currently on service with a different DME Provider that would like to transfer their services to George's Family Pharmacy, Inc. needs to complete the Transfer of Services Form and fax it to our Brookville location at 765-647-6386. Transfers will be reviewed and processed on a case by case basis. Billing cycle status and obtaining documentation from external sources are major factors in determining whether a service is eligible for transfer. George's Family Pharmacy, Inc. will make every effort to process transfers as efficiently as possible. Once a determination has been reached, George's Family Pharmacy will promptly provide detailed information to the requestor. Page 2 of 3 GL- BROOKVILLE _ 480 Main St. Brookville, IN 47012 �G7e*orge S F:765-647-6386 SUNMAN 308 N. Meridian St. Sunman, IN 47041 F:812-623-6252 VERSAILLES 326 S. Washington St. Versailles, IN 47042 F:812-689-0201 BRIGHT 24128 State Line Rd. Bright, IN 47025 F:812-637-6386 MILAN 124 W. Indian Trail Milan, IN 47031 F:812-654-6386 BATESVILLE 1198 State Rd 46E Batesville, IN 47006 F:812-932-6386 TRANSFER OF SERVICES FORM Name: Address: City: Telephone Number: Social Security Number: Primary Care Physician: Current DME Provider: Date of Birth: State: Zip Code: Current DME Provider Location: Current DME Provider Telephone Number: Type of DME currently used: I hereby authorize George's Family Pharmacy, Inc. to obtain the documents/information pertaining to the services listed above. I understand that my authorization will be effective from the date of my signature and that the information will be handled confidentially in compliance with all applicable federal laws. I understand that I may see the information that is to be sent, and that I may revoke the authorization at any time by written, dated communication. I have read and understand the nature of this release. Signature: Page 3 of 3 �Tpi] 3 PAG 3 OF (p Date: BROOKVILLE SUNMAN VERSAILLES BRIGHT MILAN BATESVILLE 480 Main St. Brookville, IN 47012 308 N. Meridian St. Sunman,3-6251 IN 47041 326 S. Washington St. Versailles, IN 47042 24128 State Line Rd. 124 W. Indian Trail 1198 State Rd 46E G765-647-6386 eorge s F: F: 812-623-6252 F: 812-689-0201 Bri ht, IN 47025 Milan, IN 47031 Batesville, IN 47006 F: 812-637-6386 F: 812-654-6386 F: 812-932 6386 City of Richmond Cash Pricing ITEM** MONTHLY RENTAL PRICE CASH PURCHASE PRICE BEDSIDE COMMODE $93.75 BEDSIDE COMMODE - BARIATRIC $150.00 BEDSIDE COMMODE- DROP ARM $112.50 CANE, QUAD TIP $30.00 CANE, QUAD TIP, BARIATRIC $33.75 CANE, SINGLE TIP $15.00 CANE, SINGLE TIP, BARIATRIC $22.50 CPAP MASK — NASAL WITH HEADGEAR $90.00 CPAP MASK — FULL FACE WITH HEADGEAR $135.00 CPAP MASK — HEADGEAR ONLY $22.50 REPLACEMENT CUSHION — FULL FACE MASK $33.75 REPLACEMENT PILLOWS — NASAL MASK $22.50 CPAP FILTERS $3.00 CPAP CHIN STRAP $15.00 CPAP TUBING — STANDARD $22.50 CPAP TUBING — HEATED $45.00 CPAP - NEW - FULL SET UP $825.00 CPAP - NEW - MACHINE ONLY $675.00 BIPAP - NEW — FULL SET UP $1,612.50 BIPAP — NEW — MACHINE ONLY $1,425.00 CRUTCHES $30.00 DIABETIC SHOES — SHOES ONLY — NO INSERTS $90.00 DIABETIC SHOES WITH 1 PAIR GEL INSERTS $112.50 ELEVATED TOILET SEAT W SIDE RAILS $44.25 ELEVATED TOILET SEAT W/OUT SIDE RAILS $36.75 FINGER PULSE OXIMETER $81.75 GAIT BELT $15.00 GEL OVERLAY FOR HOSPITAL BED $187.50 GRAB BAR (SUCTION CUP 22") $37.50 GRAB BAR (SUCTION CUP 18") $30.00 Pagel of 3 PACEOF BROOKVILLE SUNMAN VERSAILLES BRIGHT MILAN BATESVILLE :z1 .1 480 St. Brookville, IN 47012 308 N. Meridian St. Sunman, IN 47041 326 S. Washington St. Versailles, IN 47042 24128 State Line Rd. Bright, IN 47025 124 W. Indian Trail Milan, IN 47031 1198 State Rd 46E Batesville, IN 47006 7Main eore s F:765-647-6386 F:812-623-6252 F:812-689-0201 F:812-637-6386 F:812-654-6386 F:812-932-6386 HAND HELD SHOWER $36.75 HOSPITAL BED (TOTAL ELECTRIC) $93.75 $1,050.00 HOSPITAL BED - REPLACEMENT MATTRESS $150.00 KNEE ROLLATOR $37.50 $450.00 LIFT CHAIR $93.75 VARIES LIFT CHAIR CONTROLLER $93.75 LIFT CHAIR CONTROLLER (6 BUTTON) $112.50 LIFT - PATIENT (HOYER) $112.50 $1,125.00 LIFT - STAND UP $93.75 $900.00 LIFT - STAND UP - SLING $75.00 NEBULIZER $60.00 OVER THE BED TABLE $18.75 $112.50 OXYGEN CONCENTRATOR RENTAL $112.50 OXYGEN - PORTABLES - PER TANK $7.50 OXYGEN - PORTABLE CONCENTRATOR (XP02) $18.75 DAILY RAMP, WHEELCHAIR, PORTABLE 7' $93.75 $382.50 ROLLATOR WITH SEAT/BRAKES $131.25 ROLLATOR WITH SEAT/BRAKES (BARIATRIC) $213.75 SHOWER BENCH (ROUND) $36.75 SHOWER CHAIR $36.75 SHOWER CHAIR W/BACK $44.25 SHOWER CHAIR (BARIATRIC) $93.75 THRESHOLD RAMP (RUBBER 1.5") $112.50 THRESHOLD RAMP (RUBBER 2.5") $168.75 TOILET SAFETY FRAME $37.50 TRANSPORT CHAIR (17' OR 19") $18.75 $187.50 TRANSFER BENCH, REGULAR $74.25 TRANSFER BENCH, BARIATRIC $187.50 TRAPEZE BAR - FREE STANDING - NOT HD $37.50 $375.00 TRAPEZE BAR- FREE STANDING - HEAVY DUTY $150.00 $1,500.00 TRAPEZE BAR - ATTACHED TO HOSPITAL BED $22.50 $225.00 TUB SAFETY BAR $29.25 WALKER BASKET $30.00 WALKER, FOLDING - NO WHEELS, REGULAR $18.75 $41.25 WALKER, FOLDING - NO WHEELS, BARIATRIC $93.75 WALKER, HEMI $48.75 WALKER, WHEELED, REGULAR $26.25 $93.75 WALKER, WHEELED, BARIATRIC $131.25 WALKER WHEELS, 3" FIXED $21.75 Page 2 of 3 EXI-IEaIT _A PAGE S C� C� I ` BROOKVILLE 480 Main St. Brookville, IN 47012 SUNMAN 308 N. Meridian St. VERSAILLES 326 S. Washington St. BRIGHT 24128 State Line Rd. MILAN 124 W. Indian Trail BATESVILLE 1198 State Rd 46E Georg6's P:765-647-6251 F:765-647-6386 Sunman, 2 6251 P:812-623-6251 Versailles, IN 47042 P:812-689-6251 Bright, 6 -6251 P:812-637-6251 Milan, 6 47031 P:812-654-6251 Batesville, IN 47006 P:812-932-6251 F:812-623-6252 F 812-689-0201 F: 812-637-6386 F:812-654-6386 F:812-932-6386 WALKER WHEELS, 3" SWIVEL $36.75 WALKER WHEELS, 5" FIXED $28.50 WALKER WHEELS, 5" SWIVEL $43.50 WEDGE PILLOW $33.75 WHEELCHAIR GEL CUSHION (ABSOLUTE) $37.50 WHEELCHAIR $56.25 $375.00 WHEELCHAIR (BARIATRIC) $93.75 $675.00 "NOTE: George's Family Pharmacy, Inc. will charge Medicare allowable rates for any items dispensed that are not listed above. Page 3 of 3 Istyl_ PAGE CD UF? I