HomeMy Public PortalAbout154-2019 - Finance - Henry County Memor...pital - Blood Draw for Health FairPROFESSIONAL SERVICES AGREEMENT
THIS AGREEMENT made and entered into this /��11 day of1_2�,- 3 2019> and
referred to as Contract No. 154-2019, 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 Henry Community Health, 1000 North 161h Street, New _Castle,
Indiana, 47362-0490 (hereinafter referred to as the "Contractor").
SECTION I. STATEMENT AND SUBJECT OF WORK
City hereby retains Contractor to provide testing services in connection with the City's 2019
Health Fair to be held on October 4, 2019, including, but not limited to the blood --draw testing
services necessary for the wellness screening operations conducted at said Fair (the.Project).
Contractor shall perform all services described on Contractor's ' proposed Memorandum and
Statement of work materials attached and marked as "Exhibit A" consisting of six (6) pages,
which proposal was received in August of 2019, .is attached hereto, made a part hereof, and
incorporated herein by reference. The Contractor shall abide by the,same.
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 22-54.7=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. 154-2019
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SECTION III. COMPENSATION
City shalt. pay Contractor in accordance with the rates as set forth on "Exhibit A" for the
complete and satisfactory performance of all work described on "Exhibit A" and satisfactory
completion of the Project. The costs per employee shall be at the Sixty Dollar rate ($60.00) for
females and at the Seventy Dollar rate ($70.00)- for males, with the understanding that the
number of employees expected to attend, as set forth in Contractor's proposal, is an estimate that
is subj ect' to change and the total amount paid to Contractor shall be contingent upon and subject
to the actual number of employees who receive the services at the 2019 Health Fair.
SECTION IV. TERM OF AGREEMENT
This Agreement shall be effective when signed by all parties and shall continue in effect until
completion of the Project.
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.
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SECTION V. INDEMNIFICATION AND INSURANCE
City shall provide Contractor. with a certificate of insurance'- evidencing its general and
professional liability insurance covering acts and omissions of its respective employees,
representatives, or agents.
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
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.
Coveraie
A. Worker's, Compensation &
Disability Requirements
B. . Employer's Liability
C. Malpractice/Errors & omissions Insurance
r
Limits
Statutory
$100,000
$1,000,000 each occurrence
$3,000,000 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 PRUGRAM 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
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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.
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:
1. 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
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employee hired for the performance of work under this Agreement on account of
race, religion, color, sex, national origin or ancestry;
3. 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
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 as a result of Contractor's
actions or omissions in the course of Contractor's performance of its obligations pursuant to this
Agreement. City hereby agrees to release and hold harmless the Contractor and all officers'
employees, or -agents of the same from all liability for negligence. which may arise as a result of
City's actions or omissions in the course of City's performance of its obligations pursuant to this
Agreement.
SECTION XL 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
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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 the party found to be in breach, and in addition
to any other -damages or remedies, the breaching party shall be liable for all costs incurred by the
non -breaching party in its efforts to enforce this Agreement, including but not limited to,
reasonable attorney's fees.
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
r
By:
Vicki Robinson, President
By:
"'tmily P 1 er; Member
By:
Matt Evans, Member
"CONTRACTOR"
HENRY COMMUNITY HEALTH
1000 North 16th Street
New Castle, IN 47362-0490
By:
Printed:
Title: � � FI ��'►�► N,J� i��C---"�
APPROVED: Date:
.S r
Date:
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MEMORANDUM OF UNDERSTANDING (MOU)
Between Henry Community Health and City of Richmond
This is an agreement between Henry Community Health, hereinafter called Henry Community
Health and "City of Richmond", hereinafter called City of Richmond.
I. PURPOSE & SCOPE
The purpose of this MOU is to'clearly identify the roles and responsibilities of each party
relating to the delivery of certain services as defined in. the Statement of work (SOW),
Attachment A.
In particular, this MOU is intended to:
• Enhance the delivery of services in a timely manner ensuring proper billing and
r
reporting;
■ Reduce scheduling, registration and billing errors thus promoting excellent customer
service and employer/employee satisfaction;
C_
■ Establish standardized workflows between both parties to ensure expectations and
4
outcomes are met. -
II. RESPONSIBILITIES UNDER THIS MOU
Henry Community Health shall undertake the following activities:
• Share insight on current wellness trends and statistics;
• Collaborate with CITY OF RICHMOND to define Scope of Work (SOW);
• Arrive on time or earlier as needed for the Health Fair, provide at least 4 licensed,
qualified technicians responsible for providing services as defined in the SOW;
■ 'Provide a Corporate Health Fair Requisition to each employee to complete for any,
service to be performed by Henry Community Health that is related to this wellness
event;
■ Safeguard employee PHI information consistent with HIPAA requirements;
• Safeguard all laboratory specimens as required by CLIA and CAP;
• Ensure employees and designated CITY OF RICHMOND personnel receive results no later
than thirty (30) calendar days after the last screening is performed;
., - E1tWlBfT A PAGE OF (,
• Provide accurate and complete billing of services as defined in the SOW. In the event
that there is an issue related to any part of the delivery of the wellness services or
related billing, CITY OF RICHMOND is to contact Steve Myers.
IV. CITY OF RICHMOND RESPONSIBILITIES UNDER THIS MOU
CITY OF RICHMOND shall undertake the following activities:
• Communicate the event to the employees including start and end dates; and provide
Henry Community Health's Corporate Health Fair Requisition;
■ Provide appropriate, safe space on CITY OF RICHMOND's site and include tables, chairs,
lighting electrical access, and trash cans;
• Collaborate with Henry Community Health with regard to any employee questions,
concerns or limitations prior to the event whenever possible;
■ Communicate any questions or concerns about billing options to Henry Community
Health prior to completing the SOW;
• -Provide Henry Community Health with a list of employees that are eligible and may be
presenting to Cambridge City Family Health Partners after the Health Fair which would
include their full name;
• Communicate to those employees that missed the blood work during the Health Fair
that they must go to Cambridge City Family Health Partners to have the blood work
completed;
■ Ensure employees going to the Cambridge City Family Health Partners bring a Corporate
Health Fair Requisition and Informed Consent for Blood Draw Form;
■ Ensure employees follow through and arrive at their assigned time for onsite and/or
scheduled services.
Failure to provide, undertake or perform any of the above activities may result in billing issues;
specifically, the inability to identify the patient correctly as a Wellness patient resulting in the
employee being billed full charges.
V. IT IS MUTUALLY UNDERSTOOD AND AGREED BY AND BETWEEN THE PARTIES THAT:
Henry Community Health understands that circumstances may necessitate the need to
reschedule or adjust the date and/or time of the event. For the mutual benefit of both parties,
both parties agree to:
• Provide a minimum two (2) week notice in the event of any scheduling changes of the
health fair;
tXHIB1T PAGE'. �� a
• CITY OF RICHMOND agrees to notify Henry Community Health if an employee cannot
` honor their pre -scheduled time;
• Once the MOU is fully executed, modifications to the billing choice. can be
accommodated up to two (2) weeks before the event:
• Limit the open time period for walk-ins, for those who missed the on --site Health. Fair, to
one (1) week at Cambridge City Family Health Partners, 415 East Main Street,
Cambridge City, IN 47327. (Saturday, October 51h through Saturday; October 12th)
• CITY OF RICHMOND agrees to remit payment within forty-five days of receipt of bill.
This MOU terminates after one year from the date of execution.
V1. EFFECTIVE DATE AND SIGNATURE
Henry Community Health and CITY OF RICHMOND indicate agreement with this MOU by their
signatures.
Henry Community Health: r
Date:
CITY OF RICHMOND:
Date:
EXjHiBiT PAG7-
0
■
Henry Community Health
Health Fair Statement of Work (SOW)
Company Requesting Services: City of Richmond
1. Number of people expected (provide range):-230-270
2. Employees will receive printed results via the USPS.
3. Employee's Primary Care Physicians will receive printed results via the USPS as well.
4. Services:
BLOOD TESTS
FEMALE
MALE
LIPID PANEL
X
X
CBC
X
X
A1C
X
X
TSH
X
X
CMP
X
X
PSA
X — REGARDLESS OF AGE
TOTAL COST PER EE
$60
$700
5. Company/Organization Name: City of Richmond
Address: 50 North 51h Street, Richmond, IN 47374
Contact Name: Stephanie Sherwood
Phone: 765.983.7202
Fax: 765.973.1524
Email:- ssherwood@richmondindiana.gov
6.. Date of the Health Fair: 10/04/2019
I
7. Beginning Time of the Health Fair: 6:30AM
8. Ending Time of the Health Fair: 11:00 AM
9. Location name and street address including zip code:
Kuhlman Center, 861 Salisbury Road, Richmond, IN 47374
Henry Community Health and City of Richmond indicate agreement with this SOW by their
signatures.
ti -
Henry Community Health r
City of Richmond
-A- 07.
EXHIBi t PXjr- Z.a����
m..
r _
Henry
� Comm -unity
- ----- Health
CORPORATE HEALTH FAIR REQUISITION
City of Richmond - Employee Wellness Screening
Name:
DOB:
Address:
Phone:,
Primary Care Provider:
Services: Lipid Panel, CBC, Al c, TSH, CMP, PSA - (for mares of all ages)
For Lab Use
FIN
Informed Consent for Blood Draw
I, (DOB: I 1 -,),do hereby
consent to the drawing of a blood sample for the purpose of a wellness screening. I understand
that the risks involved with blood draws include, but are not limited to, discomfort at the site of
the blood draw, possible bruising, redness and swelling around the site, bleeding at the site,
feeling of lightheadedness, and rarely, an infection at the site of the blood draw.
understand and accept that. the results derived from this' blood draw are considered preliminary
only and do not constitute any kind of diagnosis. It is my responsibility to initiate a follow --up
examination to confirm results and obtain professional medical advice and treatment.
Henry Community Health will keep the results of my lab tests confidential. I understand that by
providing the name of my primary care provider below, I am authorizing Henry Community
Health to share the results of my lab draw.
Primary Care Provider:
Printed Name:
Signature:
Date:
BLOOD BORNE INFECTIOUS DISEASE TESTING:
(Initials) I authorize Henry Community Health to test for blood borne infectious
diseases including but not limited to Hepatitis and Human Immunodeficiency Virus (HIV). A `
physician will order the tests or it will be ordered by protocol. The results of these tests will be
part of my confidential medical record.
-EXI�jBj - _PL PACE F_.