Item 4G - MemoItem 4G
CITY OF
SOUTHLAKE
MEMORANDUM
August 6, 2024
To: Mayor and City Council
From: Ashleigh Casey, Chief of Police
Subject: Ratify FY 2024 Funding Authorization for Police and Fire Annual Wellness
Physicals
Action Requested: Approve the ratification of the FY 2024 funding authorization for Fire
Department annual wellness physicals with Front Line Mobile Health,
PLLC to include an additional $45,050 for Police Department annual
wellness physicals in a total amount not to exceed $97,050.
Background
Information: The purpose of this item is to seek Council consideration to ratify the FY
2024 funding authorization for Fire Department annual wellness physicals
with Front Line Mobile Health, PLLC to include an additional $45,050 for
Police Department annual wellness physicals in a total amount not to
exceed $97,050. Funding for the Police Department physicals was
budgeted and approved in the FY 2024 Police General Fund budget.
The original approved FY 2024 funding authorization amount of $52,000
for Fire Department physicals did not account for the Police Department's
budgeted physicals.
The FY 2024 fire and police annual wellness physicals are scheduled to
be completed by September 30, 2024.
Strategic Link: C1 - Achieve the highest standards of safety & security.
Legal Review: The contract was reviewed by the City Attorney.
Supporting
Documents: FY 2024 Front Line Mobile Health, PLLC Contract
Staff
Recommendation: Staff recommends ratification of the FY 2024 funding authorization as
proposed.
PROFESSIONAL SERVICES AGREEMENT
The following Terms of the Professional Service Agreement ("Agreement") are entered into and
made effective on the date of execution of this Agreement by both Parties.
BETWEEN:
FRONT LINE MOBILE HEALTH, PLLC, ("Service Provider"), a professional limited liability
company organized and existing under the laws of Texas, with its principal office located at 6517
N. Lakewood Drive, Georgetown, TX 78633, info@frontlinemobilehealth.com;
AND:
THE CITY OF SOUTHLAKE, TEXAS ("Contracting Agency"), a governmental agency
organized and existing under the laws of Texas, with its principal office located at 600 State Street,
Southlake, TX 76092 which may be contacted at:
Email Address: cbrown@ci.southlake.tx.us
Point of Contact: Chris Brown, Lt. Fire Department 817-748- 8363
Name Phone Number
Service Provider and Contracting Agency may be referred to herein individually as "Party," or
collectively as "Parties."
WHEREAS, Service Provider is in the business of providing professional medical services relating
to Pre -Employment Medical Evaluations, Annual Medical Evaluations, and Psychological
Evaluations; and
WHEREAS, Contracting Agency will provide such medical services to Contracting Agency's
personnel who volunteer to undergo these evaluations.
NOW, THEREFORE, in consideration of the mutual covenants and agreements herein
contained, the Parties hereto, intending to be legally bound, agree as follows:
AGREEMENT
Service Provider will provide the following services to Contracting Agency under the terms
of this Agreement:
1. ENTIRE AGREEMENT
1.1. This Agreement, recitals, and attachments represent the entire understanding and
agreement between Service Provider and Contracting Agency, and supersede all other
negotiations, proposals, understandings, and representations (written or oral) made by
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and between Service Provider and Contracting Agency. This Agreement includes the
following attachments which are incorporated herein:
I.I.I. Exhibit A, "Requirements for Firefighters" referencing 14 Essential Job
Tasks from NFPA 1582 Chapter 6 (Firefighter Candidates) Chapter 7
(Firefighter Incumbents)
1.1.2. Exhibit B, "Scope of Services and Fee Schedule;"
1.1.3. Exhibit C, "Minimum Billing Amount; and"
1.1.4. Exhibit D, "Examinee Waiver."
2. TERM
2.1. The initial term of this Agreement shall begin on July 29, 2024 (the "Effective Date")
and shall expire on July 29, 2025 ("Expiration Date"), unless terminated earlier in
accordance with this Agreement ("Initial Term"). After the Initial Term, Contracting
Agency shall have the option, in its sole discretion, to renew this Agreement under the
same terms and conditions for up to four (4) one-year renewal terms, subject to any
price increases as identified in paragraph 2.2.
2.2. Service Provider may, at its discretion and subject to approval by Contracting Agency,
increase the price for those services identified in Exhibit "B" of this Agreement a
maximum of 5% at the start of each year the Agreement is renewed.
3. DEFINITIONS
The terms used in this Agreement shall have the following meaning:
"Authority Having Jurisdiction" ("AHJ") shall mean and refer to Contracting Agency's
Authority Having Jurisdiction (as that term is defined in NFPA 1582 Section 3.2.2) as an
organization, office, or individual responsible for enforcing the requirements of a code or
standard, or for approving equipment, materials, an installation or a procedure. The AHJ
for Contracting Agency is the City of Southlake.
"Annual Medical Evaluation" shall mean and refer to periodic evaluation of Incumbent
Firefighters, Law Enforcement Officers, and other City of Southlake personnel to assess
each one's ability to meet the appropriate fitness standards, as well as to identify areas of
the person's medical status that may indicate the possibility of future health issues and/or
impact that participant's ability to carry out the essential job tasks associated with his or her
position.
"Candidate Firefighter and Candidate Law Enforcement Officer" shall mean and refer
to a person whom the Fire Department or Police Department leadership wants medically
evaluated before starting employment.
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"Confidential Information" shall mean and refer to all information or material that has or
could have commercial value or other utility in a disclosing party's business, and that is
disclosed by one Party to this Agreement to the other in connection with or incidental to a
Party's performance under this Agreement. All information, documentation, feedback and
communications relating to and including this Agreement are subject to the Texas Public
Information Act and the Texas Records Retention Acts and any opinion of the Texas
Attorney General or court of competent jurisdiction relating to these Acts.
"Human Performance Assessment" shall mean and refer to a series of self -reported
standardized behavioral health assessments that measure the Participant's condition
regarding behavioral health attributes that Service Provider has determined impact the
Participant's personal and work performance.
"Incumbent Firefighter or Incumbent Law Enforcement Officer" shall mean and refer
to a Participant who has been hired and is no longer a Candidate.
"NFPA 1582" shall mean and refer to the National Fire Protection Association standard
titled: NFPA 1582 Standard on Comprehensive Occupational Medical Program for Fire
Departments, as effective as of the Effective Date of this Agreement.
"Participant" shall mean and refer to Contracting Agency personnel for whom Service
Provider conducts an evaluation of any kind pursuant to this Agreement.
"Pre -Employment Medical Evaluation" shall mean and refer to a series of laboratory
tests, diagnostic exams, hands-on physical exam and consultation with a medical provider
to assess whether the Candidate meets the minimum requirements provided to Service
Provider by Fire or Police Department leadership.
"Post -Offer Psychological Evaluations" shall mean and refer to comprehensive
psychological evaluations of Candidate Firefighters or Law Enforcement Officers
conducted by licensed psychologist after a job offer has been made to the Candidate.
"Psychological Evaluation" shall mean and refer to a comprehensive psychological
evaluation of Candidate or Incumbent Firefighter or Law Enforcement Officer conducted
by licensed psychologist.
"Psychological Wellness Check" shall mean and refer to a self -reported Behavioral Health
analysis tool using standard psychological tests.
4. COMPENSATION
4.1. Contracting Agency will compensate Service Provider for services performed in the
amounts specified in the attached Exhibit B, "Scope of Services and Fee Schedule."
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4.2. Contracting Agency will compensate Service Provider in accordance with the
provisions listed in Exhibit C, "Minimum Billing Amount."
5. PAYMENT
5.1. Service Provider will invoice Contracting Agency for services completed in accordance
with the Fee Schedule and the Minimum Billable Amount (Exhibit Q. Contracting
Agency shall pay Service Provider the amounts due in accordance with the Texas
Prompt Payment Act, Texas Gov't Code Ch. 2251.
5.2. If Service Provider initiates the re -scheduling of a Participant evaluation, then Service
Provider shall delay issuing an invoice for the re -scheduled evaluation until the
evaluation is complete.
5.3. If the time allocated for the Annual Physicals exceeds 30 calendar days, Service
Provider requires an option to submit billing monthly for the work performed by
Service Provider during that month.
6. NON -APPROPRIATION
6.1. The Parties acknowledge and agree that the Fee Schedule set forth in this Agreement is
based upon Contracting Agency's current appropriated revenues.
6.2. It is understood and agreed that Contracting Agency shall have the right to terminate
this Agreement at the end of any Contracting Agency fiscal year if the governing body
of the Contracting Agency does not appropriate funds sufficient to compensate for the
services, by providing immediate written notice to Service Provider of the non -
appropriation.
7. PROFESSIONAL SERVICES TO BE PROVIDED
7.1. Service Provider will work with Contracting Agency and the AHJ to develop the medical
testing parameters of the Annual Medical Examination for Incumbent Firefighters using
the latest version of NFPA 1582 standards as a basis of the Annual Medical Examination
and adding the most recent, best medical science standards, in cardiovascular testing,
blood work, and other medical testing to include testing for pulmonary function and
cancer.
7.2. Service Provider will work with Contracting Agency to provide an annual "Psychological
Wellness Check" for Incumbent Firefighters during their Annual Medical Evaluation
known as the Human Performance Assessment. The Human Performance Assessment
will be conducted by a Physician Assistant or M.D./D.O.
7.3. Service Provider shall apply and use the standards found in the latest version of NFPA
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1582 standards or Law Enforcement standards in performing all evaluations pursuant to
this Agreement.
7.4. Service Provider will work with Contracting Agency and the applicable AHJ to provide
Candidate Firefighters and Candidate Law Enforcement Officers with an entry-level
Psychological Evaluation by a qualified Psychologist.
7.5. Contracting Agency acknowledges and agrees that Service Provider does not and shall
not provide advice or recommendations regarding, or make, direct, encourage, or
otherwise take responsibility for employment decisions, including but not limited to
Contracting Agency's employment -related decisions regarding whether Contracting
Agency hires, fires, promotes, demotes, increases or decreases pay, adjusts or restricts
personnel assignments or job duties, or takes any other potentially adverse employment
action against Contracting Agency's personnel and employees. For the avoidance of
doubt, Contracting Agency shall be solely liable for all employment decisions made in
connection with any Participant.
8. LIMITED SCOPE OF MEDICAL EVALUATION
8.1. Service Provider's Annual Medical Evaluation is limited to only those services
specified in Exhibit B, "Scope of Services and Fee Schedule" and in compliance with
Exhibits C and D, using the latest version of NFPA 1582 with modifications for
Incumbent Firefighters.
8.2. The Annual Medical Evaluation is intended to meet or exceed the National Fire
Protection Association standard titled: NFPA 1582 Standard on Comprehensive
Occupational Medical Program for Fire Departments, and Service Provider shall
perform all evaluations in accordance with applicable updated, adopted, and accepted
medical industry standards.
8.3. The Annual Medical Evaluation is conducted for the sole purpose of providing a
recommendation to Contracting Agency regarding Participant's medical fitness for
duty in light of the Participant's actual or anticipated essential job tasks.
8.4. It is understood that medical and psychological evaluations are NOT a functional or
occupational assessment. If an Incumbent Firefighter, Candidate Firefighter, or staff
participant refuses to acknowledge the limited scope of service or otherwise refuses to
participate in any part of the evaluation, then Service Provider reserves the right to
decline to make a recommendation of that Participant's medical fitness for duty.
8.5. It is also understood that an Annual Medical Evaluation alone cannot determine the
occupational success of the Participant, and therefore, Service Provider recommends
that Contracting Agency combines the Annual Medical Evaluation with other
occupational specific evaluations in determining a Participant's overall fitness for duty,
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such as a job analysis and skill performance for the essential elements of the job.
8.6. Contracting Agency acknowledges that Psychological Evaluations cannot determine
the occupational success of a Participant, and therefore, Contracting Agency releases
Service Provider from any adverse candidate outcome provided that such evaluation
and recommendation is in accordance with generally accepted psychological standards.
8.7. AHJ or Contracting Agency is not required to adopt the latest version of NFPA 1582 or
Law Enforcement standards. Contracting Agency, and AHJ shall have final authority
and responsibility for all employment decisions made in connection with the services,
recommendations, and/or reports provided by Service Provider.
9. DISPUTED RESULTS
9.1. This Agreement is between Contracting Agency and Service Provider only. SERVICE
PROVIDER SHALL NOT HAVE AN AGREEMENT WITH THE PARTICIPANT(S)
TESTED.
9.2. In the event a Participant disputes the recommendation submitted by Service Provider
to Contracting Agency, the resolution of such dispute will be accomplished through the
process established by Service Provider and Contracting Agency.
9.3. Contracting Agency shall be responsible for all expenses incurred for Service
Provider's re -testing or re-evaluation of a Participant provided expenses are not due to
the fault of the Service Provider. Additional expenses should be approved in writing
prior to incurring.
EVALUATIONS PROVIDED
10. ANNUAL INCUMBENT FIREFIGHTER MEDICAL EVALUATIONS
10.1. Service Provider will provide an Annual Medical Evaluation for Participants identified
by Contracting Agency, as set forth in the attached Exhibit A, "Requirements for
Firefighters,".
10.2. In addition, Contracting Agency may initiate a change order in writing to add additional
lab tests and other offerings provided by Service Provider at Service Provider's current
pricing.
11. PRE -EMPLOYMENT CANDIDATE FIREFIGHTER AND LAW ENFORCEMENT
OFFICER MEDICAL EVALUATION
11.1. Service Provider will perform Pre -Employment Medical Evaluations and Psychological
Evaluations for Contracting Agency, addressing the applicable components listed under
the provisions in Exhibit A, "Requirements for Firefighters," and in compliance with
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NFPA 1582 standards.
12. LOCATION AND SCHEDULE OF SERVICES TO BE PROVIDED
12.1. Annual Medical Evaluations. Annual Medical Evaluations will be conducted by
Service Provider at a location mutually agreeable. These Annual Medical Evaluations
will be provided on a schedule that is mutually agreeable to the Parties, with the
understanding that all Annual Medical Evaluations must be completed by the end of the
Agreement Term.
Pre -Employment Medical Evaluations. Pre -Employment Medical Evaluations will
take place at one of Service Provider's clinics on a schedule mutually agreeable to the
Parties. Service Provider specifically acknowledges that time is of the essence for
scheduling Pre -Employment Medical Evaluations and Psychological Evaluations and
will make all reasonable efforts to complete such evaluations within the time specified
by Contracting Agency. Contracting Agency acknowledges that it takes no less than
two weeks to coordinate, schedule, perform, and to report on any results obtained from
the Pre -Employment Medical Evaluations. Contracting Agency acknowledges that it
takes no less than three weeks to coordinate, schedule, perform, and report on any
Psychological Evaluations performed for Pre- Employment or Post -Offer
Psychological Evaluations. Service Provider reserves the right to conduct
Psychological Evaluations via a HIPAA compliant telehealth platform.
13. ADDITIONAL SERVICES
13.1. To receive any additional services not provided for under this Agreement, Contracting
Agency must separately contract with Service Provider under a change order. No
services other than those specifically identified under this Agreement will be provided
without a change order.
13.2. Additional services may be requested by Contracting Agency at any time and will be
consistent with the services and fees set forth in Exhibit B, "Scope of Services and Fee
Schedule," of the Agreement.
ADDITIONAL TERMS AND CONDITIONS
14. TERMINATION
14.1. Contracting Agency may terminate this Agreement for non -appropriation of sufficient
funds as set forth in Section 6.2.
14.2. If either Parry materially breaches any covenant under this Agreement, the other Party
may notify the breaching Parry in writing and, if the breach is not cured within 30 days,
the non- breaching Parry may terminate this Agreement.
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14.3. Service Provider may immediately suspend services if it reasonably believes continued
service would violate State or Federal law or violate applicable rules of professional
conduct. Service Provider shall provide prior notice to Contracting Agency of
suspended services.
14.4. In the event that this Agreement is terminated prior to the Expiration Date, Contracting
Agency shall pay Service Provider for all services actually rendered up to the effective
date of termination and Service Provider shall continue to provide Contracting Agency
with services requested by Contracting Agency and in accordance with this Agreement
up to the date of termination. Upon termination of this Agreement for any reason,
Service Provider shall provide Contracting Agency with copies of all completed or
partially completed documents prepared under this Agreement. In the event Service
Provider has received access to Contracting Agency's information or data as a
requirement to perform services hereunder, Service Provider shall return all Contracting
Agency provided data to Contracting Agency in a machine-readable format or other
format deemed acceptable by Contracting Agency.
15. INDEPENDENT CONTRACTING AGENCY
15.1. The Agreement shall not be construed as creating an employer/employee relationship,
a partnership, or joint venture. Service Provider's services shall be those of an
independent contracting agency.
15.2. Service Provider agrees and understands that the Agreement does not grant any rights
or privileges established for employees of Contracting Agency.
15.3. Service Provider shall not be within protection or coverage of Contracting Agency's
Worker Compensation Insurance, Health Insurance, Liability Insurance, or any other
insurance that Contracting Agency, from time to time, may have in force for its existing
employees.
16. NON DISCOSURE AND CONFIDENTIALLY
16.1. Contracting Agency acknowledges and agrees that, in the course of the Parties'
performance under this Agreement, Contracting Agency may receive or have access
to Confidential Information, proprietary information, and/or trade secrets belonging to
Service Provider in the course of the Parties' respective performance under this
Agreement. Contracting Agency understands that: (a) Confidential Information is
commercially and competitively valuable to Service Provider and that it and its
protection are vital to the success of Service Provider's business; (b) the use or
disclosure of Confidential Information by Contracting Agency, except in accordance
with this Agreement, would cause irreparable harm to Service Provider; and (c)
nothing contained in this Agreement shall prohibit Service Provider from pursuing any
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remedies, whether at law or in equity, available to Service Provider for a breach or
threatened breach of this Agreement, including the recovery of damages from, and
injunctive relief against Contracting Agency and its members, both appointed or
elected.
16.2. During the term of this Agreement and following the termination thereof, Contracting
Party, to the extent permitted by law, will not use or disclose, directly or indirectly,
any Confidential Information in any manner or for any purpose not in accordance with
this Agreement or Texas law. Upon termination of this Agreement, or at any time upon
Service Provider's request, Contracting Parry agrees to surrender to Service Provider,
or destroy at Service Provider's request, some or all records, notes, notebooks, or the
like, relating to Service Provider's operations, products, or business made or received
by it during the term of this Agreement. Upon termination of this Agreement,
Contracting Party will return all other Service Provider's property in its custody, and
shall be bound by this Non -Disclosure and Confidentiality Agreement.
16.3. Notwithstanding the foregoing, Contracting Agency may disclose Confidential
Information to the extent required by law. As required by the Texas Public
Information Act (the "Act"), Contracting Party will notify Service Provider in the event
a public information request made to Contracting Agency encompasses any
information protected by this Agreement. As authorized by the Act, Service Provider
may submit arguments against disclosure of the requested information directly to the
Office of the Texas Attorney General. Contracting Agency will only release the
requested information if required to do so by the Office of the Texas Attorney General.
16.4. Contracting Agency's obligations under this Agreement do not extend to information
that is: (a) publicly known at the time of disclosure or subsequently becomes publicly
known through no fault of the Receiving Party; (b) discovered or created before
disclosure by Service Provider; (c) learned by Contracting Agency through legitimate
means other than from Service Provider or its representatives; or (d) is disclosed by
Contracting Agency with Service Provider's prior written approval.
17. HIPAA COMPLIANCE
17.1. Service Provider is currently compliant and will remain compliant with all security
measures required by the Health Insurance Portability and Accountability Act of 1996
("HIPAA") and the Health Information Technology for Economic and Clinical Health
Act of 2009 ("HITECH").
17.2. Contracting Agency acknowledges that once Service Provider has delivered a medical
or psychological evaluation recommendation, as outlined in this Agreement, it is
Contracting Agency's responsibility to maintain these reports and protect this
information as outlined by HIPAA and HITECH.
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18. INSURANCE
18.1. Service Provider shall keep in full force and effect insurance coverage during the term
of this Agreement, including without limitation statutory workers' compensation
insurance; employer's liability and commercial general liability insurance;
comprehensive automobile liability insurance; and professional liability insurance.
18.2. The insurance certificate shall name Contracting Agency, its agents, officers,
servants, and employees as additional insureds under the commercial general liability
and automobile\policies with respect to the operations and work performed by the
named insured as required by written contract.
18.3. The General Liability policy is Primary & Non -Contributory.
18.4. Waiver of Subrogation applies under the General Liability and Workers'
Compensation policies. The commercial general liability insurance minimum
coverage shall be at least $1,000,000.00 per incident, claim or occurrence, and
$1,000,000.00 aggregate. The Automobile Liability insurance minimum coverage
shall be at least $350,000.00 covering all owned, non- owned, and hired vehicles. The
certificate shall provide that there will be no cancellation, termination, or non -renewal
of the insurance coverage without a minimum thirty (30) day written notice to
Contracting Agency, except in the case of cancellation for non-payment of premium,
which shall be at least 10 days written notice.
19. LIABILITY AND INDEMNIFICATION
19.1. SERVICE PROVIDER SHALL BE LIABLE AND RESPONSIBLE FOR ANY
AND ALL PROPERTY LOSS, PROPERTY DAMAGE, AND/OR PERSONAL
INJURY TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER,
WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE
NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE, OR
INTENTIONAL MISCONDUCT OF SERVICE PROVIDER, ITS OFFICERS,
AGENTS, SERVANTS, OR EMPLOYEES.
19.2. FURTHERMORE, SERVICE PROVIDER HEREBY COVENANTS AND
AGREES TO INDEMNIFY, HOLD HARMLESS, AND DEFEND
CONTRACTING AGENCY, ITS OFFICERS, AGENTS, SERVANTS, AND
EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS OR
LAWSUITS OF ANY KIND OR CHARACTER, WHETHER REAL OR
ASSERTED, IN CONTRACT OR TORT, FOR EITHER PROPERTY
DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO
SERVICE PROVIDER'S BUSINESS AND ANY RESULTING LOST
PROFITS) AND/OR PERSONAL INJURY TO ANY AND ALL PERSONS
ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT, TO
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THE EXTENT CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS,
MALFEASANCE, OR INTENTIONAL MISCONDUCT OF SERVICE
PROVIDER, ITS OFFICERS, AGENTS, SERVANTS, OR EMPLOYEES.
20. FORCE MAJEURE
20.1. Neither Party shall be liable hereunder for any failure or delay in the performance of
its obligations under this Agreement if such failure or delay is on account of causes
beyond its reasonable control, including civil commotion, war, fires, floods,
accident(s), earthquakes, inclement weather, telecommunications line failures,
electrical outages, network failures, governmental regulations or controls, casualty,
strikes or labor disputes, terrorism, pandemics, epidemics, local disease outbreaks,
public health emergencies, acts of God, or other similar or different occurrences, for
so long as such force majeure event is in effect. Each Party shall use reasonable efforts
to notify the other Parry of the occurrence of such an event within five (5) business
days of its occurrence.
21. CONFLICTS OF INTEREST
21.1. Texas Local Government Code Chapter 176 ("Chapter 176") requires the disclosure
of certain matters by contracting agencies doing business with or proposing to do
business with local governmental agencies such as Contracting Agency. Service
Provider has reviewed Chapter 176 and, if it is required to do so, will disclose such
matters within seven (7) days of the date of submitting this Agreement to Contracting
Agency, or within seven (7) days of becoming aware of a matter that requires
disclosure, whichever is applicable.
22. NON -BOYCOTT VERIFICATION
22.1. For purposes of Chapter 2270 of the Texas Government Code, Service Provider
represents and warrants that, at the time of execution and delivery of this Agreement,
neither Service Provider, nor any wholly owned subsidiary, majority owned
subsidiary, parent company, or affiliate of Service Provider, boycotts Israel. Service
Provider agrees that, except to the extent otherwise required by applicable federal
law, neither Service Provider nor any wholly owned subsidiary, majority owned
subsidiary, parent company, or affiliate of Service Provider, will boycott Israel during
the term of this Agreement. The terms "boycotts Israel" and "boycott Israel" as used
in this clause have the meaning assigned to the term "boycott Israel" in Section
808.001 of the Texas Government Code.
23. NO BUSINESS WITH FOREIGN TERRORIST VERIFICATION
23.1. For purposes of Subchapter F of Chapter 2252 of the Texas Government Code,
Service Provider represents and warrants that, at the time of execution and delivery
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of this Agreement, neither Service Provider, nor any wholly owned subsidiary,
majority owned subsidiary, parent company, or affiliate of Service Provider engages
in business with Iran, Sudan, or any foreign terrorist organization, as described in
Chapter 2252 of the Texas Government Code, or is a company listed by the Texas
Comptroller under sections 2270.0201 or 2252.153 of the Texas Government Code.
The term "foreign terrorist organization" as used in this clause has the meaning
assigned to such term in Section 2252.151 of the Texas Government Code.
24. NO WAIVER
24.1. The waiver by either Party of a breach or violation of any provision of this Agreement
shall not operate as or be construed as a waiver of any subsequent breach hereof.
25. NONDISCRIMINATION
25.1. Service Provider, with regard to the work performed by it after award and prior to
completion of this Agreement, shall not discriminate on the basis of race, color, sex,
or national origin, including procurements of materials and leases of equipment.
Service Provider shall not participate either directly or indirectly in the discrimination
prohibited by any Federal, State, or local law.
25.2. IF ANY CLAIM ARISES FROM AN ALLEGED VIOLATION OF THIS NON-
DISCRIMINATION COVENANT BY SERVICE PROVIDER, ITS PERSONAL
REPRESENTATIVES, ASSIGNS, OR SUCCESSORS IN INTEREST, SERVICE
PROVIDER AGREES TO ASSUME SUCH LIABILITY AND TO INDEMNIFY
AND DEFEND CONTRACTING AGENCY AND HOLD CONTRACTING
AGENCY HARMLESS FROM SUCH CLAIM.
26. RIGHT TO AUDIT
26.1. Service Provider agrees that the representatives of the Contracting Agency shall have
access to, and the right to audit, examine, and reproduce an and all Service Provider
business records related to the performance under this Agreement.
26.2. Service Provider shall retain all such records for a period of three (3) years after final
payment on this Agreement or until all audit and litigation matters that Contracting
Agency has brought to the attention of the Service Provider are resolved, whichever
is longer.
27. NOTICES
27.1. Any notice or communication permitted or required by this Agreement shall be
deemed effective when personally delivered or deposited, postage prepaid, in the first-
class mail of the United States properly, or sent via electronic means, addressed to the
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appropriate party at the address set forth in the identification of Parties section of this
Agreement.
28. CONSTRUCTION
28.1. The captions or headings in this Agreement are for convenience only and do not
define, limit, or otherwise describe the scope or intent of any provision or section of
this Agreement. References to the singular include the plural and vice versa.
29. SEVERABILITY
29.1. If any provision of this Agreement is found to be contrary to law by a court of
competent jurisdiction, such provision shall be of no force or effect; but the remainder
of this Agreement shall continue in full force and effect.
30. COMPLETE AGREEMENT
30.1. This Agreement supersedes all prior oral or written agreements and understandings
between the Parties respecting the subject matter thereof, and constitutes the entire
agreement between the Parties, and cannot be changed unless mutually agreed upon
in writing by both Parties.
31. GOVERNING LAW: SUCCESSORS AND ASSIGNS
31.1. This Agreement and all matters or issues directly or collaterally relating thereto shall
be interpreted by, governed in accordance with, and construed pursuant to the laws of
the State of Texas without regard to its conflict of laws and rules, and both Parties
agree to submit to jurisdiction in Texas.
31.2. Further, any action arising out of or relating to the performance of the parties
hereunder, or the interpretation of this Agreement shall be brought exclusively in a
court of competent jurisdiction located in Tarrant County, Texas.
31.3. This Agreement shall be binding upon and inure to the benefit of the Parties hereto
and their respective permitted successors and assigns.
32. COUNTERPARTS
32.1. This Agreement may be executed in one or more counterparts and each counterpart
shall, for all purposes, be deemed an original, but all such counterparts shall together
constitute one and the same instrument.
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[Signature Page Follows]
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SIGNATURES
"Contracting Agency"
City of Southlake, Texas
"Service Provider"
Front Line Mobile Health, PLLC
D
By: Name, Title B ame, Managi Mem
Date Signed: Date Signed:
Approved as to form:
By Name, Title
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EXHIBIT A
Requirements for Firefighters
NFPA 1582 is not incorporated by reference due to the size of the document. However, these
fourteen (14) Essential Jobs tasks are included for reference and are superseded by the Contracting
Agency's policies regarding Medical Clearance if provided to Service Provider:
(1) Wearing personal protective equipment (PPE) and self-contained breathing apparatus
(SCBA) while performing firefighting tasks (e.g., hose line operations, extensive crawling,
lifting, and carrying heavy objects, ventilating roofs or walls using power or hand tools,
forcible entry), rescue operations, and other emergency response actions under stressful
conditions, including working in extremely hot or cold environments for prolonged time
periods.
(2) Wearing an SCBA, which includes a demand -valve -type positive -pressure facepiece or
HEPA filter mask, which requires the ability to tolerate increased respiratory workloads.
(3) Exposure to toxic fumes, irritants, particulates, biological (i.e., infectious) and
nonbiological hazards, or heated gases, despite the use of PPE and SCBA.
(4) Climbing at least six flights of stairs or walking a similarly strenuous distance and incline
in jurisdictions without tall buildings while wearing PPE and SCBA, commonly weighing
40-50 lbs. (18-23 kg), and carrying equipment/tools weighing an additional 20-40 lbs. (9-
18 kg).
(5) Wearing PPE and SCBA that is encapsulating and insulated, which will result in significant
fluid loss that frequently progresses to clinical dehydration and can elevate core
temperature to levels exceeding 102.27 (39°C).
(6) Working alone while wearing PPE and SCBA, searching, finding, and rescue -dragging or
carrying victims ranging from newborns to adults weighing over 165 lbs. (75 kg) to safety
despite hazardous conditions and low visibility.
(7) While wearing PPE and SCBA, advancing water -filled hose lines up to 1 3/4 in. (45 mm) in
diameter from fire apparatus to occupancy [approximately 150 ft (50 m)], which can
involve negotiating multiple flights of stairs, ladders, and other obstacles.
(8) While wearing PPE and SCBA, climbing ladders, operating from heights, walking or
crawling in the dark along narrow and uneven surfaces that might be wet or icy, and
operating in proximity to electrical power lines or other hazards.
(9) Unpredictable, prolonged periods of extreme physical exertion as required by emergency
operations without benefit of a warm-up period, scheduled rest periods, meals, access to
medication(s), or hydration.
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(10) Operating fire apparatus or other vehicles in an emergency mode with emergency
lights and sirens.
(11) Critical, time -sensitive, complex problem solving during physical exertion in
stressful, hazardous environments, including hot, dark, tightly enclosed spaces, that is
further aggravated by fatigue, flashing lights, sirens, and other distractions.
(12) Ability to communicate (i.e., give and comprehend verbal orders) while wearing PPE
and SCBA under conditions of high background noise, poor visibility, and drenching from
hose lines or fixed protection systems (e.g., sprinklers).
(13) Functioning as an integral component of a team, where sudden incapacitation of a
member can result in mission failure or in risk of injury or death to members of the public
or other team members.
(14) Working in shifts, including during nighttime, that can extend beyond twelve (12)
hours.
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EXHIBIT B
Scope of Services and Fee Schedule
Exams and Tests to be done
Contracting Agency has chosen the PARTNERSHIP tier of service for 2023-2024 fiscal year.
Service Provider reserves the right, upon prior notice to Contracting Agency, to modify the list of
services in this Exhibit in the event better results can be obtained by using different lab tests or
methodologies. Cost will not change without the approval of the Contracting Agency.
Additional lab tests are available and can be added to this Agreement at Service Provider's then
current pricing through the Change Order process established by Service Provider.
PARTNERSHIP LEVEL LAB TESTS AND PHYSICAL EXAMS
Personalized Risk Assessment
Health Questionnaire & Screening
Annual Human Performance Assessment
Physical Examination &Consultation w/ Medical Provider
LABORATORY ANALYSIS:
Complete CBC
• Lipid Panel
Comprehensive Metabolic Panel
• Prostate Specific Antigen (male) or CA-125 (female)
Urinalysis, with microscopic
• Fecal Occult Blood
• C-Reactive Protein
• Uric Acid
HBA1C
• Apolipoprotein B
Lipoprotein (a)
• Free Testosterone with SBG (male) or Estradiol (Female)
Cortisol
• TSH (Thyroid)
Vision Screening
Body Composition Analysis
Audiogram
Cardiopulmonary Exercise Test (CPET)
Chest Radiograph (X-Ray)
Cancer Screening Ultrasound: thyroid, testicular (male only), abdomen (liver, gallbladder, pancreas, spleen,
kidneys, ovaries, non-invasive)
The price for PARTNERSHIP tier of service for the 2023-2024 fiscal year contract period is
$850.00 per Participant. and is subject to change in subsequent years.
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Exhibit C
Minimum Amount to be Billed
To determine final resource and staffing levels for the physicals, Service Provider requires
Contracting Agency to submit a final roster of participants no later than thirty (30) days before
the Introductory E-mail is sent to the participants. The number of participants listed on the roster
will be the minimum number of physicals billed. Contracting Agency may continue to add
participants in coordination with Service Provider. The charges for these additional participants
will be added to the final billing amount.
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Exhibit D
Examinee Waiver
Scope of Service
To be signed by each Participant examined
By initialing and signing below, I acknowledge that I understand the scope of the medical services
I receive today is solely to identify whether I am physically and mentally able to continue to
perform my essential job duties without undue risk of harm to myself or others, in accordance with
the standards established under the National Fire Protection Association 1582 (Standard on
Comprehensive Occupational Medical Program for Fire Departments, 2022 Edition) or appropriate
Law Enforcement Standards..
Initial
I acknowledge and understand that Front Line Mobile Health, PLLC, is not establishing a patient -
provider relationship. This evaluation is performed pursuant to the Professional Services
Agreement between Front Line Mobile Health, PLLC, and your department, and/or Texas Local
Government Code, Chapter 143 (if applicable), and/or your department's labor/management
agreement (if applicable) and it does not replace those evaluations or health care treatment plans
recommended by my primary care physician/manager or other specialty provider. I will discuss
any abnormal findings or results with my primary care physician/manager for a comprehensive
diagnosis and treatment plan.
Initial
Please note that due to the sensitivity of the testing equipment and lab procedures used by Front
Line Mobile Health, PLLC, abnormal results and findings, along with revaccination or intervention
after certain exposures, may be detected that are of insignificant physiological importance
concerning your ability to perform your duties. However, they may warrant a recommended
referral to your primary care physician/manager. You are encouraged to discuss these abnormal
results and findings with them. Please note that Front Line Mobile Health, PLLC, will not
reimburse you or your department for the cost of any appointments, additional examinations, or
testing you and your primary care physician choose to undertake.
Initial
This Annual Medical Evaluation consists of an examination of major body systems, the analysis
of laboratory results, radiographic studies, online questionnaires, and various other diagnostic
studies. All findings and results are strictly confidential and will be provided only to me, unless I
provide a separate written consent for their release. However, I fully understand and acknowledge
that the specific information, results, and findings from the medical examination, evaluation,
laboratory results, and medical findings, will form the basis of the Medical Director's
recommendation to the Fire or Police Department regarding my continued fitness for duty.
Initial
Non -identifiable aggregated medical and health information gathered from this and other co-
workers' medical examinations will be used to monitor acute and long-term effects of the working
environment; detect patterns of disease in the workforce; provide quantifiable medical information
on the entire workplace; to inform others in the workforce of the occupational hazards of your
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occupation; and for research studies that will be used to identify patterns, make correlations, and
drive positive change in your chosen profession.
Initial
I acknowledge that the Fire Chief or Police Chief, his/her designee, or the Authority Having
Jurisdiction makes the final determination on employment, work restrictions and adherence to
medical recommendations. Front Line Mobile Health, PLLC, and its medical director have no
authority or jurisdiction as it relates to my work status; they only make recommendations. If I wish
to question or contest the results of this exam, I must do so using the rules and regulations adopted
in the Professional Services Agreement between my organization and Front Line Mobile Health,
PLLC.
Examinee Signature Date
Copy: Examinee
Medical File
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Initial