HomeMy WebLinkAboutResolution - 2017-R0431 - UMC Physicians Network Services - 11/16/2017Resolution No. 2017-RO431
Item No. 6.18
November 16, 2017
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for
and on behalf of the City of Lubbock, an amendment to Contract No. 12086 for employment
physical examinations, per RFP 14-11957-KS, by and between the City of Lubbock and UMC
Physicians, formerly known as UMC Physician Network Services ("UMCP") of Lubbock, Texas,
and related documents. Said amendment is attached hereto and incorporated in this resolution as
if fully set forth herein and shall be included in the minutes of the City Council.
Passed by the City Council on November 16, 2017
DANIEL M. POPE, MAYOR
ATTEST:
Rebe ca Garza, City Se ret
APPROVED AS TO CONTENT:
Leisa Hutcheson, Director of Human Resources & Risk Management
City Attorney
vw:ccdocs/RES.Amend Agrmt#12086-Employment Physical Examinations
10.27.17
Resolution No. 2017-RO431
AMENDMENT TO AGREEMENT FOR SERVICES
for
City of Lubbock
Pre -employment and Annual Standard Fire Physical and Special Teams
Resolution No. 2014-RO385
Contract 12086
BID/ITB/RFP #: 14-11957-KS
This Amendment applies to the Agreement referenced above between UMC Physicians, formerly
known as UMC Physician Network Services ("UMCP") and the City of Lubbock ("the City"), first
effective November 20, 2014.
This Agreement and this Amendment set forth all terms, conditions, and requirements for the parties and
supersede any earlier agreements, writings, or promises. In the event of conflict or inconsistency between
the Agreement and this Amendment, the terms of this Amendment shall govern.
The parties agree to amend the Agreement as follows, effective November 1, 2017:
Amend Pricing Proposal Sheet "B" Fire, Section 4(c)(i), Physician Services, to state:
UMCP will provide fire exam services at the following location:
Orchard Park Family Medicine 806-761-0420
4420 114' Street
Jack McCarty, D.O. (performs work -related physicals and exams 20% of the time)
The City Manager is authorized to agree to changes in Physician Services regarding medical clinic
locations and designated physicians without need for further review or action by the City Council.
CITY OF LUBBOCK
By:
Daniel M. Pope, Mayor
ATTEST:
1 &Zee_-e� 1 R
Rb c eca Garza, City Secreta
APPROVED AS TO CONTENT:
UMC PHYSICIANS
Glen E. Frick, Executive Director
Agreement for Services: City of Lubbock Pre -employment and Annual Fire Physical Services Page 1 of 2
Amendment 06/17
Leisa-Hutchaon, Director of Human Resources
& Risk Management
Agreement for Services: City of Lubbock Pre -employment and Annual Fire Physical Services Page 2 of 2
Amendment 06/17
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1of1
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2017-253937
Date Filed:
08/24/2017
Date Acknowledged:
08/25/2017
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
UMC Physicians
Lubbock, TX United States
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Lubbock
3
Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
Contract # 11957
Employment Physical Exams
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
5
Check only if there is NO Interested Party.
X
6
AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said this the day of
20 , to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos. 1- 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
CERTIFICATION OF FILING
Certificate Number:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2017-253937
UMC Physicians
Lubbock, TX United States
Date Filed:
08/24/2017
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Lubbock
Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
Contract # 11957
Employment Physical Exams
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
5 Check only if there is NO Interested Party.
X
6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
HOLLEE MARIE HAMILTON
.�1PA •• LB i
Notary Public, State of Texas
�v;F,..•�ti+mac Comm. Expires 08-03-2021
Notary ID 12173070
Signature of aut orized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
AA''0p LAM
Sworn to and subscribed before me, by the said .."r�IVCi�1 this the
20�, to certify which, witness my hand and seal of office.
-j' f_ day of �1 T
%
at cer tering oath Printed name of officer administering oath
Title of officer admini ering oath
corms proviaea ay i exas ttnics commission www.ethics.state.tx.us Version V1.0.3337
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1of1
Complete Nos. 1- 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
CERTIFICATION OF FILING
Certificate Number:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2017-253937
UMC Physicians
Lubbock, TX United States
Date Filed:
08/24/2017
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Lubbock
Date Acknowledged:
3
Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
Contract # 11957
Employment Physical Exams
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
5
Check only if there is NO Interested Party.
X
6
AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
NN0pr P&1" HOLLEE MARIE HAMILTON
ti..--. L9 4
?r°; Tz Notary Public, State of Texas
'FOF�tiComm, Expires 08-03-2021
;,� Notary ID 12173070 Signature of aut orized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
0 A
to and subscribed before me, by the said .`� i�Ci�1 k X this the
1Sworn
_day of t1
20J:, to certify which, witness my hand and seal of office.
t o
at icer tering oath Printed name of officer administering oath
Title of officer admini tering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337