HomeMy WebLinkAboutResolution - 2015-R0101 - Contract: Belinda Alexander & Citibus - 03/26/2015No. 2015 -ROI OI
h 26, 2015
No. 5.12
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, Contract No. 12112 for Citibus ADA Paratransit Client
Assessments, by and between the City of Lubbock and Belinda Alexander, OTR, CLT, of
Lubbock, Texas, and related documents. Said Contract 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 March 26, 2015
G C. RTSON, MAYOR
ATTEST:
Rebe ca Garza, City Seef6tary
APPROVED AS TO
Bill
APPROVED AS TO FORM:
RES.Contract-Belinda Alexander, OTR, CLT.
1.30.15
Resolution No. 2015 -ROI OI RFP 15 -12112 -MA. Citbm ADA Paratransit Client Assessments
CONTRACT 12112
City of Lubbock, TX
Service Agreement
Citibus ADA Paratransit Client Assessments
RFP 15 -12112 -MA
This Service Agreement (this "Agreement") is entered into as of the 26 day of, February,2015
("Effective Date") by and between Belinda Alexander, OTR, CLT_(the Contractor),and the City of Lubbock
(the "City").
RECITALS
WHEREAS, the City has issued a Request for Proposals 15 -12112 -MA for Citibus ADA Paratransit
Client Assessments which becomes part of this contract,
WHEREAS, the proposal submitted by the Contractor has been selected as the proposal which best
meets the needs of the City for this service; and
WHEREAS, Contractor desires to perform as an independent contractor to provide Citibus ADA
Paratransit Client Assessments upon terms and conditions maintained in this Agreement; and
NOW THEREFORE, for and in consideration of the mutual promises contained herein, the City and
Contractor agree as follows:
City and Contractor acknowledge the Agreement consists of the following exhibits which are
attached hereto and incorporated herein by reference, listed in their order of priority in the event of
inconsistent or contradictory provisions:
1. This Agreement
2. Exhibit A — General Requirements
3. Exhibit B — Fees
4. Exhibit C — Insurance
Article 1 Services
1.1 Contractor shall provide the services that are specified in Exhibit A. The Contractor shall
comply with all the applicable requirements set forth in Exhibit B, and hereto.
1.2 Contractor shall use its commercially reasonable efforts to render Services under this
Agreement in a professional and business -like manner and in accordance with the standards
and practices recognized in the industry.
Nonappropriation clause. All funds for payment by the City under this Agreement are
subject to the availability of an annual appropriation for this purpose by the City. In the
event of nonappropriation of funds by the City Council of the City of Lubbock for the goods
or services provided under the Agreement, the City will terminate the Agreement, without
termination charge or other liability, on the last day of the then -current fiscal year or when
the appropriation made for the then -current year for the goods or services covered by this
Agreement is spent, whichever event occurs first. If at any time funds are not appropriated
for the continuance of this Agreement, cancellation shall be accepted by the contractor on
thirty (30) days prior written notice, but failure to give such notice shall be of no effect and
the City shall not be obligated under this Agreement beyond the date of termination.
QTumhaseBid Documents/15-12112-MA
RFP 15 -12112 -MA, Cihbus ADA Pamtr it Client Assessments
Article 2 Miscellaneous.
2.1 This Agreement is made in the State of Texas and shall for all purposes be construed in
accordance with the laws of said State, without reference to choice of law provisions.
2.2 This Agreement is performable in, and venue of any action related or pertaining to this
Agreement shall lie in, Lubbock, Texas.
2.3 This Agreement and its Exhibits contains the entire agreement between the City and
Contractor and supersedes any and all previous agreements, written or oral, between the
parties relating to the subject matter hereof. No amendment or modification of the terms of
this Agreement shall be binding upon the parties unless reduced to writing and signed by
both parties.
2.4 This Agreement may be executed in counterparts, each of which shall be deemed an
original.
2.5 In the event any provision of this Agreement is held illegal or invalid, the remaining
provisions of this Agreement shall not be affected thereby.
2.6 The waiver of a breach of any provision of this Agreement by any parties or the failure of
any parties otherwise to insist upon strict performance of any provision hereof shall not
constitute a waiver of any subsequent breach or of any subsequent failure to perform.
2.7 This Agreement shall be binding upon and inure to the benefit of the parties and their
respective heirs, representatives and successors and may be assigned by Contractor or the
City to any successor only on the written approval of the other party.
2.8 All claims, disputes, and other matters in question between the Parties arising out of or
relating to this Agreement or the breach thereof, shall be formally discussed and negotiated
between the Parties for resolution. In the event that the Parties are unable to resolve the
claims, disputes, or other matters in question within thirty (30) days of written notification
from the aggrieved Party to the other Party, the aggrieved Party shall be free to pursue all
remedies available at law or in equity.
2.9 The City reserves the right to exercise any right or remedy to it by law, contract, equity, or
otherwise, including without limitation, the right to seek any and all fomes of relief in a
court of competent jurisdiction. Further, the City shall not be subject to any arbitration
process prior to exercising its unrestricted right to seek judicial remedy. The remedies set
forth herein are cumulative and not exclusive, and may be exercised concurrently. To the
extent of any conflict between this provision and another provision in, or related to, this
document, this provision shall control.
Q:Pumhm aid Documents/15-12112-MA
RFP 15 -12112 -MA. Cihbue ADA Parammit Client Assessments
IN WITNESS WHEREOF, this Agreement is executed as of the Effective Date.
CITY OF LUBBOCK, TX CONTRACTOR
Glen 6pleftson, Kayor
ACT
Reb ca Garza, City Secretary
APPROVED AS TO C- ONTENT:
Bill Hqg ton, Assistant Ci ager
APPROVED AS TO FORM:
Amy Si uty City ttomey
Q:P=ha Bid Docmn m 15 -12112 -MA
Title
RFP 15 -12112 -MA, Citibus ADA Pm transit Client Assessments
H. GENERAL REQUIREMENTS
I= IM Wul
Exhibit A
a) Citibus is seekingproposals for interested occupational therapists to assess Citibus clients for
ADA Paratransit eligibility.
b) Offerors are invited to submit demonstrated competence and qualifications of their firm for
providing these services.
c) The information contained within this document is intended to provide interested firms with the
requirements and criteria that will be used to make the selection.
No ,_ t I JLK
ADA Paratransit client assessments are conducted as a cost-saving measure to ensure that
individuals requiring specialized ADA curb -to -curb service are certified to use it. ADA Client
Assessment contract will be active for a period of one (1) year with an additional two (2) year option
at the contractor's discretion. Assessment services will be compensated based on an hourly rate.
3. PROJECT SCOPE OF WORK
3.1 ADA Paratransit client assessments:
d) must be conducted by a licensed occupational therapist, as certified by the Texas Board of
Occupational Therapy Examiners. Copies of appropriate certificates and/or licenses must
accompany proposal.
e) will be performed at Citibus' Administrative Building at 801 Texas Avenue (Lubbock,
Texas).
f) will occur every Tuesday between the hours of 9:00am and 12:00pm. Therapist will be
notified of cancellations in advance of Tuesday showtime.
3.2 Under the contract, the selected occupational therapist:
h) will be responsible for own transportation to/from Citibus facility and other related
activities.
i) will conduct a blood pressure check and a number of physical activities to gauge the client's
ability to board/alight and walk to a bus stop.
j) will conduct a review of the client's medical questionnaire for accuracy.
k) will be available by phone or email to respond to Citibus staff inquiries.
I) will be required to defend client eligibility determination at Lubbock Public Transit
Advisory Board meeting, or in a court of law.
m) will be required to file deposition or represent Citibus if contractor is sued over the
determination of a client's eligibility.
n) will be required to ensure that Citibus facility is registered and has appropriate
registration/renewal certificates.
3.3 This agreement includes incorporation of Federal Transit Administration (FTA) Terms. The
preceding provisions include, in part, certain Standard Terms and Conditions required by the
Department of Transportation (DOT), whether or not expressly set forth in the preceding contract
provisions. All contractual provisions required by DOT, as set forth in FTA Circular 4220.117, are
hereby incorporated by reference. Anything to the contrary herein notwithstanding, all FTA
mandated terms shall be deemed to control in the event of a conflict with other provisions contained
in this agreement. The Contractor shall not perform any act, fail to perform any act, or refuse to
QPurcbaseBid Documents/15-12112-MA
RFP 15 -12112 -MA, Citibus ADA Paratmnsit Client Assessments
comply with any requests which would cause Citibus to be in violation of the FTA terms and
conditions.
4. EVALUATION CRITERIA
The following criteria will be used to evaluate and rank submittals:
a) Experience — The offeror's experience in providing the services as requested in the
specifications. Provide three verifiable references on similar and related contracts. Please use
attached reference form. (20%)
b) Understanding of Services — The offeror shall have the capability, in all respects, to perform
fully the contract requirements and the moral and business integrity and reliability that will
assure good faith performance as required by these specifications. (30%)
c) Capability and Skill — Offeror's capability, flexibility and skill to perform the services stated
in the specifications. (20%)
d) Responsiveness — The degree to which the offeror has responded to the purpose and scope of
specifications. (10%)
f) Cost (20%)
5. PROPOSAL FORMAT
a) Proposals should provide a straightforward, concise description of the offeror's capabilities to
satisfy the requirements of the RFP. Emphasis should be on completeness, clarity of content,
and conveyance of the information requested by the City.
b) The proposal should be bound in a single volume where practical. All documentation submitted
with the proposal should be bound in that single volume (notebooks preferred).
c) If the proposal includes any comment over and above the specific information requested in the
RFP, it is to be included as a separate appendix to the proposal.
d) The proposal must be organized into the following response item sections and submitted in an
indexed binder.
i) Cover letter addressed to the Honorable Mayor and City Council that states the Offeror's
understanding of the services to be provided. Include any additional information believed
necessary that is not requested elsewhere in the RFP.
ii) A description of the methodology to be used to complete the project to include, but not be
limited to, how recommendations will be formulated and commitment of appropriate
resources to the project.
iii) Offeror's specific expertise in areas pertinent to the project to include a listing and brief
description of similar projects completed (with the dates of completion) or in progress and a
list of references by name, address, and telephone number for each project listed. This list
of projects in progress shall include the phase of work that each project is currently in (i.e.
design, bid, construction), and the estimated completion date.
iv) A brochure of past work, with emphasis on comparable projects.
v) List of principal(s) of the Proposer and amount of time that principal(s) will be involved in
the project.
Q:Pmchase/Bid Documents/15-12112-MA
RFP 15 -12112 -MA, Cililms ADA Patammsit Client Assessments
vi) List of other professionals to be used, if applicable, with a record of experience in projects
of this nature. Identification of principal(s) and percentage of time the principal(s) will be
involved in the project.
vii) The organizational structure of the employees who will be assigned to this project along
with resumes of those individuals. If a joint venture is expected, then provide the
organizational structure of the subcontractor and resumes of those persons who will be
involved in the project.
viii) The Proposer must assure the City that he/she will, to the best of his/her knowledge,
information and belief, be cognizant of, comply with, and enforce, where applicable and to
the extent required, all applicable federal or state statutes and local ordinances including,
but not limited to, the Davis -Bacon Federal minimum wage requirements.
ix) Describe the Offeror's methodology for handling errors and omissions.
x) Disclosure of any obligations posing a potential conflict of interest, including service on
City boards and/or commissions and any current contracts with the City of Lubbock. This
would apply to the Proposer as well as consultants subcontracted by the Proposer.
xi) Offerors are strongly encouraged to explore and implement methods for the utilization of
local resources, and to outline how they would address outreach issues in their proposal. It
is also the desire of the City that the City of Lubbock program serve, as much as practicable,
to stimulate growth in all sectors of the local business community. Describe how your firm
would facilitate this process, and provide any relevant information about similar efforts on
previous projects.
Q:Pwchase/Bid DocumentO 5 -12112 -MA
RFP 15 -12112 -MA, Cinbae ADA Pamtrnasit Client Assessments
Citibus Forms
Attached are the forms Citibus uses for the client ADA Eligibility Process.
1. CitiAccess Certification of ADA Eligibility (This form is completed by the client
and/or client's physician).
2. Citibus Physical Assessment (This form is completed by the Occupational Therapist)
Q:P=base/6id Dncamencs'15-12112-MA
Applicant,
We appreciate your interest in our curb -to -curb paratransit
service. The following application must be filled out legibly
and completely. The physicians form must be completed by a
doctor, licensed health care provider, or licensed social
caregiver familiar with your disability.
After CitiAccess receives your completed application you
may be contacted to schedule an in-person interview to
determine your eligibility. Transportation will be provided to
you free of charge both to and from the Citibus
administrative offices at 801 Texas Ave.
You will receive a determination letter within 21 business
days. If you require any assistance in completing this
application you may call our scheduling office at 712-2000 x
236. You can also request assistance during your in-person
interview.
Again, we thank you for your interest in CitiAccess.
Director of Paratransit
806-712-2010
CITIAccess CERTIFICATION
OF
ADA ELIGIBILITY
Return completed application to:
CITIBUS
Director of Transportation
801 Texas Avenue
Lubbock,Texas 79401
OFFICE USE ONLY
Determination:
Expiration Date:
Assessment Date:
Date Letter Mailed:
CitiAccess will only use the information obtained in this certification process for the
provision of transportation services.
PART I -- To Be Completed By Applicant (Please Print or Type)
Name First Name Mid. Initial
Street Address
Zip Code
Home Phone Work Phone Social Security No. Date of Birth
PART II — Please answer all of the following questions.
1. Are you able to board and disembark without assistance from a Citibus without a
wheelchair lift?
Yes_ No_ If no, please explain:
2. Are you able to board and disembark without assistance from a Citibus with a
wheelchair lift?
Yes_ No If no, please explain:
3. Are you able to travel to the nearest bus stop?
Yes_ No If no, please explain:
Location:
How Far:
N
4. Do you currently use Citibus services?
Yes_ No_
What routes?
5. Are you able to handle money and transfers?
Yes_ No If no, please explain:_
6. And are you able to use railings and handles?
Yes_ No_ If no, please expla
Are you able to keep balance while seated on a moving bus?
Yes_ No_
8. Are you able to understand bus schedules? Yes_ No
Understand and follow directions? Yes_ No
Process information to ride Citibus? Yes No
9. If you can use a lift -equipped bus, are you presently unable to ride because:
One of more routes you want to ride do not have lift -equipped buses?
The lift cannot be operated at bus stops where you need to board?
Your wheelchair cannot be accommodated on a transit vehicle?
_Other reasons. Please explain:
10. Are you prevented from traveling to or from a bus stop boarding location for one
or more of the following reasons?
_Inability to negotiate hilly terrain
_Extreme sensitivity to climatic conditions
_Al[erg ic/environmental sensitivities
—Hyper -fatigue, frailty
_Night blindness
_Inability to cross busy intersections
_Inability to climb three 10 -inch steps
_Bus stop too far away
_Other reasons. Please explain:
11. Are you able to perform the following functions without supervision?
a) Find your way between familiar locations?
Yes_ No_ Yes, with training
b) Signal the bus driver to get off at a familiar stop and get off the bus
there?
Yes_ No_ Yes, with training
c) At a bus stop served by more than one bus route, can you distinguish
the correct bus to board and indicate your intention to board?
Yes_ No_ Yes, with training
12. Are you able to perform the following functions without the assistance of another
person?
_Travel 200 feet (the length of a city block)
_Travel % mile (the length of 3 city blocks)
_What is the maximum distance you can travel to get to a bus stop?
13. Is your ability to get from place to place affected by:
_Terrain, such as steep hills, no sidewalks/crosswalks, or other
conditions
14.
_Rain, snow, ice
_Extreme temperatures of heat or very cold, windy weather
Are you able to wait outdoors for 10 minutes?
Yes_ No Sometimes_
If no, please explain
15. Do you have trouble standing for more than 15 minutes?
Yes_ No Sometimes_
If yes, please explain
16. Does your disability allow you to use the bus when you are feeling well?
Yes_ No_
17. Does your disability allow you to use the bus when you are not feeling well?
Yes_ No_
18. Are there sidewalks at your residence?
Yes No
19. How would you describe the terrain where you live? (very steep hill, long gradual
hill, flat, etc.)
20.
21
Are you able to cross the street or a busy intersection by yourself?
Yes_ No_
If yes, under what circumstances?
Have you ever received mobility training for routes or destinations?
Yes_ No
What did you learn?
22. If travel training were available, would you be interested in participating?
Yes_ No_
23. List three of your most frequent destinations, and how you get there?
Frequency
Destination or Street Address of Travel How do you get there now?
24. Are there places you would like to go that you cannot get to now?
Frequency
Destination or Street Address of Travel Barrier?
25. How did you find out about the CitiAccess service?
PART III — These questions in this section are designed to give us a better
understanding of your opinions about certain aspects of accessible fixed route bus
service. Please read each question carefully and circle the number that indicates
whether you agree, disagree, or are not sure.
Not
Agree Disagree Sure
1. The bus system is too complicated for me to 1 2 3
figure out.
2. I've heard good stories about Citibus service 1 2 3
from other people.
3. I'm not at all interested in using Citibus service 1 2 3
for my transportation.
4. 1 have to have a seat on the bus, but I'm afraid 1 2 3
1 won't get one.
5. Everyone on the bus will be inconvenienced 1 2 3
since it takes me longer to board. People
will get angry.
6. Riding the bus makes me more vulnerable to 1 2 3
crime, and I'm afraid for my safety.
7. 1 think my neighborhood has good bus service.
8. I'm afraid I'll get off at the wrong stop.
9. Arriving at my destination on time is not
important to me.
10. Lower Citibus fares compared to CitiAccess are
an incentive for me to ride the bus.
11. Taking my trips by bus would take me too long.
12. 1 need help with the tie downs and I don't think
the Citibus driver will help me.
13. I'd have to get up earlier in the morning to use
the bus, which would be a problem.
14. If the bus moves before I'm seated, I'm afraid
I might fall.
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
1 2 3
PART IV — Please select someone who would NOT be riding with you.
In Case Of Emergency Notify:
Name Relationship
Home Phone Work Phone
Address City State Zip Code
A
Please indicate below if the applicant can be left alone at their destination
_ Applicant can be left alone at destination _ Applicant can't be left alone at destination
PART V — Please answer all of the following questions.
I understand my rights and responsibilities for CitiAccess Service and they are:
1. CitiAccess is public transportation and I will be
sharing rides with other passengers ................................................... 0
2. CitiAccess does not provide emergency service ................................... 0
3. 1 must show my CitiAccess I.D. card and pay the fare
eachtime I ride.............................................................................
4. Three "No Shows" in 30 days could result in ridership
suspension.................................................................................. 0
5. CitiAccess has 15 minutes before and 15 minutes after the
scheduled pick up time to arrive........................................................ 0
6. CitiAccess will wait only 5 minutes from the time it arrives ......................
7. CitiAccess is curb to curb service ...................................................... 0
I certify that the information provided in this application is accurate. I understand that
false information may result in the denial or annulment of CitiAccess service. I further
understand that all information will be kept confidential, and only the information
required to provide the services I request will be disclosed to those who perform those
services.
Applicant's Signature
Interviewers Signature
Date
Date
7
"If applicant has been assisted by someone else in completing this application, that
person must complete the following:
Last Name First Name Mid. Initial
Street Address
City
State
Apt. No.
Zip Code
Home Phone Work Phone Relation to Applicant
Office Use Only
Screening Committee Review:
Reviewed By: Date: Decision:
Reviewed By: Date: Decision:
Reviewed By: Date: Decision:
9
Dear Health Care Provider:
The Americans with Disabilities Act and its implementing federal regulations
established categories of persons who are eligible to receive paratransit services
complementary to fixed -route bus services. The three categories of persons with
rights to complementary paratransit are:
1. Persons who, because of their disability, cannot independently board, ride and/or
disembark from an accessible vehicle.
2. Person who, because of their disability, cannot use vehicles without lifts or other
accommodations.
3. Persons who, because of their disability, cannot get to or from a boarding or
disembarking location.
Any individual is to be certified as ADA paratransit eligible if there is any part of the
transit system that cannot be used or navigated by that individual because of a
disability. Persons are not to be qualified or disqualified on the basis of a specific
diagnosis or disability.
The information requested from you on the following pages will allow CitiAccess to
obtain the information necessary to establish eligibility of the applicant. Thank you
for your assistance.
PART VI -- To Be Completed By Appropriate Health Care Provider
(Please Print or Type)
Please Check One: _ Physician
_ Licensed Health Care Provider
Licensed Rehab/Social Worker
Applicant's Name
Last First Mid. Initial
Medical diagnosis of condition causing disability:
Is the condition permanent?
Yes_ No_ If not, expected duration:
Does this disability prevent the applicant from utilizing the fixed route services (regular
bus service)? If yes, please describe in detail.
PART VII — Please answer all of the following questions.
The following information will be used to ensure that an appropriate vehicle is sent to
provide transportation and that CitiAccess can make an accurate analysis of the
applicant's trip requests.
Does the applicant use any of the following mobility aids? (Check all that apply)
Q Cane
Q White Cane
0 Walker
F7 Crutches
Q Leg Braces
0 Power Chair
0 Large Power Chair
0 Power Scooter
0 Manual Chair
0 Picture/Alphabet Board
0 Communication Board
0 Service Animal
0 Portable Oxygen Supply
Q Personal Care Attendant
Q Other:
Please indicate below if the applicant can be left alone
Q Applicant can be left alone
0 Applicant can't be left alone
10
Can the applicant walk or wheel '% mile (3 blocks) without the assistance of another
person?
Yes_ No
1. Can the applicant climb three 10 -inch steps with assistance?
Yes_ No
2. Can the applicant wait outside without support for 15 minutes?
Yes No
3. Is applicant on dialysis?
Yes_ No
4. Does the applicant have a hearing impairment?
Yes_ No
5. Is the applicant able to give addresses and phone numbers upon request?
Yes_ No
6. Is the applicant able to recognize a destination or landmark?
Yes_ No
7. Is the applicant able to deal with unexpected situations or unexpected changes in
routine?
Yes_ No
8. Is the applicant able to ask for, understand, and follow directions?
Yes_ No
9. Is the applicant able to safely and effectively travel alone through crowded and/or
complex facilities?
Yes_ No
** If the applicant has a visual impairment:
Visual acuity with best correction:
Visual Fields:
Right Eye Left Eye
Both Eyes
Right Eye Left Eye
Both Eyes
Please describe any other disability or effect that prevents the applicant from using the
regular bus service.
11
PART VIII
Based upon my professional knowledge of the applicant, I certify that the preceding
information is true and correct.
Name of Health Care Provider (Please Print) Office Phone Number
Office Street Address City State Zip Code
State License Number (Complete if Applicable — Must be Current)
Signature
Date
12
Citibus Transit System
Physical Ability Testing
Informed Consent
Page I of 1
The physical ability test is a voluntary test of your ability to independently complete
given tasks for a simulated bus arrival and departure. All tests will be explained thoroughly
before you perform them.
There are risks during testing which will require heart rate and blood pressure
checking. You may experience an increase in your pain during testing. Therefore, it is
important for you do the following:
1. Report any pain increase immediately, although some pain may be normal.
2. Stop any test if you experience a pain increase that you feel is unsafe for you.
3. Do not perform any test you do not feel you are able to perform.
Your evaluator will stop any test if you appear to be overstressing yourself. You will
not be forced to perform any test you feel you are not able to perform, and you should stop
any test if your pain increases beyond a level that you feel is undesirable to you.
It is critical for you to give your best effort during the evaluation so we may
determine how your injury is affecting your ability to use the fixed transit system, and what
modifications need to be made to accommodate you. Your evaluator will report your
estimated functional ability based on any available information.
I understand that the purpose of this evaluation is to determine my physical abilities
and to establish any accommodations that need to be made to ensure safe mass transit travel.
I understand the above information and I agree to participate in the Physical Ability
Testing to the best of my ability to help determine proper accommodations for my travel.
Patient Signature
Evaluator Signature
Date
Date
Citibus Physical Assessment
Name: Date:
Date of Birth: Time Of Evaluation:
Medical Conditions:
Evaluator: Belinda Alexander, OTR,CLT
Mobility Aids Used During Assessment:cane _rolling walker 4 wheel walker
_manual w/c mower chair/scooter _none _other:
Wheelchair User (circle one): Full Time Part Time N/A
If part time, explain:
Resting Heart Rate: Resting Blood Pressure:
75% max of age: = 220- (age) x .75
Current Transportation: _fixed route bus citi-access _Medicaid transp. _none
other:
Functional Mobility:
1. Distance to nearest bus stop
HR: Time: 2°" HR: Time:
Pass Fail
2. Curbs and Curb Cuts
Able to independently go: Up curb cut? Yes No Down curb cut? Yes No
Pass Fail
3. Ramps/Steps
Able to independently go: Up bus ramp/steps? Yes No
Down bus ramp/steps? Yes No
Pass Fail
Belinda Alexander, OTR, CLT Date
Status:
_ADA approval x 3 years _ADA temporary x _mths Fixed ID needed: Y / N
_Denied Citiaccess (Indep w/fixed route) _Denied other:
_Offered Special Efforts _Offered United Shopper
TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS
333 Guadalupe • Ste 2-510 • Austin TX 78701
512/305-6900 • info@ptot.texas.gov
THIS CERTIFIES THAT
Belinda D Alexander
Occupational Therapist
License # 104238
HOLDS A REGULAR LICENSE TO PRACTICE IN TEXAS
FOR A PERIOD ENDING 10/31/2016
Verify this license at: www.ptot.texas.gov
Print x
Exhibit B
December 19, 2014
Marta Alvarez, Director of Purchasing and Contract Management
City of Lubbock
1625 13th Street, Room 204
Lubbock, Texas 79401
RE: RFP 15 -12112 -MA
I, Belinda Alexander, OTR, CLT, will provide my services as an
Occupational Therapist, to come on-site and evaluate client's
physical and mental capabilities for utilizing fixed route services
at a fee of $85.00 per hour. Currently utilized physical screening
tools will be used for the assessment. Upon evaluation, the
application is reviewed with medical conditions taken into account
and how that correlates with government guidelines and
parameters, then making appropriate recommendations in
compliance with federal or state statutes and local ordinances.
Determinations will be made as Denied, Temporary, Conditional,
or Full ADA for the use of the paratransit services.
Respectfully,
;�4 Lely -t CA/T_
Belinda Alexander, OTR, CLT
Occupational Therapist
Texas license number: 104238
NBCOT certification number: 981735
RFP 15 -12112 -MA. Citibm ADA Pamuil Client Asses =.N
Exhibit C
Citibus ADA Paratransit Client Assessments
RFP 15 -12112 -MA
INSURANCE
SECTION A. Prior to the approval of this contract by the City, the Contractor shall furnish a completed
Insurance Certificate to the City, which shall be completed by an agent authorized to bind the named
underwriter(s) to the coverages, limits, and termination provisions shown thereon, and which shall furnish
and contain all required information referenced or indicated thereon. THE CITY SHALL HAVE NO
DUTY TO PAY OR PERFORM UNDER THIS CONTRACT UNTIL SUCH CERTIFICATE SHALL
HAVE BEEN DELIVERED TO THE CITY.
INSURANCE COVERAGE REQUIRED
SECTION B. The City reserves the right to review the insurance requirements of this section during the
effective period of the contract and to require adjustment of insurance coverages and their limits when
deemed necessary and prudent by the City based upon changes in statutory law, court decisions, or the
claims history of the industry as well as the Contractor.
SECTION C. Subject to the Contractor's right to maintain reasonable deductibles in such amounts as are
approved by the City, the Contractor shall obtain and maintain in full force and effect for the duration of this
contract, and any extension hereof, at Contractor's sole expense, insurance coverage written by companies
approved by the State of Texas and acceptable to the City, in the following type(s) and amount(s):
Type
Worker's Compensation or
Employers Liability
Commercial General Liability per Occurrence
Endorsements
- General Aggregate
- Products/Op AGG
- Personal & Adv. Injury
- Contractual Liability
Amount
Statutory
$500,000
Combined single limit for bodily
injury and property damage of
$1,000,000 per occurrence or its
equivalent.
1,000,000
Professional Liability
- General Aggregate
The City of Lubbock shall be named as additional insured on auto/general liability with a waiver of
subrogation in favor of the City on all coverage's and include products of completed operations
endorsement. All copies of the Certificates of Insurance shall reference the RFP or proposal number for
which the insurance is being supplied.
ADDITIONAL POLICY ENDORSEMENTS
The City shall be entitled, upon request, and without expense, to receive copies of the policies and all
endorsements thereto and may make any reasonable request for deletion, revision, or modification of
particular policy terms, conditions, limitations, or exclusions (except where policy provisions are established
by law or regulation binding upon either of the parties hereto or the underwriter of any of such policies).
Upon such request by the City, the Contractor shall exercise reasonable efforts to accomplish such changes
in policy coverages, and shall pay the cost thereof.
REQUIRED PROVISIONS
Q:Pmhase/aid Dmmentsl15-12112-MA
RFP 15 -12112 -MA, Citbus ADA Pamtmnsit Client Assessments
The Contractor agrees that with respect to the above required insurance, all insurance contracts and
certificate(s) of insurance will contain and state, in writing, on the certificate or its attachment, the following
required provisions:
• Name the City of Lubbock and its officers, employees, and elected representatives as additional
insureds, (as the interest of each insured may appear) as to all applicable coverage;
• Provide for 30 days notice to the City for cancellation, nonrenewal, or material change;
• Provide for notice to the City at the address shown below by registered mail;
• The Contractor agrees to waive subrogation against the City of Lubbock, its officers, employees,
and elected representatives for injuries, including death, property damage, or any other loss to the
extent same may be covered by the proceeds of insurance;
• Provide that all provisions of this contract concerning liability, duty, and standard of care together
with the indemnification provision, shall be underwritten by contractual liability coverage
sufficient to include such obligations within applicable policies.
• All copies of the Certificates of Insurance shall reference the project name or proposal number for
which the insurance is being supplied.
NOTICES
The Contractor shall notify the City in the event of any change in coverage and shall give such notices not
less than 30 days prior the change, which notice must be accompanied by a replacement CERTIFICATE OF
INSURANCE.
All notices shall be given to the City at the following address:
Marta Alvarez, Director of Purchasing & Contract Management
City of Lubbock
1625 13s' Street, Room 204
Lubbock, Texas 79401
SECTION D. Approval, disapproval, or failure to act by the City regarding any insurance supplied by the
Contractor shall not relieve the Contractor of full responsibility or liability for damages and accidents as set
forth in the contract documents. Neither shall the bankruptcy, insolvency, or denial of liability by the
insurance company exonerate the Contractor from liability.
Q:Pu hase/Bid Documents/15-12112-MA