HomeMy WebLinkAboutResolution - 2023-R0543 - Contract 17557, University Medical Center Physicians, City's Health Care Plan - 11/07/2023Resolution No. 2023-R0543
Item No. 5.11
November 7, 2023
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, Service Contract No. 17557 for off-site medical
services for employees and dependents, by and between the City of Lubbock and UMC
Physicians, and related documents. Said Service 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 November 7, 2023 .
ATTEST:
Courtney Paz, City Secretary �
APPROVED AS TO CONTENT:
Bill How n, Deputy Ci ager
APPROVED A'�TO F�RM:
itchell S�f�Gv}�iR�; �irst Assistant City Attorney
ccdocs IIIRES.Contract-UMC Physicians
October 31, 2023
Resolution No. 2023-R0543 Contract 17557
AGREEMENT FOR SERVICES
for
City of lubbock Off-Site Medical Services for Employees and Dependents
This Agreement is between UMC Physicians ("UMCP") and the City of Lubbock ("the Cit�%').
City is a Texas municipality. It maintains the Ciry of Lubbock Health Care Plan for its employees and their eligible
dependents (hereinafter called "Plan Members"). City desires to establish medical clinic locations within the city
limits of Lubbock, Texas for City's Plan Members. The availability of one or more medical clinics would provide
convenience and greater access to quality health care for Plan Members at an efficient and affordable cost to the
City.
UMCP is a Texas nonprofit corporation that operates and manages medical clinics and physician practices. UMCP
desires to provide medical services to Plan Members.
Therefore, the parties agree:
ARTICLE 1: TERM AND TERMINATION
1.1 Term. The term of this Agreement begins on February 1, 2024 and continues for a five-year term through
January 31, 2029
1.2 Renewal. This Agreement shall renew automatically for additional terms, unless either Party gives 90-day
written notice to terminate the contract.
1.3 Termination. Either party may terminate this Agreement at any time without cause by giving the other
party ninety (30) days written notice of termination. Either party may terminate the agreement for cause provided
the other party fails to cure a default within fifteen days prior written notice of the default.
ARTICLE 2: SCOPE OF Work
2.1 Senrices. UMCP shall provide safe, high-quality, and efficient health care to Plan Members aaed two vears
and above. Plan Members may obtain medical care for primary and acute health care issues at any of the eleven
clinics listed in Exhibit A. In addition to primary and acute medical services, plan members will have access to
pediatric care, annual exams and screenings, and immunizations and injections.
2.2 Weliness. Wellness programs have emerged as a transformative way to help reshape the physical well-
being of patients. UMCP is committed to this vital component of health and well-being by offering a Diabetes
Prevention and Educational program called Preveni T2. Prevent T2 is a program to stop or delay Type 2 Diabetes
and consists of a 12-month course taught by trained Lifestyle Coaches. Plan members will be encouraged to enroll
in the program through quarterly email notifications sent to the City Health Plan point of contact. In addition, UMCP
will make a concerted effort to attend all health fairs and events requested by City of Lubbock.
2.3 Health Screening. UMCP will perform Biometric Screenings for Plan Members. Screening will include Blood
draw- CBC, CMP, PSA for males over 50, and Lipid Profile, Body Mass Index, Body Fat Percentage, weight, height,
blood pressure, and pulse. The Plan Member can obtain one health screening annually at any of the UMCP clinics
listed in Exhibit A. Appointments for health screenings should be made by calling one of the clinic locations listed in
Exhibit A. Health screening results will be available to the Plan Member within 72 hours through the MyTeamCare
patient portal which is accessible at any time. Health screening and lab results which are housed in the Plan
Member's medical record will be reviewed by a provider. If additional services are needed, it will be communicated
to the Plan Member through the patient messaging section of the patient portal.
2.3.1 High Risk Individuals. Plan Members identified through the health screening as being at risk for
diabetes or other health condition will be scheduled with a primary care provider for follow-up.
Agreement for Services: City of Lubbock Off-Site Medical Services for Employees and Dependents Page i of 9
2.4 Health Interventions/Disease Management. Plan Members will be added to the Care Coordination efforts
and programs currently supported by UMCP. Plan Members who have been seen at any UMCP location will be
monitored for compliance with health and wellness metrics such as mammograms, colonoscopies and annual exams.
Email notifications will be sent when Plan Members are due for services.
2.5 Reporting. UMCP will provide to the City, no later than the 15`h day of the month immediately following
the end of each month of the calendar year, a written report with respect to the provision of the medical services
during the immediately preceding month. The written report shall be in a form reasonably satisfactory to the City
and shall specifically indicate (a) the number of covered Plan Members seen with diagnosis codes, (b) the number
of Health Screenings conducted, and (c) savings report in a form to be agreed upon by UMCP and the City. UMCP
will coordinate and exchange medical and claims information with the City's Health Administrator for disease and
case management via monthly SFTP monthly transmissions.
2.6 Appointments. Plan members have several options when making appointments. Appointments can be
made in the following ways:
• Call clinic directly
• Online scheduling portal https:/findadoc.umchealthsystem.com
• Walk-in basis
• Wait From Home www.waitfromhome.com online and mobile app available.
Plan members may also utilize the EZ Care Nurse program which connects plan members with available primary care
providers. The EZ Care Nurse Program can be accessed by calling 806.761.0239. Additional information can be found
online at https://www.umchealthsystem.com/patients-visitors/ez-care-nurse-navi�ator/.
2.7 Medical Clinics. UMCP shall provide access to Plan Members at eleven medical clinic locations as described
below. Six of the eleven medical clinic locations offer extended and weekend hours. UMCP will always have at least
one medical clinic location open 365 days of the year including holidays.
2.7.1 UMC Family Medicine at West Wind. West Wind is located at 5520 4th Street Lubbock, Texas.
West Wind Center provides primary and acute health care services. If the Plan Member needs care outside
the scope of the services offered at West Wind, UMCP will assist in obtaining an appointment for the Plan
Member with an appropriate health care provider within the Plan Member's Health Plan Network. West
Wind will be open Monday through Friday 8:00 AM until 5:00 PM and Saturday 9:00 AM until 1:00 PM. If
these hours change substantially, UMCP will notify the City.
2.7.2 UMC Express Care Clinic at South Plains Mall. UMC Express Care is located at 6002 Slide Road,
Lubbock, Texas (inside the South Plains Mall). UMC Express Care will provide acute health care services. If
the Plan Member needs care outside the scope of the services offered at Express Care, UMCP will assist in
obtaining an appointment for the Plan Member with an appropriate health care provider within the Plan
Member's Health Plan Network. UMC Express Care will be open Monday through Saturday 9:00 AM until
7:00 PM, and Sunday 12:00 PM until 6:00 PM. If these hours change substantially, UMCP will notify the City.
2.7.3 UMC Family Medicine at Milwaukee. Milwaukee Family Medicine is located at 7301 Milwaukee
Avenue Lubbock, TX. This clinic will provide primary and acute medical services. If the Plan Member needs
care outside the scope of the services offered at the clinic, UMCP will assist in obtaining an appointment
for the Plan Member with an appropriate health care provider within the Plan Member's Health Plan
Network. Milwaukee clinic will be open Monday through Friday from 8:00 AM until 5:00 PM and Saturday
9:00 AM until 1:00 PM. If these hours change substantially, UMCP will notify the City.
2.7.4 UMC Family Medicine at I-27 Medical Center. UMC Family Medicine at I-27 Medical Center is
located at 4105 I-27 , Lubbock, Texas. I-27 Medical Center will provide primary and acute health care
services. If the Plan Member needs care outside the scope of the services offered at I-27 Medical Center,
UMCP will assist in obtaining an appointment for the Plan Member with an appropriate health care provider
Agreement for Services: City of Lubbock Off-Site Medical Services for Employees and Dependents Page 2 of 9
within the Plan Member's Health Plan Network. I-27 Medical Center will be open Monday through Friday
8:00 AM until 5:00 PM. If these hours change substantially, UMCP will notify the City.
2.7.5 UMC Family Medicine at Orchard Park. Orchard Park Family Medicine is located at 4420 114"'
Street, Lubbock, Texas. Orchard Park Family Medicine will provide primary and acute health care services.
If the Plan Member needs care outside the scope of the services offered at Orchard Park Family Medicine,
UMCP will assist in obtaining an appointment for the Plan Member with an appropriate health care provider
within the Plan Member's Health Plan Network. Orchard Park Family Medicine will be open Monday
through Friday 8:00 AM until 8:00 PM and Saturday 9:00 AM until 5:00 PM. If these hours change
substantially, UMCP will notify the City.
2.7.6 UMC Children's at 98`h & Frankford located at 9615 Frankford Avenue is` Floor, Lubbock, Texas.
UMC Children's will provide primary and acute health care services. If the Plan Member needs care outside
the scope of the services offered at UMC Children's, UMCP will assist in obtaining an appointment for the
Plan Member with an appropriate health care provider within the Plan Member's Health Plan Network.
UMC Children's will be open Monday through Friday 8:00 AM until 5:00 PM. If these hours change
substantially, UMCP will notify the City.
2.7.7 UMC Family Medicine at 98th & Frankford located at 9615 Frankford Avenue 2nd Floor, Lubbock,
Texas. UMC Children's will provide primary and acute health care services. If the Plan Member needs care
outside the scope of the services offered at UMC Family Medicine, UMCP will assist in obtaining an
appointment for the Plan Member with an appropriate health care provider within the Plan Member's
Health Plan Network. UMC Family Medicine will be open Monday through Friday 8:00 AM until 5:00 PM. If
these hours change substantially, UMCP will notify the City.
2.7.8 UMC Children's at KingsPark Urgent Care is located at 7501 Quaker Avenue, Lubbock, Texas.
KingsPark Urgent Care will provide acute health care services. If the Plan Member needs care outside the
scope of the services offered at UMC Children's at KingsPark, UMCP will assist in obtaining an appointment
for the Plan Member with an appropriate health care provider within the Plan Member's Health Plan
Network. UMC Children's at KingsPark will be open Monday through Friday 8:00 AM until 9:00 PM, Saturday
and Sunday 9:00 AM until 6:00 PM. If these hours change substantially, UMCP will notify the City.
2.7.9 UMC Urgent Care Center at KingsPark is located at 7501 Quaker Avenue, Lubbock, Texas. UMC
Urgent Care will provide acute health care services. If the Plan Member needs care outside the scope of
the services offered at UMC Urgent Care, UMCP will assist in obtaining an appointment for the Plan Member
with an appropriate health care provider within the Plan Member's Health Plan Network. UMC Urgent Care
will be open Monday through Friday 8:00 AM until 9:00 PM, Saturday and Sunday 9:00 AM to 6:00 PM. If
these hours change substantially, UMCP will notify the City.
2.7.10 UMC Family Medicine at 69th & Slide is located at 6809 Slide Road Suite J, Lubbock, Texas. UMC
Family Medicine will provide primary and acute health care services. If the Plan Member needs care outside
the scope of the services offered at UMC Family Medicine, UMCP will assist in obtaining an appointment
for the Plan Member with an appropriate health care provider within the Plan Member's Health Plan
Network. UMC Family Medicine will be open Monday through Friday 7:00 AM until 5:00 PM. If these hours
change substantially, UMCP will notify the City.
2.7.11 UMC Family Medicine at LakeRidge is located at 5130 82"d Street, Lubbock, Texas. UMC Family
Medicine will provide primary and acute health care services. If the Plan Member needs care outside the
scope of the services offered at UMC Family Medicine, UMCP will assist in obtaining an appointment for
the Plan Member with an appropriate health care provider within the Plan Member's Health Plan Network.
UMC Family Medicine will be open Monday through Friday 8:00 AM until 5:00 PM. If these hours change
substantially, UMCP will notify the City.
2.8 Medical Staffing. In addition to physicians, UMCP employes advanced practitioners. Some locations are
staffed with Advanced Practice Registered Nurses and Physician Assistants all of which are under the supervision
and oversight of a physician. A supervising physician is always available either onsite or by phone for consultation.
Agreement for Services: City of Lubbock Off-Site Medical Services for Employees and Dependents Page 3 of 9
All personnel will be appropriately qualified, licensed and credentialed to provide medical services in the State of
Texas.
2.8.1 Staff Performance and Satisfaction Evaluation. UMCP measures staff performance and patient
satisfaction after every encounter. Patient satisfaction is measured through the categories and goals listed below.
Current UMCP patient sats
Rewlcs iTop Box �l � GOAL
Number of Surveys -
Facility tivould Recommend 94%
Care providers listened 94%
Discuss illness prevention 73%
Enough infa about treatment 90%
Environment cleanJcamfortable 94%
Front OeSk Courtesy/Respect 93%
Included in decisions 9U%
Nur5e5 listened carefully 92'%
Providers knew medical history 939�6
Ratin� of provider 9496
2.9 Electronic Medical Records. UMCP has utilized Cerner as its electronic medical record keeping system for
15 years. Plan members may access their medical records as well as communicate with any UMCP providers by
signing up online at www.mvteamcare.com or at one of the eleven medical clinics.
2.10 Operational Issues. UMCP and the City designate the following contact persons for operational issues and
coordination of services, as well as for any notices required to be delivered hereunder:
UMCP: Glen Frick
Executive Director
5219 City Bank Parkway, Suite 135
Lubbock, TX 79407
(806)761-0333
glen.frick@umchealthsystem.com
City: Elizabeth Lara
Director of Human Resources, City of Lubbock
1314 Ave K
Lubbock, TX 79401
(806)775-2277
With copy to:
City Attorney
City of Lubbock
1314 Ave K
Lubbock, Texas 79401
A party will notify the other party promptly of any change to the contact information.
2.11 City Health Plan. UMCP will cooperate with the City to work within the City's health benefit structure and
assure proper services and referrals within the provider network and available benefits. This provision shall not
restrict a healthcare provider from discussing all health care options with a patient. The parties will cooperate to
promote the use of the clinics to Plan Members. UMCP shall work with City Health Plan to create a landing page
with locations that link between websites for such promotion. Additionally, UMCP will work with City Health Plan
to use the desired branding in communication and program materials.
Agreement for Services: City of Lubbock Off-Site Medical Services for Employees and Dependents Page 4 of 9
2.12 Plan Member ldentification. The City will provide its Plan Members with identification cards that show the
person's status as a Plan Member.
2.13 Patient Information. All medical records and patient information maintained by the medical clinic shall be
the property of UMCP. UMCP shall protect the confidentiality of patient information in compliance with all state
and federal laws. UMCP shall not disclose patient information to the City without the Plan Member's written
authorization unless disclosure is permitted by law. If UMCP ceases operation of a medical clinic, UMCP will transfer
medical records and patient information to a successor medical provider in accordance with applicable laws.
2.14 Insurance. UMCP shall maintain professional liability insurance for itself and its medical providers
throughout the term of this Agreement, in the minimum annual coverage amounts and type acceptable to the City.
In the alternative, if UMCP self-insures as defined under the Texas Insurance Code, UMCP shall provide to the City
all state filings indicating solvency of any self-insured plan and any other proof of solvency as may be required by
the City. UMCP shall maintain general liability insurance with a combined single limit of a minimum of $1,000,000
each occurrence and in the aggregate. UMCP shall maintain worker's compensation insurance for its employees and
shall provide a waiver of subrogation in favor of the City.
2.15 Indemnity. UMCP SHALL PROTECT, DEFENO, INDEMNIFY, AND HOLD HARMLESS, TO THE FULLEST
EXTENT PERMITTED BY LAW, THE CITY AND CITY'S OFFICERS, EMPLOYEES, ELECTED OFFICIALS, AND/OR AGENTS
FROM AND AGAINST ANY AND ALL LOSSES, DAMAGES, CLAIMS OR LIABILITIES, OF ANY KIND OR NATURE, WHICH
ARISE DIRECTLY OR INDIRECTLY FROM, OR ARE RELATED TO, IN ANY WAY, MANNER OR FORM, THE ACTIVITIES OF
UMCP CONTEMPLATED HEREUNDER, OR THE OMISSION OF THE ACTIVITIES OF UMCP CONTEMPLATED
HEREUNDER. UMCP FURTHER COVENANTS AND AGREES TO DEFEND ANY SUITS OR ADMINISTRATIVE
PROCEEDINGS BROUGHT AGAINST THE CITY AND/OR THE CITY'S OFFICERS, EMPLOYEES, ELECTED OFFICIALS,
AND/OR AGENTS ON ACCOUNT OF ANY SUCH CLAIM, AND, WITHOUT LIMITING THE INDEMNITY PROVIDED
HEREIN, TO PAY OR DISCHARGE THE FULL AMOUNT OR OBLIGATION OF ANY SUCH CLAIM INCURRED BY,
ACCRUING TO, OR IMPOSED ON THE CITY, OR THE CITY'S OFFICERS, EMPLOYEES, ELECTED OFFICIALS, AND/OR
AGENTS, AS APPLICABLE, RESULTING FROM ANY SUCH SUITS, CLAIMS, AND/OR AUMINISTRATIVE PROCEEDINGS
OR ANY MATTERS RESULTING FROM THE SETTLEMENT OR RESOLUTION OF SAID SUITS, CLAIMS, AND/OR
ADMINISTRATIVE PROCEEDINGS. UMCP DOES NOT AGREE TO PROTECT, DEFENO, INDEMNIFY, AND HOLD
HARMLESS THE CITY AND CITY'S OFFICER EMPLOYEES, ELECTED OFFICIALS, AND/OR AGENTS FROM AND AGAINST
CLAIMS AND LIABILITIES ARISING FROM THE CITY'S DUTIES. ACTS, OR OMISSIONS REGARDING ACTtVITIES UNDER
THIS AGREEMENT.
THE INDEMNITY AND RELEASE PROVIDED HEREIN SHALL SURVIVE THE TERMINATION OR VOtDANCE OF
THIS AGREEMENT.
ARTICLE 3: COMPENSATION
3.1 Fees. The City will pay UMCP the following amounts, payable within 30 days of the City's receipt f a monthly
invoice from UMCP:
Primary/Acute Medical Services -$68,500 each month for up to 750 Plan Member visits per month PLUS
$75 for each Plan Member visit over 750 per month. Member Visits for the purpose of counting against the
base 750 visits shall include only those visits where the Member is seen and treated by the health care
professional. Member Visits shall not include paperwork drop-offs by Members, telephone consultations,
if any, setting of appointments by Members, or other contacts wherein direct, in-person professional
medical services are not rendered.
• Lab tests and radiology tests will be excluded from this agreement and billed separately to the
City's existing health insurance plan.
• The health care provider will administer allergy injections if the Plan Member provides the allergy
serum. The administration of the injection is included in the visit fee.
• Workers Compensation is not part of this agreement.
Health Screening -- $75 per Health Screening billed separately from medical services.
Agreement for Services: City of Lubbock Off-Site Medical Services for Employees and Dependents Page 5 of 9
Immunizations/injections will be charged separately to the City at the standard rates. The administration
of the immunizations/injections will be included.
If UMCP provides services to Plan Members and the services are not covered by this Agreement, UMCP will
bill the Health Plan, and the Plan Member will be responsible for applicable copayments.
3.2 Nonappropriation. All funds for payment by the City under this Contract are subject to the availability of
an annual appropriation for this purpose by the City. In the event of non-appropriation of funds by the City Council
of the City of Lubbock, for the services provided under this Agreement, the City may 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 services 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 UMCP on thirty (30) days
prior written notice.
ARTICLE 4: RELATIONSHIP OF THE PARTIES
INDEPENDENT CONTRACTOR STATUS: Nothing in this agreement is intended nor shall be construed to create an
employer/employee relationship between the contracting parties. The sole interest and responsibility of the parties
is to ensure that the services covered by this agreement shall be performed and rendered in a competent, efficient
and satisfactory manner.
ARTICLE 5: GENERAL PROVISIONS
5.1 Non-Discrimination. Each party shall provide services without discrimination on the basis of race, color,
religion, sex (including pregnancy), national origin, age, physical or mental disability, genetic information, status as
a protected veteran, or any other legally protected category, class or characteristic.
5.2 Waiver. The waiver by either party of a breach or violation of any provision of this Agreement shall not
operate as or be construed to be a waiver of any subsequent breach of any provision of the Agreement.
5.3 Severability. If any term or provision of this agreement is held to be invalid for any reason, the invalidity of
that section shall not affect the validity of any other section of this agreement provided that any invalid provisions
are not material to the overall purpose and operation of this agreement. The remaining provisions of this agreement
shall remain in full force and shall in no way be affected, impaired, or invalidated.
5.4 Assignment. Neither party shall have the right to assign or transfer their rights to any third parties under
this agreement.
5.5 Governing Law and Venue. This agreement shall be governed by and construed and enforced in accordance
with the laws of the State of Texas and any applicable Federal Law or Statute. Venue shall be in Lubbock, Lubbock
County, Texas for all purposes.
5.6 Amendment. This agreement may be amended in writing to include any provisions that are agreed to by
the contracting parties.
5.7 Exclusion. Each party certifies that neither it nor its employees or contractors is presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in any
government program by any federal department or agency or by the State of Texas. EACH PARTY WILL NOTIFY
PROMPTLY THE OTHER PARTY if this status changes and the name of any person who provides services under this
Agreement or is an agent or managing employee who is convicted of a criminal offense related to the person's
involvement in a government program or is suspended, debarred, or excluded from participation in a government
program.
5.8 Notice. All notices required or permitted to be given under this Agreement shall be sufficient if furnished
in writing, sent by certified mail, return receipt requested to the party's last known principal office.
Agreement for Services: City of Lubbock Off-Site Medical Services for Employees and Dependents Page 6 of 9
5.9 Authority. The undersigned to this Agreement hereby represent and warrant their respective authority to
execute this Agreement.
oate: November 7, 2023 �ate:
ciry oF �uBBocK
UMC PHYSICIANS
By: �/ - �
Glen Frick, Executive Director
APPROVED AS TO CONTENT:
����I' �. _
Elizabeth Lara, Director of Human Resources
�I��:�i1�l��Z��ZiI�i]:li�iA
�
�/i
,���... 1�,.
��,�•,�•,,A
► �
Agreement for Services: City of Lubbock Off-Site Medical Services for Employees and Dependents Page 7 of 9
--_. _.._, . .._, _.., ..__. _._. ,
EXHIBIT A
CLINIC LOCATIONS AND SERVICES
Acute Care Services rovided on a walk-in or a ointment basis
UMC Express Care at South Plains Mall 806-761-0450
6002 Slide Road #D24
Inside the South Plains Mall
M-F 9:00 am — 7:OOpm; Sat 9:OOam — 7:OOpm; Sun 12:OOpm — 6:OOpm
UMC Children's at KingsPark 806-788-3306
7501 QuakerAvenue
M-F 8:00 am-9:OOpm; Sat and Sun 9:OOam — 6:OOpm
UMC Urgent Care at KingsPark 806-7883306
7501 QuakerAvenue
M-F 8:00 am-9:OOpm; Sat and Sun 9:OOam —6:OOpm
Services provided under this Agreement include but are not limited to:
Diagnosis of diabetes and referral to PCP for treatment
Asthma
Acute conditions-sore throats, ears, headache, fever, body aches
Allergies/Cough/Sinus
Rashes
Stomach aches
Strains/sprains/musculoskeletal problems
Immunizations/Injections:
• Will be charged separately to the City at standard rates
• Administration included
Agreement for Services: City of Lubbock Off-Site Medical Services for Employees and Dependents Page 8 of 9
Primary Care and Acute Care Services
Services are provided on a walk-in or appointment basis.
UMC Children's at 98�h & Frankfo�d
9615 Frankford Avenue
ls' Floor
Lubbock TX 79424
M-F8:OOam—S:OOpm
806-761-0265
UMC Family Medicine at 98"' & Frankford
9615 Frankford Avenue
2"d Floor
Lubbock TX 79424
M-F 8:OOam — 5:00 pm
UMC Family Medicine at I-27 Medical Center
806-761-0267
806-762-2633
4105 I-27
Lubbock TX 79403
M-F 8:00 am — S:OOpm
UMC Family Medicine at West Wind
5520 4th Street
Lubbock TX 79416
M-F 8:00 am — 5:00 pm, Sat 9:00 am —1:00 pm
806-761-0475
UMC Family Medicine at Milwaukee
7301 Milwaukee Ave
Lubbock TX 79424
M-F 8:00 am — 5:00 pm; Sat 9:OOam —1:00 pm
UMC Family Medicine at Orchard Park
7301 Milwaukee Ave
Lubbock TX 79424
M-F 8:00 am — 8:00 pm; Sat 9:OOam — 5:00 pm
UMC Family at 69"' & Slide
6809 Slide Road
Suite J
Lubbock TX 79424
M-f 8:00 am — 5:00 pm
806-761-0464
806-761-0424
806.764.9378
Services provided under this Agreement include but are not limited to:
Ordinary and routine healthcare
Chronic conditions- diabetes, hypertension, etc.
Asthma
Acute conditions- sore throat, ears, headache, fever, body aches
AI le rgies/Cough/Si n us
Rashes
Stomach aches
Strains/sprains/musculoskeletal problems
Immunizations/I njections:
• Will be charged separately to the City at standard rates
• Administration included
Agreement for Services: City of Lubbock Off-Site Medical Services for Employees and Dependents Page 9 of 9
CERTIFICATE OF INTERESTED PARTIES FORnn 1295
lofl
Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos. l, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING
i Name of business entity filing torm, and the city, state and country of the business entity's place Certificate Number:
of business. 2023-1087332
UMC Physicians
Lubbock, TX United States Date Filed:
2 Name o governmental entity or state agency that is a party to the contract for which t e arm is 10/25/2023
being filed.
City of Lubbock Date Acknowledged:
3 Provide the identification number used by the governmental entiry 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.
17557
Off-Site Medical Services for Ciry Employees and their Dependents
Nature of interest
4
Name of Interested Party City, State, Country (place of business) (check appllcable)
Controlling Intermediary
UMC Physicians Lubbock, TX United States X
5 Check only if there is NO Interested Partyr. ❑
6 UNSWORN DECLARATION
My name is � 1 �=-��� ���� O U x , and my date of birth is �
My address is �0 31 O GfL 7 L17 0 , L✓�3� ��—� ,)i� ,'I Z , V 5� .
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
� tY� �^ 2� da �.
Executed in ��60t� Coun State of � L��i , on the y of �G�Ui�� , 20 Z
(month) (year)
ignature of a orized agent of contracting business entiry
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.bc.us Version V3.5.1.9b4369cc
CERTIFICATE OF INTERESTED PARTIES
FORnn 1295
1 of 1
Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos. l, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form, and the ciry, state and country of the business entity's place Certificate Number:
of business. 2023-1087332
UMC Physicians
Lubbock, TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 10/25/2023
being filed.
Ciry of Lubbock Date Acknowledged:
10/26/2023
g Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
17557
Off-Site Medical Services for Ciry Employees and their Dependents
Nature ofinterest
4
Name of Interested Party Ciry, State, Country (place of business) (check applicable)
Controlling Intermediary
UMC Physicians Lubbock, TX United States X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is , and my date of birth is
My address is , ,
(streeq (city) (state) (zip code) (country)
I declare under penalty of peryury that the foregoing is true and correct.
Executed in Counry, State of , on the day of , 20
(month) (year)
Signature of authorized agent of contracting business entiry
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.9b4369cc