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HomeMy WebLinkAboutResolution - 2024-R0275 - Service K 17915, Life Extension Clinics, Inc. Dba Life Scan Wellness Centers - 05/28/2024Resolution No. 2024-R0275 Item No. 7.21 May 28, 2024 RESOLUI'ION BE IT 12ESOLVED BY THE CITY COUNCIL OF THE CITY OF LUI3BOCK: 1'HAT 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. 17915, as per RFP-17915-YB, for the purchase of annual firefighter medical, physical, and wellness exams for Lubbock Fire Rescue, by and between the City of Lubbock and Life Extension Clinics, Inc. dlbla Life Scan Wellness Centers of Tampa, Florida, and all 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. 1'assed by the City Council on Mav 28, 2024 TRAY I'A ATTEST: Courtney Paz, City Secretary APPROVED AS TO CONTENT: �� �i , Rob Keinast, Interim Chief of Fire Rescue APYI20VED AS TO FORM: Rya 3ro e. Se �or ssistant City Attorney ItES.Contract No. 17915-LFR-Life f-_ztension Clinics 5. I .24 Resolution No. 2024-R0275 Contract 17915 City of Lubbock Annual Firefighter Medical, Physical and Wellness Exams Agreement This Service Agreement (this "Agreement") is entered into as of the2gchday of Mav 2024 ("Effective Date") by and between Life Extension Clinics, Inc. dba: Life Scan Wellness Centers (the Contractor), and the City of Lubbock (the "City"). RECITALS WHEREAS, the City has issued a Request for Proposals 24-17915-YB, Annual Firefighter Medical, Physical and Wellness Exams and 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, Firefighter Medical, Agreement; and Contractor desires to perform as an independent contractor to provide Annual Physical and Wellness Exams, upon terms and conditions maintained in this 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. Eachibit A— General Requirements 3. Exhibit B— Best and Final Offer 4. E�chibit C— Insurance Requirements Scope of Work 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 Exhibit C attached hereto. Article 1 1.1 The contract shall be for a term of one (1) year, with the option of four (4), one (1) year extensions, said date of term beginning upon formal approval. This Contract will renew automatically for the additional terms, unless either Party gives 90-day written notice to terminate the Contract. 1.2 All stated annual quantities are approximations of usage during the time period to be covered by pricing established by this bid. Actual usage may be more or less. Order quantities will be deternuned by actual need. The City of Lubbock does not guarantee any specific amount of compensation, volume, minimum, or maximum amount of services under this bid and resulting contract. 1.3 The Contractor must maintain the insurance coverage required during the term of this contract including any extensions. It is the responsibility of the Contractor to ensure that valid insurance is 1.4 A) Prices quoted shall be guaranteed for a period for six (6) months upon City approval. The rate may be adjusted at the City's discretion for the effective change in Consumer Price Index (CPI) or Product Price Index (PPI) as appropriate. B) Further, if the Contractor can provide documentation for actual charges for material, labor, etc. that demonstrates that the change in CPI or PPI is not sufficient, the Contractor shall provide such documentation to the City, and at the City's sole discretion, the contractual rate may be further adjusted. If agreement regarding a new rate cannot be reached, the City shall terminate at the end of the current contract period. C) If an adjustment to pricing is granted under this section, the Contractor must provide the Director of Purchasing and Contract Management written, quarterly documentation to justify the ongoing adjustment. If no such documentation is timely received, the rate will automatically revert to the initial, awarded rate. 1.5 This contract shall remain in effect until the first of the following occurs: (1) the expiration date, (2) performance of services ordered, or (3) termination of by either party with a 30 day written notice. The City of Lubbock reserves the right to award the canceled contract to the next lowest and best bidder as it deems to be in the best interest of the city. 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 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 At any time during the term of the contract, or thereafter, the City, or a duly authorized audit representative of the City or the State of Texas, at its expense and at reasonable times, reserves the right to audit Contractor's records and books relevant to all services provided to the City under this Contract. In the event such an audit by the City reveals any errors or overpayments by the City, Contractor shall refund the City the full amount of such overpayments within 30 days of such audit findings, or the City, at its option, reserves the right to deduct such amounts owing the City from any payments due Contractor. 2.10 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 forms 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. 2.11 The contractor shall not assign or sublet the contract, or any portion of the contract, without written consent from the Director of Purchasing and Contract Management. Should consent be given, the Contractor shall insure the Subcontractor or shall provide proof of insurance from the Subcontractor that complies with all contract insurance requirements document, this provision shall control. 2.12 Contractor acknowledges by supplying any Goods or Services that the Contractor has read, fully understands, and will be in full compliance with all terms and conditions and the descriptive material contained herein and any additional associated documents and Amendments. The City disclaims any terms and conditions provided by the Contractor unless agreed upon in writing by the parties. In the event of conflict between these terms and conditions and any terms and conditions provided by the Contractor, the terms and conditions provided herein shall prevail. The terms and conditions provided herein are the final terms agreed upon by the parties, and any prior conflicting terms shall be of no force or effect. 2.13 Contracts with Companies Engaged in Business with Iran, Sudan, or Foreign Terrorist Organization Prohibited. Pursuant to Section 2252.152 of the Texas Government Code, prohibits the City from entering into a contract with a vendor that is identified by The Comptroller as a company known to have contracts with or provide supplies or service with Iran, Sudan or a foreign terrorist organization. 2.14 Texas Public Information Act. The requirements of Subchapter J, Chapter 552, Government Code, may apply to this contract and the contractor or vendor agrees that the contract can be terminated if the contractor or vendor knowingly or intentionally fails to comply with a requirement of that subchapter. To the extent Subchapter J, Chapter 552, Government Code applies to this agreement, Contractor agrees to: (1) preserve all contracting information related to the contract as provided by the records retention requirements applicable to the governmental body for the duration of the contract; (2) promptly provide to the governmental body any contracting information related to the contract that is in the custody or possession of the entity on request of the governmental body; and (3) on completion of the contract, either: (A) provide at no cost to the governmental body all contracting information related to the contract that is in the custody or possession of the entity; or (B) preserve the contracting information related to the contract as provided by the records retention requirements applicable to the governmental body. 2.15 No Boycott of Israel. Pursuant to Section 2271.002 of the Texas Government Code, a) This section applies only to a contract that: (1) is between a governmental entity and a company with 10 or more full-time employees; and (2) has a value of $100,000 or more that is to be paid wholly or partly from public funds of the governmental entity. (b) A governmental entity may not enter into a contract with a company for goods or services unless the contract contains a written verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the contract. 2.16 Texas Government Code 2274. By entering into this Agreement, Contractor verifies that: (1) it does not, and will not for the duration of the contract, have a practice, policy, guidance, or directive that discriminates against a frearm entity or firearm trade association or (2) the verification required by Section 2274.002 of the Texas Government Code does not apply to the contract. If Contractor is a company with 10 or more full-time employees and if this Agreement has a value of at least $100,000 or more, Contractor verifies that, pursuant to Texas Government Code Chapter 2274, it does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and will not discriminate during the term of the contract against a firearm entity or firearm trade association. 2.17 Contractor represents and warrants that: (1) it does not, and will not for the duration of the contract, boycott energy companies or (2) the verification required by Section 2274.002 of the Texas Government Code does not apply to the contract. If Contractor is a company with 10 or more full-time employees and if this Agreement has a value of at least $100,000 or more, Contractor verifies that, pursuant to Texas Government Code Chapter 2274, it does not boycott energy companies; and will not boycott energy companies during the term of the Agreement. This verification is not required for an agreement where a governmental entity determines that these requirements are inconsistent with the governmental entity's constitutional or statutory duties related to the issuance, incurrence, or management of debt obligations or the deposit, custody, management, borrowing, or investment of fi.�nds. 2.18 Confidentiality. The Contractor shall retain all information received from or concerning the City and the City's business in strictest coniidence and shall not reveal such information to third parties without prior written consent of the City, unless otherwise required by law. 2.19 Indemnify. The Contractor shall indemnify and save harmless the city of Lubbock and its elected officials, offcers, agents, and employees from all suits, actions, losses, damages, claims, or liability of any kind, character, type, or description, including without limiting the generality of the foregoing, all expenses of litigation, court costs, and attorney's fees, for injury or death to any person, or injury to any property, received or sustained by any person or persons or property, to the extent arising out of, related to or occasioned by, the negligent acts of the Contractor, its agents, employees, and/or subcontractors, related to the performance, operations or omissions under this agreement and/or the use or occupation of city owned property. The indemnity obligation provided herein shall survive the expiration or termination of this agreement. IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and year first above written. Executed in triplicate. Tray Payne, Mayor Courtney Paz, City Secretary APPROVED AS TO CONTENT: I C,�� �� Rob Keinast Interim Chief of Fire Rescue APPROVED AS TO FORM Ryan Br e, nior Assistant City Attorney CONTRACTO BY: Authorized presentative .� 8 Print Name - O �1 • � (l Address � City, Stat Zip Code CITY OF LUBBOCK Exhibit A City of Lubbock, TX RFP 24-17915-YB Annual Firefighter Medical, Physical and Wellness Exams GENERAL REQ�]IREMENTS 1. INTENT Lubbock Fire Rescue (LFR) invites you to submit a proposal to perform comprehensive annual medical physicals and wellness exams for all sworn personnel. 2. SCOPE OF WORK Lubbock Fire Rescue is seeking to administer a health and wellness program that will deliver a quality health evaluation and wellness assessment to ensure the health and well-being of personnel as well as provide prevention and early detection of disease / illness. In order to implement this program, LFR is seeking a firm with a minimum of 10 years' experience that will carry out a comprehensive medical exam that includes a health risk assessment and a complete medical history review to determine any health conditions that would prevent or could be aggravated by personnel performing their duties. The medical history shall also include any significant changes, job related exposures and new symptoms since the previous medical evaluation. Vendor must commit to delivering the services noted below with appropriately trained and qualified personnel (Nurse Practitioner or other approved heath care provider) and by a Medical Review Offcer (MRO) PHYSICIAN/MEDICAL DOCTOR for Secondary Review for all "sworn civil service personnel". S�rvices provided under items 2 through 5 below must be performed onsite at Lubbock Fire Rescue Administration located at 1515 East Ursuline, Lubbock Texas 79403. 1. Laboratory analysis must include: (must take place prior to physicals and reviewed during physicals): • Hemoccult Test • Urinalysis • Lipid Panel • Diabetes Tests (Hemoglobin A 1 C and Glucose) • Complete Blood Count • Comprehensive Metabolic Panel • Thyroid Panel • PSA (Men) • CA-125 (Women) • Heavy Metal Urine (For Hazmat / Dive Members only - approx. 73 personnel) • Chlolinesterase —(For Hazmat / Dive Members only - approx. 73 personnel) Laboratory analysis should be completed in such a way for the results to be reviewed with the individual at the time of the exam. If multiple trips are involved, this should be identified in the proposal for scheduling purposes. 2. Comprehensive Medical Exam (NFPA 1582 Compliant) to include: • Vision Exam (Titmus) • Personal Consultation with review of testing results • Behavioral Health / Trauma Screening • Occupational Hearing Exam • Skin Cancer Screening 3. Cardiopulmonary evaluation to include: • Echocardiogram (Heart Ultrasound) • Resting EKG • Cardiac Pulmonary Exercise Test "CPET" / Cardiac treadmill stress test with EKG • Carotid Arteries (Ultrasound) • Aortic Aneurysm (Ultrasound) • Pulmonary Function Test • Aorta and Aortic Valve 4. Cancer and Disease Assessment to include: • Thyroid (Ultrsound) • Internal Organs — Liver, Pancreas, Gall Bladder, Kidneys and Spleen (Ultrasound) • Bladder (Ultrasound) • Testicular and Prostate for Men (Ultrasound) • Pelvic Ultrasound for Women (External) 5. Fitness Analysis (NFPA 1583 — WFI Guidelines): • Muscular Strength and Endurance Evaluation • Aerobic Endurance Evaluation (V02 Max Calc.) • Flexibility Evaluation • Nutrition and Diet Recommendations • Personal Fitness Recommendations • Metabolic Analysis with Body Fat 6. Medical Clearances: • OSHA Respirator Medical Clearance Written medical clearance issued to LFR for each individual to perform emergency response services in compliance with National Fire Protection Association (NFPA) standard 1582. LFR Administration will require notification within 24 hrs. of any employee found not fit for duty. • Firefighter Medical Clearance NFPA 1582 as needed Written respiratory protection clearance issued to LFR for each individual to wear positive and negative pressure respiratory protection in compliance with OSHA respiratory protection standard, 29CFR1910.134. 7. Written recommendation(s) of inedical intervention and behavioral modiiication changes as well as programs and training to lessen the chance of injury and illness presented to employee ONLY. 8. Medical assessments revealing conditions that dictate further testing or treatment will be presented to employee ONLY so that follow-up can be pursued with personal physician. NIINIMUM QUALIFICATIONS The vendor must satisfy the following mandatory minimum requirements in order to have their responses evaluated. By submitting a proposal, the vendor warrants and represents that each satisfies these requirements. Failure to meet these requirements will result in the response not being evaluated and being rejected as non-responsive. REQUIREMENTS Briefly outline how the firm will meet the needs for conducting Annual Firefighter Medical Physicals and Wellness Exams for LFR. Proposals should include a historical summary of the firm's experience (min. 10 years) conducting Fire Service specific baseline medical evaluations and key business data about the organization. The Proposer will identify the staff (including any subcontractors) that will provide the services defined in in the RFP. • Medical Physicals and Wellness Exams may be determined by a Nurse Practitioner or approved health care provider and by a Medical Review Officer (MRO) PHYSICIANIMEDICAL DOCTOR for Secondary Review. Doctors of inedicine or osteopathy should have completed residency training in an accredited medical training program and / or American Boards of Medical Specialties (ABMS) or American Osteopathic Association (AOA) Board certiiied. • Identify a Project Manager as a primary contact available for communication for the duration of the contract and a consistent point of contact for scheduling exams and other work scope matters. • For each member of the team, describe the role that she / he will serve. Indicate those members of the team who will work closely with LFR's point of contact. • Please indicate the members of your project team who are sub-contractors (if any) to your organization. Include the ratio of staff to subcontractors in your proposed project team. • Provide a short resume for each of the key medical and management project staff inembers and medical providers as appendices. Resumes should be no longer than (1) page and should contain the following information about each project member: o Position with the company and work location o Years with the company o Education, Licenses and Certifications o Work experience related to purpose on contact Proposals shall outline proven practices and procedures that will be used to perform the services: • Assurance of Primary Health Care Provider qualification • Plan detail of evaluation activities including confidentiality of records • Plan for maintaining written documentation regarding follow-up / referral program or procedures(s) recommendations • Provide a separate document signed by the official representative of the provider of assurance that confidentiality requirements are acknowledged and shall be met. The proposal should identify four current, major clients, particularly other fire department and / or governmental entities. Utilizing the Reference Form provided (Exhibit `A"), include contact names and telephone numbers, indicate how long your firm has provided occupational medical exam services to these clients and the approximate number and type of exams conducted in each organization. Must be able to provide on-site testing with qualiiied personnel capable of administering scheduled physicals and procedures outlined. Health care provider shall be board certified with experience in occupational medicine health care to Fire Rescue, Police and EMS agencies with a minimum 5 years of experience. The sonographer's personnel shall be registered diagnostic medical sonographers. Vendor shall develop a detail staffing plan that ensures that an adequate number of full and or part-time staffing is trained and available and must provide other qualified licensed professionals as needed. 3. EVALUATION CRITERIA The following criteria will be used to evaluate and rank submittals: Cost — 40 Points Please submit the Bid Table provided. Ability to Deliver Services - 30 Points Please submit information in regard to your ability to provide ultrasounds, physicals, physical fitness, wellness, labs, ali done on site. Please submit information in regard to your ability to provide National Fire Protection Association 1582 clearance for firefighter. Please submit a detailed staffing plan as described. Please submit the requested information as described in the General Reyuirements. QualificationslExpertise and Experience — 30 Points Please submit short resumes for each key medical, management project staff inember and medical provider. Please submit the Business Questionnaire provided. Please submit "Exhibit A" Reference Form, provided. City of Lubbock Exhibit B RFP 24-17915-YB Annual Firefighter Medical, Physical and Wellness Exams Price Proposal Sheet BAFO Life Exentison Clinics, Inc. dba Life Scan Wellness Centers Location Tampa, FL Total Cost $625.00 Quanrity Unit Total # Items Required UOM Price Cost � ��._ - �—��.� #0-1 Cost Excluding Last Two Lines Demarked with Asterisk - as Listed in � EA $85.00 $85.00 General RequirementslScope of Work. Section 1 - Per Specifications � #0-2 Laboratory Analysis Per Head Packaged Cost Including Last Two Lines Demarked with Asterisk - as Listed in 1 �A $143.00 $143.00 General RequirementslScope of Work. Section 1 - Per Specifications � #0-3 Comprehensive Medical Exam to Include - as Listed in General � EA $85.00 $85.00 RequirementslScope of Work. Section 2 - Per Specifications � #0-4 Cardiopulmonary Evaluation to Include - as Listed in General � EA $236.00 $236.00 RequirementslScope of Work. Section 3 - Per Specifications #0-5 Cancer and Disease Assessment to Include - as Listed in General � �A $58.00 $58.00 RequirementslScope of Work. Section 4 - Per Specifications #0-6 Fitness Analysis (NFPA 1583-WFI Guidelines) - as Listed in General � EA $18.00 $18.00 RequirementslScope of Work. Section 5 - Per Specifications #0-7 Medical Clearances - as Listed in General RequirementslScope of Work. I EA $ 0 $ 0 Section 6 - Per Specifications #0-8 Medical Clearances Overall Per Head Packaged Cost for All Listed - as Listed � EA $ 0 $ 0 in General RequirementslScope of Work. Section 6- Per Specifications VENDOR ACKNOWLEDGEMENT In compliance with this procurement, the undersigned offeror having eaamined t6e request for proposal, instructions to offerors, documents associated with the request for proposals, and being familiar wit6 the conditions to be met, has reviewed the information regarding: • Insurance Requirements • Suspension and Debarment Certification • Tezas Government Code Section 2252.152 • Tezas Government Code Section 2271.002 . Texas Government Code 2274 An individual authorized to bind the company must sign the following section. Failure to execute this portion may result in proposal rejection. Life Extension Clinics, inc. Company Name Title 3/ I S/2024 Date 1011 North MacDill Avenue Address Tampa, FI 33607 City, State Zip Code Print/Type Name Exhibit C 32. INSURANCE REQUIREMENTS 32.1. 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 DELNERED TO THE CITY. 32.2. 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. 32.3. 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): Commercial Liability Repuirements: $1 M occurrence /$2M aggregate (can be combined with an Excess Liability to meet requirement). CGL is required in ALL contracts. It is perhaps the most important of all insurance policies in a contractual relationship. It insures the Contractor has broad liability coverage for contractual activities and for completed operations. Commercial General Liability to include Products Completion/OP, Personal and Advertising Injury, Contractual Liability, Fire Damage (any one fire), and Medical Expenses (any one person). Auto Liability Requirements: $1 M/occurrence is needed. Workers Compensation Requirements: Statutory. If the vendor is an independent contractor with no employees and are exempt from providing Workers' Compensation coverage, they must sign a waiver (obtained from COL Purchasing) and include a copy of their driver's license. Employer Liability ($1 M) is required with Workers Compensation. Cvber Liability Requirements: $1M of coverage is needed for Cyber Liability. Technology Errors and Omissions Requirements: $1M of coverage is needed. * The City of Lubbock (including its officials, employees and volunteers) shall be afforded additional insured status on a primary and non-contributory basis on all liability policies except professional liabilities and workers' comp. * Waivers of Subrogation arc required for CGL, AL, and WC. * To Include Products of Completed Operations endorsement. * Carrier will provide a 30-day written notice of cancellation, 10-day written notice for non- payment. * Carriers must meet a A.M. Best rating of A- or better. * Subcontractors must carry same limits as listed above. IMPORTANT: POLICY ENDORSEMENTS The Contractor will provide copies of the policies without expense, to the City 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. Any costs will be paid by the Contractor. REQUIRED PROVISIONS 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: a. 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; b. Provide for 30 days notice to the City for cancellation, nonrenewal, or material change; c. Provide for notice to the City at the address shown below by registered mail; d. 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; e. 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. 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 1314Avenue K, 9�' Floor Lubbock, Texas 79401 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. � CERTIFICATE OF INTERESTED PARTIES FORnn 1295 1 of 1 Complete Nos. 1- 4 and 6'rf there are interested parties. Complete Nos. i, 2, 3, 5, and 6'rf there are no interested parties. i Name of business entity filing form, and the c'rty, state and country of the business entity's ptace of business. Life Extension Clinics Inc Tampa, TX United States being filed. City of Lubbock or state agency OFFICE USE ONLY CERTIFICATION OF FILING Certiflcate Number: 2024-1144341 Date Filed: 04/09/2024 Date Acknowledged: g Provide the identification number used by the governmental entity or state agency to track or idendiy the contract, and provide a description of the services, goods, or other property to be provided under the contract 17915 Annual Firefighter Medical, Physical and Wellness Exams Name of Interested Party 5 Check only if there is NO Interested Party. ❑ X City, State, Country (place of business) Nature of interest UNSWORN RATION �` i My name is � .5� , and my date of birlh is � My address is �✓� �--.-•- � —�� � �� � r ' ' —' ' �' (street) [ ' ) (stete) (zip code) (country) I declare under penalry ot perjury that the foregoing is Vue and correct. Executed in ! County, State of � on the I day of 1 , 20� �—`� �� (month) (Year) Signature of t zed agent of contracting business entity (Dedarant) � � CERTIFICATE OF INTERESTED PARTIES 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. 1 Name of business entity filing form, and the ciry, state and country of the business entity's place of business. Life Extension Clinics Inc Tampa, TX United States or state agency tnat is a FORnn 1295 1of1 OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2024-1144341 Date Filed: 04/09/2024 being filed. City of Lubbock Date Acknowledged: 04/09/2024 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. 17915 Annual Firefighter Medical, Physical and Wellness Exams Name of Interested Party 4 5 Check only if there is NO Interested Parcy 6 UNSWORN DECLARATION � Nature of interest City, State, Country (place of business) (check applicable) My name is , and my date of birth is My address is , , , (street) (ciry) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Forms provided by Texas Ethics Commission State of , on the day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Dedarant) wuvw.ethics.state.bc.us Version V3.5.