HomeMy WebLinkAbout2022 CON Serene Health IPA - Transcranial Magnetic StimulationSHORT FORM SERVICES AGREEMENT
BY AND BETWEEN
THE CITY OF NATIONAL CITY
AND
SERENE HEALTH/NOUVITA MEDICAL MANAGEMENT, LLC/
SERENE HEALTH IPA
THIS AGREEMENT is entered into this i st day of July, 2022, by and between the CITY
OF NATIONAL CITY, a municipal corporation (the "CITY"), and SERENE
H ALTH TOUVITA MEDICAL MANAGEMENT, LLC/SERENE HEALTH IPA, a
corporation (the "CONTRACTOR").
NOW, THEREFORE, CITY agrees to engage CONTRACTOR to perform the services set
forth herein m accordance with the following terns and conditions:
1. Description of Services. CONTRACTOR shall provide the following services:
Personalized Repetitive Transcranial Magnetic Stimulation (PrTMS) services to
enhance cognitive performance and sleep quality from baseline metrics for up to
Firefighters who have been diagnosed and need PrTMS and talk therapy provided by
licensed therapist.
1.1.. CONTRACTOR shall function as the service provider and deliver PrTl1 .S
services to up to 8 Firefighters at NC .
1.2. CONTRACTOR shall devote as much time as needed to provide the up to
40 sessions per person services described in this Agreement. The number of sessions will
be determined by the physician of record for each patient. Hours of work shall be mutually
acceptable to NCFD and CONTRACTOR. The Physician will engage and evaluate each
patient receiving PrTMS services on a weekly basis through a tele-medicine consult.
1.3. The Physician will provide the initial. consultation, treatment
recommendation, along with supervision throughout the entire treatment.
1. . CONTRACTOR shall provide a mobile unit to be parked off site and
adjacent to the i CFD parking lot.
1.5. If necessary, CONTRACTOR ACT shall provide talk therapy by a licensed
therapist at $125.00 per hour support.
2. Lend_ of Agreement. The duration of this Agreement is from July 1, 2022
through June 30, 2023.
3. Compensation. The total compensation to C N. RA.CT I for providing the
services set forth herein sha.11 not exceed an annual total cost of $28,000.00.
4. Payment Schedule. CITY will make payment within thirty 3 days of receiving
and approving a billing statement for the satisfactorily completed services of CONTRACTOR.
. Termination. CITY may terminate this Agreement at any time by providing thirty
(30) day's written notice to CONTRACTOR.
. Independent Contractor. It is agreed that C NTI&ACT R i.s an independent
Contractor, and all persons working for or under the direction of CONTRACTOR are
CONTRACTOR'S agents, servants and employees, and said persons shall not be deemed agents,
servants, or employees of CI TY.
7. Insurance. CONTRACTOR shall obtain:
A. If checked, Professional Liability Insurance (errors and omissions)
with minimum limitliniits of $1,000,000 per occurrence.
B. Automobile insurance covering all bodily injury and property damage
incurred during the performance of this Agreement, with a. minimum coverage of $1,000,000
combined single limit per accident. Such automobile insurance shall include owned, non -owned,
and hired vehicles. The policy shall name the CITY and its officers, agents, employees, and
volunteers as additional insureds, and a separate additional insured endorsrrnent shall be provided.
C. Commercial General Liability Insurance, with minimum limits of either
$2000,000per occurrence and $4,000,000 aggregate, or Si ,$1,000,000 per occurrence and
$2,000,000aggregate with a $2,000,000 umbrella policy, covering all. bodily injury and property
damage arising out of its operations, work, or performance under this Agreement. The policy shall
name the CITY and its officers, agents, employees, and volunteers as additional insureds, and
separate additional insured endorsement shall be provided. The general aggregate limit must apply
solely to this "project" ject" or "location". The "project" or "location" should be noted with specificity
on an endorsement that shall be incorporated into the policy.
D. Workers' compensation insurance in an amount sufficient to meet statutoiy
requirements covering all of CONTRACTOR'S employees and employers' liability insurance
with lints of at least $1,000,000 per accident. In addition, the policy shall be endorsed with a
waiver of subrogation in favor of the CITY. Said endorsement shall be provided prior to
commencement of work under this Agreement.
If CONSULTANT has no employees subject to the California Workers'
Compensation and Labor laws, CONSULTANT shall execute a Declaration to that effect. Said
Declaration shall be provided to CONSULTANT bCITY,
E. The aforesaid policies shall constitute primary insurance as to the CITY, its
officers, employees, ees, and volunteers, so that any otherpolicies held by the CITY shall not contribute
to any loss under said insurance. Said policies shall provide for thirty 3 days prior written notice
to the CITY's Risk Manager, at the address listed in subsection G below, of cancellation or material
change.
F. Said policies, except for the professional liability and workers'
compensation policies, shall name the CITY and its officers, agents, employees, and volunteers as
additional insureds, and separate additional insured endorsements shall be provided.
G. The Certificate Holder for all policies of insurance required by this Section
shall be:
City of National City
c/o Risk Manager
1243 National City Boulevard
National City, CA 91950-4397
tandard Short Form Agreement Page 2 of 6 City of National_ City and
Revised January 2021 Serene H altli/Nou ita Medical Management, LL /serene Health IPA
H. If required insurance coverage is provided on a "claims made" rather than
"occurrence" form, the CONTRACTOR shall maintain such insurance coverage for three years
after expiration of the term and any extensions) of this Agreement. In addition, the "retro" date
must be on or before the date of this Agreement.
I . Insurance shall be written with only insurers authorized to conduct business
in California which hold a current policy holder's alphabetic and financial size category rating of
not less than ANII according to the current Best's Key Rating Guide, or a. company of equal
financial stability that is approved by the City's Risk Manager. In the event coverage is provided
by non -admitted "surplus lines" carriers, they must be included on the most recent List of
Approved Surplus Line Insurers ("LASLI") and otherwise met rating requirements.
J. ; This Agreement shall not take effect until certificate(s) or other sufficient
proof that these insurance provisions have been complied with, are filed with, and approved by the
CITY Risk Manager. If the CONTRACTOR does not keep all insurance policies required by this
Section 7 in full force and effect at all times during the term of this Agreement, the CITY may
treat the failure to maintain the requisite insurance as a breach of this Agreement and terminate the
Agreement as provided herein.
K. All deductibles and self -insured retentions in excess of $10,000 must be
disclosed to and approved by the CITY. CITY reserves the right to modify the insurance
requirements of this Section 7, including limits, based on the nature of the risk, prior experience,
insurer, coverage, or other special circumstances.
L. If the CONTRACTOR maintains broader coverage or higher limits (or
both) than the minimum limits shown above, the CITY shall be entitled to the broader coverage or
higher limits (or both) maintained by the CONTRACTOR. Any available insurance proceeds in
excess of the specified minimum limits of insurance and coverage shall be available to the CITY.
8. tademnifjeatiton and Mid Harmless. To the maximum extent provided by law,
the CONTRACTOR agrees to defend, indemnify and hold harmless the City ofNational City, its
officers, rs, ffi ials, agents, employees, and volunteers against and from any and all liability, loss,
damages to property, injuries to, or death of any person or persons, a.nd all claims, demands, suits,
actions, proceedings, reasonable attorneys' fees, and defense costs, of any kind or nature, including
workers' compensation claims, of or by anyone whomsoever, resulting from or arising out of the
CONTRACTOR'S performance or other obligations ations n 1 er this Agreement; provided, however,
that this indemnification and hold harmless shall not include anyclaims or liabilit arisingfrom
�
the established sole negligence or willful misconduct of the CITY, its agents, officers employees,
or volunteers. CITY will cooperate reasonably in the defense of any action, and CONTRACTOR
shall employ competent counsel, reasonably acceptable to the City Attorney.
The indemnity, defense, and hold harmless obligations contained herein shall
survive the termination of this Agreement for any alleged or actual omission, act, or negligence
under this Agreement that occurred during the terra of this Agreement.
9. EMPLOYEE PAYMENTS ND_I Ml IF!CATIOI .
9.1 PIS Eligibility Indemnification. If CONTRA CT R's employee(s) p
services under this Agreement claims, or is determined by a court of competent jurisdiction or the
California Public Employees Retirement System "PERS" to be eligible for enrollment in PERS
of the CITY, CONTRACTOR shall indemnify, defend, and hold harmless CITY for the payment
of any employer and employee contributions for PERS benefits on behalf of the employee as well
Standard Short Form Agreement Page 3 of 6 City of, National City and
Revised January 2021 Serene HeahhiNouvita Medical Management, ement, LL /Serene Health IPA
as for payment of any penalties and interest on such contributions which would otherwise be the
responsibility of the CITY.
CONTRACTOR'S employees providing service under this Agreemen.t shall not:(1)
qualify for any compensation and benefit under PERS; 2 be entitled to any benefits under PERS;
enroll in PERS as an employee of CITY; receive any employer contributions paid by CITY
for PERS benefits; or be entitled to any other PERS-related benefit that would accrue to a CITY
employee. CONTRACTOR's R's employees hereby waive any claims to benefits or compensation
described in this Section 9. This Section 9 applies to CONTRACTOR notwithstanding any other
agency, state or federal policy, rule, regulation, law or ordinance to the contrary.
9.2 Limitation of CITY Liability. The payment made to CON I RACT R under this
Agreement shall be the full and complete compensation to which CONTRACTOR and
CO TACT R's officers, employees, agents, and subcontractors are entitled for performance of
any work under this Agreement. Neither CONTRACTOR nor C NTRACT 's officers,
employees, agents, and subcontractors are entitled to any salary or wages, or retirement, health,
leave or other fringe benefits applicable to CITY employees. The CITY will not make any federal
or stateta.xwithholdings on behalf of CONTRACTOR. The CITY shall not be required to pay any
workers' compensation insurance on behalf of CONTRACTOR,
9.3 Indemnification for Employee payments_, CONTRACTOR agrees to defend and
indemnify the CITY for any obligation, claim, suit, or demand for tax, retirement contribution
including any contribution to PERS, social security, salary or wages, overtime payment, or
workers' compensation payment which the CITY may be required to make on behalf of(I)
CONTRACTOR, 2 any employee of CONTRACTOR, or any employee of CONTRACTOR
construed to be an employee of the CITY, for work performed under this Agreement. This is a
continuing obligationthat survives the termination of this Agreement.
10. Acceptability of Work. The CITY shall, with reasonable diligence, determine the
quality or acceptability of the work, the manner of performance, and/or the compensation payable
to the CONTRACTOR.
11. usin s__Li ens . CONTRACTOR must possess or shall obtain business license
from National City Finance Depaitment before beginning work.
12. PrevailingWages. Stateprevailing wa.ge rates may apply to work performed under
this Agreement. State prevailing wages rates apply to all. public works contracts as set forth inCalifornia Labor Code, including but not limited to, Sections 1720, 1720.2, 172 . , 17 0. , and
1771. CONTRACTOR is sol.ely responsible to determine if State prevailing wage rates apply and,
if applicable, pay such rates in accordance with all laws, ordinances, rules, an.d regulations.
13. Administrative Provisions.
A. Computation of Time Periods. If any d ate or time period provided for in
this Agreement i.s or ends on a Saturday, Sunday or federal, state or legal holiday, then such date
shall automatically be extended until 5:00 p.m. Pacific Time of the next clay which is not a
Saturday, Sunday or federal, state, or legal holiday.
tandard Short Form Agreement Page 4 of 6 City of National City and
Revised January 2021 Serene Iealt/1\ ou ita Medical Management, LLC/Serene Health TPA
B. Counterparts. This Agreement may T' executed multiple counterparts,
each of which shall be deemed an original, but all of which, together, shall constitute but one and
the same instrument.
C. Captions. Any captions to, or headings of, the sections or subsections of
this Agreement are solely for the convenience of the patties hereto, are not a part of this
Agreement, and shall not be used for the interpretation or determination of the validity of this
Agreennent or any provision hereof.
D. No Obligations to Third Parties. Except as otherwise expressly provided
herein, the execution and delivery of this Agreement shall not be deemed to confer any rights upon,
or obligate any of the parties hereto, to any person or entity other than the parties hereto.
E. Exhibits and schedules. The Exhibits and Schedules attached hereto are
hereby incorporated herein by this reference for all purposes. To,the extent any exhibits, schedules,
or provisions thereof conflict or are inconsistent with the terms and conditions contained in this
Agreement, the terns and conditions of this Agreement will control.
F. Amendment to this Agreement. The terns of this Agreement may not be
modified or amended except by an instrument in writing executed by each of the parties hereto.
G. ,4ssign rent & Assumption Rights. CONTRACTOR ACT shall not assign this
Agreement, in whole or in part, to any other party without first obtaining the written consent of
CITY.
H. Waiver. The waiver or failure to enforce any provision of this Agreement
shall not operate as a waiver of any future breach of any such provision or any other provision
hereof.
I. Applicable Law. This Agreement shall be governed by and construed in
accordance with the laws of the State ofCalifornia, The venue for any legal action arising under
this Agreement shall be in either state or federal court in the County of San Diego, State of
California. The CONTRACTOR shall comply with all laws, including federal, state, and local
laws, whether now in force or subsequently enacted.
J. Audit. If this Agreement exceeds ten. -thousand dollars $1. 0,000 , the parties
shall, be subject to the examination and audit of the State Auditor for a period of three 3 years
after final payment under the Agreement, per Government Code Section 8546.7,
K. Entire Agreement. This Agreement supersedes any prior agreements,
negotiations and communications, oral or written, and contains the entire agreement between the
parties as to the subject matter hereof. No subsequent agreement, representation, or promise made
by either party hereto, or by or to anemployee, officer, agent, or representative of any party hereto
shall be of any effect unless it is in writing and executed by the party to be bound thereby.
L . Successors and Assigns. This Agreement shall be binding upon and shall.
inure to the benefit of the successors and assigns of the parties hereto.
M. Subcontractors or Subconsultants. The CITY is engaging the services of the
CONTRACTOR ACT identified in this Agreement. The CONTRACTOR shall not subcontract any
portion of the work, unless such subcontracting was part of the original proposal or is allowed by
the CITY. In the event any portion of the work under this Agreement is subcontracted, the
subcontractors shall be required to comply with and agree to, for the benefit of and in favor of
the CITY, both the insurance provisions in Section 7 and the indemnification ication and hold harmless
provision of Section 8 of this Agreement.
N. Construction. The parties acknowledge wedge and agree that i each party is of
equal bargaining strength, (ii) each party has actively participated in the drafting, preparation and
.negotiation of this Agreement, (iii) each such party has consulted with or has had the
opportunity
Standard short Form Agreement ,Page 5 of 6 City of National City and
Revised January 2021 Serene Health / ouvita Medical Management, LIE/Serene Health .IPA
to consult with its own, independent counsel and such other professional advisors as such party
has deemed appropriate, relative to any and all utters contemplated under this Agreement, (iv)
any rule or construction to the effect that ambiguities are to be resolved against the drafting party
shall not apply in the interpretation of this Agreement or any portions hereof, or any amendments
hereto.
IN WITNESS WHEREOF, this Agreement is executed by CITY and by CONTRACTOR
on the date and year first above written.
CITY OF NATIONAL CITY
By:
Brad Raulston (_.ity Manager
APPROVED AS TO FORM:
By:
Barry v. it z, Interimit r Attorney
C [NT :\ ..' T INFORMATION
CITY OF NATIONAL CITY
1243 National City Boulevard
National +iCA 91950-4397
Phone: (619) 336-4555
Fax: (619) 336-4562
Contact: Brian Ksepps
Title: Battalion Chief
Dep.: Fire
Email: hl reppsr i iiationaleityca.gov
SERENE TE A LTI-UNOUVITA MEDICAL
L
MANAGEMENT, LLC/ ERENE
EALTH IPA
By.
Oscar V. Me in:a. President
hristopher Peters, Director
SERENE HEALTIENOL ITA MEDICAL
MANAGEMENT, ILEX/SERENE HEALTH WA
4849 Ronson Ct. #207
San Diego CA 9211 l
Phone: (844) 737-3638
Fax: (619) 403 -949 7
Contact: Oscar ed ina
Title: President
E-mail: info:lserenehealth.com
Taxpayer I.D. o.: 84488,599
Standard Short Form Agreement Page 6 of 6 City of National City and
Revised January 2021 serene HealthiNouvita Medical Management. LLC/Serene Health [PA
CDH
A S EI ATE S
Certificate of Liability Insurance
Date Issued: 07/2712022
HIL DE PHI
SURANCE OnsiI1 NlES
S 'sir •I,C ,I� II'u I..6n, A1.4-,ui
Underwritten by: Philadelphia Indemnity Insurance Company • One Bala Plaza, Suite 100 Bala Cynwyd, PA 19004 NA1 $ : 18058
Administered by: CPI-4 & Associates - 711 S. Dearborn St, Ste 20 • Chicago, IL 60605 • P 800 875.1911 • F 31 .987.0902 • info@ephins.com
cphins.com
DISCLAIMER: This certificate is issued as a ,natter of information only and confers no rights upon the certificate holder. The Certificate of Insurance does not
constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend, or alter the coverage afforded by the policies listed thereon.
Insured: Serene Health IPA dba Nouvita Medical
Management
Iirlos Guerguis
4849 Ronson Court Suite 207
San Diego, CA 92111
Policy Number: AR125030
Policy Terra: 02/24/2022 to 02/24/ 0 3
Covered Locations
Professional Liability: Portable coverage, not location specific
General Liability Insured Location(s):
4849 Ronson Court, San Diego, CA 92111
4452 Park Blvd Unit 301 & 302,, San Diego, CA 92116
1401 l i Camino Ave, Suite 100„ Sacramento, CA 95815
1224 VV State St. Ste A. El Centro, CA 92243
13810 Cerritos Corporate Drive, Suite D- 401., Cerritos, CA 90703
1661 N. Raymond Ave, Suite 220-1K„ Anaheim, CA 92801
3625 Ruffin Rd, Suite 204-206, San Diego, CA 92123
4351 Latham Street, Suite 206. Riverside. CA 9 501
1626 North Litchfield Rd, Suite 260, Goodyear, AZ 85340
3625 Ruffin Rd, Suite 108, San Diego, CA 92123
2213 Buchanan Road, Suites 105 & 106, Antioch, CA 94509
Coverage Type
(Occurrence Form)
Professional Liability
Supplemental Liability
Licensing Board Defense
'Commercial General
Liability
Fire/Water Legal Lis bllit
Business Personal Property
Vicarious Sexual
Misconduct
Non -Owned Auto
Cyber Liability
(Claims Made Form)
Retroactive Date:
05/23/2022
Comments/Special Descriptions:
Per incident
Per individual claim)
$ 1,000, 000
$ 1,000,000
$ 100,000
$ 1,000,000
$ 250,000
$ 15,000
$ 1,000,000
$ 1,000,000
25
Certificate Holder
PROOF OF COVERAGE
Aggregate
(Total amount per year)
$ 5,000,000
$ 5,000,000
$ 100,000
$ 3,000,000
$ 250,000
$ 15,000
$ 1,000,000
$ 1,000,000
$ 25,000
If the certificate holder is an ADDITIONAL INSURED, ED, the polik (les) must be endorsed. A statement an this certificate does not confer rights to the certificate holler in
lieu of such endorsernent(s). Notice of Cancellation will only be provided to the first named insured in accordance with policy provisions, who shall act on behalf of all
additional insureds with respect to giving notice of can ellatfon.
ei4dr /440,
Authorized Representative
C. Philip Hodson
Exhibit
Annual Firefighter Health & FitnessAssessments
Standard NFPA-15821 WFI Assessment
Comprehensive Labs Urinalysis
Full Physical Assessment w/ Vision & Hearing
rit
Maximal 1 -lead EKG Treadmill Stress Test
wiCardiology f li wup when indicated
43
a
$749
_Lk Za
-11
$32,207.00
Included
included
Included
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TRuEvo2max Testing
Muscular Endurance and Strength Analysis
Ultrasound Enhanced Cancer Screening w/
Radiology followup when indicated
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Behavioral Health Assessment
Cancer marker screening (CEA, CA 1 . , AFP,
Amylase, Lipase)
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Testosterone Levels Testing
Cancer antigen 15-3 (CA 15.3) [breast cancer
Mobile Phlebotomy
-E. lollinifinTAI
Cardiology/Radiology Followup Contingency
•
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$99
$29
$29
r
A breakdown of the above item; is provided on the next page, including additional
services offered and pricing.
Included
Included
Included
Included
1;4257,,O
$2,058.00
$99.00
`l 7
.00
1, .0
Exhibit A
Comprehensive Labs
Mobile Phlebotomy (On -site draw fee. If all patients visit
$29
LabCorp directly for their draws, this fee will not be charged)
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Urinalysis
CBC (Complete Blood Count AN/differential)
CiVIP (Comprehensive Metabolic Panel)
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Lipid Panel with LDLIFIDL Ratio
Al C (Glucose/Hemoglobin Diabetes Test)
Included
Included
Included
Included
Included
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TSH (Thyroid Stimulating Hormone) Included
W YY
PSA (Prostate Specific Antigen - Men) [included over 40] Included
• • deer. •
FIT (Fecal Occult Blood Colorectal Cancer Screening)
[included over 40]
7.•
Physical Assessment Comprehensive Physical
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Vital Signs
Vision Test & Audiometry Exam
44 AAA. A A A A A
Skin Cancer Assessment
41..• v I .11
Personal Consult with Review of Results
Included
Personalized Health Plan with Nutrition & Exercise
Recommendations
Behavioral Health Assessment with Questionnaires & Oral
Examination
V )
Fitness Assessment Pulmonary Function Test (Spirometry)
ll .
Resting EKG
Included
V 44.14 VA V.•
Maximal 12-Lead EKG Treadmill Stress Test using WFI
Protocol, Includes Cardiology followup read when indicated
TRUE V02 Max Testing
Ultrasound Enhanced
Cancer Screening
Included
tncluded
Included
Included
Included
Included
Included
included
Included
Included
Metabolic Analysis w/ Body Composition Included
Muscular Strength, Endurance & Flexibility Evaluation included
Includes ultrasound imaging of the heart with function,
aorta & aortic valves, carotid arteries, thyroid, liver, pancreas,
gall bladder, spleen, kidneys, bladder, pelvic (women), breast Included
(women), testicular and prostate (men). Includes R
followup read when indicated
RE
JUL I 8 2022
CITY OF NATIONAL CITY
FIRE DEPARTMENT
Exhibit A
Cancer Labs
Galleri lulti-Cancer Early Detection Blood Test (50+ cancers)
Cancer marker screening (CEA, CA 19-9, AFP, Amylase, Lipase)
CA-12 (ovarian cancer screening - women)
Cancer antigen 15-3 (CA 15-3) [breast cancer]
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Other Labs CHID-19 Antibody Testing
WAWA, V V w
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$719
$99
$59
$gg
$99
Hepatitis A, B and C Test (Acute Hepatitis Panel) $49
QuantiFERON Gold TB (Blood test)
$89
Medical Professionals Urine Drug Screen $99
Nicotine Screening (Urine)$49
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W.V„ w,wuwV rvV I v k•
HIV testing$49
kV WI
Heavy Metals Profile I, Blood (arsenic, lead, mercury) $129
Heavy Metals Profile II, Blood (arsenic, cadmium, lead, mercury) $159
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Cholinesterase (HazMat) testing $59
Testosterone levels
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Radiology
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$49
Chest -ray Reviewed by radiologist 129
New Hire & Return to Available on an ongoing basis with regional scheduling (Send member to Standard
Duty us at a nearby agency). Sarre pricing as full assessment.
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Mental Health Each health assessment comes standard with a written and oral Variable
Support behavioral health assessment, designed for firefighters. For continued Pricing
support, we use counselors & therapists that are specifically trained to
meet the needs of your firefighter with PTSD support and more, Can b
offered on -site or through tele-medicine.
Personal Training Our certified personal trainer can build individual or group packages to Variable
improve health outcomes through customized workout routines and Pricing
demonstrations
Nutrition Counseling Each health assessment cones standard with nutrition recommendations. Variable
However, our licensed nutritionist can build individual or group packages to Pricing
work with your members for guidance in meal planning, shopping, cooking,
and more for enhanced health outcomes.
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