Contract 2019-66AADocuSign Envelope ID: E7511DC7-FB73-4DF9-89E8-9F0802FFD95D
FOURTH AMENDMENT TO AGREEMENT FOR
PUBLIC SAFETY PHYSICAL EXAMINATION SERVICES
THIS AMENDMENT is entered into as of this 25t' day of August 2024 and is to that
certain Agreement dated August 27, 2019, No. 2019-66 hereinafter "the Agreement", by and
between the CITY OF CLERMONT, FLORIDA, a municipal corporation under the laws of the
State of Florida whose address is: 685 W. Montrose Street, Clermont, Florida, hereinafter referred
to as "CITY' and FLORIDA AND LIFE EXTENSION CLINICS, INC. d/b/a LIFE SCAN
WELLNESS CENTERS, 1011 North MacDill Ave., Tampa, FL 33607 hereinafter referred to as
"CONTRACTOR". The parties, in exchange for the mutual covenants contained herein and in the
Agreement, agree as follows:
1. This Amendment expressly modifies the Agreement and in the event of a conflict,
the terms and conditions of this Amendment shall prevail.
2. The Compensation Schedule is being amended as provided in Exhibit A.
3. All other terms and conditions set forth in the Agreement shall remain in full force
and effect and unchanged as agreed to by the parties.
IN WITNESS WHEREOF, the parties hereto have executed this Amendment as of the dates set
forth below.
City of Clermont
DocuSigned by:
431F57D413554D6...
Freddy Suarez, Procurement Services Director
Date: 6/4/2024
Florida and Life Extension Clinics, Inc.
d/b/a Life Scan Wellness Centers
DocuSigned by:
nau., a. Sk"'.
B y. 1 AE07FO68CCD455...
Patricia Johnson, CEO
Attest:
DocuSigned by:
? A Nowt
3AD7F34905B344A...
Tracy Ackroyd, City Clerk
DS
DocuSign Envelope ID: E7511 DC7-FB73-4DF9-89E8-9F0802FFD95D
EXHIBIT A
Life Scan Wellness Centers: Request for Increase RENEWAL 3
Medical Examination and Drug/Alcohol Testing Services,
No. 2019-66
Annual Physical Examination Requirements
PRICING FOR RENEWAL 3
Price per Service
Notes
Police Officer or Firefighter Physical Examination
$
495.00
Aditional Test Services, (Section B,1K)
Price per Service
Chest X-ray: Optional anually, required a minimum evert five (5) years
$
71.00
Respirator Fit Testing (SCBA/N95 Fittest)
$
39.00
(Per mask)
Hepatitis C Test
$
56.00
Hepatitis B Test (antigen)
$
56.00
Hepatitis B Titer (antibody)
$
28.00
Hepatitis B Vaccine (3 per series)
$
236.00
(78.66 each)
Hepatitis ATest (antigen)
$
33.00
Hepatitis A Titer (Antibody)
$
28.00
Hepatitis A Vaccine (2 per series)
$
162.00
($81.00 each)
PPD Test
$
14.00
Tetanus
$
27.00
Tuberculosis screening, annually by QuantiFERON - TB Gold In -Tube
Test (QFT-GIT)
$
68.00
Additional Services: Job Applicant Examinations for
Fire, Police, and General Employee - (Section B, 2)
Price per Service
Pre -employment Drug Screen
$
38.00
Height, Weight, and Blood Pressure
Included
Blood Chemical Profile
1. Complete Blood Count (CBC)
$
16.00
2. Lipid Panel
$
16.00
3. Comprehensive Metabolic Panel
$
16.00
4. Thyroid Stimulating Hormone (TSH)
$
27.00
Urinalysis
Included
Resting ECG or Stress ECG if recommended by Physician
$
38.00
Stress ECG (includes resting ECG and Stress 12 lead)
$
189.00
Purified Protein Derivative (PPD)
$
11.00
Chest X-ray (2 view)
$
68.00
Vision Test (Snellen and Ishihara Color)
$
16.00
Audiometric Test
$
24.00
Pulmonary Function Test (PFT)
$
24.00
HAZMAT: Heavy Metals and Cholinesterase
$
130.00
(65.00 each)
NFPA 1583 Fitness Evaluation (PD,FD, Pre -employment)
Included
Life Scan Wellness Centers: Request for Increase for RENEWAL 3
Medical Examination and Drug/Alcohol Testing Services,
No. 2019-66