Contract 2019-71A RRDocusign Envelope ID: DE567AAF-C427-44A7-B73A-CD993BBC788F
THIRD AMENDMENT TO AGREEMENT FOR
MEDICAL EXAMINATION AND DRUG/ALCOHOL TESTING SERVICES
THIS AMENDMENT is entered into as of this 20t' day of August 2024 and is to that
certain Agreement dated August 27, 2019, No. 2019-71, 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 ADVENTIST HEALTH SYSTEM/SUNBELT, INC. D/B/A
ADVENTHEALTH CENTRA CARE, 2600 Westhall Lane, Box 300, Maitland, FL 32751
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 referred to and incorporated into the Agreement is
hereby amended to include an adjustment to the contract price, as more particularly described in
Attachment "A" attached hereto and incorporated herein.
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:
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Freddy Suarez, Procurement Services Director
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DocuSigned by:
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Tracy Ackroyd Howe, City Clerk
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Docusign Envelope ID: DE567AAF-C427-44A7-B73A-CD993BBC788F
ADVENTIST HEALTH SYSTEM/SUNBELT, INC.
D/B/A ADVENTHEALTH CENTRA CARE
DocuSigned by:
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By:
Print Name: Robert Paswaters
Title: Chief Operating Officer Centra Care
Date: 8/21/2024
Docusign Envelope ID: DE567AAF-C427-44A7-B73A-CD993BBC788F
ATTACHMENT A
EXHIBIT
SECTION — C
RESPONSE FORMAT
Police Officer or Firefighter Physical Examination
Ex Chest x-ray: Optional annually, required a minimum every five (5) years $67.00
Respirator Fit Testing (Centra Care does not perform the SCBA Face $65.00
piece fit test but can perform the N95 respirator mask fit
Hepatitis C Test $35.00
Hepatitis B Test (antigen) $22.00
Hepatitis B Titer (antibody) $22.00
Hepatitis B Vaccine (3 per series) $70.00
Hepatitis A Test (antigen) $30.00
Hepatitis A Titer (antibody) $30.00
Hepatitis A Vaccine (2 per series) $100.00
PPD Test $20.00
Tetanus (Td) $45.00
Tuberculosis screening, annually by QuantiFERON — TB Gold In -Tube Test $85.00
(QFT-GIT)
Docusign Envelope ID: DE567AAF-C427-44A7-B73A-CD993BBC788F
SECTION — C
RESPONSE FORMAT
Physical Examination - appointments to be scheduled within 72 hours $90.00 - Fire/Police
Examinations
$70.00 General/DOT
Examinations
$5.00 U/A Dip
Pre -employment drug screens $35.00
Height, Weight and Blood Pressure Recorded $ Inc
Blood Chemical Profile:
1. Complete Blood Count (CBC) $14.00
2. Lipid Panel $20.00
3. Comprehensive Metabolic Panel $16.00
4. Thyroid Stimulating Hormone (TSH) $25.00
Urinalysis / Micro Urinalysis $5.00 / $15.00
EKG at rest — or Stress EKG of recommended by physician) $47.00
Stress EKG $190.00
Purified Protein Derivative (PPD) — or chest x-ray if a positive reactor $20.00 -PPD
$67.00 - 2 View x-ray
Chest X-Ray (2 view) $67.00
Vision Test (Snellen and Ishihara Color) $ Inc.
Audiometric Test $25.00
Pulmonary Function Test (PFT) $22.00
Other exams as recommended for police officers and firefighters $20.00 — Titmus
$60.00—Tdap Vaccine
Docusign Envelope ID: DE567AAF-C427-44A7-B73A-CD993BBC788F
SECTION — C
RESPONSE FORMAT
Random, Reasonable Suspicion and Post Accident Drug
Screens for both CDL and non-CDL positions including MRO
review and consultation as needed.
Random, Reasonable Suspicion and Post Accident Breath or
Blood Alcohol Test as required including MRO review and
consultation as needed
After-hours drug and alcohol testing services
Medical Fitness for Duty evaluation
Psychological Fitness for Duty evaluation
Post Exposure services — exposure hotline, surveillance, and
source testing
MRO Consultation outside of drug test result review (e.g.,
review of prescription drug disclosures)
$35.00
$30.00 - Breath Alcohol
Test
$28.00 Breath Alcohol
Test Confirmation
$ Not available by
Centra Care.
$90.00 - Simple
$175.00 - Moderate
$300.00 - Complex
$ Not available. Referral
if needed.
$See pricing below
$25.00
Docusign Envelope ID: DE567AAF-C427-44A7-B73A-CD993BBC788F
SECTION - C
RESPONSE FORMAT
COST I AVAILABILITY
A. Exposure Hotline and Surveillance Services
Exposure Hotline $180 per call per exposure 24 hours a day,
Exposure hotline call, which is
per Employee seven days a
the initial point of contact for
week
the Employee. The exposure
The cost of the Exposure
hotline is staffed by nurses to
Hotline is separate and in
triage the type and severity of
addition to the cost for Post
the Employee exposure. The
Exposure Nurse ("PEN'
nurses use Centers for Disease
Services in Section B below;
Control and Prevention ("CDC")
Specific Exposure Services in
algorithms for evaluation.
Section C below; and other
AHCC will provide a report that
charges in Section D below.
summarizes the exposure and
recommended next steps for
the Employee.
Surveillance $250 per exposure per
Employee for up to six
months.
The cost of surveillance is
separate and in addition to
the cost for PEN Services in
Section B below; Specific
Exposure Services in Section
C below; and other charges
in Section D below.
Monday to Friday
from 8 a.m. to 5
p.m.
Following exposure, AHCC
PEN team to monitor
Employee to make sure the
Employee follows
recommended next steps
for follow-up testing,
surveillance and/or medical
care.
Docusign Envelope ID: DE567AAF-C427-44A7-B73A-CD993BBC788F
SECTION - C
RESPONSE FORMAT
PRODUCT /
SERVICE
COST
AVAILABILITY
DESCRIPTION OF
PRODUCT / SERVICES
B. Post Exposure Nurse Services
PEN Dispatch (WITH
$900 per exposure per
24 hours a day, seven
Source testing, exposed testing,
Medications)
Employee plus mileage
days a week
and laboratory results; human
immunodeficiency virus ("HIV")
post -exposure prophylaxis
("PEP") medications, as
needed; and mandatory
physician consult with
Employee.
PEN Dispatch
$675 per exposure per
24 hours a day, seven
Source testing, exposed testing
(WITHOUT
Employee plus mileage
days a week
and laboratory results with
Medications)
exposure counseling and
education.
PEN Dispatch -Holidays $950 per exposure per
24 hours per day on
Source testing, exposed testing,
Employee plus mileage
New Years' Day,
and laboratory results; HIV PEP
Martin Luther King
medications, as needed; and
Day, Easter,
mandatory physician consult
Memorial Day,
with Employee, as needed.
Fourth of July, Labor
Day, Thanksgiving,
Christmas Eve,
Christmas, and New
Year's Eve.
C. Specific Exposures Services
Hepatitis B Exposure AHCC will bill Client for the
Daily at any AHCC
PEN to recommend
actual cost +10% of
location during
administration of Hepatitis B
Hepatitis B Immune Globulin
business hours or by
Immune Globulin ("HBIG")
(-HBIG")
appointment
when the source is Hep B
positive, and the exposed titer
is inadequate for immunity.
AHCC will order and procure
from third -party vendor and
administer at a designated
AHCC clinic location. HBIG is
not administered on site at the
Employee's location and is not
administered by PEN.
Docusign Envelope ID: DE567AAF-C427-44A7-B73A-CD993BBC788F
SECTION - C
RESPONSE FORMAT
Hepatitis C Quantitative PCR $245 — Lab Test
PRODUCT /
SERVICE
CGT•W,
24 hours a day, CDC updated the MMWR 2013
seven days a week for 2020 to state that Hepatitis
C RNA testing of the Source
patient should be initiated if
their Hepatitis C antibody
testing comes back as
"reactive" (positive for Hep C
antibodies).
NOR ;
-13-13 CTME& MI
Communicable Disease
$82 per hour per Employee
24 hours a day,
Services include testing for
Mass Exposure Testing
with 2 hour minimum, plus
seven days a week
tuberculosis (' TB"), pertussis,
mileage.
scabies and other
** Lab services are billed to
communicable disease mass
Client per contracted rates.
exposure testing as mutually
agreed by the parties.
Post Meningitis Exposure
$150 per Employee per
24 hours a day,
PEN coordinates with infection
Telephonic Management
exposure
seven days a week
prevention and hospital
Services
laboratory staff to determine
type of meningitis following
suspected meningitis exposure
by Employee and then
recommends next steps for the
Employee. PEN remains in
telephone contact with the
exposed Employee until
diagnosis and/or need for
treatment is confirmed.
Post -Meningitis Exposure
$350 per exposure per
24 hours a day,
On -site PEN management for
Onsite PEN Services
Employee plus mileage
seven days a week
post -meningitis exposure with
meningitis prophylaxis and
physician consult. Need for
treatment is confirmed.
Mileage
$1 per mile to cover miles and
tolls
D. Additional Services
Bloodborne
$75 per hour
In -person or virtual
Training for bloodborne
Pathogen Training by PEN
pathogen
team
Account Set -Up and $100.00 One-time, flat fee for initial
Implementation setup