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HomeMy WebLinkAboutThomas A Brady Sports Medicine, P.C. d/b/a Forte Sports Medicine and Orthopedics Professional Services/UTL/$50,000/Medical Services PSACzTfshfzHsfdivlijobu3;43qn-Gfc37-3135 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 3/6/2024 3/6/2024 3/6/2024 NOT PRESENT DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 SPORTS MEDICINE AND ATHLETIC TRAINING SERVICES AGREEMENT This Sports Medicine and Athletic Training Services Agreement (the "Agreement") is made and entered into and effective as of the 1st day of April, 2024 (the "Effective Date"), by and between the Cam1el Public Works Department (CPWD) and Thomas A. Brady Sports Medicine, P.C. d/b/a Forté Sports Medicine and Orthopedics. RECITALS: WHEREAS, the CPWD desires to establish a working relationship with an independent health care provider to provide sports medicine and athletic training services to the CPWD; and WHEREAS, Forté is capable and willing to provide sports medicine and athletic training services and to manage athletic training services at the CPWD; NOW, THEREFORE, in consideration of the mutual covenants and agreement set forth herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the CPWD and Forté hereby agree as follows: 1.Management of Athletic Training Services. a.Forté will establish appropriate care, competency, and clinical protocols for the athletic trainer(s) providing services to the employees of the CPWD (the "Protocols"). b.Forté and the CPWD will jointly work together to allow Forté to provide athletic training and medical staff services to employees of the CPWD in accordance with the Protocols and this Agreement. 2.Sports Medicine and Athletic Training Services. Forté will provide the following services to the CPWD: a.Establish and update (during the term of this Agreement) the Protocols consistent with the best practices for athletic training services; b.Provide care which will include, but not limited to, physical therapy, chiropractic care, sports medicine and athletic training services; c.All such services and the services set forth in Section 3 below (the "Services") will be provided by duly qualified and licensed personnel in accordance with the tenns and conditions stated in this Agreement as well as compliance with all applicable federal and state requirements and any requirements or policies and procedures of fire service regulatory agencies. 3.Sports Medicine and Other Services. Forté will be allowed to bill reasonable professional fees associated with the provision of care outside of the scope of Athletic Training Services which may include, but are not limited to, medical services, chiropractic care, bracing, splinting, orthotics, durable medical equipment, imaging and administration/dispensing of medication. Forté will be solely responsible forany such billing of its services and for appropriate physician involvement and oversight of these services. Nothing in the Agreement is intended to restrict Forté's or its personnel's exercise of his or her professional judgement in the provision of care to patients. Exhibit A DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 4.Facility Use. The CPWD agrees to provide a location to render sports medicine and athletic training services. 5.Payment. a.Forté and the CPWD agree to share the cost of one full time equivalent (FTE) athletic trainer, split 50/50. b.CPWD agrees to compensate Forté a maximum of $50,000 annually with a 3% annual increase to account for cost of living adjustments of the athletic trainer. The exact amount will be determined after the successful hiring of an athletic trainer, but total payment shall not exceed $50,000 annually with a 3% annual increase. Forté shall notify the CPWD of the final compensation amount, no more than seven (7) business days following the successful hire of the athletic trainer. c.Fringe benefit costs are included which have been calculated based on rates which are both necessary and consistently applied by Forté. d.Forté will invoice no more frequently than quarterly. e.CPWD will make every effort to ensure that payments are processed within thirty (30) days of received invoice. f.Forté reserves the right to initiate termination of the Agreement should payment be delayed, without mutual agreement by both Parties, by more than sixty (60) days. 6.Licenses/Permits. At the commencement of this Agreement and during its Term, Forté will secure and maintain all licenses, permits, and certifications required to provide the Services hereunder. Forté and its employees, contractors or agents will operate without any restriction, sanction, discipline, probationary status or other limitation on any license, certification or accreditation related to or associated with the Services provided under this Agreement. Forté will also ensure that all of its employees, contractors and agents maintain all licenses, permits and certifications required by federal, state or local laws with respect to the Services provided by Forté and by said individuals and that said individuals only provide services that are within the scope of their respective licensure, pennit or certification. Forté will also perform reasonable and necessary credentialing functions, including personal and professional background checks for all licensed professionals providing Services. Forté will ensure that any personnel providing Services hereunder are Basic Life Support (BLS) certified on or before commencement of the initial tenn of this Agreement, and will continue to be BLS certified during the initial and any renewal term of this Agreement. Forté will provide current proof of licensure for itself or its employees, contractor and agents upon the CPWD's request. Forté will notify the CPWD in the event that any of the foregoing qualifications of Forté or its employees, contractors or agents are no longer true and accurate. Forté will furthernotify the CPWD of any threatened or pending malpractice claim or other patient-related litigation related to any of the employees, contractors or agents that provide services under this Agreement. 7.Warranty. Forté warrants that neither it nor any of its employees, contractors or agents are currently, or have ever been sanctioned, suspended, excluded or disbarred from any federal health care program, including without limitation, the Medicare or Medicaid programs. 8.Administrative Responsibilities. Forté agrees that it will be responsible for maintaining and securing any health information including patient information and medical records, in accordance with any state and federal legal and regulatory requirements. Forté will also be responsible for confidentiality and security measures with respect to health information for the services provided with any services provided to patients. The ownership and right of control of a 3-s DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 and suppo1ting documents, including patient information and medical records, prepared in connection with any services rendered belongs exclusively to Forté. This section will survive the expiration or earlier tem1ination of this Agreement. 9.Exclusive Provider. It is the intent of the parties that, throughout the term of this Agreement, Forté shall be the exclusive provider to the CPWD and its employees forthe Services; provided however, that such exclusivity would not apply in the following instances: a.an emergency situation, in which case the individual will be directed to the nearest hospital emergency room; b.if the individual expresses a preference for a different provider, practitioner, or supplier; c.ifthe individual's insurer determines the individual should be treated by a different provider, practitioner, or supplier, or d.iftreatment by Forté is not in the individual's best medical interests. 10.Term and Termination. Unless tenninated earlier as provided herein, this Agreement will commence on the Effective Date and continue for a period ofTwo (2) years, and thereafter will automatically renew for periods of one (1) year unless written notice of non-renewal is provided at least one hundred twenty (120) days prior to the end of the current tenn. IfForté fails to comply with any term or provision ofthis Agreement and fails to cure such default with the grace periods provided therein, the CPWD may tenninate this Agreement by providing Forté with fifteen (15) days written notice oftermination. Either party may terminate this Agreement without cause by providing the other party with six (6) months prior written notice. 11.Insurance. Forté will provide and maintain throughout the duration of this Agreement such professional liability or self-insurance for itself and its personnel in such amounts as are necessary for itself and its personnel as applicable to be "qualified providers" under the Indiana Medical Malpractice Act, as amended. Forté further agrees to maintain such professional liability or self- insurance coverage in the amounts of required under this Section ofthis Agreement for all services provided by itself and its personnel until the statute of limitations expires forthe filing of malpractice claims pertaining to the provision of the services. Forté will notify the CPWD of cancellation or material modification of the coverage under any such professional liability insurance covering its employees in full compliance with the laws of the State of Indiana; and insurance or self-insurance ofcommercial general and public liability insurance in minimum amounts of One Million Dollars ($1,000,000.00) per occurrence, Two Million Dollars 2,000,000.00) aggregate and One Hundred Thousand Dollars ($100,000.00) property damage per occurrence. Such instance must include broad form contractual liability insurance insuring MSM's obligations under this Agreement. The commercial general and public liability insurance must name the CPWD and their officers, members, directors, employees, and agents as additional insured. 12.Own Acts and Indemnification. a. Each party will be responsible for its own acts or omissions and any and all claims, liabilities, injuries, suits, demands and expenses of all kinds which may result or arise out ofany alleged malfeasance or neglect caused or alleged to have been caused by either party or their employees, contractors or agents in the perfonnance or omission ofany act or responsible of either party of this Agreement. DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 b.Forté agrees to defend, indemnify and hold ham1less the CPWD, its officers, council members, employees and agents from any loss, cost, damage, expense, attorneys' fees, and liability by reason of bodily injury, death, property damage, or all ofthe foregoing, of whatsoever nature or kind, arising out of or as a result of the alleged or actual willful or negligent act or omission of Forté, its employees, contractors or agents including, but not limited to, its medical professionals related to (i) the perfonnance or non-perfonnance of the Services under this Agreement; or (ii) the violation ofany applicable law, regulation or rule. c.The CPWD agrees to defend, indemnify and hold harmless Forté, its successors, assignees, trnstees, directors, officers, agents and employees from any loss, cost, damage, expense, attorney'sfees, and liability solely arising out ofthe breach of its obligations under this Agreement. Notwithstanding anything contained herein to the contrary, the CPWD liability and any obligation to defend, indemnify, or hold Forté harmless shall be limited in substance by statutes designed to protect and limit the exposure and liability of the CPWD as an instrumentality of the State of Indiana (e.g. actions and conditions as to which the CPWD is immunized by the Indiana Tort Claims Act, dollar limits stated in such Act, exemption from punitive damages, and the continued ability to defeat claims by reason of contributory negligence or fault of the claimant), so that the CPWD's liability and obligation to indemnify and hold harmless will not exceed what might have been paid directly to the claimant ifsued directly by claimant and all appropriate defenses had been raised by the CPWD. d.This section will survive the expiration or earlier termination of this Agreement. 13.HIPAA Compliance. Forté and its personnel will comply with all applicable laws, rules and regulations governing the privacy ofprotected health information and medical records including, but not limited to the Health Insurance Portability and Accountability Act of 1996, as amended from time to time ("HIP AA"), the privacy provisions (Subtitle D) ofthe Health Information Technology of Economic Clinical Health Act, Division A, Title XIII ofPub. L: 111-5, and its implanting regulations, as amended from time to time (HITECH Act"). The parties agree that the CPWD is not intended to serve as a business associate ofForté with respect to the Services or other activities ofForté under this Agreement or any other relationship between Forté and the CPWD. Notwithstanding the foregoing, in the event that the parties determine that the CPWD is serving as a business associate, then it will execute a standard Business Associate Agreement as an addendum to this Agreement, provided that such agreement will only extend to the Services provided by the CPWD to or forthe benefit ofForté under this Agreement. 14.OSHA Compliance. Forté and its personnel will comply with all applicable Occupational Safety and Health Administration ("OSHA") regulations and standards including, but not limited to, rules, pertaining to blood borne pathogens and the disposal and removal of any waste that is generated as a result ofthe services provided hereunder, including bodily fluids. 15.Notices. All notices and demands which may or are required to be given by either party to the other hereunder will be in writing and will be deemed to have been fully given three (3) days after being deposited with the United States Postal Service, or its successor, as certified or registered mail, postage prepaid, and addressed as follows. All notices and demands which may or are required to be given by either party to the other hereunder will be in writing will be deemed to have been fully given five (5) days afterbeing deposited with the United States Postal Service, or its successor, as certified or registered mail, postage prepaid, and addressed as follows: Exhibit A L/of DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 Forté:Thomas A. Brady Sports Medicine, P.C. d/b/a Forté Sports Medicine and Orthopedics 10767 Illinois Street, Suite 3000B Carmel, Indiana 46032 Attn: Martin Rosenberg, Forté 16.Independent Relationship. Each party is at all times acting and performing as an independent contractor with respect to the other party, and no party will have or exercise any control or direction over the method by which the other party will perfonn such work or render or perform such services and functions under this agreement. 17.Non-Discrimination. The parties agree that they and their respective employees, contractors, and agents will not discriminate in the provision of Services under this Agreement based upon race, color, religion, gender, disability, national origin, ancestry, age, sexual orientation, gender identity, United States military service veteran's status, genetic information or any other basis as may be a recognized protected class during the term of this Agreement. The parties affirm that they are equal opportunity employers and will comply with all applicable federal, state, and local laws, regulations, and executive orders. 18.Governing Law, Wavier of Trial by Jury, and Venue. The parties affirm that this Agreement has been entered into the State of Indiana and will be construed in accordance with the laws of the State of Indiana. THE PARTIES EXPRESSLY AND KNOWINGLY WAIVE AND RELEASE ALL RIGHTS TO A TRIAL BY JURY IN ANY ACTION, PROCEEDING OR COUNTERCLAIM BROUGHT BY EITHER PARTY AGAINST THE OTHER ON ANY MATTERS ARISING OUR OF OR IN ANY WAY CONNECTED WITH THIS AGREEMENT, AND/ORANY CLAIM FOR INJURY OR DAMAGE FOR THE PURPOSE OF ANY SUIT, ACTION OR PROCEEDING ARISING OUT OF OR RELATING TO THIS AGREEMENT, EACH PARTY HEREBY IRREVOCABLY CONSENTS AND SUBMITS TO THE EXCLUSNE JURISDICTION AND VENUE OF THE COUNTY, CIRCUIT OR SUPERIOR COURTS LOCACTED IN HAMILITON COUNTY, INDIANA. EACH PARTY IRREVOCABLY WAIVES ANY OBJECTION THAT IT MAY NOW OR HEREAFTER HAVE TO THE LA YING OF VENUE OF ANY SUCH SUIT, ACTION OR PROCEEDING BROUGHT IN ANY SUCH COURT AND ANY CLAIM THAT SUCH SUIT, ACTION OR PROCEEDING BROUGHT IN SUCH COURT HAS BEEN BROUGHT IN AN INCONVENIENT FORUM. 19.Further Assurances. Each party will, from time to time, upon reasonable request by the other party, execute such additional documents as reasonably may be required to effectuate the purpose of this Agreement. The parties also agree to meet from time to time upon either party's reasonable request of the other, to discuss the reasonable needs and/or concerns of the parties. IN WITNESS WHEREOF, the parties have entered into this Agreement to be effective as of the date set forth above. DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 EXHIBIT B Invoice Date: Name of Company: Address & Zip: Telephone No.: Fax No.: Project Name: Invoice No. Purchase Order No: Goods Services Person Providing Date Goods/Services Provided Cost Per Hourly Total Goods/Services Goods/ (Describe each good/service Item Rate/ Service separately and in detail) Hours Provided Worked GRAND TOTAL Signature Printed Name DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732 DocuSign Envelope ID: 399A3E29-3B85-4AC0-B00D-9EF0F465E732