CONTRACT 3907G Amendment CLOSEDDocuSirn Envelope ID: OFC6AEAA- 48C1- 4EEB- A85B- 01F8EAAC6829
Agreement No. 3907G
SEVENTH AMENDMENT TO
AGREEMENT NO. 3907 BETWEEN
THE CITY OF EL SEGUNDO AND
U.S. HEALTHWORKS MEDICAL GROUP, P.C.
THIS 7TH AMENDMENT ( "Amendment ") is made and entered into this 1 st day of October, 2015,
by and between the CITY OF EL SEGUNDO, a general law city and municipal corporation
existing under the laws of California ( "CITY "), and U.S. HEALTHWORKS MEDICAL GROUP,
P.C. incorporated under the laws of the State of California ( "CONTRACTOR").
Pursuant to Agreement No. 3907 ( "Agreement "), executed by the parties on or about
February 25, 2009 and subsequently amended, the term of the agreement is extended until
September 30, 2016.
2, This Amendment may be executed in any number of counterparts, each of which will be an
original, but all of which together constitute one instrument executed on the same date.
3. Except as modified by this Amendment, all other terms and conditions of Agreement No..
3907 remain the same.
4, Exhibit A is a revised compensation schedule reflecting the increased rates for the period of
October 1, 2015 through September 30, 2016. Amount not to exceed $25,000.00.
IN WITNESS WHEREOF the parties hereto have executed this amendment the day and
year first hereinabove written.
ATTEST:
U.S. HEALTHWORKS MEDICAL GROUP, P.C.
fSd "'S"a " by:
Taxpayer ID No.
T Wea
Ci ty/f' Ner
APPROVED AS TO FORM:
MARK D. :,NS .,EY, City Attorney
BY.......... ...
David King, As IstG� t Cit Attcr e
C Y y
Agreement No. 3907G
EXHIBIT "A" — COMPENSATION SCHEDULE
ATTACHMENT A
USHealthworks
Pre - employment costing for each medical evaluation component
Audiogram
$23
Physical Examination
$63
Chest X -Ray (1 view)
$53
Chest X -Ray (2 view)
$68
Lumbar Spine (2 view)
$68
Non - Regulated UDS
$100
(Drug screen — insta- check)
$42
PPD (TB test)
$26
Pulmonary Function Test
$37
Vision Test — Ishihara
$11
Vision Test — Peripheral
$11
Vision Test — Titmus
$11
"Stress Treadmill
(performed at Westchester Center for Heart and Health)
Other miscellaneous services
DOT Random drug testing
(Regulated)
$68
Reasonable Suspicion
(BAT and confirmation)
$84
DMV Physical
$74
Stress EKG with over read
$68
Tetanus
$100
Hepatitis A (2 series)
$126
Hepatitis B (3 series)
$95 each
Vaccine — Twinrex
$147
Agreement No. 3907G
EXHIBIT "A" — COMPENSATION SCHEDULE
ATTACHMENT B
USHealthworks
Medical Exam Component Profiles Cost
Battalion Chief
$262
Building Inspector
$153
Building Safety Manager
$153
Business Services Manager
$153
City Engineer
$153
Civil Engineer Associate
$153
Community Cable Program Spec /Manager
$153
Computer Graphics Designer
$153
Crime Prevention Analyst
$153
Crime Scene Investigator
$153
Custodian
$153
Dispatcher
$153
Environmental Safety Manager
$153
Equipment Maintenance Supervisor
$153
Equipment Mechanic
$153
Facilities Maintenance Mechanic /Supervisor
$153
Fire Prevention Specialist
$153
Firefighter / Engineer / Captain
$246
Fleet Supervisor
$153
General Services Manager
$153
Information Systems Manager
$153
Library Network Assistant
$153
Librarian / Senior Library Asst / Library Page / Clerk
$153
License Permit Specialist
$153
Lifeguard
$193
Maintenance Craftsworker
$153
Network Assistant
$153
Park Maintenance Worker
$153
Planning Manager / Senior Planner / Asst Planner
$153
Police Assistant
$153
Police Cadet
$153
Police Officer
$235
Police Service Officer
$231
Police Volunteer
$153
Pool Center Maintenance Technician
$153
Pool Manager
$153
Principal Fire Prevention Specialist
$153
Agreement No. 3907G
EXHIBIT "A" — COMPENSATION SCHEDULE (continued)
USHealthworks
Medical Exam Component Profiles
Cost
Program Coordinator
$153
Public Works Director
$153
Public Works Street Maintenance Worker /
Lead / Supervisor
$153
Rangemaster
$153
Recreation and Parks Director
$153
Recreation Leader/ Coordinator
$153
Recreation Supervisor (plus Aquatics)
$153
Revenue Inspector
$153
Sedentary
$153
Special Events Coordinator
$153
Street Maintenance Worker I / II
$153
Technical Services Analyst
$153
Tree Maintenance Worker
$153
Utilities Manager
$153
Video Specialist
$153
Wastewater Supervisor
$153
Wastewater / Water Maintenance Worker
$153
Water Supervisor
$153
Agreement No. 3907G
Sandoval, Lili
From: DeZiel, Julie
Sent: Tuesday, September 22, 2015 10:27 AM
To: Sandoval, Lili
Subject: FW: PSA renewal
Attachments: Amendment form _ 7th.pdf
Here you go, Lili
From: DeZiel, Julie
Sent: Saturday, August 22, 2015 10:42 AM
To:'Lori Hoel'
Cc: Houston, Mayra; DeZiel, Julie
Subject: RE: PSA renewal
Hi Lori,
Attached is the renewal amendment with the name change.
Thanks.
Julie
From: Lori Hoel mailto: Lori. Hoe l USHWor'ks.co l
Sent: Friday, August 21, 2015 11:30 AM
To: DeZiel, Julie
Subject: RE: PSA renewal
Hi Julie,
The Amendment document has an incorrect legal name. Correct name should be U.S. HealthWorks Medical Group,
P.C. That should be stated in first paragraph on and on signature line. We cannot sign under U.S. HealthWorks of
California, Inc.
Please correct the legal name .
Thanks,
Lori Hoe!
Sales Consultant
(310) 469 -4412 Cell
loiri.hioel(@ushworks.com
II. 1°ieaiII IIIhWorks
Ctrl +Click the buttons below for helpful USHW Links
Rr$
1