HomeMy WebLinkAboutFlorida Hospital Agreement for Services -1996 10 24- .~ .
901 North Lake Destiny Road
Suite 376
Maitland, Florida 32751
407/660-8118
FAX 407/660-8121
~~~ FLORIDA
III Hos-~irp
AGREEMENT FOR SERVICES
This Agreement made, by and between City of Winter Springs, Winter Springs, FL 32708, hereafter
referred to as "Company", and D.O.T. STOP and Centra Care Medical Center, divisions of Florida
Hospital, hereinafter referred to as "DS" and "GCMG", do hereby enter into this Agreement in accordance
with and subject to the following:
1. Scope of Service. DS and CCMC will provide the following services for the Company:
AHCA (HRS) 5 Panel Urine Drug Screen
AHCA (HRS) 8 Panel Urine Drug Screen
AHCA (HRS) 10 Panel Urine Drug Screen
DOT 5 Panel Urine Drug Screen
2. Terms of Agreement. This Agreement shall be for 12 months beginning September 20, 1996 and
expire September 20, 1997.
3. Fee for Service. Company agrees to pay DS and CCMC within 30 days of receipt of invoice for
services rendered.
DS -DOT 5 Panel Urine Drug Screen $25.00
CCMC -Specimen Collection $15.00
DOT 5 Panel Total Cost $40.00
DS - AHCA (HRS) 5 Panel Urine Drug Test $25.00
Includes drug test and MRO services
CCMC -Specimen Collection $15.00
AHCA (HRS) 5 Panel Total Cost $40.00
DS - AHCA (HRS) 8 Panel Urine Drug Test $28.00
Includes drug test and MRO services
CCMC -Specimen Collection $15.00
AHCA (HRS) 8 Panel Total Cost $43.00
DS - AHCA (HRS) 10 Panel Urine Drug Test $30.00
Includes drug test and MRO services
CCMC -Specimen Collection $15.00
AHCA (HRS) 10 Panel Total Cost $45.00
D5 - AHCA (HRS) Blood Alcohol Test plus MRO $20.00
CCMC -Blood Alcohol Collection $20.00
Total Cost $40.00
'~ •C
CCMC -DOT Breath Alcohol Testing
DOT Breath Alcohol Confirmation Test
$25.00
$25.00
4. Location. Specimen collections may be performed at any Centra Care Location listed below:
Longwood Centra Care Sanford Centra Care Lee Road Centra Care
855 S. US Highway 17-92 3505 S. Orlando Avenue 2540 Lee Road
Longwood, FL 32750 Sanford, FL 32773 Winter Park, FL 32789
(407) 699-8400 (407) 322-7906 (407) 629-9281
5. Contact Person. Mary Wilson at (407)327-1800
WHEREFORE, having fully agreed, the parties have set their hands to this document this 24 day of
October, 1996.
~~~w~~ ~
Ronalu~ VV . 1Vlc ,emore
City Manager
City ~f Winter ,Springs
Debbie Swartwood
Sr. Account Manager
Florida Hospital
i
APPENDIX
In consideration of the fee charged, CS agrees to provide the following services:
AHCA (5) Panel Urine Drug Screen to test for the following substances:
* Amphetamines * PCP
* Cocaine * Opiates
* Cannabinoids (Marijuana)
AHCA (8) Panel Urine Drug Screen to test for the following substances:
* Amphetamines * PCP * Barbiturates
* Cocaine * Opiates * Benzodiazepines
* Methaqualone * Cannabinoids (Marijuana)
AHCA (10) Panel Urine Drug Screen to test for the following substances:
* Amphetamines * PCP * Barbiturates
* Cocaine * Opiates * Benzodiazepines
* Methaqualone * Methadone * Cannabinoids (Marijuana)
* Propoxyphene
*
Staff will use the pre-printed chain-of custody forms and kits supplied by American Medical Laboratories,
Inc.
CS staff will complete the collection and chain-of-custody forms as provided by AML and upon completion,
call AML at (407) 857-8188 for pick-up.
Forward MRO copy of Chain-of-Custody to: Dr. Jock Sneddon
Medical Review Officer
D.O.T. STOP
9484 S. Orange Blossom Trail.
Orlando, Florida 32837
l~TEMO~NDUM
TO: John Ketterinsham, General Services Director
y `
F~tObi: Mary Wilson, Employee Relations Coordinator
SUBJECT: Contract Asreements For Services
DATE: October 2~. 1996
Attached are copies of the following contract agreement for services:
1. Controlled Substances (Drug) and Alcohol Policy for C.D.L. Drivers
(D.O.T. Stop)
2. Drug-Free Workplace Fee Schedule
(D.O.T. Stop and Centra Care Nledical Center
Divisions of Florida Hospital)
3. Drug-Free Workplace Policy Drug Testing
(D.O.T. Stop)
On October 2=I, 1996, the City Manager executed the attached contracts.
Attached is a copy of the signed contracts.
A copy of the signed contracts will be forwarded to:
Purchasing Director
Attachments