Resolution of the City of Jersey City, N.J.
File No. Agenda No. Approved: Res. 20-695 10.29RESOLUTION AUTHORIZING A PROFESSIONAL SERVICES AGREEMENT WITH CAREPOINT HEALTH MEDICAL GROUP TO PROVIDE PRIMARY MEDICAL CARE SERVICES FOR EMPLOYEES INJURED ON THE JOB FOR THE CITY OF JERSEY CITY
COUNCIL offered and moved adoption of the following resolution:
WHEREAS, the City of Jersey City (“City”) must provide medical services to employees who are injured on the job; and
Whereas, these services qualify as professional services exempt from public bidding under the Local Public Contracts Law, N.J.S.A. 40A:11-1 et seq.; and
Whereas, the City publicly advertised a Request for Proposals (“RFP”) using the fair and open process as described under the Pay-to-Play Law, N.J.S.A. 19:44A-20.4 et seq.; and
WHEREAS, on August 18, 2020, the City received two (2) proposals in response to the RFP; and
Whereas, the Jersey City Insurance Fund Commission (IFC) recommended the award of this contract to CarePoint Health Medical Group (“CarePoint”), 550 Newark Avenue - Suite 407, Jersey City, NJ 07306 whom the IFC determined submitted the most beneficial proposal for these services; and
Whereas, CarePoint agrees to provide these services for a fee of three hundred fifty thousand dollars ($350,000.00) in twelve (12) equal monthly installments of twenty-nine thousand one hundred sixty-six dollars and sixty-six cents ($29,166.66) for Primary Medical Care services for City employees injured on the job; and
Whereas, for a given matter, CarePoint shall submit required reports including case progress assessment report immediately following an employee visit, weekly reports of injuries and work status and a monthly invoice setting forth its time and services performed.
Whereas, CarePoint has submitted its Certification of Compliance with the City’s Contractor Pay-to-Play Reform Ordinance 08-128 adopted on September 3, 2008; and
Whereas, the resolution authorizing the award and the agreement itself must be available for public inspection; and
Whereas, the City is awarding the contract pursuant to the fair and open provisions of the Pay-To-Play Law, N.J.S.A. 19:44A-20.4 et. seq.; and
Whereas, funds in the amount of $58,333.32 are available in Account 20-01-201-23-210-312 P.O.#138542.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF JERSEY CITY AS FOLLOWS:
1. Subject to modifications as may be deemed necessary and appropriate by Corporation Counsel, the mayor or Business Administrator is authorized to execute the attached contract with CarePoint Health Medical Group to provide primary medical care services.
2. Pursuant to N.J.A.C. 5:30-5.5(c)(2), the continuation of this contract after the expenditure of the funds encumbered in the 2020 calendar year temporary and permanent budget shall be subject to the appropriation of sufficient funds in the 2021 calendar year temporary and permanent budgets.
3. The term of the contact is one (1) year effective as of September 10, 2020 and the total amount of the contract shall not exceed $350,000.00.
4. The award of this contract shall be subject to the condition that the vendor provides satisfactory evidence of compliance with the Affirmative Action Amendments to the Law Against Discrimination, N.J.S.A. 10:5-31 et seq.
5. A copy of this resolution will be published in a newspaper of general circulation in the City of Jersey City as required by law within (10) days of the adoption of the resolution.
Res. 20-695 Approved:
Resolution authorizing a professional services agreement with CarePoint Health Medical Group to provide primary medical care services for employees injured on the job for the City of Jersey City
Res. 20-695 Approved:
Resolution authorizing a professional services agreement with CarePoint Health Medical Group to provide primary medical care services for employees injured on the job for the City of Jersey City
I,_______________ Elizabeth Castillo, Chief Financial Officer, hereby certify that there are sufficient funds for the payment of this resolution in the amount of $58,333.32, in account number 20-01-201-23-210-312;
PO# 138542.
APPROVED AS TO LEGAL FORM
Business Administrator Corporation Counsel
☐ Certification Required
RECORD OF COUNCIL VOTE –
AYE NAY N.V. Absent AYE NAY N.V. Absent AYE NAY N.V. Absent N.V. –
RIDLEY SALEH LAVARRO (Abstain)
PRINZ-AREY SOLOMON RIVERA
BOGGIANO ROBINSON WATTERMAN,
PRES Adopted at a meeting of the Municipal Council of the City of Jersey.
Res. 20-695 Approved:
Resolution authorizing a professional services agreement with CarePoint Health Medical Group to provide primary medical care services for employees injured on the job for the City of Jersey City
RESOLUTION FACT SHEET -
This summary sheet is to be attached to the front of any resolution that is submitted for Council consideration. Incomplete or vague fact sheets will be returned with the resolution.
Project Manager
Matt Hogan, Risk Manager 201-547-5034 matthew@jcnj.org
Division Office of Risk Management
Note: Project Manager must be available by phone during agenda meeting (Wednesday prior to council meeting @ 1:00 p.m.)
Purpose
Primary medical care for City employees injured on the job as part of the required workers compensation program. Contract term (include all)
9/10/20 - 9/10/21
Type of award: fair and open ATTACHMENTS:
CarePoint Agreement 08-21-20 CarePoint FORMS
Approved by Status:
John Mercer, Assistant Business Administrator Approved - Aug 25 2020
Matt Hogan, Risk Manager None
Joanne Rosa, Senior Personnel Technician Approved - Aug 25 2020
John McKinney, Attorney None
Peter Baker, Corporation Counsel None
Amy Forman, Attorney None
Nick Strasser, Attorney None
Norma Garcia, Attorney None
Ray Reddington, Attorney Approved - Aug 31 2020
Jeremy Jacobsen, Attorney None
Sapana Shah, Attorney None
Jeana Abuan, Public Agency Compliance Officer Approved - Aug 31 2020
Soraya Hebron, Diversity and Inclusion Approved - Aug 31 2020
Raquel Tosado, Assistant Purchasing Agent Approved - Sep 02 2020
Patricia Vega, Assistant Purchasing Agent None
Patrice Lambert, Purchasing None
Elizabeth Castillo, Chief Financial Officer Approved - Sep 02 2020
AGREEMENT
Agreement made this day of 20 _____ by and between the City of Jersey City (“City”) and CarePoint Health Medical Group (“CarePoint”) a New Jersey corporation with offices at 550 Newark Avenue - Suite 407, Jersey City, NJ.
WITNESSETH
WHEREAS, a Request For Proposals (RFP) was prepared and released by the City and annexed hereto as Exhibit A and referred to herein as the “RFP”; and
WHEREAS, CarePoint submitted a proposal to the City responsive to the RFP, pursuant to which CarePoint would provide certain occupational medicine and related services to the City, all as more particularly detailed in CarePoint‘s proposal (Proposal); and
WHEREAS, pursuant to Resolution Number adopted on
the City accepted such Proposal an awarded a contract to CarePoint to provide medical services for all City employees who suffer an on the job injury during the period of September 10, 2020 to September 10, 2021; and
WHEREAS, the parties are desirous of memorializing the terms of the Contract;
NOW, THEREFORE, in consideration of the mutual promises and covenants herein, the parties agree as follows:
SECTION ONE MEDICAL SERVICES A. Facility
1. CarePoint intends to provide the medical services at the Jersey City office operated by Dr. Edward Boylan which is located at 550 Newark Avenue - Suite 407, Jersey City, NJ (Facility) and will provide free parking for clients on site.
2. The Facility is handicapped accessible and in compliance with the Americans with Disabilities Act.
3. CarePoint will provide a physician at the Facility during all hours of operation, which presently comprise 8:00 a.m. to 5:00 p.m., Monday through Friday.
B. Emergency Care
1. CarePoint will provide emergency care and urgent care of all non-life threatening emergencies at the Facility during the hours 8:00 a.m. to 5:00 p.m., Monday through Friday.
Christ Hospital or the nearest hospital in extreme emergency.
3. No appointment will be necessary for emergency care at the CarePoint facility at 550 Newark Avenue.
Examples of the sort of emergency care CarePoint will undertake at its facility include strains, sprains, lacerations, contusions, fractures, occupational exposures such as smoke inhalation.
C. Primary Curative Care
1. CarePoint will provide Primary Care at the office located at 550 Newark Avenue (Facility). Primary Care will include the treatment of the presenting employee for the duration of the disability. The Primary Care Physician (PCP) will make recommendations concerning the treatment and work status of the employee.
2. CarePoint shall provide Worker’s Compensation (WC) health care to heal employees injured in the course of their work. Since injuries often leave some permanent residual health problems, care will not necessarily return the injured employees to their pre-injury health status, which may be impossible.
3. The acute injury will be treated either to cure to the point at which maximal improvement has been attained, called "Maximum Medical Improvement" (MMI).
4. If, at MMI, pain or discomfort remains, the health care involved is palliative care. Palliative care is not covered under Worker’s Compensation and patients who need such care are referred to their personal physicians for palliation of their enduring conditions. D. Occupational Medicine
1. CarePoint will provide the following occupational medical services; a. Care navigation for injured workers
b. ER fast tracking c. Injury management
d. Injury medical examinations e. Progress evaluations
E. Specialist Care
h. Pulmonology
i. Radiology (excluding MRI / Nuclear testing) j. Surgery
2. At the request of the City office of Risk Management or the patient, CarePoint may utilize the services of a qualified provider of medical services, such as may be requested by an injured employee, as long as the fees do not exceed the cost for that service within CarePoint’s panel (“Panel”) of occupational medicine physicians for a given service. 3. Such services will be managed by CarePoint and the services may be interrupted and returned to CarePoint’s Panel if any questionable care or conditions are noted by the Project Director.
F. Pain Management
1. Pain Management will only be authorized when it relates directly to curative care of the injured employee’s work injury. Pain Management may include but not be limited to injections and epidurals. Net cost of this Pain Management, post PPO review, shall be shared equally by the PCP and the City.
2. Pain Management that is Palliative in nature is not authorized by this contract. Injured employees who require palliative care are to be referred to their personal physician for treatment.
G. Need for Treatment
1. When an injured employee requests a need for treatment exam, within two (2) years of reaching MMI, the PCP must conduct a follow-up evaluation.
2. Need for Treatment exam shall be included under the PCP capitated program contract. H. Second Opinions
3. When an injured employee requests a second opinion, within two (2) years of reaching MMI, the PCP must conduct a follow-up evaluation in order to:
a. provide an alternate specialist within the PCP’s network; or
b. approve an out of network specialist, recommended by the City or the City’s TPA, to perform a one-time evaluation only; and
c. the decision on the specialist to be used for the second opinion shall be at the discretion of the City’s TPA
The City will be responsible for the cost of second opinion evaluations.
4. The PCP must then provide follow-up consultation with the injured employee to review the second opinion report and determine what, if any, further treatment is required. Follow up consultation shall be included under the PCP capitated program contract. 5. If upon review, of the second opinion evaluation, the PCP determines that further
as provided under sections 4.1 through 4.4 of this RFP. The City will be responsible for fees as provided under sections 4.1 through 4.4 of this RFP.
I. Prior Claims
1. Upon reaching MMI, the injured employee will be discharged from care by CarePoint. 2. Re-opening a previously closed case, after five (5) years’ time from date of injury, will be
billed on a fee for service basis. J. Diagnostics
1. CarePoint will provide the following diagnostic services at its facility at 550 Newark Avenue:
a. Blood and Urine Testing (exposure during an incident) b. Electrocardiogram (EKG)
c. Pulmonary Function Tests (PFT)
2. Upon presenting at the facility, a CarePoint physician will examine the employee who will be designated the employee’s primary care physician (PCP) throughout the course of the employee disability. The PCP will make the provisional and final diagnosis,
determine the work status of the employee and deliver such findings to the City office of Risk Management or its designee.
3. The PCP will thereupon determine the treatment and referrals necessary to aid in employee recovery and resumption of duties.
4. CarePoint will prepare and deliver to City and/or the City’s Third Party Administrator (TPA) reports of the Medical Evaluation and Treatment of covered employees within 24 hours of the medical visit.
5. CarePoint will prepare and deliver to City and or the City’s TPA typed reports of the Medical Evaluation and Treatment of covered employees within 48 hours of the medical visit.
6. CarePoint will be responsible for provide the following diagnostic services at a location other than its primary facility:
a. Electroencephalogram (EEG) b. Electromyography (EMG)
c. Radiology, including but not limited to:
i. Computed Tomography Scan (CT-Scan or CAT-Scan) ii. X-Rays
iii. Ultrasound K. Hospital Admissions
1. The cost of all physician services attendant to the following categories of hospital admission will be borne by CarePoint as included in its annual fee:
a non-life threatening injury such as a complex fracture or neck or back injury requiring admission to such hospital, the hospital will notify the CarePoint on-call physician who will arrange for admission and treatment of the patient.
b. When an employee receives treatment at a CarePoint facility or by a CarePoint physician and it is determined by such physician that a hospital admission is necessary, CarePoint will arrange for the admission and treatment of such employee.
L. Status Reports
1. CarePoint will provide a status report, to the claims administrator designated in writing by the City, after each hospital or office visit. Such report will delivered by facsimile or courier, as may be requested in writing, by the City’s plan administrator. Type written reports will be sent by facsimile to the claims administrator designated by City the day following the appointment.
SECTION TWO QUALITY CONTROL A. Business Operations
1. All CarePoint health care providers will be credentialed in their respective specialties. 2. All licenses, insurance policies, permits, and the like will be maintained current and be
available for inspection by the City at all reasonable times during ordinary business hours at CarePoint’s Facility.
3. CarePoint will be current on all taxes, fees, and other financial obligations in connection with its operations hereunder.
SECTION THREE RECORD KEEPING A. Management Reports
1. CarePoint will provide, at the request of the City’s plan administrator, the following reports, which will be provided to the plan administrator in a form and format to be determined by coordination between the City’s plan administrator and CarePoint’s program administrator. It is anticipated that this will include:
a. Activity by City Department b. Activity by Patient
c. Activity by Diagnosis (ICD Code) d. Activity by Procedure (CPT Code)
e. Activity by standard cost for services (CarePoint standard fees)
B. Medical Records
1. CarePoint shall maintain medical records for each employee consistent with professional industry standards, including the date of each visit, diagnosis, treatment and such other information as CarePoint deems appropriate for the proper care of such employee. 2. Medical records will be maintained and made available to the employee, City, and such
others as may be authorized to inspect such records in compliance with applicable Federal and State law.
3. CarePoint shall maintain such records for a period of at least six (6) years from the date of treatment (or such greater period as may be required by applicable law).
4. CarePoint shall upon valid written request of the employee or the City provide such parties with a true and legible copy of such records.
5. In the event of termination of this agreement, CarePoint, upon request of the City, will deposit such records in a public warehouse, or such other repository as the City may request. Such transfer shall be at the expense, and at the risk of the City, and upon compliance with such request CarePoint’s obligations with respect to such records shall cease.
6. In the event this agreement is terminated, CarePoint will provide the City with a
cumulative report of its activities hereunder, including an annual summary of the services provided and the reason such services were provided.
C. Monthly Reports
1. CarePoint shall supply the City with monthly reports, delivered to the plan administrator, detailing CarePoint’s activities with respect to the City. Such reports will include the employee’s name, social security number, treating physician, date of visit, diagnostic services provided and diagnosis and the customary cost of such services.
D. Format
SECTION FOUR COMPENSATION A. Fee and Schedule
1. CarePoint’s compensation for the services shall be an annual flat fee of three hundred fifty thousand dollars ($350,000.00) as per its Proposal.
2. The annual flat fee shall be payable in twelve (12) equal monthly installments of twenty-nine thousand one hundred sixty-six dollars and sixty-six cents ($29,166.66) each. The first monthly payment shall be due the first day of the month following the month in which this contract becomes effective.
3. The City shall be afforded a thirty (30) day grace period in payments before it will be in default hereunder.
4. This annual flat fee includes the following curative medical services, each of which is more specifically detailed herein:
a. Diagnostic Services b. Emergency Care c. Primary Care d. Specialist Care B. Exclusions
1. The Annual Flat Fee does not include the following specified exclusions:
a. Care by a physician that is not one of CarePoint’s physicians or a physician selected by CarePoint as a provider for a given service.
b. Services rendered by providers not affiliated with CarePoint as detailed herein (including, by way of example and not of limitation, charges for employees referred by their supervisor or another provider for care). CarePoint may determine, in the best interest of a patient, to authorize selected physicians to provide care in specific cases, and the physician=s fee for such care is included in the services provided under the flat fee. CarePoint will provide the method for this form of authorization to be documented and for the case to be managed.
c. Service not related to the treatment of an occupational injury or exposure. d. Personal health care of employees. Treatment of personal medical problems,
defined as medical problems not directly caused by an employee’s injury as the result of their work for the City. Referrals for personal health care may become required of patients at their own expense or paid by personal insurance when their personal medical problems are otherwise creating an impediment to recovery. e. Health care required due to a violation in following the physician’s orders. This
includes any health care services determined by the treating physician to have resulted from the patient not having followed all of the doctor’s treatment orders. f. Physical therapy services.
g. Any ambulance services or costs for transportation of patients.
hospital inpatients at Christ Hospital or Jersey City Medical Center, when that care is provided by physicians who are employed by Concentra.
i. As regards hospital charges for in-patient or ambulatory services, the primary surgeon’s fees are included in the services provided under the annual fee. By way of example and not of limitation, exclusions of hospital charges for in-patient or ambulatory services would be: required services in the operating room such as the second surgical assistant, anesthesiologist and anesthesia, pathologist and
pathology laboratory evaluation of surgical specimens, pre-admission testing (PAT) required by the hospital.
j. Emergency services delivered in a hospital, health care services in a Hospital. Emergency Room and whenever the Emergency Room admits the patient to the hospital.
k. Replacement of corrective lenses, such as eyeglasses. However, general ophthalmology eye care for injured eyes is included in the annual fee.
l. Pathology services, anesthesia services, unusual ophthalmology services such as retinal surgeons, or very rare medical specialties not routinely provided by CarePoint.
m. Care of injured employees who were injured before CarePoint (when CarePoint first became the provider of the City’s WC care).
n. Treatment of HIV infection and treatment of AIDS.
o. Tetanus vaccinations are included in the annual fee. Most other medications are excluded. Prescriptions may be given to the patients, as needed. Free sample starter medication is included in the flat fee, whenever adequate samples are available
SECTION FIVE
EMPLOYMENT PRACTICES A. Nondiscrimination in Employment
1. In accordance with all applicable New Jersey and Federal statues, including N.J.S.A. 10:5-31 et seq., CarePoint does not and will not discriminate against any employee because of race, creed, color, sex, or national origin and further represents to Jersey City that it will take affirmative action to insure that applicants are employed, and that
employees are treated, without regard to their race, creed, color, sex, or national origin.
SECTION SIX
INDEMNITY & INSURANCE A. Indemnify and Hold Harmless
B. Insurance
1. CarePoint shall maintain at all times throughout the course of this agreement, and any extensions thereof, the following insurance, which coverage shall name, as an additional insured, the City of Jersey City;
a. Commercial General Liability in the amount of $1,000,000 per occurrence and $2,000,000 in aggregate; including Products & Completed Operations coverage. b. Workers Compensation with NJ statutory limits and Employer’s Liability in
the amount of $1,000,000.
c. Medical Malpractice-Professional Liability in the amount of $2,000,000 per occurrence and in aggregate.
SECTION SEVEN CONTRACT TERMS A. Contract Documents
1. The contract documents are this Agreement, the RFP, attached hereto as Exhibit A and incorporated herein by reference; and CarePoint’s Proposal hereto attached herewith as Exhibit B and incorporated herein by reference.
2. These documents are intended to complement and supplement each other. In the event that there is a conflict or discrepancy among the provisions of the Agreement, the City’s RFP and CarePoint’s Proposal, the provisions of this Agreement shall govern over the RFP and CarePoint’s Proposal. The provisions of the RFP shall govern over the provisions of CarePoint’s Proposal.
B. Effective Date and Termination
1. This agreement shall remain in force for a period commencing not later than October 1, 2019 and shall continue through September 20, 2020 unless earlier terminated upon the mutual agreement of the parties or as provided in this SECTION SEVEN.
2. This agreement may be terminated with or without cause at any time during the term hereof by either party upon sixty (60) days’ notice by the terminating party to the non-terminating party.
3. Pursuant to N.J.A.C. 5:30-5.5(c)(2), the continuation of this contract after the expenditure of the funds encumbered in the 2019 fiscal year budget shall be subject the appropriation of funds in the 2020 fiscal year temporary and permanent budgets.
C. Compliance with Affirmative Action Plan
1. If the Agreement exceeds $40,000.00, it shall also be subject to the Affirmative Action Amendments to the Law Against Discrimination N.J.S.A. 10:5-31 et seq.
2. This Agreement shall not become effective and CarePoint shall provide no services under this Agreement until it has executed the following documents:
incorporated herein by reference).
b. An Affirmative Action Employee Information Report (form AA-302) (for contracts which exceed $40,000.00).
D. New Jersey Business Registration Requirements
1. The contractor shall provide written notice to its subcontractors of the responsibility to submit proof of business registration to the contractor.
2. Before final payment on the contract is made by the contracting agency, the contractor shall submit an accurate list and the proof of business registration of each subcontractor or supplier used in the fulfillment of the contract, or shall attest that no subcontractors were used.
3. For the term of the contract, the contractor and each of its affiliates and a subcontractor and each of its affiliates (N.J.S.A. 52:32-44(g)(3)) shall collect and remit to the
Director, New Jersey Division of Taxation, the use tax due pursuant to the Sales and Use Tax Act on all sales of tangible personal property delivered into this State, regardless of whether the tangible personal property is intended for a contract with a contracting agency.
4. A business organization that fails to provide a copy of a business registration as
required pursuant to section 1 of P.L. 2001, c. 134 (C.52:32-44 et seq.) or subsection e. or f. of section 92 of P.L. 1977, c. 110 (C.5:12-92), or that provides false business registration information under the requirements of either of those sections, shall be liable for a penalty of $25 for each day of violation, not to exceed $50,000 for each business registration copy not properly provided under a contract with a contracting agency.
E. City of Jersey City Contractor Pay-to-Play Reform Ordinance
1. This contract was awarded in accordance with the City of Jersey City’s Contractor Pay-to-Play Reform Ordinance, Section 3-51.1 of the City Code. As such the undersigned does hereby attest that Concentra, its subsidiaries, assigns or principals have neither made a reportable contribution in the one year period preceding the date that the City Council awards the contract that would be deemed to be a violation of Section 3-51.1, nor will Concentra, its subsidiaries, assigns or principals make a reportable contribution during the term of the contract that would be in violation of Section 3-51.1
F. City of Jersey City Lobbyist Disclosure Ordinance
disqualified from entering into contracts with the City for a period of two (2) years for each violation.
SECTION NINE MISCELLANEOUS
Notices; any notice, consent or other communication required by, or to be given pursuant to this agreement shall be in writing and shall be deemed delivered if mailed to the intended recipient, postage paid, certified mail, return receipt requested.
Survival; if any of the provisions of this agreement are contrary to the law or regulation, the parties shall by agreement have the right to modify and restructure the provisions thereof in whole or in part such that the covered employee will be able to obtain substantially all of the benefits provided herein or the parties by agreement shall have the right to declare the agreement null and void, in which case, City and CarePoint shall thereafter be relieved of all obligations hereunder.
Choice of Law; this agreement is made in the State of New Jersey under, and subject to, its laws. The laws of New Jersey shall govern and be used for interpretation, construction, and enforcement of the agreement.
Arbitration; in the event of any dispute between the parties hereto with respect to the
construction of the agreement, the parties agree that such dispute shall be settled by arbitration in New Jersey in accordance with the rules of the America Arbitration Association, and judgment upon an award rendered by such arbitration may be entered in any court of competent
jurisdiction.
Defense of City; CarePoint physicians, medical technicians and other staff shall cooperate with City’s Corporation Counsel or any other party designated by City’s Corporation Counsel in the defense of worker’s compensation claims of workers covered by this agreement.
Such cooperation will include, but not be limited to, submission and certification of records, testimony at depositions and/or workers compensation court. The standard fee for professional services involved in these legal cases or legal projects relating to worker’s compensation claims are excluded from the annual fee under this contract. The charges to the City for professional services involved in these legal cases will be the standard hourly fee charged by each physician for his services to the City’s legal advisors. These fees will be separate and apart from this agreement for worker’s compensation curative care and will be billed separately to the City at standard rates for such legal project services.
All expenses for legal services will be charged at cost. In accepting this agreement City agrees to pay the additional fees for CarePoint’s services when requested by the City’s Corporation
are independent contractors and the City will reach agreement with them for these services outside of this agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year first written above.
ATTEST: City of Jersey City
Sean Gallagher Brian Platt
City Clerk Business Administrator
Witness: By:
CarePoint Medical Health Group
Cityoflersey City Bid2007-O02
STATEMENT OF OWNERSHIP DISCLOSURE
N.I.S.A. 52:25—24.2(PL. 1977, 0.33,asamendedbyP.L.2016, (3.43)
Thisstatement shall be completed, certi?edto, and included with all bid and proposal submissions. Failureto submit the required information iscauseforautomaticrejectionofthe bid orproposal.
Name ofOrganization: Organization Address:
CAREPOINTHEALTH
MEDICAL GROUP550NEWARKAVENUE, SUITE 407,JERSEY CITY, NJ 07306
Part I Check the boxthat represents the type ofbusiness organization:
X
SoleProprietorship (skipParts 11and HI,execute certi?cationinPart IV)
Non-Pro?tCorporation (skip Parts H and HI,execute certi?cation in PartIV)
For-Pro?tCorporation(any type) X Limited Liability Company (LLC)
Partnership Limited Partnership LimitedLiability Partnership (LLP)
Other(be speci?c): Part II
The list below contains thenames and addresses of all stockholders in the corporation whoown 10
percentor more ofitsstock,of anyclass,or of all individualpartners in
me
partnershipwhoowna 10 percentor greater interest therein,orof all members in the limited liability company whoown a 10 percentor greater interesttherein,asthecase may be. (COMPLETE THE LIST BELOW INTHIS SECTION)OR
corporation owns 10percent or more ofitsstock, any class,orno individual
l_l —
partner
in
the
partnershipowris
a 10 percentorgreater
interest therein,orno
member
inthe
limited liability company owns a10percent or greater interest therein,asthecase may be. (SKIP TO PART IV)(Please attachadditionalsheets ifmore space isneeded?
Name ofIndividualor Business Entity Home Address (for Individuals) or Business Address
AMRKSPEKTOR, D.0. 550 NEWARKAVENUE,SUITE 407
JERSEYCITY,NJ 07306
Part DI DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLCMEMBERS LISTED 1NPART II
If a bidder has a direct or indirect parent entity which ispublicly traded, and any person holds a 10 percent or greater bene?cial interest in the publicly traded parent entity as of the last annual federal Security and Exchange Commission (SEC) or foreign equivalent ?ling, ownership disclosure can be met by
providing links to the website(s) containing the last annual ?ling(s) with the federal Securities and
City of Jersey City Bid 20O7'006
(REVISED 4/13)
EXHIBIT A
MANDATORY EQUALEMPLOYNIENT OPPORTUNITY LANGUAGE
N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127) N.J.A.C. 17:27
GOODS,PROFESSIONAL SERVICE AND GENERGAL SERVICE CONTRACTS
During the performanceof thiscontract, thecontractor agrees as follows:
Thecontractor or subcontractor,Whereapplicable, willnot discriminate against any employeeor
applicantfor employment because ofage, race, creed, color,national origin,ancestry, marital
status, affectionalor sexualorientation,genderidentity orexpression, disability, nationality or sex. Exceptwithrespect to affectionalorsexual orientationand gender identity or expression, the contractor willensure that equalemploymentopportunity is affordedto suchapplicantsin recruitment and employment, and that employeesare treatedduring employment,withoutregard
to theirage, race, creed, color,nationalorigin,ancestry, maritalstatus, affectionalor sexual
orientation, gender identityor expression,disability, nationality or sex. Such equal employment
opportunity shallinclude, butnot belimitedtothefollowing: employment, upgrading, demotion
or transfer; recruitmentorrecruitmentadvertising; layoff ortermination;rates ofpay or other
forms ofcompensation; andselection for training, including apprenticeship.Thecontractor
agreesto post in conspicuousplaces, availableto employees andapplicantsfor employment, noticesto beprovidedbythe PublicAgency ComplianceOfficer setting forthprovisionsofthis
nondiscrimination clause.
Thecontractor or subcontractor, where applicableWill,in all solicitationsor advertisements for employeesplaced byor onbehalf ofthe contractor, state that all quali?ed applicants will receive
’
considerationfor employmentwithoutregardto age, race, creed, color,nationalorigin,ancestry,
maritalstatus, affectional or sexual orientation,gender identity or expression,disability, nationality or sex
Thecontractor or subcontractorwill sendto eachlabor union,withwhichit has acollective
bargaining agreement, anotice,to beprovidedbythe agency contracting of?cer, advising the labor union of the contractor’s commitmentsunder thischapter andshallpost copies of the notice in conspicuousplacesavailableto employeesandapplicants for employment.
Thecontractor orsubcontractor,where applicable,agrees to complywithanyregulations
promulgatedby the Treasurer pursuant to N.J.S.A. 10:5-31et seq., as amendedand
supplemented?om timeto timeand the Americans with DisabilitiesAct.
Thecontractor or subcontractoragrees to make good faith efforts to meet targeted county
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2015o421o9502213a
STATE
OF
NEW JERSEY
BUSINESSREGISTRATION
CERTIFICATE
NEWJERSEYMEDICALANDHEALTH ASSOCIATES,LLC CAREPOINTHEALTHMEDICALGROUP
10EXCHANGEPLACE,ISTHFLOOR
JERSEYCITY, NJ 07302 ‘ Certificate Nunxber:' 1878.959 Iuue05, 2014 April21.2015
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Taxpayer Name:“
Trade Name:,‘
Address: V Effebtive Date.-Date ofIssuance:,SUPPLIER DIVERSITY BIDDER QUESTIONNAIRE
TheCity ofJersey Cityis committedto ensuring that its utilization ofvendorsre?ects the diversityofits community. Please complete thisform to assistuswithmonitoringoursupplier diversity performance.
Business Name: CAREPOINTHEALTHl\/IEDICAL GROUP
Address: 550NEWARKAVENUESUITE 407 JERSEY CITY.NJ 07306
Phone: TEL# 201-656-8700
Email: MELISSA.CRECCO@CAREPO]NTHEALTH.ORG
Contact Name: MELISSA CRECCO
Please Indicate if your business gualifies any ofthe following: (See de?nitions for clari?cation)
Minority Owned Women Owned
:
Veteran OwnedDisability Owned
Lesbian,Gay, Bisexual, Transgender Owned
,—/
Ls/_]None
Please indicate ifyour business is currently certi?ed by an authorized certifying body as any of the
following:
Minority BusinessEnterprise
Woman Business Enterprise Veteran Business Enterprise
DisabilityOwnedBusiness Enterprise
Lesbian,Gay,Bisexual, Transgender Business Enterprise Disadvantaged BusinessEnterprise
Small BusinessEnterprise
City ofJersey City Bid2007»OO2
CITY OF JERSEY CITY
ADDENDUM ACKNOWLEDGMENT FORM
GOODS ANDGENERALSERVICESCONTRACTS
Theundersigned acknowledges receipt of the following addendato the Request For
Proposal: WORKERS COMPENSATION PRIMARYCARE PHYSICIAN
THE COMPLETED ACKNOWLEDGMENT OF ADDENDAFORM SHOULD BE
RETURNED WITH PROPOSAL PACKAGE: NOT TO BE SENTSEPARATELY
NOTE: Failureto acknowledge receiptof all addendawillcause theproposalto be considered
non—responsive,and the proposal willberejected. Acknowledgementofreceiptofeach addendum
must beclearlyestablished and includedwiththeproposalpursuantto N.J.S.A. 4OA:11-23 .2 (e).
Addendum No. Dated
Addendum No. Dated
Addendum No. Dated
Name ofCompany: Carepoint HealthMedical Group
Street Address: 550 Newark Avenue.Suite 407
City, State, Zip Jersey Citv, NewJersev 07306
Authorized