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4.20 4.20 2024 ORGANIZATIONAL MEETING\Standard Medical Division of Mountain Medical Services-Drug Testing&Physicals RESOLUTION AUTHORIZING AGREEMENT BETWEEN TOWN OF QUEENSBURY AND STANDARD MEDICAL TESTING SERVICES, A DIVISION OF MOUNTAIN MEDICAL SERVICES, FOR PROVISION OF CERTAIN HEALTH CARE SERVICES DURING 2024 RESOLUTION NO.: ,2024 INTRODUCED BY: WHO MOVED ITS ADOPTION SECONDED BY: WHEREAS, the Queensbury Town Board wishes to enter into an Agreement with Standard Medical Testing Services, a division of Mountain Medical Services, (SMTS) for provision of certain healthcare services such as physical exams and substance testing in accordance with Federal Motor Carrier Safety Regulations (FMCSR)for the Town during 2024, and WHEREAS, SMTS has offered to perform such services in accordance with the terms and provisions of the Contractual Agreement presented at this meeting, NOW, THEREFORE, BE IT RESOLVED, that the Queensbury Town Board hereby approves and authorizes the Contractual Agreement between the Town of Queensbury and Standard Medical Testing Services, a division of Mountain Medical Services, for provision of certain healthcare services such as physical exams and substance testing for the Town during 2024 in substantially the form presented at this meeting,with the costs for such services to be paid for from the appropriate accounts, and BE IT FURTHER, RESOLVED, that the Town Board further authorizes and directs the Town Supervisor to execute the Contractual Agreement in substantially the form presented at this meeting and any other needed documentation and the Town Supervisor and/or Town Budget Officer to take any other actions necessary to effectuate the terms of this Resolution. Duly adopted this I'day of January, 2024,by the following vote: AYES Mr. Metivier, Mr. Freer, Mr. Dixon, Mr. McNulty, Mr. Strough NOES None ABSENT: None -+rN 1ur ` ;S ectical ,services � , , I"C? UNTAIiPQ M1E ICAIL Contractual Agreement This agreement is made between Standard Medical Testing Services, a division of Mountain Medical Services, located at 597 Bay Road, Queensbury, NY 12804 and with the Town of Queensbury Attn: Victoria Eberlein having an address at 742 Bay Rd Queensbury, NY 12804. This agreement shall be in effect from January 1 , 2024 - Dec 310 2024, The responsibilities and obligations and liabilities shall survive the term of this agreement. This agreement may be canceled by either party after thirty days of written notification. Both parties to this agreement are independent contractors, and nothing contained herein shall be construed to place the parties in the relationship of partners, joint venture, principal-agent or employer-employee, and neither party shall have the power to obligate or bind the other whatsoever beyond the terms of this agreement. Standard Medical Testing Services, a division of Mountain Medical Services, will be compensated for its services as follows: Yearly Administrative Fee: 10 or more employees $150.00 9 or less employees $ 80.00 Urine Drug Screens, 5 panel Dot $ 49.00 Urine Drug Screen, 10 panel expanded $ 52.00 Alcohol Breath Testing $ 38.00 JPA/Functional Capacity $ 70.00 DOT/CDE Physicals they do not pay for Hap B Vaccine $120.00 Audiogram $ 45.00 Fit For Duty, PE $110,00 Respirator PE, includes PFT & Fit $ 140,00 Ppd $45.00 Resp Fit Test $35600 Ostia Review $40.00 Observed Urine Collection $40.00 *All Vaccineslshots prices are subject to change due to market value* In addition, should there be after hours, post accident testing/reasonable suspicion, there shall be a flat rate fee of $120.00 per hour with a minimum two hour charge. Also there will be a mileage charge of 56.5 cents per mile applied. Shy Bladder wait time is $40.00 per hour, Including after 4:30 pm closing time. The fee for split specimen re-testing of positive specimens (including shipping, lab fees and chain of custody) shall be $250.00. The review of all Positive drug screens will be $100.00, regardless of final outcome. This Includes the MRO time for contacting physicians, donors and specialists whom the employee is being treated by. Payment of invoices is expected within 30 days of receipt of Invoice payable to Mountain Medical Services, PO BOX 13395, Belfast Maine, 04915. A late fee/interest fee of 1 .5% monthly will be applied to outstanding invoices over 30 days old. We accept payment online at www.ouickpayi)ortal.com. Code is on invoice. Standard Medical Testing Services, a division of Mountain Medical Services attests that it will keep all information obtained from the Town of Queensbury for the purpose of testing confidential unless otherwise required to disclose said information by applicable law, regulation, or subsequent agreement. The provisions of the Agreement shall be construed, interpreted and governed by the substantive laws of the state of New York, including all matters of construction, validity and performance. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed as of the day and year executed below: Standard Medical Testing Services Merrie Lynn Towle, BSN Mountain Medical Services Town of Queensbury Dr. Michael P. M. Pond, MD Name: A2214'7 Name: Title: Director of ©ccupational Medicine Title: Date: l. . '17 - Date: Please execute this agreement, retain the original, and forward a duplicate to Standard Medical Testing Services at 597 Bay Road, Queensbury, NY 12804. Mon-Thor 8-4 & Fri 8-3 Standard Medical Testing Services Mountain Medical Services A division of Mountain Medical Merrie Lynn Towle, BSN Michael Pond, MD/MRL3 597 Bay Road 1927 Saranac Avenue Queensbury, NY 12804 Lake Placid, NY 12945 518-744-6560 518-523-7575 fax: S18-409-8441 FAX: S18-523-7577 www.standardmedicalservices.com www.mountainmedical,net standardmedicalservicesC 8mail.com 3S4 Broadway, Saranac Lake, NY 12983 2 Hospital Drive, Massena, NY 13662 3372 St. Rte. 110 Suite H, Malone, NY 12953 r1 r '•- ,c"� d ed�2' �er�iees h�101JNTAIN MECAI +CAAgoo Consortium Certificate Agreement According to the US Department of Transportation rules and regulations, a company must implement a drug and alcohol testing program. Included In these regulations are requirements that owner-operators.small motor carriers or municipalities must join a consortium to handle testing procedures, and under 392,401 Q (6)(1), you must have a written agreement from the consortium on file. Standard Medical Testing Services/Mountain Medical has agreed to act as the consortium. I hereby certify I am knowledgeable of the requirements for conducting urine collection, the duties of the Medical Review Officer, Breath Alcohol Technician, the Substance Abuse Professional, and the use of DHHS certified laboratory, and all the requirements of the U5 Department of Transportation regulations, 49 CFR Part 40. 1 further certify that I am familiar with the random selection requirements and have on file all documents required by 382 and I will provide those documents In case of an audit from the US Department of Transportation on one of my clients. I hereby agree to comply with all such regulations governing the procedures In performing drug and alcohol testing for the below listed owner-operator/motor carrier/municipality. Name of Owner-operator/M,t, nicir)aMmIMotor Carrier: _ Address of Owner-orseratQr/MunirjpalitytMotor Qrrjer. Phone NUmben P d Contact Person: F.mall Address: ---------------------- Dated This Day of Year Signature 2 g;2asor iuM Official: ❑ Mountain Medical Services * 597 Bay Road Queensbury, NY 12804 518-744-6560 f: 518-40943841 m-yrmstandardmedicalservices.com gtandai-dmeWcaLls4.rvfces g emaiLcom ❑ Mountain Medical Services * 1927 Saranac Ave Cake Placid, NY 12983 51,8-523-7577 www.mountalumedical.net ❑ Mountain Medical Services * 354 Broadway Saranac Cake, NY 12983 518497-10Dd ❑ Mountain Medical Services *2 hospital Drive, Marssena, NY 13662 5184214322 0 Mountain Medical Services 103372 St:. late. 11, Suite H Malone, NY 12953 315-70S-0700 Please execute this agreement retain the original, and forward a duplicate to Standard Medical Services at the 597 Bay Road Queensbury, NY for our files, Email Is great ''•-_. Medico Semis ^ACi [JNTo&% f1 /#*4EC> ICA►L Company Designated Em,pr,�Q.ym Renresentaflye Form Date: Company Name: Company Address: Company MallingBilifing Address (if di$erent)0 HOW WOULD YOU LIKE RESULTS: Emalled Fared . MaUed "M "Mooed' optfon is chosen there wM be a t time addidonat fee added to oLtr servhm of SsoAo** AEU INFORMATION BELOW IS MANDATORY - WE NEED 2 DER'S Primary DER (Designated Employer Rep) Alternate DER (Designated Employer Rep) Name- Names• Company Phone: Company Phones Company Fax: Company Far: DER Cell Phone: DER Cell Phone: DER Home Phone: DER Home Phone: DER a mafl• DAR a mail: An part of our Drug dig Alcohol gr0igraink t10 keep us updated on goer current Vot of Drivers whether it be DOLT or NON DC M As well as anid new hires or or rethmes. Please staid current list with drivexs "comm se " back with the sIgned cantracL As needed email its txpdat+es. standardmedicalservicesOgmagucom ❑ Mountain Medical Services * S97 Bray Road Queensbury, MY 12804 518-7444560 Co S1.84094W41 ❑ Mountain Medical Services . 1927 Saranac Ave Lake Placid, MY 12993 518=323-7577 lyffWAMOUnte ❑ Mountain Medical Services ' 354 Broadway Saranac Lake, MY 12983 SIB-897=1000 D Mountain Medical services *2 FEospital orive, Masserake MY I2562 sl"214322 O Mountain Medical Services *3372 St. Rte. 11, suite H, Malone, MY 129SS 315-705•0700