Vers.: Aug. 5, 2019
AMENDMENT NO. 1 TO CONTRACT NO. S22183286
BETWEEN THE CITY OF PALO ALTO AND
THE PERMANENTE MEDICAL GROUP, INC, (“TPMG”)
This Amendment No. 1 (this “Amendment”) to Contract No. S22183286 (the “Contract” as defined below) is entered into as of April 14, 2025, by and between the CITY OF PALO ALTO, a California chartered municipal corporation ( “CITY”), and THE PERMANENTE MEDICAL GROUP, INC, (“TPMG”) , a California corporation , located at 950 Franklin Street, Oakland, California, 94612 (“CONSULTANT”). CITY and CONSULTANT are referred to collectively as the “Parties” in this Amendment.
R E C I T A L S
A. The Contract (as defined below) was entered into by and between the Parties hereto for the provision of pre -employment occupational medical services , as detailed therein.
B. The Parties now wish to amend the Contract in order to add more budget funding for occupational medical services by increas ing compensation by One Hundred Thousand Dollars ($100,000) from Fifty Thousand Dollars to a new total not to exceed value of One Hundred Fifty Thousand Dollars ($150,000) and extend the term by 12- months, changing expiration date from June 14, 2025, to June 14, 2026.
NOW, THEREFORE, in consideration of the covenants, terms, conditions, and provisions of this Amendment, the Parties agree:
SECTION 1. Definitions. The following definitions shall apply to this Amendment:
a. Contract. The term “Contract” shall mean C ontract No. S22183286 between CONSULTANT and CITY, dated June 15, 2022, as amended by:
b. Other Terms. Capitalized terms used and not defined in this Amendment shall have the meanings assigned to such terms in the Contract.
SECTION 2. Section 2 “TERM.” of the Contract is hereb y amended to read as follows:
“The term of this Agreement shall be from the date of its full execution through June 14, 2026 unless terminated earlier pursuant to Section 19 (Termination) of this Agreement.”
Docusign Envelope ID: 5CD9601C-7E91-486F-9B0F-5335ABD0B346 Vers.: Aug. 5, 2019
SECTION 3. Section 4 “NOT TO EXCEED COMPENSATION” of the Contract is hereby amended to read as follows:
“The compensation to be paid to CONSULTANT for performance of the Services shall be based on the compensation struc ture detailed in Exhibit C, entitled “COMPENSATION,” including any reimbursable expenses specified therein, and the maximum total compensation shall not exceed One Hundred Fifty Thousand Dollars ($ 150,000.00). The hourly schedule of rates, if applicable, is set out in Exhibit C -1, entitled “SCHEDULE OF RATES.” Any work performed or expenses incurred for which payment would result in a total exceeding the maximum compensation set forth in this Section 4 shall be at no cost to the CITY. CITY shall monitor the total amount of payments owed to CONSULTANT and shall immediately notify CONSULTANT when the maximum payment amount permitted under this Agreement is reached. Notwithstanding anything to the contrary in this Agreement, CITY shall be liable for and pay CON SULTANT for any services provided by CONSULTANT before CITY notified CONSULTANT of the reaching of the maximum payment amount permitted under this Agreement.”
SECTION 4. The following exhibit(s) to the Contract is/are hereby amended or added, as indicated below, to read as set forth in the attachment(s) to this Amendment, which is/are hereby incorporated in full into this Amendment and into the Contract by this reference:
a. Exhibit “C-1” entitled “SCHEDULE OF RATES”:
The Exhibit C-1 attached to the Original Agreement is hereby deleted in its entirety and replaced with the fee schedule attached hereto as Exhibit C-1.
SECTION 5. Legal Effect. Except as modified by this Amendment , all other provisions of the Contract, including any exhibits thereto, shall remain in full force and effect.
SECTION 6. Incorporation of Recitals . The recitals set forth above are terms of this Amendment and are fully incorporated herein by this reference.
Docusign Envelope ID: 5CD9601C-7E91-486F-9B0F-5335ABD0B346 Vers.: Aug. 5, 2019
EXHIBIT C-1
SCHEDULE OF RATES
Billing Code Description of Services Cost of Services
PREPLACEMENT EXAM (PP3)
300388 Preplacement Physical Exam $65.00
As Employer Requested:
86580 PPD, 1 step, placement and reading $20.00
300415 Respirator Med Clearance/OSHA $35.00
92552 Audiogram, screening $54.00
As Clinically Indicated:
71045 Chest X-Ray, 1 view $55.00
71046 Chest X-Ray, 2 views $75.00
94010 Spirometry $60.00
93000 EKG, resting $50.00
93015 Cardiac Stress Test with Treadmill $230.00
36415 Venipuncture $15.00
86706 Titer: Hepatitis B Surface Antibody (HBsAb) $35.00 90746 Vaccine: Hepatitis B, may need series of 3 injections $130.00/injection 300408 Physician consultation, each 15 minutes $64.00/15 mins
POLICE/SHERIFF PREPLACEMENT EXAM (POSTPP)
300399 POST Physical Exam $127.00
92552 Audiogram, screening $54.00
94010 Spirometry $60.00
93000 EKG, resting $50.00
93015 Cardiac Stress Test with Treadmill $230.00
86480 QuantiFERON $145.00
80053 Chem Comprehensive Panel $41.00
85025 CBC with automated differential $20.00
86706 Titer: Hepatitis B Surface Antibody (HBsAb) $35.00 86704 Titer: Hepatitis B Core Antibody (HBcAb) $31.00
86803 Titer: Hepatitis C Antibody Screen $56.00
86708 Titer: Hepatitis A IgG Antibody (HAAb) $40.00
36415 Venipuncture $15.00
As Employer Requested:
300411 Collection for Drug Screen-Preferred Alliance Billed by Preferred Docusign Envelope ID: 5CD9601C-7E91-486F-9B0F-5335ABD0B346 Vers.: Aug. 5, 2019
Alliance
As Clinically Indicated:
90746 Vaccine: Hepatitis B, may need series of 3 injections $130.00/injection 90632 Vaccine: Hepatitis A, may need series of 2 injections $114.00/injection 90636 Vaccine: Twinrix (Hep B and Hep A combo), series of 3 injections
$191.00/injection
90707 Vaccine: Measles Mumps Rubella (MMR), may need
series of 2 injections
$103.00/injection
90716 Vaccine: Varivax (Varicella or Chickenpox), may need series of 2 injections
$152.00/injection
90715 Vaccine: Tdap $63.00
90658 Vaccine: Influenza (when seasonally available) $20.00 86735 Titer: Mumps Antibody Screen $35.00
86762 Titer: Rubella Antibody Screen (German Measles) $35.00 86765 Titer: Rubeola Antibody Screen (Measles) $35.00
86787 Titer: Varicella (Varicella or Chickenpox) Antibody Screen
$35.00
81001 Urinalysis with microscopy $16.00
71045 Chest X-Ray, 1 view $55.00
71046 Chest X-Ray, 2 views $75.00
75571 Cardiac calcium scoring CT scan $265.00
300408 Physician Consultation, each 15 minutes $64.00/15 mins
FIREFIGHTER PREPLACEMENT EXAM (FFPP)
300398 Firefighter Physical Exam $127.00
92552 Audiogram, screening $54.00
94010 Spirometry $60.00
85025 CBC with automated differential $20.00
80053 Chem Comprehensive Panel $41.00
36415 Venipuncture $15.00
71046 Chest X-Rays (2 views, PA & Lateral) $75.00
86480 QuantiFERON $145.00
93000 EKG, resting $50.00
93015 Cardiac Stress Test with Treadmill $230.00
86706 Titer: Hepatitis B Surface Antibody (HBsAb) $35.00 86704 Titer: Hepatitis B Core Antibody (HBcAb) $31.00
86803 Titer: Hepatitis C Antibody Screen $56.00
86708 Titer: Hepatitis A IgG Antibody (HAAb) $40.00
As Clinically Indicated:
Docusign Envelope ID: 5CD9601C-7E91-486F-9B0F-5335ABD0B346 Vers.: Aug. 5, 2019
90746 Vaccine: Hepatitis B, may need series of 3 injections $130.00/injection 90632 Vaccine: Hepatitis A, may need series of 2 injections $114.00/injection 90636 Vaccine: Twinrix (Hep B and Hep A combo), series of 3 injections
$191.00/injection
90707 Vaccine: Measles Mumps Rubella (MMR), may need
series of 2 injections
$103.00/injection
90716 Vaccine: Varivax (Varicella or Chickenpox), may need series of 2 injections
$152.00/injection
90715 Vaccine: Tdap $63.00
90658 Vaccine: Influenza (when seasonally available) $20.00 86735 Titer: Mumps Antibody Screen $35.00
86762 Titer: Rubella Antibody Screen (German Measles) $35.00 86765 Titer: Rubeola Antibody Screen (Measles) $35.00
86787 Titer: Varicella (Varicella or Chickenpox) Antibody Screen
$35.00
81001 Urinalysis with microscopy $16.00
86580 PPD, 1 step, placement and reading $20.00
300422 PPD, 2 step, 2 placements and readings $30.00
71045 Chest X-Ray, 1 view $55.00
75571 Cardiac calcium scoring CT scan $265.00
300408 Physician Consultation, each 15 minutes $64.00/15 mins
HAZMAT BASELINE / ANNUAL / PERIODIC (HAZ)
300393 Hazardous Worker Exam $106.00
92552 Audiogram, screening $54.00
94010 Spirometry $60.00
80053 Chem Comprehensive Panel $41.00
85025 CBC with automated differential $20.00
36415 Venipuncture $15.00
As Clinically Indicated:
71046 Chest X-Ray, 2 views $75.00
93000 EKG, resting $50.00
93015 Cardiac Stress Test with Treadmill $230.00
300408 Physician Consultation, each 15 minutes $64.00/15 mins
RESPIRATOR BASELINE / PERIODIC (RESP)
300415 Review of OSHA Respirator Questionnaire by
MD/NP/RN
$35.00
As Clinically Indicated:
Docusign Envelope ID: 5CD9601C-7E91-486F-9B0F-5335ABD0B346 Vers.: Aug. 5, 2019
300391 Respirator Clearance Physical Exam $64.00
94010 Spirometry $60.00
71046 Chest X-Ray (2 views) $75.00
93000 EKG, resting $50.00
93015 Cardiac Stress Test with Treadmill $230.00
300408 Physician Consultation, each 15 minutes $64.00/15 mins
AUDIOGRAM (AUDIO)
92552 Audiogram, screening $54.00
As Clinically Indicated:
300408 Physician Consultation, each 15 minutes $64.00/15 mins
DMV/DOT EXAM (DMV/DOT)
300390 DMV/DOT Physical Exam $115.00
As Clinically Indicated:
92552 Audiogram, screening $54.00
URINE DRUG AND BREATH ALCOHOL TESTING (DRUG)
300411 Collection for Drug Screen-Preferred Alliance Billed by Preferred Alliance
As Indicated:
82075 Breath Alcohol Testing (BAT) – Preferred Alliance Billed by Preferred Alliance
300421 Breath Alcohol Testing (BAT), Confirmatory –
Preferred Alliance
Billed by Preferred
Alliance
VACCINATION ONLY (VAX)
300406 History/Review of Tests/Brief Screen - No Physical Exam
$42.00
As Clinically Indicated:
90746 Vaccine: Hepatitis B, may need series of 3 injections $130.00/injection 90632 Vaccine: Hepatitis A, may need series of 2 injections $114.00/injection 90636 Vaccine: Twinrix (Hep B and Hep A combo), series of 3 injections
$191.00/injection
90707 Vaccine: Measles Mumps Rubella (MMR), may need
series of 2 injections
$103.00/injection
90716 Vaccine: Varivax (Varicella or Chickenpox), may need series of 2 injections
$152.00/injection
90715 Vaccine: Tdap $63.00
Docusign Envelope ID: 5CD9601C-7E91-486F-9B0F-5335ABD0B346 Vers.: Aug. 5, 2019
90658 Vaccine: Influenza (when seasonally available) $20.00 90675 Rabies Vaccine, series of 3 injections $579.00/injection
LABORATORY ONLY (LAB)
300406 History/Review of Tests/Brief Screen - No Physical Exam
$42.00
36415 Venipuncture $15.00
As Clinically Indicated:
86706 Titer: Hepatitis B Surface Antibody (HBsAb) $35.00 86708 Titer: Hepatitis A IgG Antibody (HAAb) $40.00
86735 Titer: Mumps Antibody Screen $35.00
86762 Titer: Rubella Antibody Screen (German Measles) $35.00 86765 Titer: Rubeola Antibody Screen (Measles) $35.00
86787 Titer: Varicella (Varicella or Chickenpox) Antibody Screen
$35.00
86382 Titer: Rabies Antibody Testing $43.00
TB CLEARANCE PPD/QUANTIFERON (PPD/TB CLEARANCE)
86580 PPD, 1 step, 1 placement and reading
-OR-
$20.00
86480 QuantiFERON $145.00
As Clinically Indicated:
36415 Venipuncture $15.00
300422 PPD, 2 step, 2 placements and readings $30.00
71045 Chest X-Ray, 1 view $55.00
71046 Chest X-Ray, 2 views $75.00
99211 Brief encounter with non-MD Provider (PPD-Review
of Symptoms Form)
$25.00
(SIGNATURE BLOCK FOLLOWS ON THE NEXT PAGE.)
Docusign Envelope ID: 5CD9601C-7E91-486F-9B0F-5335ABD0B346 Vers.: Aug. 5, 2019
SIGNATURES OF THE PARTIES
IN WITNESS WHEREOF, the P arties have by their duly authorized representatives executed this Amendment effective as of the date first above written.
CITY OF PALO ALTO
City Manager
APPROVED AS TO FORM:
City Attorney or Designee
THE PERMANENTE MEDICAL
GROUP, INC, (“TPMG”)
By:
Name:
Title:
Docusign Envelope ID: 5CD9601C-7E91-486F-9B0F-5335ABD0B346 Amanpreet Dhillon
Regional Medical Director OHSS