HomeMy WebLinkAbout026-26 RESOLUTIONPage 1
113 West Mountain Street
Fayetteville, AR 72701
(479) 575-8323
Resolution: 26-26
File Number: 2025-2744
A RESOLUTION TO APPROVE A SERVICES AGREEMENT WITH WASHINGTON REGIONAL
MEDICAL SYSTEM IN THE AMOUNT OF $585.00 PER PERSON FOR ONE YEAR WITH A MAXIMUM
TWO PERCENT ANNUAL INCREASE AND AUTOMATIC RENEWALS FOR UP TO FOUR ADDITIONAL
YEARS TO PROVIDE MEDICAL EXAM AND TESTING SERVICES FOR THE FAYETTEVILLE FIRE
DEPARTMENT
WHEREAS, the Fayetteville Fire Department Wellness Program policy requires that an annual medical evaluation be
conducted using the standard developed by the National Fire Protection Association (NFPA); and
WHEREAS, the standard developed by NFPA is designed to detect physical or medical conditions that could
adversely affect a firefighter’s ability to safely perform the essential job tasks; and
WHEREAS, the Fayetteville Fire Department Wellness Fitness Committee developed the desired performance
objectives for the physician that will administer the annual medical evaluations based on the components of the medical
evaluations detailed by the NFPA, as well as the operational needs of the fire department; and
WHEREAS, pursuant to Ark. Code Ann. § 19-61-103(14)(H), “fees, including medical fees and physician fees” are
exempt from competitive bidding requirements.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE,
ARKANSAS:
Section 1: That the City Council of the City of Fayetteville, Arkansas hereby authorizes Mayor Rawn to sign a
Services Agreement with Washington Regional Medical System in the amount of $585.00 per person for one year with
a maximum two percent annual increase and automatic renewals for up to four additional years to provide medical
exam and testing services for the Fayetteville Fire Department.
PASSED and APPROVED on January 6, 2026
Approved:
_______________________________
Molly Rawn, Mayor
Attest:
_______________________________
Kara Paxton, City Clerk Treasurer
Mailing address:
113 W. Mountain Street
Fayetteville, AR 72701
www.fayetteville-ar.gov
CITY COUNCIL MEMO
2025-2744
MEETING OF JANUARY 6, 2026
TO: Mayor Rawn and City Council
THROUGH: Brad Hardin, Fire Chief
FROM: Granville Wynn, Fire Operations Manager
SUBJECT: Staff requests City Council approval and the Mayor’s signature on a Services
Agreement with Washington Regional Medical System to provide medical exam and
testing services for the Fayetteville Fire Department in the amount of $585 per person
for one year with a maximum two percent annual increase allowed with automatic
renewals for up to four additional years.
RECOMMENDATION:
Staff requests City Council approval and the Mayor’s signature on a Services Agreement with Washington
Regional Medical System to provide medical exam and testing services for the Fayetteville Fire Department in
the amount of $585 per person for one year with a maximum two percent annual increase allowed with
automatic renewals for up to four additional years.
BACKGROUND:
The Fayetteville Fire Department Wellness Program policy requires that an annual medical evaluation be
conducted using the standard developed by the National Fire Protection Association (NFPA). The 2022 edition
of NFPA 1582-Standard on Comprehensive Occupational Medical Program for Fire Departments, Chapters 7
and 9, detail the required components of the annual comprehensive medical evaluation for fire department
emergency responders. The standard developed by NFPA is designed to detect physical or medical
condition(s) that could adversely affect a firefighter’s ability to safely perform the essential job tasks.
DISCUSSION:
The Fayetteville Fire Department Wellness Fitness Committee developed the desired performance objectives
for the physician that will administer the annual medical evaluations. These performance objectives were
based on the components of the medical evaluations detailed in NFPA 1582, 2022 Edition, as well as the
operational needs of the fire department. Per A.C.A. § 19-61-103, medical fees and physician fees are defined
as an exempt commodity/service under Arkansas Procurement Law.
BUDGET/STAFF IMPACT:
Funds are budgeted in the approved Budget and Work Program each year for this expense. The total cost will
be $585 per person with a maximum two percent annual increase allowed and any itemized tests as required
per the Pricing Overview in Appendix A.
ATTACHMENTS: 3. Staff Review Form, 4. WRMS Contract, 5. Appendix A - WRMS Physical Proposal, 6.
WRMS - Blanket Additional Insured - GL
Page 1
City of Fayetteville, Arkansas
Legislation Text
113 West Mountain Street
Fayetteville, AR 72701
(479) 575-8323
File #: 2025-2744
A RESOLUTION TO APPROVE A SERVICES AGREEMENT WITH WASHINGTON
REGIONAL MEDICAL SYSTEM IN THE AMOUNT OF $585.00 PER PERSON FOR ONE
YEAR WITH A MAXIMUM TWO PERCENT ANNUAL INCREASE AND AUTOMATIC
RENEWALS FOR UP TO FOUR ADDITIONAL YEARS TO PROVIDE MEDICAL EXAM
AND TESTING SERVICES FOR THE FAYETTEVILLE FIRE DEPARTMENT
WHEREAS, the Fayetteville Fire Department Wellness Program policy requires that an annual medical
evaluation be conducted using the standard developed by the National Fire Protection Association
(NFPA); and
WHEREAS, the standard developed by NFPA is designed to detect physical or medical conditions that
could adversely affect a firefighter’s ability to safely perform the essential job tasks; and
WHEREAS, the Fayetteville Fire Department Wellness Fitness Committee developed the desired
performance objectives for the physician that will administer the annual medical evaluations based on
the components of the medical evaluations detailed by the NFPA, as well as the operational needs of the
fire department; and
WHEREAS, pursuant to Ark. Code Ann. § 19-61-103(14)(H), “fees, including medical fees and
physician fees” are exempt from competitive bidding requirements.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS:
Section 1: That the City Council of the City of Fayetteville, Arkansas hereby authorizes Mayor Rawn to
sign a Services Agreement with Washington Regional Medical System in the amount of $585.00 per
person for one year with a maximum two percent annual increase and automatic renewals for up to four
additional years to provide medical exam and testing services for the Fayetteville Fire Department.
City of Fayetteville Staff Review Form
2025-2744
Item ID
1/6/2026
City Council Meeting Date - Agenda Item Only
N/A for Non-Agenda Item
Brad Hardin 12/17/2025 FIRE (300)
Submitted By Submitted Date Division / Department
Action Recommendation:
Staff requests City Council approval and the Mayor’s signature on a Services Agreement with Washington Regional
Medical System to provide medical exam and testing services for the Fayetteville Fire Department in the amount of
$585 per person for one year with a maximum two percent annual increase allowed with automatic renewals for
up to four additional years.
Budget Impact:
1010.300.3020-5314.00 General
Account Number Fund
Project Number Project Title
Budgeted Item?Yes Total Amended Budget $180,700.00
Expenses (Actual+Encum)$-
Available Budget $180,700.00
Does item have a direct cost?Yes Item Cost $77,805.00
Is a Budget Adjustment attached?No Budget Adjustment $-
Remaining Budget $102,895.00
V20221130
Purchase Order Number:Previous Ordinance or Resolution #
Change Order Number:Approval Date:
Original Contract Number:
Comments:Estimated costs based on $585 per person (133 Uniformed Personnel); Total Cost could vary dependent
on any required testing per the itemized listing of testing services in the appendix.
CITY OF FAYETTEVILLE ARKANSAS
City of Fayetteville
Fire Department Physicals
Contract -Between City of Fayetteville, AR
and Washington Regional Medical System
This contract executed this 6th day of January 2026, between the City of Fayetteville, Arkansas
(CITY), of 113 W. Mountain, Fayetteville, AR 72701 and Washington Regional Medical System (WRMS) with
corporate office at 3215 N Northhills Blvd., Fayetteville, AR 72703, in consideration of the mutual covenants
contained herein, the parties agree as follows:
l.Purpose: The purpose of this Contract is to provide the terms and conditions necessary for the medical
physicals for the City of Fayetteville Fire Department (the "Project"), as defined in the scope of work of RFP
25-04, Fire Department Physicals.
2.Contract Documents: The Contract documents which comprise the contract between the City and WRMS
consist of this Contract and the following documents attached hereto, and made a part hereof:
a.Appendix A: WRMS's proposal
b.Appendix B: WRMS's Certificate of Insurance
3.City's Responsibilities:
a.The City shall make available to WRMS, all relevant information or data it has pertinent to the Project
which is required by WRMS to perform the Services. WRMS shall be entitled to rely upon the accuracy
and completeness of all information and data furnished by the City, including information and data
originating with other consultants employed by the City whether such consultants are engaged at
the request of WRMS or otherwise.
b.When requested by WRMS, the City may engage specialist consultants directly to perform items
of work necessary to enable WRMS to carry out the Services. Whether arranged by the City or
WRMS, these services shall be deemed to be provided under direct contracts to the City unless
expressly provided otherwise. If the City chooses not to engage specialist consultants, then the
Parties will work cooperatively to modify the scope of services to reflect any reductions or
additions to the services to be provided by WRMS.
c.The City shall give prompt consideration to all documentation related to the Project prepared by
WRMS and whenever prompt action is necessary shall inform WRMS of City's decisions in such
reasonable time so as not to delay the schedule for providing the Services.
d.The City's Fire Chief is the project representative with respect to the services to be performed under
this Agreement. The Fire Chief shall have complete authority to transmit instructions, receive
information, interpret and define policies and decisions with respect to materials, equipment,
elements and systems to be used, under this Agreement.
City of Fayetteville, AR
Contract: Karas Healthcare
Page 1 of 5
4. WRMS Responsibilities:
a. WRMS shall furnish the necessary qualified personnel to provide the Services. WRMS represents that
it has access to the experience and capability necessary to and agrees to perform the Services with
the reasonable skill and diligence required by customarily accepted professional practices and
procedures normally provided in the performance of the Services at the time when and the location
in which the Services were performed. This undertaking does not imply orguarantee a perfect Project
and in the event of failure or partial failure of the product or the Services, WRMS will be liable only
for its failure to exercise diligence, reasonable care, and professional skill. This standard of care is the
sole and exclusive standard of care that will be applied to measure WRMS's performance. There are
no other representations or warranties expressed or implied made by WRMS.
5. Non -Assignment: WRMS shall not assign its duties under the terms of this agreement without prior written
consent of the City.
6. Indemnification and Hold Harmless:
a. WRMS agrees to hold the City harmless, indemnify, and defend the City against any and all claims for
property damage, personal injury or death, arising from WRMS's performance under this contract.
This clause shall not, in any form or manner, be construed to waive that tort immunity set forth under
Arkansas Law.
b. As the City's sole and exclusive remedy under this contract any claim, demand or suit shall be directed
and/or asserted only against WRMS and not against any of WRMS's employees, officers or directors.
Neither the City nor WRMS shall be liable to the other or shall make any claim for any incidental,
indirect or consequential damages arising out of or connected to this contract or the performance
of the services on this project. This mutual waiver includes, but is not limited to, damages related to
loss of use, loss of profits, loss of income, unrealized energy savings, diminution of property value or
loss of reimbursement or credits from governmental or other agencies.
7. Insurance:
a. WRMS shall furnish a certificate of insurance addressed to the City within ten (10) calendar days after
contract finalization, presenting insurance which shall be maintained throughout the term of the
Contract. If applicable, WRMS shall require any subcontractor to provide insurance. In the event any
employee engaged in work on the project under this contract is not protected under Worker's
Compensation insurance, WRMS shall provide and shall cause each subcontractor to provide
adequate employer's liability insurance for the protection of such of their employees are not
otherwise protected. Worker's Compensation coverage shall be applicable with state law.
WRMS shall carry the following coverages, at minimum:
1. Worker's Compensation Insurance — Statutory Amount
2. Automotive Insurance covering all vehicles and trailers, if applicable
3. General Liability - $1,000,000 each occurrence, $3,000,000 aggregate
City of Fayetteville, AR
Contract: Karas Healthcare
Page 2 of 5
ii. Certificates of Insurance shall list the City as an additional insured. Listing the CITY as a
Certificate Holder only is NOT an acceptable substitute. Certificates of Insurance must
include the endorsements) showing the City listed as an additional insured.
8. Price:
a. WRMS shall perform the services included in this proposal, over the length of 5 years, using the fee
breakdown for services and purchases as identified in Appendix A.
i. Additional services requested that fall outside the scope of this project shall be provided
on a time -and -materials basis, subject to pre -approval.
9. Payments:
a. Payments shall be made after approval and acceptance of each itemized invoice, which shall not be
unreasonably withheld.
b. Unless disputed by the City, payments shall be made 30 calendar days after acceptance of invoice.
Electronic funds transfer is preferred.
10. Terms: This contract shall be effective for one (1) year from City Council approval and shall be automatically
renewable for up to four (4) annual, automatic renewals for a possible contract term of five (5) years.
11. Ownership of Documents:
a. All documents provided by the City are and remain the property of the City. WRMS may retain copies
of documents.
b. WRMS shall retain its rights in its standard document details, specifications, databases, computer
software, and other proprietary property. Rights to intellectual property developed, utilized, or
modified in the performance of the Services shall remain the property of WRMS.
12. Independent Contractor: WRMS is an independent contractor of the City and shall maintain complete
responsibility for applicable state or federal law on unemployment insurance, withholding taxes, social
security, or other industrial, labor or discrimination law for its employees. WRMS is responsible for its agents,
sub -consultants, methods, and operations.
13. Notices: Any notice required to be given under this Agreement to either party to the other shall be sufficient
if addressed and mailed, certified mail, postage paid, delivery, e-mail or fax (receipt confirmed), or overnight
courier.
14. Freedom of Information Act: City of Fayetteville contracts and documents prepared while performing city
contractual work are subject to the Arkansas Freedom of Information Act. If a Freedom of Information Act
request is presented to the City, the contractor will do everything possible to provide the documents in a
prompt and timely manner as prescribed in the Arkansas Freedom of Information Act (A.C.A. 25-19-101 et.
City of Fayetteville, AR
Contract: Karas Healthcare
Page 3 of 5
Seq.). Only legally authorized photo coping costs pursuant to the FOIA may be assessed for this compliance.
15. Termination: This Contract may be terminated by the City or WRMS for any reason with thirty (30) days
written notice. If either party breaches this agreement, the non -defaulting party may terminate this
Agreement after giving seven (7) days' notice to remedy the breach. On termination of this agreement, the
City shall pay WRMS for the services performed through the date of termination within thirty (30) days of
acceptance of final invoice.
16. Changes in Scope or Price: Changes, modifications, or amendments in scope, to this contract shall not be
allowed without a prior formal contract amendment approved by the City in advance of the change in scope.
A maximum of two percent (2%) annual increase shall be allowed without a formal contract amendment.
Increases shall be agreed upon by June 3011 for the following year. No modification of this contract shall be
binding unless made in writing and executed by both parties.
17. Applicable Law: This Agreement shall be governed by and construed in accord with the laws of the State of
Arkansas. Venue for all legal disputes shall be Washington County, Arkansas.
18. Contract Administration: The Mayor or their Designated Representative shall be the Contract Administrator for
this contract. WRMS's Principal or their Designated Representative shall be the primary contact for all matters
pertaining to this contract.
19. Professional Responsibility: WRMS shall exercise reasonable skill, care, and diligence in the performance of
services and will carry out its responsibilities in accordance with customarily accepted professional practices.
20. Permits & Licenses: WRMS shall secure and maintain any and all permits and licenses required to complete
this Contract.
21. Entire Agreement: These Contract documents constitute the entire agreement between the City and WRMS
and may be modified only by a duly executed written instrument signed by the City and WRMS. In the event
of a conflict between the terms of this Contract and the appendices, this Contract shall control.
22. Force Maieure: Any default in the performance of this Agreement caused by any of the following events and
without fault or negligence on the part of the defaulting party shall not constitute a breach of contract: labor
strikes, riots, war, acts of governmental authorities, unusually severe weather conditions or other natural
catastrophe, disease, epidemic or pandemic, or any other cause beyond the reasonable control or
contemplation of either party. Nothing herein relieves the City of its obligation to pay WRMS for services
actually rendered.
23. Severability: In the event that any court of competent jurisdiction shall determine that any provision of this
agreement shall be unenforceable, then that provision shall be deemed to be null and void and the remaining
provisions hereof shall remain in full force and effect.
City of Fayetteville, AR
Contract: Karas Healthcare
Page 4 of 5
01/06/2026
Washington Regional Medical System
City of Fayetteville Fire Department
Firefighter Physical Proposal
Introduction
Washington Regional Medical System (WRMS) submits this proposal to the City of Fayetteville
(City) to provide comprehensive physical examinations for the Fayetteville Fire Department
(FFD). WRMS will designate a single point of contact to serve as the Fire Department Physician
(FDP) for the FFD. In addition, WRMS will appoint a separate point of contact to manage all
other aspects of the agreement, including contract administration, billing, and logistics.
Scope of Services
WRMS Fire Department Medical System Proposal
General Overview
WRMS is available to provide care to fire personnel outside the existing contract, should any
member choose to designate the Fire Department Physician (FDP) or another WRMS physician
as their Primary Care Provider (PCP).
The FDP will work closely with the Fire Department (FFD) to develop a thorough understanding
of the unique health challenges faced by firefighters and will be fully familiar with the current
NFPA 1582 standard and the essential job functions of firefighting personnel. The FFD is
responsible for providing the current NFPA 1582 standard and reviewing it with the FDP.
The FDP will also ensure that all physicians or APRNs conducting firefighter physicals are
properly trained to meet NFPA 1582 requirements.
WRMS can conduct at least three (3) physicals within a compressed timeframe, enabling an
entire fire company to complete evaluations while on duty. WRMS also provides, or partners
with providers for, physical therapy and behavioral health services. The assigned mental health
professional has specific training and experience with emergency responders. Qualifications and
responsibilities are outlined in the Mental Health Professional section below.
Medical Evaluation Scope
WRMS will conduct comprehensive medical evaluations including:
•Medical, Exposure, and Behavioral Health Histories
•Vital Signs: Temp, pulse, respiratory rate, BP (per JNC 7 guidelines)
• HEENT: Full inspection for trauma, abnormalities, vision and hearing (including
audiometry), nasal/oral health, and cancer screening
• Neck: Evaluation of lymph nodes, thyroid, salivary glands, and cervical spine ROM
• Cardiovascular: Pulse, BP, auscultation, signs of CHF (JVP, edema)
• Pulmonary: Respiratory assessment, auscultation, and further exams if clinically
indicated
• Gastrointestinal: Full abdominal exam; digital rectal exam if indicated
• Lymphatic: Cervical, supraclavicular, axillary, and inguinal regions
• Neurological: Mental status, cranial nerves, motor/sensory systems, reflexes,
coordination
• Musculoskeletal: ROM, asymmetries, joint-specific exams as indicated
• Skin: General inspection and cancer screening
• Vision: Near/far acuity, uncorrected/corrected, color vision (e.g., Ishihara)
Laboratory Testing
Blood Tests:
• CBC with differential
• Electrolytes (Na, K, Cl, CO₂)
• Renal: BUN, creatinine
• Glucose
• Liver: ALT, AST, bilirubin, alkaline phosphatase
• Lipids: Total cholesterol, HDL, LDL, triglycerides, ApoB
Urine Tests:
• Dipstick (glucose, ketones, leukocyte esterase, protein, blood, bilirubin)
• Microscopic analysis if indicated
• Occupational exposure screening if indicated
Functional Testing
• Audiometry: Annual thresholds at 500–8000 Hz; compared to baseline; OSHA age
correction applied
• Spirometry: Annual FVC, FEV1, FEV1/FVC; adjusted using NHANES III norms
• Chest X-Ray: Baseline and as medically indicated
• ECG: Annual 12-lead ECG with comparison to baseline and prior results
• Coronary Calcium Score: Baseline, For all new hires over the age of 30 years old
Behavioral Health Screening
Conducted during the annual physical or a separately by licensed mental health professional.
Screens include:
•PTSD
•Major depressive disorder
•Suicidality
•Substance use disorder
Findings will be discussed confidentially with the firefighter and appropriate referrals will be
provided. Mental health care will be coordinated with the Fire Department Physician. Referrals
will be to the Mental Health Professional fulfills the role listed below.
Mental Health Professional
Qualifications:
•Master’s degree in psychology, clinical social work, or equivalent
•Experience with emergency responders
Responsibilities:
•Coordinate care with Fire Department Physician
•Provide psychological wellness services and referrals
•Engage with Fire Department personnel through station visits
•Maintain strict confidentiality
•Support and guide Peer Support Team (PST)
•Assist with incident reviews, intervention planning, and follow-ups
•Develop strategies for stress management and suicide prevention
Note: This section is intended to clearly define the role of the Mental Health Provider. While
WRMS will coordinate care with the designated Mental Health Provider, it holds no further
responsibility for their services. The City of Fayetteville is solely responsible for establishing and
maintaining a separate contractual agreement with the Mental Health Provider.
Optional Testing (not included in “standard testing”)
Covered by the City
• Ultrasounds: Screening may include heart (echo), carotid arteries, aortic aneurysm,
thyroid, liver, spleen, pancreas, kidneys, bladder, gallbladder, pelvic (women), testicular
(men)
o Provider to recommend need and interval for scans.
• Women:
o PAP smear: Every 3 years (21–65 years)
o Mammogram: Biennially (40–50); Annually (50+)
• Men:
o PSA: Annually (40+)
o Prostate occult
• Heavy Metals (provided by the City for Hazmat team member based on exposure): Lead,
Mercury, Arsenic, Cadmium, Chromium
Employee-Paid
• Galleri™ Cancer Screening
• Testosterone
• Apolipoprotein a
• Coronary Calcium Score (when not recommended as part of the standard testing)
Immunizations & Infectious Disease Screening
• Tuberculosis: Baseline and annual (PPD or IGRA)
• Hepatitis C: Baseline, post-exposure, or as requested
• Hepatitis B: Vaccine series and titer per CDC guidelines
• Td/Tdap: Tdap once; Td every 10 years or after 5 years for wounds
• MMR: Two doses if no immunity
• Polio: Single booster (if indicated)
• Hepatitis A: Offered to HAZMAT/USAR and high-risk personnel
• Varicella: Offered to non-immune personnel
• HIV: Baseline, post-exposure, or as requested
Reporting & Documentation
• To Employee: Written summary of health risks, findings, and recommendations to
support long-term wellness
• To Fire Department: Certification of medical clearance or essential job task-specific
restrictions (see NFPA 1582 for list of essential job tasks)
Data Collection (Confidential and Aggregated):
•Illness/injury data
•Tobacco/alcohol use
•Diagnoses, meds, surgeries
•Physical activity levels
•Vitals: BP, height, weight, pulmonary function
•Lab values
•Immunization records
•Audiometry
Pricing Overview
Note: Pricing may not increase more than three percent (3%) annually without formal contract
amendment as described in section 16 of the contract.
Service Price
Annual Physical (includes all standard testing
listed above)
$585
Additional Tests
Coronary Calcium Score $55
Stress Test (VO2 Max) - Not Performed at WRMS.
Refer out to pulmonary
Mammogram - Not performed at WRMS
can refer
Pap Smear $52 Would also have pathology
cost from NWA pathology
Stool Occult $59
Immunizations
Tdap $37.63
Hepatitis A $149.56
Hepatitis B $148.56
MMR $85.58
Varicella $409.46
Polio $46.80
Blood Tests
PSA $25
Galleri
-
Send out Lab. Not offered
by WRMS. Would assist
with finding vendor
Apo A $15 Quest Labs
Heavy Metals:
•Lead
•Mercury
•Arsenic
$Panel
$Panel
$Panel
$35.30
Panel: $158.10 performed
by Quest
•Cadmium
•Chromium
$56.40
Screening Tests
Hep B Titer $13
MMR Titer $105.46
Varicella Titer $44.16
Hep C Virus $48.96
HIV $26.49
Ultrasound
STUDY CPT Price
US CAROTID DUPLEX BILAT 93880 $ 79.48
US AORTA 76775 $ 26.40
US THYROID 76536 $ 46.62
US ABDOMEN COMPLETE (LIVER, SPLEEN, PANCREAS, GALLBLADDER) 76700 $ 49.63
US KIDNEYS/BLADDER 76770 $ 46.27
US
PELVIS 76856+76830 $ 95.35
US SCROTUM 93976 $ 62.77
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other
than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes
effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy
by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
Countersigned by
Authorized Agent
Blanket Addl Insd endst- FF 1 Page 1 of 4
Named Washington Regional Medical System
Insured 3215 N. Northhills Blvd .
and Fayetteville, AR 72703-4424
Address
This endorsement forms a part of Policy No. 3-H000008 issued by the LAMMICO RRG, Inc. and takes
effect as of the effective date of said policy unless another effective date is stated herein.
Effective date 10/1/24. Effective hour is the same as stated in the Declarations of the policy.
BLANKET ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
COMMON CONDITIONS
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other
than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes
effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy
by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
Countersigned by
Authorized Agent
Blanket Addl Insd endst- FF 1 Page 2 of 4
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other
than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes
effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy
by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
Countersigned by
Authorized Agent
Blanket Addl Insd endst- FF 1 Page 3 of 4
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other
than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes
effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy
by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
Countersigned by
Authorized Agent
Blanket Addl Insd endst- FF 1 Page 4 of 4
C.As respects the coverage period provided under this endorsement , Healthcare Facility
Policy Common Conditions, Condition 10. Other Insurance or Risk Transfer Arrangements
is deleted and replaced with the following:
10. Other Insurance or Risk Transfer Arrangements
All other terms and conditions remain unchanged.