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Home My WebLink About2000-09-05 - Agendas - Final FAYETTEVALE • THE CITY OF FAYETTEVILLE, ARKANSAS FINAL AGENDA CITY COUNCIL SEPTEMBER 5, 2000 A meeting of the Fayetteville City Council will be held on September 5, 2000 at 6:30 p.m. in Room 219 of the City Administration Building located at 113 West Mountain Street, Fayetteville, Arkansas. A. CONSENT AGENDA 1. APPROVAL OF THE MINUTES: Approval of the minutes from the August 1 , 2000 meeting. 2. ERNEST LANCASTER DRIVE: A resolution approving a contract for the construction of the "Ernest Lancaster Drive Extension" with Harrison Davis Construction Company in the amount of $243 ,473 .00 with a 15% project contingency of $36,520.00. Authorization for the Mayor to sign the FAA grant upon its arrival and after staff review is also requested. 3, SOLID WASTE BUDGET: A resolution approving a budget adjustment in the amount of $ 126,769 to adjust the personnel services category of the Solid Waste budget. 4. ROLLBACK SETTLEMENT: A resolution approving a budget adjustment to appropriate funds for the rollback of ad valorem taxes lawsuit for the years 1994 through 1999 settlement approved at the City Council meeting on August 1 , 2000. B. OLD BUSINESS 1 , WINGS AIR, INC.: A resolution approving a lease agreement with Wings Air, Inc. for an above ground facility which they will locate south of the terminal building ramp. This will allow self-service fueling by the pilot using a credit card. Annual compensation will be $384.00 for the ground area with three three- year renewal options. Flowage fees will be remitted to the City as set forth in Section 91 . 16 of the Code of Fayetteville. 2. FEE WAIVER: An ordinance waiving Large Scale Development fees for Wings Air, Inc. 113 WEST MOUNTAIN 72701 501521 -7700 FAX 501 575-8257 C. NEW BUSINESS 1 . BOOM LIFT BID WAIVER: An ordinance approving a bid waiver for the purchase of one used self propelled articulated boom lift. This will allow the Mayor to approve the purchase of the unit recommended by the Fleet Operations, Building Maintenance, Parks Division, and the Equipment Committee. 2. 113 S. WILLOW RAZE AND REMOVAL: An resolution approving the raze and removal of the house located at 113 S. Willow Ave. as per Ordinance 3948 . 3, 11 N. WILLOW RAZE AND REMOVAL: An resolution approving the raze and removal of the house located at 11 N. Willow Ave. as per Ordinance 3948. 4, VOLUME BASED GARBAGE: An ordinance amending Ordinance 4111 , 50.2, (B)( 1 )(a) to allow for the distribution of 104 33-gallon bags to households in the year 2001 and future years and implementation of a bag exchange program. 5. BID 00-59: A resolution awarding Bid 00-59 to the only qualified bidder, Phoenix Recycling, for the purchase of plastic garbage bags to be used in the 2001 volume based program in the amount of $306,421 and approval of a budget adjustment in the amount of $ 140,421 . 6. McDONALDS: An ordinance approving a cost-share agreement and a bid waiver in the amount of $90,015 .00 with McDonald's Corporation for the design and widening of approximately 400 feet of Joyce Boulevard and installation of approximately 520 feet of 48" storm pipe along the widened portion of Joyce Boulevard and across Mall Lane. 7, GATHA STEIN REIMBURSEMENT: A resolution authorizing the City to reimburse Ms. Gatha Stein an amount totaling $ 12,350.81 for doctor and hospital costs due to injuries received when Ms. Stein stepped in a hole at Walker Park resulting in breaking both ankles. 8. CAMPBELL-BELL BUILDING PARKING LEASE: A resolution approving a one-year lease agreement with Campbell-Bell Building LLC, for two parking spaces in the parking lot west of the Campbell Bell Building. 9. TED BELDEN PARKING LEASE: A resolution approving a one-year lease agreement with Ted Belden (Campbell-Bell Building) for one parking space in the parking lot west of the Campbell Bell Building. 10, GAIL AND JERRY MOORE PARKING LEASE: A resolution approving a one-year lease with Gail and Jerry Moore (Campbell Bell Building) for two parking spaces west of the Campbell Bell Building. Meeting of SEPTEMBER 5, 2000 vky /2oC.L REYNOLDS �/ ✓ AUSTIN DAVIS ✓ ✓ TRUMBO ✓ ✓ DANIEL ✓ v SANTOS YOUNG r/ ✓ RUSSELL ✓ ,� HANNA REYNOLDS J AUSTIN DAVIS � TRUMBO DANIEL SANTOS YOUNG RUSSELL HANNA Meeting of SEPTEMBER 5, 2000 n ado \ h REYNOLDS ✓ !✓ �/ AUSTIN DAVIS ✓ ✓ ✓ TRUMBO ✓ DANIEL ✓ ✓ �/ SANTOS ✓ ✓ YOUNG ✓ ✓ RUSSELL ✓ / ✓ HANNA REYNOLDS ✓ ✓ ✓ AUSTIN DAVIS ✓ ✓ ✓ TRUMBO ✓ ✓ ✓ DANIEL ✓ ✓ ,/ SANTOS ✓ '� ,i YOUNG !� r RUSSELL ✓ ✓ ✓ HANNA 7-O . • Meeting of SEPTEMBER 5, 2000 ) *D . REYNOLDS AUSTIN DAVIS +� TRUMBO DANIEL SANTOS ✓ YOUNG ✓ RUSSELL ✓ HANNA 7 d REYNOLDS ✓ AUSTIN DAVIS TRUMBO ✓ DANIEL ✓ SANTOS ✓ YOUNG C/ RUSSELL HANNA Meeting of SEPTEMBER 5, 2 00 0\ fz jm o qo REYNOLDS AUSTIN / DAVIS �/ !/ ✓ TRUMBO ✓ ✓ �/ DANIEL ✓ '� ✓ SANTOS '� ✓ ✓ YOUNG v RUSSELL v ✓ HANNA 7—O . 2--b . REYNOLDS AUSTIN DAVIS TRUMBO ✓ DANIEL '✓ SANTOS YOUNG ✓ RUSSELL ✓ HANNA ?- 0 Meeting of SEPTEMBER 5, 2000 REYNOLDS ✓ AUSTIN DAVIS ✓ TRUMBO i/ ✓ ✓ DANIEL ✓ ✓ SANTOS ✓ ✓ ✓ YOUNG ✓ RUSSELL / ✓ ✓ HANNA 7— o . 7 S7 � • REYNOLDS AUSTIN DAVIS TRUMBO DANIEL f SANTOS YOUNG RUSSELL HANNA Meeting of SEPTEMBER 5, 2000 REYNOLDS ✓ AUSTIN DAVIS TRUMBO DANIEL v SANTOS YOUNG ✓ RUSSELL HANNA REYNOLDS AUSTIN DAVIS TRUMBO DANIEL SANTOS YOUNG RUSSELL HANNA Meeting of SEPTEMBER 5, 2000 REYNOLDS/ AUSTIN DAVIS TRUMBO DANIEL SANTOS YOUNG RUSSELL HANNA REYNOLDS AUSTIN DAVIS TRUMBO DANIEL SANTOS YOUNG RUSSELL HANNA FAYETTEVIRLE 0 THE CITY OF FAYETTEVILLE, ARKANSAS FINAL AGENDA CITY COUNCIL SEPTEMBER 512000 A meeting of the Fayetteville City Council will be held on September 5, 2000 at 6:30 p.m. in Room 219 of the City Administration Building located at 113 West Mountain Street, Fayetteville, Arkansas. A. CONSENT AGENDA 1. VeAPPROVAL OF THE MINUTES: Approval of the minutes from the August 1 , f 2000 meeting. 2. ,/ ERNEST LANCASTER DRIVE: A resolution approving a contract for the construction of the 'Ernest Lancaster Drive Extension" with Harrison Davis Construction Company in the amount of $243,473 .00 with a 15% project contingency of $36,520.00. Authorization for the Mayor to sign the FAA grant upon its arrival and after staff review is also requested. _ 3. /SOLID WASTE BUDGET: A resolution approving a budget adjustment in the " amount of $ 126,769 to adjust the personnel services category of the Solid Waste budget. 4. ,/ ROLLBACK SETTLEMENT: A resolution approving a budget adjustment to appropriate funds for the rollback of ad valorem taxes lawsuit for the years 1994 through 1999 settlement approved at the City Council meeting on August 1 , 2000. B. OLD BUSINESS npg5 _ 1. /WINGS AIR, INC.: A resolution approving a lease agreement with Wings Air, Inc. for an above ground facility which they will locate south of the terminal building ramp. This will allow self-service fueling by the pilot using a credit �a3 card. Annual compensation will be $384.00 for the ground area with three three- year renewal options. Flowage fees will be remitted to the City as set forth in Section 91 . 16 of the Code of Fayetteville. 2,/V/ FEE WAIVER: An ordinance waiving Large Scale Development fees for Wings Air, Inc. 7 113WESTMOUNTAIN 72701 501521-7700 FAX 501 575.8257 C. NEW BUSINESS _ °1 1.///BOOM LIFT BID WAIVER: An ordinance approving a bid waiver for the �J(I purchase of one used self propelled articulated boom lift. This will allow the L Mayor to approve the purchase of the unit recommended by the Fleet Operations, Building Maintenance, Parks Division, and the Equipment Committee. 2. ✓ 113 S. WILLOW RAZE AND REMOVAL: An resolution approving the raze and removal of the house located at 113 S. Willow Ave. as per Ordinance 3948. _uy 3. ✓ 11N 0 1N. WILLOW RAZE AND REMOVAL: An resolution approving the raze and removal of the house located at 11 N. Willow Ave. as per Ordinance 3948. 4. ✓y1OLUME BASED GARBAGE: An or ce amending Ordinance 4111 , 50.2, a� (B)(1 )(a) to allow for the distribution of '�3-gallon bags to households in the year 2001 and future years and implementation of a bag exchange program. 5. BID 00-59: A resolution awarding Bid 00-59 to the only qualified bidder, Phoenix Recycling, for the purchase of plastic garbage bags to be used in the 2001 6 '00 volume based program in the amount of $306,421 and approval of a budget /�/adjustment in the amount of $ 140,421 . 6. J✓ JMcDONALDS: An ordinance approving a cost-share agreement and a bid waiver y � in the amount of $90,015 .00 with McDonald' s Corporation for the design and widening of approximately 400 feet of Joyce Boulevard and installation of approximately 520 feet of 48" storm pipe along the widened portion of Joyce Boulevard and across Mall Lane. GATHA STEIN REIMBURSEMENT: A resolution authorizing the City to reimburse Ms. Gatha Stein an amount totaling $ 12,350.81 for doctor and hospital costs due to injuries received when Ms. Stein stepped in a hole at Walker Park resulting in breaking both ankles. CAMPBELL-BELL BUILDING PARKING LEASE: A resolution approving a one-year lease agreement with Campbell-Bell Building LLC, for two parking k Yn� spaces in the parking lot west of the Campbell Bell Building. TED BELDEN PARKING LEASE: A resolution approving a one-year lease bL agreement with Ted Belden (Campbell-Bell Building) for one parking space in the parking lot west of the Campbell Bell Building. GAIL AND JERRY MOORE PARKING LEASE: A resolution approving a one-year lease with Gail and Jerry Moore (Campbell Bell Building) for two parking spaces west of the Campbell Bell Building. • STAFF REVIEW FORM •/� I i X AGENDA REQUEST CONTRACT REVIEW --�-�� GRANT REVIEW For the Fayetteville City Council meeting of September 5 , 2000 FROM : Charles Venable Public works Name Division Department ACTION REQUIRED : Approval of a Resolution authorizing the City to reimburse Ms . Gatha Stein , an amount totaling $ 12 , 350 . 81 , for doctor and hospital costs due to injuries received when Ms . Stein stepped in a h-_o'l_ eI at Walker Park 'resulting in breaking both ankles . QPpAa„ftd $ e. b�M ail >slvk� % % COST TO TY : : Z, / vfeeo1 $ 9 o1 , Soo �rrte r+F a� S Cost of this Request Category/Project Budget Category/Project Name loko-6yooi Zo-1 , [oO k %& &QLi"CO4 % Account Number Funds Used To Date Program Name 6' ' CV4ekA L Project Number Remaining Balance Fund BUD ET REVIEW : Budgeted Item _� Budget Adjustment Attached Budget oordinator Administrative Services Director CONTRACT/GR /L ASE REVIEW : GRANTING AGENCY : Ac c� nti ger Date ADA Coordinator Date ' � - 2S; JJ City At r ev.. Date Internal Auditor Date Purchasing Officer Date Grant Officer Date STAFF RECOMMENDATION : si Head Date Cross Reference (51.1 gl 00 New Item : Yee NO Dep ptment D ' ctor Dat IA /Y- /rt Prev Ord/Res # : , �' ✓ D D Orig Contract Date : May6i Date • STAFF REVIEW FORM • Page 2 Description Meeting Date Comments : Budget Coordinator Reference Comments : Accounting Manager Reference Comments : City Attorney Reference Comments : Purchasing Officer Reference Comments : ADA Coordinator Reference Comments : Internal Auditor Reference Comments : Grants Offcier Reference Comments : FAYETTEVILE THE CITY OF FAYMEVILLE, ARKANSAS MEMO To: Mayor & City Council From: Charles Venable, Public Works Director Com/ Date: August 21 , 2000 Subject: Gatha Stein Claim Enclosed are bills, correspondence, etc. for a claim filed by Ms. Gatha Stein in the amount of $ 12,350.81 covering the costs of doctor and hospital bills. Ms. Stein stepped in a hole at Walker Park on June 23, 2000 as she was leaving a baseball game in which her grandson had played. Ms. Stein fell breaking both ankles and had to be transported to the hospital. One ankle required surgery and resulted in Ms. Stein having to stay at the hospital for a few days. Ms. Stein, although a Registered Nurse, does not have any type of health insurance to cover the costs incurred. The original claim filed on July 16, 2000 was in the amount of $20,000 but contained no bills from either the doctor or the hospital. After consulting with the City Attorney's office regarding the claim it was determined that the City of Fayetteville had no legal liability and that the City was not negligent in the park maintenance. A letter denying the claim was sent to her on July 25 , 2000. Ms. Stein upon receipt of the letter telephoned me and during our conversation I asked her is she had received any bills. She indicated that she had and that she would forward them to me. She also asked if the city would further review her claim. Ms. Stein faxed the bills to me on August 10, 2000. These bills totaled $ 12,350.81 . I certainly understand Ms. Stein's problem in that she has to pay the doctor and hospital bills since she is uninsured. It is still my feeling that the City has no liability in this claim. However, since the accident did occur on our City property I feel that further discussion of the claim is justified and therefore I am submitting it for your consideration. enol: 113 WEST MOUNTAIN 72701 501521 -7700 FAX 501 575-8257 FAYETTEVIWE THE CITY OF FAYETTEVILLE, ARKANSAS July 25, 2000 Ms. Gatha Stein P.O. Box 4381 Fayetteville, AR 72720-4381 Re Claim/June 23, 2000 Dear Ms. Stein: Your claim dated July 16, 2000 has been reviewed and following is our response: Under Arkansas law, municipalities such as the City of Fayetteville are immune from liability and from suit for damages. I am enclosing a copy of A. .C.A. §21 -9-301 for your information. The City has no liability insurance which covers this claim. If I may provide you with any further information, please don't hesitate to write or call. Yours truly, Charles Venable Public Works Director pkh enc: cc: LaGayle D. McCarty, Assistant City Attorney 113 WEST MOUNTAIN 72701 501521-7700 FAX 501575-8257 Arkansas Code L - 9-301. oTort.,liability - Immunityaclared . • 'It is declared to be the public policy of the State of rkansas that all counties , municipal corporations , school istricts , special improvement districts , and all other Dlitical subdivisions of the state and any of their boards , Dmmissions , agencies , authorities , or other governing bodies hall be immune from liability and from suit for damages except • the extent that they may be covered by liability insurance . • tort action shall lie against any such political subdivision acause of the acts of its agents and employees . History . Acts 1969 ? No . 165 , § 1 ; . S . A . 1997 , § 12 - 2901 ; cts 1991 , No . 592 , § 7 ; 993 , No . 292 , § 2 ; 999 , No . 989 , § 1 . Date Printed : July 25 , 2000 9 : 10 : 57 AM Cnovriaht 2000 . Law Office Information Svstems . Inc . . All Riahts Reserved . • F A Y E T T E V I L L E • _ CITY ATTORNEY DEPARTMENT � �� f` , Jerry E . Rose JUL 2 5 2000 LaGayle D . McCarty CITY OF FAY,-] I Ly L' - Clarice Buffalohead-Pearnan MAYORS OFFICE 575 - 8313 DEPARTMENTAL CORRESPONDENCE TO : Charlie Venable , Public works Director FROM : LaGayle D . McCarty , Asst . City Attorney i DATE : July 24 , 2000 RE : Gatha Stein/ Injury Claim As you know , the Arkansas legislature has granted cities , such as Fayetteville , tort immunity and made them immune from liability for damages . A . C . A . X21 - 9 - 301 . Accordingly , I do not believe that the City has any legal liability resulting from Ms . Stein ' s unfortunate injuries . If I may provide you with any further information , please give me a call . Arkansas Code 21 - 9X01 . Tort liability - Immunitleeclared . • It is declared to be the public policy of the State of Arkansas that all counties , municipal corporations , school districts , special improvement districts , and all other political subdivisions of the state and any of their boards , commissions , agencies , authorities , or other governing bodies shall be immune from liability and from suit for damages except to the extent that they may be covered by liability insurance . No tort action shall lie against any such political subdivision because of the acts of its agents and employees . History . Acts 1969 , No . 165 , § 1 ; A . S . A . 1947 , § 12 - 2901 ; . Acts 1991 , No . 542 , § 7 ; 1993 , No . 292 , § 2 ; 1999 , No . 984 , § 1 . Date Printed : July 24 , 2000 12 : 00 : 43 PM { Coovricht 2000 . Law Office Information Svstems . Inc: . All Riahts Reserved . t 08/10 / 00 MU 15 : 50 FAX 19 001 . v jGATHA STEIN, R.N. i Legal Nurse Consultant FAX COVER SHEET DATE : c� — Oy TO : 06 XIS FROM : G . Stein , AS, Fax No . ( 501 ) 444- 0702 TOTAL NUMBER OF PAGES I ( including cover sheet ) O COMMENTS : r ( � DLJ 4 . PRIVILEGED AND CONFIDENTIAL _ 98 /10/q0 THU 15 : 50 FAX 10002 August 8, 2000 Mr. Charles Venable Public Works Director 113 West Mountain Street Fayetteville, AR 72701 FAX NUMBER: 575-8257 Dea r Mr. Venable: Pursuant to our phone conversation, and at your request, I am providing you with the medical bills to date. As we discussed, the bills are for surgery and treatment of my fractured ankles from 6/23/00 when I stepped in a deep hole at Walker Park. The enclosed bills are those received to date. I am still being treated/x-rayed by the orthopedic surgeon, Dr. Robert Tomlinson. Should you need further information, I can be reached at 575-1853 or 527-0971 . Listing of attachments: $6,895.65 Washington Regional Medical Center 3,894.00 Dr. Robert Tomlinson (to date) 184.00 Family Medical Center 420.48 Central Ambulance 550.00 Ozark Regional Anesthesia 166.00 Northwest Arkansas Radiology 50.34 Prescription Medications (Walmart Pharmacy) 24.34 Supplies/Equipment Rental (Collier's Drug Store) (NOTE: I was able to borrow wheelchair, walker, crutches and cane from family/friends; therefore, no cost for these items. $ 12,350.81 OTAL TO DATE Thanks for your assistance with this matter. I look forward to hearing from you Gatha Stein �l- t2, & 08 / 10 /00 THU 15 : 50 FAX It 003 WASHINGTON REGIONAL • • MEDICAL CENTER 1125 NORTH COLLEGE • FAYETTEVILLE. AR 72703 DATE DATE PpTIENT ACCOUNTNUMBER ADMITTED DISCHARG D PAGE STEIN, GATHA L 00175 - 00355 06 / 23 / 00 06 / 26 00 000 F1 REFER TO THIS 4 NUMBER ON ALL ATTENTION GATHA L STEIN CORRESPONDENCE ITEMIZED STATEMENT OFACCOUNT PO BOX 4381 FAYETTEVILLE AR 72702 07 /10 / 00 IPW O MASTERCARD O VISA O AMERICAN EXPRESS 1. CARD N0. EXPIRATION DATE 2. 3. SIGNATURE 4. PLEASE DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE 120RO0M- BOARD/ SEMI -.940 . 00 ....;:�;:.:.;, ., . . , , t:•:+.25OPHARMACY .:.,:. _ 216.8 . 15 258IV SOLUTIONS 174 . 45 259DRUGS/OTHER 163 . 80 260IV THERAPY 41 . 75 270MED- SUR SUPPLIES 907 . 85 278SUPPLY/ IMPLANT 329 . 70 300LAB 215 . 70 320DX XRAY 710 . 00 360OR SERVICES 1 , 622 . 50 370ANESTHESIA 240 . 00 41OPESPIPATORY SVCS 50 . 00 420PHYSICAL THERAPY 243 . 75 450EMERGENCY ROOM 225 . 00 700CAST ROOM 50 . 00 71ORECOVERY ROOM 555 . 00 730EKG/ECG 60 . 00 981PRO FEE/ER 119 . 00 985PRO FEE/EKG 19 . 00 TOTAL CHARGES 61895 . 65 TOTAL PAYMENTS/ADJUSTMENTS 0 . 00 Thank you for choosing us for your healthcare needs . To help us keep healthcare costs down , we would appreciate prompt payment of your bill . If there are any questions , please call our business office at 501 - 713 - 6000 during the hours of 8 : 00am and 4 : 30pm, Monday through Friday . 6 , 895 . 65 00175 - 00355 w7000 (10188) . UC/ 1U / 0U AnU 10 : 01 rAA WJ uua WASHINGTON REGIONAL MEDICAL SYSTEM 1125 NORTH COLLEGE AVENUE / FAYETTEVILLE, ARKANSAS 72703 August 21 2000 GATHA L STEIN 189458 PO BOX 4381 FAYETTEVILLE AR 72702 -RE : -PATIENT -NAS.: .,. . .GATgA-L .STEIN ACCOUNT NUMBER : W001750035S DATE OF SERVICE : 06 - 23 - 00 ACCOUNT BALANCE : 6895 . 65 We are writing in regard to this hospital bill with Washington Regional Medical Center . It has come to our attention that we need to discuss the status of this hospital bill or other bills you may have with us . We would appreciate you calling us within this next week . Washington Regional Medical Center 501 - 713 - 6065 Monday thru Friday 8 : 00am - 4 : 30pm Please include your account number on your check or money order Please note Ow each Igsp W registration vn9 Male a new awwmt number and different WIN which will mquhe a separate payrnent unless arrangements are made for a consolidation at accounts. 08/ 10 / 00 THU 15 : 51 FAX ,- 19 005 PLEASE MAKE CI4ECK PAYABLE TO a . -0R?SOPRD]C 1R5f_TiUTB, P , A . N liAF1E AVENIB8585 C 1 i r c a l : . VISA . . .RASTERCABD 6112 601 , Card Ra : . . SPRINGDALE AR 72769 ( 5811 521 - 5262 Expiration Dat = . 2816 , 00 Rage on Card ; :. aigaature • . . 55ta '4•eixM 26! 6 . 96 CHARGES OR PAYMENTS MADE Gatha stein . . . - AFTER'CLOSING DATE WILL AP- . .. 735 Edna Si .. . . .. PEAR ON NEXT STATEMENT. Fayetteville* AR 72163 PLEASE CHANGE u L LRETURNU7H ADDRESS IFINCORRECTDETACH THIS STUB ANPAYMENT DATE '.PArI9 .. : .' CODR . . . DESCRIPTIOR OF TRANsACsIOA . . DOCTOR - - - - -- - - -PA.YNRN 5- - - _ ----- .. - . - CHARGE : ADJUST NEDICAEE OfSSR INS aATIRN4 BALANCE 96123/90 Gat he 652SdS1 - --- -- - - Eger Visit level 4 To ! tnson, Jr, . : 286 , 88r 08 80 BS 96/24 108 Gat 27911 Open Tx 6:�alIeoIar Ana1e Fx 'Toalinson, Jr, 4251e . 08 86 68 . 08 286 . 68 . BB 8B Z610 , 80' . � . , ,� ;. Uv � L / � � .� � � 1, � - fin ' PECIAI ROTS. EIRE " T � " _ "�"`� L 'LD ( . URRENT P. A T"C In ' f r �(,a OVER 30 DAYS^ OVER 60 DAYS OVER 40 DAYS . OVER 120 DAYS .,A e - 2B16 . 9 ' B ACCOUNT BALANCE PENDING Ol . 88 Be .. 2816 , 00 BB SING ACCOUNT 2616 ` 69 TE: 07/91 /08 NUMBER 6] 12 - - - _ -' AST PATIENT . A. ,ENT-- - - - - DATE ; HOW ; , 88 ORT90PEDIC INSTITUTE, P . A . " Stateaent Due Upon Receipt ° Thank You " 08/10/00 THU 15 : 52 FAX ® 006 IHOPEDIC INSTITUTE • P. 0vt2? Account 6112. Stein , Gatha D . O . B , : 11 / 12 / 1939 60yr Sex , g 735 Edna St ACcnt Date : 06 / 23 / 00 Stat DOL visit 07 / 05 / 00 arit a , 1 Hill Type . , al Fayettev11 Race tille AR 72703 ace Home , ( 501Ref Dr R ) 443 - 3502 0 Doctor 1 Robert J Tomlinson , Jr , M 11115111 1 - PWill 06 , Steln,flltha 1 12 1i/1S/11 1 Stelh,Gatha ! 9921 afflce telt, e , �� past 17115111 1 6teln,Gatha 4 13211 Caet Shoe ! 29415 6bort Leg Ceet 824 . 4 1 . 11 31 . 10 I7/IS/10 1 Stela,0atha 4 73611 Y-lay of Aulfle 3-4 1 814.4 1 .19 /7115 /11 1 Steia,Glth1 162 .01 4 27.706 Cl ti d10ta1 fibular 824 . 4 1 ' 11 87 . 11 TOTALS /0S ACCOM 6112 pATIGi8T8 , 814 .4 1_11 492. 11 8 . 11 ADJUSTS 1 , 11 CSAIGBS 3788 . 11 7 . 11 @8)NHDS: 0, 11 3111 .81 1. 18 1 , 11 ........1. 3711 . 11 o� 3718 . 11 �z X ra', S 19 '/. 00 sh. PCU)om+ a CA:� Co 3co9y0C: TOTFIL p. 02 t W P . 1 08/ 10 /00 THU 15 : 52 FAX (¢1007 IF PAVING BY MASTERCARD ON VISA. FILL OUT BELOW. FAMILY MEDICAL CENTER C1W ARD USING FOR PAYMENT 2907 E JOYCEr'U ❑ MASTERCARD "'1'+•11 VISA FAYETTEVILLE AR, AR 72703- 5011 CARD NUMBER AMOUNT 6034 SIGNATURE EXP. DATE OFFICE PHONE: 501 -521 -8260 STATEMENT DATE PAY THIS AMOUNT ACCT. d 07/28100 184. 00 steiga-00 Page: 1 ISHOWAMOUNIT PAID HERE 1111111111111111111 IIII VIII II VIII I IIII IIIIII II II II II 1111111 / III IIIIIII'IIIII [111111111111111loll lllllllll GATHA L STEIN FAMILY MEDICAL CENTER 735 EDNA ST 2907EJOYCE FAYETTEVILLE , AR 7270311112722 FAYETTEVILLE AR, AR 72703-5011 STATEMENT mTOPP RTION01ITHYOARtPAYME T U Please check bon ifgad,address is incorrect or insurance PLEASE DETACH AND RETURN TOP PORTION Wlili YOUR PAYMENT U information has changed, and indicate changelal an reverse side. MV/S (7189) DATE DR PATIENT DESCRIPTION CHARGESCREDITS ' : Balance Forward: 0 . 00 06123/00 GathaHospital Care Subsequent Per Da' 46 . 00 06/24/00 Gatha ° Hospital_::Care.Subsequent, Per Da .; 46 : 00 06/25/00 Gaiha Hospital Care :Subsequerit .Per Da 46 . 00 06/26/00 Gatha mm mb I Hospital Care: Subsequent Per Da 46 : 00' : mm mm mm mmm mm'mm mm mmmmm • Amounts pending with Insurance are noi'included In the balance due. '' .You: willmm mm I mm I :be billed once your insurance responds to our claffn IIACCT 11: steiga-00 CURRENT 31.-60 DAYS 61 ;m90 DAYS OVER mm 90. DAYSOVER 120 DAYS DINS BAL07/28/00 o. bo 0 00 0.00 0II00 mm m I I m 0.00 `IPTNT. BAL 07/28/00 184.00 0 00 0.0.0 0-00 0. 00 FAMILY MEDICAL CENTER we will +.be. closed Labor day. . . . . :. 2907 E JOYCE FAYETTEVILLE AR, AR 72703-5011 II _THIS AMOUNT _ . . 184.00 .: P 6034.OSXOURYOY001696 08/10 /00 THU 15 : 53 FAA - �UVo Our Membership Plan Can Save You Money 645 S. 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L_ . 3-.t�,�. ,sr'y�.v±r -c ,.Y r _ >ws •-4 t `r. s--r zp L�'$•J._Yx_ q'E�v 'toO v PLEASE PAY THIS AMOUNT ! ;$ L t +J � a ^�-,�._.�� % 3r�- '6ETACN AEOft6 PERF,:OB�ON ABOVE AND•RETURN STU9-WITH'COUN PAYMENt •�'r� ay 5•+y-c' .r +3^ �AIIENTNAME STEIN � �� s �` �>• ka "�r .�.a�i�r Y,,�w�'.ri��a��,;'� PATIENT NUMBER a 1 CALL NUMBER � Y '' fl AMOUNT DUE $ � 420 Q� ' t� -",. a'• raya•. � a ""r � , -€.. .c . h. 0.7�,�27/0¢ � .o{eF -ENCLOSED""-ri ."' -`x T'4 i `r . . ., �'..�.ia:-r � -•�yc� , . .sem' _ _ -tl�.-.Jk _ ter+ �'' ie�-e.`r .! " r .r —`— _�.:r—r.'�:-�,..'`"""�.� ' *** YOUR ACCOUNT IS PAST DUE ! If � *** Tete & return the pink form - jfunotve insurance please comp- ** * *** at ( sol ) 521 -5801 to make please call our office *** Payment arrangements - THANK YOU ! ! ! *** 645 S. SCHOOL AVENUE - FAYETTEVILLE, AR 727ni - PL.Inkrr 08 / 10 /00 THU 15 : 57 YAX c uuu OZARK REGIONAL ANESTHESIA : PATIENT:NAME."" �°. P o Box 6340 FAYETTEVILLE AR 72702 GATHA L STEIN 42$#449 'v ACCDUNTNUMBER "'STATEMENYOATE Return service Requested 11881 - 106872 639dio017500355 1 : 07 - 11 - 00 , OUM'PAIW; Place of Service : WASHINGTON REGION MED CTR AR701 +639*0017500355 . 1 425#449 550 00 . . .. IAl It , HIM, , IIs „ If II ,III „111 „ 111 „1111111111 , , ,1 OZARK REGIONAL ANESTHESIA GATHA L STEIN P 0 Box 6340 735 E EDNA ST FAYETTEVILLE AR 72702 FAYETTEVILLE AR 72703 - 2722 12622422210000017500355 . 14870005500017 PLEASE DETACH AND RETURN TOP PORTION WITH PAYMENT ...... - - 7 - - - DATE DOCTOR CODE ' ' =DESCRIPTION 06 - 24 -00 LARKUS PESNELL , M . D , 27822P1 ANESTHESIA ADMINISTRATION 450 . 00. . : 06 - 24 - 00 LARKUS PESNELL , M . D , 99140 ANESTH COMP BY EMERGENCY 100 . 00 . : -Mc— WE AM-PT MA51MCARD/v15A Billing questions ? Call : 501 / 442 - 3961 . . ,.. --. . . :. sP: BAUINCE WDUWV DUE- . . ACCDUNT'NUMBER GATE OF 67ATEMENT . PAYMENIS Af THI6 ' ' - DATE WILL APPEAR rON . . 550 OO 0017500355 . 1 07 - 11 - 00 YOUR NEXT STATEMENT — PLEASE SEND . PAYMENT.. . FOR THE , AMOUNT. :'DUE' .:: ..._ ;:.: .PATEM.NAME _' .. ,.. : � ... r.,. __ 1 - . . ,. • . ND1'LATED' , :: :I F : .Y. OU NAVE ANY :QUESTIONS , ' . :PLEASE .: GATHA L STEIN `' CALLL OUR OFFICE :: .THANK .You MAKE. CHECKS PAYABLE .TO : OZARK REGIONAL ANESTHESIA . Tax Ld 71 .-.0. 817483 ., PI ace of s ervi ce . .WASHI NGTON + REGION MED ' Cl ; . .. Referring.. Doctor : ;ROBERT :JTOML.TNSON MD . , _ .. .. .. . . . ' - _ .. OZARKREG I ONAL : ANESTHES 6A' . - ' : . . .. .. ... . . . . .. . . _ . .. .. .. " .. .FAYETTEV LLLE . .AR .72702 . . . . - . . . .. . .. . . .. .. . .. � �� - ' Sot /44z 996t . . " FOR OFFICE ' USE ONLY : . ' TOT MINS ' BASE rU TIME ' U RISK U TOT U : ' 89 ' 8 .'00, . ; .. . '6 . OD 9 . 00 . . 0,8 /10/OQ THU 15 : 58 FAX 10010 STATEM E �011 fit It 13111'141M �111mamlimmIll 311111111m NORTHWEST AR RAD ASSOC L 07 / 21 / 00 I 166 . 00 P O BOX 1286 / FAYETTEVILLE , AR 72702 - 1286 Phone # ( 501 ) 521 - 6480 17500355 J AMOUNT ENCLOSED 3 391 GATHA L STEIN NORTHWEST AR RAD ASSOC PO BOX 4381 PO Box 1286 Fayetteville , AR 72702 - 4381 Fayetteville , AR 72702 - 1286 Iltttllt1111[[[ lllttttrltltlttlttllrltrlrtttllltrlttttllltttll IItt.I.rltlltttlllrrtt.Itlrrtllttltllttlttllttlttlttllttrt.III ❑ Fleas e mark box and indicate nay change in address on reverse side. Detach at perforation and return above Portico With payment PATIENT NAME: GATHA L STEIN .. .: . .._... ... .. . . ._ ...?LACE OF SERVICE: WASH?NGTON ,REGIONAL- IP . - a r DESCRIPTION „ ' ;GATHA 'L STEIN r • t 5 -01 106 /23 /00 73630 • XR" ,FOOT :COMPLETfi e' 824 B 24 00 c • 06 /23./,OQ 73610 : XR 'ANKLE' „COMPLETE 824 8 24 ^OD , .,06 / 23 /00 .'73610 ' : XR , ANKLE• COMPLETE - 1i 1 . :824 8 29 ..0:0 . 66 /23 /00 :.13630 XR .FOOT COMPLETE 829 8 2400 : 06/23/ 007102D : XR -:CHEST ` 824 B 27 00' .06 /24/ 00 73600 )CR ANKLE AP . LATERAL . : . 824 8 19 00, - 06/24/00 73610 , XR, _ANKLE COMPLETE . ? 824 8 24 00 - 1 7 -: r ' WEAR CURRENTLY GOING THROUGH A COMPUTER ONVERSIO IF THE E IS A PROBLEM WITH YOUR ACCOUNT PLEAS CALLUS. -- RETAIN - -'=- HIS . 00 . 00 . 00 - 00 1 166 . 00 PORTIONFORPAY THIS 166 . 00 . - YOUR RECORDS AMOUNT NOW - — Page 1 Northwest Arkansas Radiology Associates, P.A. North Hills Imaging / North Hills Breast Center P.O. Box 1286 Fayetteville, AR 72702- 1286 3352 N. Futrall Drive Phone (501) 521-6480 RS NO. 71-0473593 08 /10 /00 TIW 15 : 58 FAX 10011 AUG-04-00 •FRI 10 : 24 AM , FAX : PAGE 1 STEIN, GAY yl�ilr�IV�gRt PHARwtcr Rx8 4902119 N yeu�htave any questions. )please feel hoe to Date: 08/04/2000 or DDr. TOMLIN DN amt (501) SZ1f 6 RSPh-DUANE JONES TOMLINSON, ROBERTJ. IF YOU HAVE CONCERNS ABOUT TAKING THE MEDICATION BELOW. PLEASE CO ACT YOUR PHARMACIST OR PHYSICWH IMMEDIATELY. Directions; TAKE ONE TO TWO TABLETS BY MOUTH EVERY 4 TO 6 HOURS AS NEEDED FOR PAM Drug: HYDROCO/APAP 5/500 TAB WAIS HYDROCODONE (hyedroe•KOdone) and ACETAMINOPHEN (e-sea"-MtN.oh fen) COMMON USES: This medicine is an analgesic combination used to relieve pain, HOW TO USE THIS MEDICINE: Follow the directions for using this med;ane y yo MEDICINE MAY BE TAKEN WIT}I IaD00 i< ft u yourstonmach STARE 7 th M 1bCINE a doom. THIS by dosed container, away from heat and li t IF YOU MISS A DOSE OF TH15 MEDIC W E and you erre In a ndt 18�. to n as possible. it is almost time for your neon dose, skip the 0o your regular dosing schedule. Do not fake 2 doaee at ortcs, CAUTIONS lF YOU 1 IAVE HAD A SEVERE ALLERGIC REACTION to calcine. oxycodone ((such as Tybx, Tylenol with Codeine, Mcodin), contact your ttoctor or ne d rocodeine, or THIS MEDICW E A severe allergic reaction includes a severe resp, fmives, preathin"oQ d;j 1pea ofOE TAKING diafnesa. If you have a question about whether you are allergic b this medicine or Tt a certain medicine contains cpd¢m� hydrocodone, dlh tocodeine or oxycodone contact r doctor or Pharmacist IF YOU EXPERIENCE d'A�ieu (I y breathin • tf you g of chwA swelbV of eyelids, face or lips• or d you develop a rash or hives. tall your doctor immediately Do not take arty more doses of dto meclidrme unless pyour docbr tells you to do so. DO NOT EXCEED T}{EnRRECeOrgMMENDED DOSE or take this medicine for Ion than ranggeerr tl gpr MOW Od t^gy cking with h fo ^gr, VA OfD)ALCaF10L white Ia you are mfg tt�i'� g this m ane for medxine writ add to the effects of alcohol a ott((�t�r depressants. DO NOT DRIVE OpERATt= MACHINERY OR DO ANYTHING ELSE THAT COULD BED ANG�ROUS until you know how you mad to tit% medicine. Using this medk:bte oboe with other medicines, or with alcohol may lessen your abt�'a� to drive onto p pota^6aty dangerous tasks THIS MEDICINE CONTAINS ACETdMINOPH�J Do not raoform ja additional acebmt^aphen for Debt or fever wi9101 t checking with your doctor or pharmacist. Ask your pharrnacist if you have alco�i onabout which medicines oontem acetaminopphhe�n�. Acetaminophen rmrrey pose fiver dame It use combinedrwth d0 not take this medicine wtTltpul first dlsetrsstng it wi0m !� ya+ dttrtk acetaminophen maY tnaease r. Alcohd MEDICINE• either tion or over the-0ountercheq�fothr liverdemage. BE7 ORE YO BEGIN TAKING ANY NEW YOU PLAN ON 8 MI G PREGNANT discuss with yp yowdodOt or phemlaC�51 FOR WOMEN: IF 3u^ng pregna R IS UNKNOWN IF TTiIS MEDICINE IS F�CCP;® 5e ets�tIF W AE OR wQ BE 3tieREAST FEE1 G while you are using this medicine, check with your doctor or pttarrttacist b discuss the 'OSSIBLE SIDE EFFECTS: SIDE EFFECTS, that may 90 away dwfng treatment, include dlalness drowsiness, ightheaded co tion nausea or vomieny. it ff,ey con Us or Bre bothersome, check with your ftcf3 CHEC ITH OUR ct your 'i AS SOON or POSSIBLE If you experience rash or It "ng. K you notice other dfecb not Gstad above, contact you►doetor, nurse, a pttarmadst V191L*II (501) 571a67a 10,V45 rm_wurooawrr 2690 FUST CITtID15 DRIVE WILNIlAR( 01) 571-0673 162714 P M w M M A C Y PAYErrEYKAZM >•z7aa RECEIPT P H, c� v�9O STLL�S o f FEIN GAY AR 72M RECEIPT 12 EBNA O6&W0o0 STOGAI STEIN GAY 013/29M2000 \r, 444-7 031 AR 72701 NEW AYES TEMLLE AR 72701 1L- 4447657 �50�) 7851 NEW G 4402119 TX L025208 DAW: O RX 4119 TX: 1025206 DAW: 0 MROGWAP 51500 TAB MATS ' $12.97 HYDROCO/APAP 5rsoo TTAB WATS $12.97 AT52544-0049 Oti CITY: 30 OS: 2 NDC: 62544-0349-05 OTY: 30 DS: 2 ATS REFILLS: 0 WATS REFILLS: 0 )MLINSON, ROBERT J. TOMLINSON. R00191TJ. 48P: 0420757 NABP: 0420757 08/10/A0 THU 15 : 59 FAX tA012 m`*MAW' PHARMACY STEIN, GAY 73 If you have any questions, lease feel free to qph-DUANE JONES Rx#: 4402241 contact DUANE JONES at -01) 571-6673 TOMLINSON, ROBERT J. Date: 07/11/2000 or Dr. TOMLINSON at (501) 521-5262 IF YOU HAVE CONCERNS ABOUT TAKING THE E CONTACT PHARMACIST OR PHYSICIANEIMME IATELYOUR Directions: NEEDED O 2 PAIN TS BY MOUTH EVERY 4 TO 6 HOURS IF NED Drug : HYDROCO/APAP 5/500 TAB WATS HYDROCODONE (hye-droe-KO�done) ind ACETAMINOPHEN (a-seat-a-MIN-oh4en) COMMON USES: This medicine is an analgesic combination used to relieve pain. HOW TO USE THIS MEDICINE: Follow the directions for using this medicine provided I yNour doctor. THIS TH MEDICINE DI CINE containerp away WITH he0a5andlliQuht sets YOU MISstomach. A OSE OF THISMMEDICI INE and you temperature in a tasting it regularly, take It as soon as possible., ff it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. Y oxAyUrodone (suds YOU THAD le oAwith Codeine, Vlcodln)Rcontactyour ON to or pharmacdisf BEFORE TAKeNG' or T dizziness.I ifCyou have ques'tiion about whether you are allergic to Uns medicine or it a cerrtaains, or IFaYdOU EXPERIENCE difficulty breadthing;aightneess of lchest;or swelling of eyelids, facer Of doctor ps; Orli youU develop a rash or hives, tell your doctor Immediate% . Do not take any more doses of take medicine unless your doctort011s Yto do OU wig youOr doctorEExcED eeding threcommended doseoorakinglthis medicine for ger than Ponger than prescribed may be habit-forming. AVOID ALCOHOL while you are using this medicine. This medicine will add to the effects of alcohol and other depressants. DO NOT DRIVE, OPERATE MACHINERY, m DO ANYTHING otELSher medlcines�or withalcoholalcohoGma des5en(lour affil N to drive or m c erform other medicine. Using this medicine y y AM o not take additional acetaminophen- ppotentially dangerous tasks. THIS MEDICINE CONTAINS ACEI _ _ INOPHEN. _ for pain or fever without checking with your doctor or pharnacist. Ask your phayrmacist if you have alroe hos on about daily basis, do lnottake this acetaminophen. edici el wl hout firsCd cussing It wdn tour doctor. Alcohgo If you drink MEDICINE etharthpaescthnpmtio oeoveramecounteY check W thlyou doctor or pEhamlacistFOBEGIN WOMEN: IF ANY NEW YOU gPpLAf� ONeBy,ECOMING PREGNANT, discuss with your doctor the benefifits and is, of using this medicine BREAST EDING whi a you are using ttHiis meEdiclneN chleck with our docmreor pharmacistt to diisscusssRthenLL BE risks to your baby. Pghtheladetlnle s coFnseCpati nSnauseaFoCvominagt maysyyocea nffnueuor e e bothersoma, check with yourrowsiness, doctor. CHECK WITH YOUR DOCTOR AS SOON AS POSSIBLE it you experience rash or itching. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist ewrN�®°°rw°.`Buk ucMgr,d..a °.yam�aox y�mnyneMr.Iw iaemo WA6*MART (sol) 571-6673 1D-2745 L* � (501) 571-5673 102745 .1WAL*PAp1�t 2690 EAST CmZENS DRIVE RECEIF 2690 EAST CITIZENS DRIVE pHA 0. M A C Y FAYErTEviL E, AR 72703 FAVETTEVILLE, AR 72703 RECEIPT P H A FLM A C Y 07111/2000 STEIN GAY 07/11/2000 STEIGAI STEIN N AY NEW 732 EaNA NEW FAYETTEVILLE AR 72701 FAYETTEVILLE AR 72701 (501444-7851 (501 ) 444-7851 5X: 4402241 TX: 1026699 DAW: 0 12.97. X:'4402241 TX: 1026699 DAW: O HYDROCO/APAP 5/500 TAB WATS $12.97 .' . . :` `; NDC: 52544-0349-05 500 TOTM 30 TS DS: 3 NDC: 52544-0349.05 CITY: 30 DSi 3 WATS WATS TOMLINSON, ROBERT J. TOMLINSON, ROBERT J. NAEP: 0420757 NABP: 0420757 .. •• GENERIC SAVINGS = $12.75