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TO: BOARD OF SUPERVISORS
FROM: Mark Finucane, Health Services Director Contra
Costa
DATE: September 21, 1995 County
SUBJECT:
Approval of Contract Amendment Agreement #26-916-4 with
Jerrold J. Schwartz, M.D.
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Health Services Director, or his designee,
(Frank Puglisi, Jr. ) to execute on behalf of the County, Contract
Amendment Agreement #26-916-4, effective August *1, 1995, to amend
Medical Specialist Contract #26-916-3 with Jerrold J. Schwartz, M.D.
(Specialty: Family Practice) , to increase the hourly payment rate
from $49.35 to a new total hourly payment rate of $51.82.
II. FINANCIAL IMPACT:
Cost to the County depends upon utilization. As appropriate, patients
and/or third party payers will be billed for services.
III. REASONS FOR RECOMMENDATIONSIBACKGROUND:
On July 18, 1995, the Board of Supervisors approved Medical Specialist
Contract #26-916-3 with Jerrold J. Schwartz, M.D. , for the period from
August 1, 1995 through July 31, 1996, to provide Family Practice
services for patients at the Brentwood Health Center.
Approval of Contract Amendment Agreement, #26-916-4 will increase Dr.
Schwartz 's hourly rate to reflect the rate paid to County's Medical
Staff Physicians.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
—RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOAR T COMMITTEE
—APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON C2CI6 Q 1 ") - Z
APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
UNANIMOUS (ABSENT I HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT; ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
Contact: Frank Puglisi, jr. (370-5100) OF SUPERVISORS ON THE DATE SHOWN.
CC: Health Services (Contracts) ATTESTED r )A j - - _ j 1295
Risk Management Phil Batchelor,cleA of the Board of
Auditor—Controller Supervisors and County Administrator
Contractor
M302/7-83 BY V DEPUTY,
Ctntra Costa County Standard Form ' 1/87
CONTRACT AMENDMENT AGREEMENT
(Purchase of Services) Number 26-916-4
Fund/Org # 6500
Account #
Other #
1. Identification of Contract to be Amended.
Number: 26-916-3
Effective Date: August 1, 1995
Department: Health Services - Hospital and Clinics
Subject: Provision of---services in Contractor's medical
specialty Practice)
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2 . Parties. The County of Contra Costa, California (County) , for its
Department named above, and the following named Contractor mutually
agree and promise as follows:
Contractor: JERROLD J. SCHWARTZ, M.D. Medical License #G-2424
Capacity: Professional Corporation Taxpayer ID# 94-2362009
Address: 227 Cove Court, Byron, California 94514
3 . Amendment Date. The effective date of this Contract Amendment Agreement
is August 1, 1995
4 . Amendment Specifications. The Contract identified above is hereby
amended as set forth in the "Amendment Specifications" attached hereto
which are incorporated herein by reference.
5. Signatures. These signatures attest the parties' agreement hereto:
COUNTY OF CONTRA COSTA, CALIFORNIA
ATTEST: Phil Batchelor, Clerk of
BOARD OF SUPERVISORS the Board of Supervisors and County
Administrator
By
Chairman/Designee Deputy
CONTRACTOR
By ByXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Professional Corporation XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
(Designate business capacity A) (Designate business capacity B)
Note to Contractor: For corporations(profit or nonprofit),the contract must be signed by two officers. Signature A must be that of the president or vice-president and
Signature B must be that of the secretary or assistant secretary (Civil Code Section 1190 and Corporations Code Section 313). All signatures must be acknowledged as set
forth on page two.
r
Contra Costa County Standard Form(Rev. 1/95)
APPROVALS/ACKNOWLEDGMENT
Number 26-916-4
APPROVALS
RECOMMENDED BY DEPARTMENT FORM APPROVED
COUNTY COUNSEL
By By
Designee Deputy
APPROVED: COUNTY ADMINISTRATOR
By:
Designee
ACKNOWLEDGMENT
STATE OF CALIFORNIA )
ss.
COUNTY OF CONTRA COSTA )
On , before me,
(insert name and title of the officer), personally appeared
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose
name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same
in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or
the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS MY HAND AND OFFICIAL SEAL.
(Seal)
Signature
ACKNOWLEDGMENT(by Corpomdoq Pa m iship,or Individual)
(Civil Cade¢1189)
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AMENDMENT SPECIFICATIONS
Number 26-916-4
In consideration for Contractor's willingness to provide additional
professional services under the Contract identified herein, County
agrees to increase the amount of its payment to Contractor. County
and Contractor agree therefore to amend said Contract as set forth
below while all other parts of the Contract remain unchanged and in
full force and effect.
Payment Increase. The hourly payment rate specified in the
Additional Provisions Paragraph 1. (Payment) is hereby increased
from $49.35 to a new hourly payment rate of $51.82 .
Initials:
Contractor county Dept.