HomeMy WebLinkAbout2004-145 Agrmt - PSR Physician ServicesAgreement for Provision of Services
of EMT Supervising Physician
This Amendment to the 2003-2004 Agreement for Provision of Services of EMT
Supervising Physician is made on the date last written below by and between PSR Physician
Services, an Oregon limited liability company ("Physician") and Ashland Fire & Rescue
("Agency").
The following items are amended to read as follows'
2.0 Term
The term of this Agreement shall b.9 one (!) year, .",', ,-,,,-' , ,
- ,,,.,mm,.,..,.4ng July I 2004 and ending
June 30, 2005. Either party may terminate this Agreement at any time for any reason upon
sixty (60) days advance written notice to the other.
5.0 Compensation
Agency shall pay Physician $3,180.66 per year as compensation for the services
performed under this Agreement. Payment shall be made no later than the 30th of September
of the term of this Agreement, unless other arrangements have been mutually agreed to.
Ashland Fire & Rescue
¢ -,~C/6;'¢~' ~'- ~,~~ ~ Date
By
Title ]~ ~_-~ x,/--C/~-
PSR Physician Services, an Oregon Limited Liability Company
By Date
Paul S. Rostykus,c~VlD - Member
2004-2005 Agreement for Provision of Services of EMT Supervising Physician
CITY OF ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541 ) 488-5300
CITY RECORDER'S COPY
Page 1 / 1
I I 052'i8 ...... ~
VENDOR: 006381
PSR PHYSICIAN SERVICES, LLC, DR. PAUL ROS1
436 GRANDVIEW DR
ASHLAND, OR 97520
FOB Point:
Terms: Net 30 days
Req. Del. Date:
Special Inst:
SHIP TO: Ashland Fire Department
(541 ) 482-2770
455 SISKIYOU BLVD
ASHLAND, OR 97520
Req. No.:
Dept.: FIRE & RESCUE
Contact: Keith Woodley
Confirming? No
for
FY 2004-2005
4ces of
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
0.00
0.00
3,180.66
Authorized'S~hature VENDOR COPY
A reques.~ fear ~ Purchase O~fler
REQUISITION FORM
THIS REQUEST IS A:
f-]. Change Order(existing PO #~
Vendor Name:
Address:
City, State, Zip:
Phone:
Fax Number
Deliver Location
CITY OF
SHLANE
Required Date of Delivery/Service:
Services Only
Description
Total Cost
Solicitation Process:
Exempt 3 Written Quotes
(copies attached)
Sole Source Invitation to Bid
(copies on file)
Less than Request for
Proposal (copies on file)
Account Number if 1_~- 0._~ _.t3.~. ~_~_~_ ~"~
the Original signed contract and Insurance certificate.
Unit Cost Total Cost
Account Number
*Please attach the quotes.
Employee Signature: SupervisodDept. Head Signature:
NOTE: By signing this requisition form, I certify that the above request meets the City of Ashland Solicitation Process reqd~rements and can be provided
when necessary.