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CITY <br /> EV E R E T T LETTER OF AGREEMENT#2019-064 <br /> WASHINGTON <br /> Letter of Agreement(LOA)between Everett Clinic and City of Everett, Effective <br /> September 1,2019. The Agreement will remain in effect without any action of <br /> the parties unless either party provides written notice of termination. <br /> This LOA shall represent the entire understanding regarding the above matter <br /> between The Everett Clinic("The Clinic"), and City of Everett,collectively <br /> referred to as"Parties", <br /> The Everett Clinic Vision Center has agreed to provide to the City of Everett's <br /> Fire Department employees the services listed below("Covered Services") <br /> which the Fire Department employees will bring in at the time the order is <br /> placed. <br /> The reimbursement schedule for Covered Services shall be as follows: <br /> TES C Y ml _ 4� 07 r v r 1 N 1-A <br /> yrs Edi �. { ; � .70 <br /> 's.;* .. .:r:',-�''I fvek _ ,�. "'`...:. <br /> Rx metal insert for mask:single $105.00 $0.00 <br /> vision lenses(pair) <br /> Rx metal insert for mask:bifocal $150.00 $0.00 <br /> lenses(pair) <br /> Digital Grinding: $130.00 $0.00 <br /> Single vision lenses(pair) <br /> Digital Grinding: $210.00 $0.00 <br /> Bifocal lenses{pair) <br /> Digital Grinding: $400.00 $0.00 <br /> Progressive lenses(pair)— <br /> Varilux X <br /> Non-Glare (anti-reflective) $50.00 $0.00 <br /> coating <br /> erred Frames citirofv+ re' xfwe -i <br /> Wiley X-without polarized Up to$135.00 Any amount <br /> lenses >$135.00 <br /> Employe 1i,6 b►li.W.,. 3 .:;r` <br /> Purchasing Any additional services are the employee's responsibility. <br /> Q3200 Cedar Street,Door#5 <br /> Everett,WA 98201 <br /> The Clinic must be provided with a letter of approval and prescription from City <br /> O425.257.8840 of Everett Fire Department in advance of providing Covered Services.The Clinic <br /> 425.257.8864 fax <br /> shall bill City of Everett's Fire Department for Covered Services in accordance <br /> purchasing@everettwa.gov with the above reimbursement schedule,and City of Everett's Fire Department <br /> • everettwa.gov shall reimburse the Clinic within thirty(30)days of submittal of bill. <br />