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FROM: Garret Olson, Fire Chief
Prepared By: Julie Cox, Administrative Analyst
SUBJECT: AGREEMENT WITH MED-STOPS MEDICAL CLINIC, INC. FOR FIRE
FIGHTERS MEDICAL EXAMS
RECOMMENDATION:
1. Approve five year agreement with Med-Stops Medical Clinic, Inc., (Med-Stop) authorizing
Med-Stop to provide Firefighter Medical Exams.
2. Authorize the Mayor to execute the agreement.
DISCUSSION
Medical examinations for City firefighters are required annually. Several changes have occurred
with regard to firefighter medical examinations from FY 2008-09 to present.
• In FY 2009-10, Fire Department budget reductions included reducing medical examinations
from $37,000 to $5,000. The three year contract with French Hospital ended and French
Hospital was not interested in renewing the contract.
• In FY 2009-10 a one year agreement was approved with Med-Stop for Fire Fighter Medical
Exams at a cost of $17,190.
• In FY 2010-11, a three year agreement with Med-Stop was approved to provide the medical
exams.
Staff recommends awarding a sole source agreement to Med-Stop for these medical examinations.
Currently Med-Stop provides medical examinations to the Cambria, South Bay Fire, Five Cities
Fire Department and SLO County Fire Department and has provided good service to each of those
agencies. Med-Stop is located within the City of San Luis Obispo and this fact allows for
scheduling the exams to occur in a manner that minimizes the disruption in emergency response.
There is $25,000 budgeted for firefighter medical exams for FY 2013-14. There will be no
additional cost to the General Fund for FY 2013-14.
ALTERNATIVES
Develop a request for proposals. This option is not recommended as Med-Stop is a professional
specialized service located within the City making it efficient to schedule and has kept firefighters in
the city should their immediate response be needed. (Section 3.24.070. of the Purchasing Ordinance).
Meeting Date
Item Number 2/4/2014
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Firefighter Medical Exam Agreement Page 2
ATTACHMENT
Firefighter Medical Exam Agreement
T:\Council Agenda Reports\2014\2014-02-04\Fire Dept Agreement Medstop (Olson-Cox)\E-CAR Agreement with
MedStop.docx
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Attachment
CITY OF SAN LUIS OBISPO
AGREEMENT FOR MEDICAL PROVIDER SERVICES
THIS AGREEMENT, is made and effective as of ____________, (“Effective Date”)
between the City of San Luis Obispo Fire Department (“City”) and Med-Stops Medical
Clinic, Inc., a professional corporation (“Medical Provider”).
RECITALS
WHEREAS, the City has the obligation to verify that its public safety employees
employed by the City Fire Department (“Public Safety Employees”) meet the physical
standards necessary to perform the responsibilities as required by their jobs; and
WHEREAS, the Medical Provider is a professional corporation employing duly
licensed physicians, physician assistants, nurse practitioners and other personnel who have
the expertise to perform medical evaluations to determine whether the Public Safety
Employees meet the physical standards necessary to perform their responsibilities as
required by their jobs (“Medical Evaluations”); and
WHEREAS, the City desires to engage the services of the Medical Provider as an
independent contractor to provide such Medical Evaluations, to interpret the results from
such medical evaluations, and to provide medical advice based on the results of those
medical evaluations; and
Therefore, in consideration of the mutual covenants and conditions set forth herein,
the parties agree as follows:
1. TERM
This Agreement shall commence on the effective date and shall remain and continue
in effect for five years.
2. SERVICES TO BE RENDERED BY MEDICAL PROVIDER
(a) Medical Provider shall provide Medical Evaluations as requested by the City.
Medical Evaluations include any of the physical examinations, individual diagnostic studies
or immunizations listed on Exhibit A, attached hereto, and incorporated by reference.
Attached as Exhibit B is Medical Provider’s estimate of Medical Evaluations that Medical
Provider will provide based on information provided by the City about its current Public
Safety Employees.
(b) Within five (5) business days of the Medical Evaluation being completed,
Medical Provider shall either provide a Clearance for Duty Certificate or notify the City that
a Clearance for Duty Certificate will not be provided, whichever is applicable in the
professional judgment of the Medical Provider. A Medical Evaluation deemed completed
the date that the Medical Provider examines the City’s Fire Department public safety
employee or the date that all results from diagnostic studies are received by the Medical
Provider, whichever date is later.
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(c) Subject to federal and state privacy laws, Medical Provider shall take all steps
necessary to facilitate the transfer of the medical records of the Public Safety Employees
from any other medical provider identified by the City as having Public Safety Employees’
medical records to Medical Provider.
3. CITY’S OBLIGATIONS
(a) The City shall provide an Employee Medical Questionnaire (“EMQ”) to each
City employee requiring a medical evaluation and shall deliver the EMQ completed by the
City employee in a sealed envelope at least five (5) business days before the scheduled
Medical Evaluation.
(b) The City shall provide a City employee’s job description to the Medical
Provider when requested by the Medical Provider.
4. PERFORMANCE STANDARDS
Services rendered under this Agreement by the Medical Provider shall be provided
by duly licensed, certified or otherwise authorized, and accredited personnel who shall
provide such services consistent with the scope of their license, certification or accreditation
and in accordance with generally accepted medical and surgical practices and standards
prevailing in the applicable professional community and all applicable requirements of
federal, state and local law.
5. LICENSES
Medical Provider acknowledges that all of its directors, officers, employees or agents
(“Medical Provider’s Employees”) that will participate in delivering a Medical Evaluation,
interpreting a Medical Evaluation or rendering medical advice based on a Medical
Evaluation shall be licensed as required by the laws of the State of California and shall be in
good standing with both the Federal Government of the United States of America and the
State of California. Furthermore, Medical Provider’s Employees shall remain fully licensed
to practice medicine in compliance with the applicable law during the term of this
Agreement
6. CITY MANAGEMENT
City’s Fire Chief shall represent City in all matters pertaining to the administration of
this Agreement, review and approval of all services rendered by Medical Provider, but not
including the authority to enlarge the scope of services rendered or to change the payment
due to Medical Provider.
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7. PAYMENT
(a) The City agrees to pay Medical Provider monthly, in accordance with the
payment rates and terms and the schedule of payment as set forth in Exhibit A, attached
hereto and incorporated herein by this reference as though set forth in full, based upon actual
services rendered. Medical Provider may adjust the payment rates annually effective
January 1, 2015 and annually thereafter in proportion to the change in the Los Angeles-
Riverside-Orange County Consumer Price Index. However, in no event shall the annual
increase exceed three percent (3%). The indexes shall be for All Urban Consumers as
published by the Bureau of Labor Statistics.
(b) Medical Provider shall not be compensated for any services rendered in
connection with its performance of this Agreement which are in addition to those set forth in
Exhibit A or Exhibit B, unless such additional services are authorized in advance and in
writing by the City Manager. Medical Provider shall be compensated for any additional
services in the amounts and in the manner as agreed to by City Manager and Medical
Provider at the time City’s written authorization is given to Medical Provider for the
performance of said services. The City Manager may approve additional work not to exceed
ten percent (10%) of the amount of the Agreement, but in no event shall such sum exceed
ten-thousand dollars ($10,000.00). Any additional work in excess of this amount shall be
approved by the City Council.
(c) Medical Provider will submit invoices monthly for actual services performed.
Invoices shall be submitted on or about the first business day of each month, or as soon
thereafter as practical, for services provided in the previous month. Payment shall be made
within thirty (30) days of receipt of each invoice as to all non-disputed fees. If the City
disputes any of Medical Provider’s fees, it shall give written notice to Medical Provider
within thirty (30) days of receipt of an invoice of any disputed fees set forth on the invoice.
8. SUSPENSION OR TERMINATION OF AGREEMENT WITHOUT CAUSE
(a) The City may at any time, for any reason, with or without cause, suspend or
terminate this Agreement, or any portion hereof, by serving upon the Medical Provider at
least one (1) day prior written notice. Upon receipt of said notice, the Medical Provider
shall immediately cease all work under this Agreement, unless the notice provides
otherwise. If the City suspends or terminates a portion of this Agreement such suspension or
termination shall not make void or invalidate the remainder of this Agreement.
(b) Medical Provider may at any time, for any reason, with or without cause,
suspend or terminate this Agreement, or any portion hereof, by serving upon the City at least
sixty days (60) day prior written notice.
(c) In the event this Agreement is terminated pursuant to this Section, the City
shall pay to Medical Provider the actual value of the work performed up to the time
termination, provided that the work performed is of value to the City. Upon termination of
the Agreement pursuant to this Section, the Medical Provider will submit an invoice to the
City pursuant to Section 7.
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9. INDEMNIFICATION
(a) Indemnification for Professional Liability. When the law establishes a
professional standard of care for Medical Provider’s Services, to the fullest extent permitted
by law, Medical Provider shall indemnify, protect, defend and hold harmless City and any
and all of its officials, employees and agents (“Indemnified Parties”) from and against any
and all losses, liabilities, damages, costs and expenses, including attorney’s fees and costs to
the extent same are caused in whole or in part by any negligent or wrongful act, error or
omission of Medical Provider, its officers, agents, employees or sub-contractors (or any
entity or individual that Medical Provider shall bear the legal liability thereof) in the
performance of services rendered under this Agreement.
(b) Indemnification for Other Than Professional Liability. Other than in the
performance of professional services and to the full extent permitted by law, Medical
Provider shall indemnify, defend and hold harmless City, and any and all of its employees,
officials and agents from and against any liability (including liability for claims, suits,
actions, arbitration proceedings, administrative proceedings, regulatory proceedings, losses,
expense or costs of any kind, whether actual, alleged or threatened, including attorneys fees
and costs, court costs, interest, defense costs, and expert witness fees), where the same arise
out of, are of a consequence of, or are in any way attributable to, in whole or in part, the
performance of this Agreement by Medical Provider or by any individual or entity for which
Medical Provider is legally liable, including but not limited to officers, agents, employees or
sub-contractors of Medical Provider.
(c) General Indemnification Provisions. Medical Provider agrees to obtain
executed indemnity agreements with provisions identical to those set forth here in this
section from each and every sub-contractors or any other person or entity involved by, for,
with or on behalf of Medical Provider in the performance of this agreement. In the event
Medical Provider fails to obtain such indemnity obligations from others as required here,
Medical Provider agrees to be fully responsible according to the terms of this section.
Failure of City to monitor compliance with these requirements imposes no additional
obligations on City and will in no way act as a waiver of any rights hereunder.
(d) This obligation to indemnify and defend City as set forth here is binding on
the successors, assigns or heirs of Medical Provider and shall survive the termination of this
agreement of this section.
10. INSURANCE
Medical Provider shall maintain prior to the beginning of and for the duration of this
Agreement adequate professional liability insurance coverage as required by law, and
Medical Provider further agrees that during the term hereof he shall maintain a policy of
malpractice insurance in the minimum amount of one (1) million per occurrence with an
aggregate amount of three (3) million. Medical Provider shall, upon execution of this
Agreement, provide City with proof of insurance. Such insurance during the term hereof
shall not be changed or terminated without at least thirty (30) days notice in writing to the
City.
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11. INDEPENDENT MEDICAL PROVIDER
(a) Medical Provider is and shall at all times remain as to the City a wholly
independent Medical Provider. The personnel performing the services under this Agreement
on behalf of Medical Provider shall at all times be under Medical Provider’s exclusive
direction and control. Neither City nor any of its officers, employees, or agents shall have
control over the conduct of Medical Provider or any of Medical Provider’s officers,
employees, or agents, except as set forth in this Agreement. Medical Provider shall not at
any time or in any manner represent that it or any of its officers, employees, or agents are in
any manner officers, employees, or agents of the City. Medical Provider shall not incur or
have the power to incur any debt, obligation, or liability whatever against City, or bind City
in any manner.
(b) No employee benefits shall be available to Medical Provider in connection
with the performance of this Agreement. Except for the fees paid to Medical Provider as
provided in the Agreement, City shall not pay salaries, wages, or other compensation to
Medical Provider for performing services hereunder for City. City shall not be liable for
compensation or indemnification to Medical Provider for injury or sickness arising out of
performing services hereunder.
12. LEGAL RESPONSIBILITIES
The Medical Provider shall keep itself informed of State and Federal laws and
regulations which in any manner affect those employed by it or in any way affect the
performance of its service pursuant to this Agreement. The Medical Provider shall at all
times observe and comply with all such laws and regulations. The City, and its officers and
employees, shall not be liable at law or in equity occasioned by failure of the Medical
Provider to comply with this Section.
13. UNDUE INFLUENCE
Medical Provider declares and warrants that no undue influence or pressure is used
against or in concert with any officer or employee of the City in connection with the award,
terms or implementation of this Agreement, including any method of coercion, confidential
financial arrangement, or financial inducement. No officer or employee of the City will
receive compensation, directly or indirectly, from Medical Provider, or from any officer,
employee or agent of Medical Provider, in connection with the award of this Agreement or
any work to be conducted as a result of this Agreement. Violation of this Section shall be a
material breach of this Agreement entitling the City to any and all remedies at law or in
equity.
14. NO BENEFIT TO ARISE TO LOCAL EMPLOYEES
No member, officer, or employee of City, or their designees or agents, and no public
official who exercises authority over or responsibilities with respect to the services rendered
during his/her tenure or for one year thereafter, shall have any interest, direct or indirect, in
any agreement or sub-agreement, or the proceeds thereof, for work to be performed in
connection with the services rendered under this Agreement.
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15. RECORDS
(a) All information gained by Medical Provider in performance of this
Agreement shall be considered confidential and shall not be released by Medical Provider
without City’s prior written authorization. Medical Provider, its officers, employees, agents,
or sub-contractors, shall not without written authorization from the City Manager or unless
requested by the City Attorney, voluntarily provide declarations, letters of support,
testimony at depositions, response to interrogatories, or other information concerning the
work performed under this Agreement. Response to a subpoena or court order shall not be
considered “voluntary” provided Medical Provider gives City notice of such court order or
subpoena.
(b) Medical Provider shall promptly notify City should Medical Provider, its
officers, employees, agents, or sub-contractor be served with any summons, complaint,
subpoena, notice of deposition, request for documents, interrogatories, request for
admissions, or other discovery request, court order, or subpoena from any person or party
regarding this Agreement and the work performed thereunder. City retains the right, but has
no obligation, to represent Medical Provider and/or be present at any deposition, hearing, or
similar proceeding. Medical Provider agrees to cooperate fully with City and to provide the
opportunity to review any response to discovery requests provided by Medical Provider.
However, City’s right to review any such response does not imply or mean the right by City
to control, direct, or rewrite said response.
(c) The City hereby acknowledges that information obtained directly from the
City’s employee during the course of a Medical Evaluation by Medical Provider is subject to
both federal and California state privacy laws.
(d) Medical Provider shall maintain all patient medical records relating to the
Medical Evaluations provided, in such form and containing such information as required by
federal, state and local law. Medical records shall be maintained in a current manner that is
legible, complete, organized, and shall permit effective patient care and review by any third-
party medical provider. Subject to all applicable patient confidentiality laws, upon written
request, with at least five (5) business days to respond, Medical Provider shall provide to
City or its delegate, the City’s respective expenses, copies of the Public Safety Employees’
medical records for the purposes of conducting quality assurance and utilization review,
claims processing, verification and payment, resolving any grievances and appeals, and
other activities reasonably necessary for the proper administration of this Agreement
consistent with the law. Medical records shall be retained by Medical Provider for at least
five years following a medical evaluation and as required by law. This section survives
termination of the Agreement.
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16. NOTICES
Any notices which either party may desire to give to the other party under this
Agreement must be in writing and may be given either by (i) personal service, (ii) delivery
by a reputable document delivery service, such as but not limited to, Federal Express, which
provides a receipt showing date and time of delivery, or (iii) mailing in the United States
Mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the
party as set forth below or at any other address as that party may later designate by notice:
To City: City of San Luis Obispo
Attn: Fire Chief
2160 Santa Barbara Ave.
San Luis Obispo, California 93401
To Medical Provider: Med-Stops Medical Clinic, Inc.
Attn: Brian Roberts, M.D.
283 Madonna Rd., Suite B
San Luis Obispo, California 93405
17. ASSIGNMENT
The Medical Provider shall not assign the performance of this Agreement, nor any
part thereof, nor any monies due hereunder, without prior written consent of the City.
Because of the personal nature of the services to be rendered pursuant to this Agreement,
only Medical Provider shall perform the services described in this Agreement.
18. NO THIRD PARTY BENEFICIARIES
This Agreement shall not confer or be construed to confer any rights or benefits to
any person or entity other than the Parties.
19. GOVERNING LAW
The City and Medical Provider understand and agree that the laws of the State of
California shall govern the rights, obligations, duties, and liabilities of the parties to this
Agreement and also govern the interpretation of this Agreement. Any litigation concerning
this Agreement shall take place in the municipal, superior, or federal district court with
jurisdiction over the City.
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20. ENTIRE AGREEMENT
This Agreement contains the entire understanding between the parties relating to the
obligations of the parties described in this Agreement. All prior or contemporaneous
agreements, understandings, representations, and statements, oral or written, are merged into
this Agreement and shall be of no further force or effect. Each party is entering into this
Agreement based solely upon the representations set forth herein and upon each party’s own
independent investigation of any and all facts such party deems material. Any future
modification or amendment to this Agreement must be in writing. The illegality, invalidity
or unenforceability of any provision, or part any provision, of this Agreement shall not affect
any other provisions of this Agreement, which shall continue in full force and effect.
21. SEVERABILITY
If any provision of this Agreement, in whole or in part, or the application of any
provision in whole or in part, is determined to be illegal, invalid or unenforceable by a court
of competent jurisdiction, such provision, or part of such provision, shall be severed from
this Agreement.
22. AUTHORITY TO EXECUTE THIS AGREEMENT
The person or persons executing this Agreement on behalf of Medical Provider
warrants and represents that he/she has the authority to execute this Agreement on behalf of
the Medical Provider and has the authority to bind Medical Provider to the performance of
its obligations hereunder.
IN WITNESS HEREOF, the parties hereto have caused this Agreement to be
executed the day and year first above written.
CITY OF SAN LUIS OBISPO MEDICAL PROVIDER
By: _______________________________ By: ____________________________
Jan Marx, Mayor (Signature)
____________________________
Attest: (Name)
__________________________________ Its: ____________________________
Anthony J. Mejia, City Clerk (Title)
Approves As to Form:
______________________________
J. Christine Dietrick, City Attorney
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MED STOP
DEPARTM ENT OF M EDICAL SERVICES HEALTH
AND WELLNESS PROTECTION PROGRAM
EXHIBIT A: SLO CITY FIRE PRICE LIST (Updated 1/1/2014)
Physical Examination
Charge
Notes
LEVEL II EXAM
$127
PHYSICAL – Doctor’s complete physical exam with review of
Employee Medical Questionnaire (EMQ). If physical exam, history or
job description reveals the need to individual diagnostic studies,
notification of those studies will be made and the cost will not exceed
the amount itemized listed below.
REVIEW OF EMQ $53 EMQ review charged only on years with no physical exam
DMV PHYSICAL $50 When completed with a scheduled physical.
DMV PHYSICAL $100 When completed without a scheduled physical.
INDIVIDUAL DIAGNOSTIC STUDIES
CHEST X-RAY (2-VIEW)
$95
CHEST X-RAY (1-VIEW)
$74
PULMONARY FUNCTION,
PULSE OX ON ROOM AIR
$74
RESTING EKG
$90
TREADMILL
$264
AUDIOGRAM
$53
TITMUS / VISION ACUITY
N/C
Includes near, far, color and peripheral testing.
BLOOD DRAW
$11
CBC
$26
CMP
$26
LIPID PANEL
$26
PSA
$74
Lead Panel
$47
URINE DIP
$11
URINALYSIS W/ MICRO
$16
If indicated.
INSECTICIDE EXPOSURE
PANEL
$26
TB SKIN TEST
$21
2ND TB SKIN TEST
$16
For new employees only.
QFT GOLD
$
As per County charges
IMMUNIZATIONS – NFPA 1582 touches on immunizations with recommendations not requirements. Cal
OSHA however does have requirements. If yo u choose to pursue vaccinations I have included them below.
Hepatitis A (2 shot series)
$136
$68 EACH
Hepatitis B (3 shot series)
$252
$84 EACH
Hepatitis A/B Titers
$52
$26 EACH
Varicella Zoster titer
$25
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EXHIBIT-B
SERVICE COST ESTIMATES FOR 2014
Firefighters under age 35
Level I Exam for this age group (Note: Level II Physical Exam done every 3 years)
EMQ Review = $53
Tb Skin Test = $21
EKG = $90
Spirometry = $74
CBC = $26
UA-Dip = $11
CMP = $26
Lipids = $26
Total $327
Level II Physical Exam Cycle = add $127
(Plus $127 for Level II Exam, plus $53 Audiogram, minus $53 for EMQ)
You have seven <35 y/o with Level I only services = $2,289
You have one <35 y/o with Level I and II services = $ 454
Age group sub-total in 2014 = $2,743
Firefighters age 35 - 45
Level I Exam for this age group (Note: Level II Physical Exam done every 2 years)
EMQ Review = $53
Tb Skin Test = $21
EKG = $90
Spirometry = $74
CBC = $26
UA-Dip = $11
CMP = $26
Lipids = $26
Total $327
Level II Physical Exam Cycle = add $127
You have eleven 35 – 45 y/o with Level I only services = $3,597
You have twelve 35 - 45 y/o with Level I and II services = $5,448
Age group sub-total in 2014 = $9,045
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Firefighters age 46-49
Level I and II examination done every year
Level II Exam = $127
Tb Skin Test = $21
Audiogram = $53
Spirometry = $74
CBC = $26
UA-Dip = $11
CMP = $26
Lipids = $26
EKG = $90
Total $454
You have seven 46 - 49 y/o with Level I and II services.
Age group sub-total in 2014 = $3,178
Firefighters age 50+
Level I, II and III examination done every year. (Level III Exam = Treadmill)
Level II Exam = $127
Tb Skin Test = $21
Audiogram = $53
Spirometry = $74
PSA = $80
CBC = $26
UA-Dip = $11
CMP = $26
Lipids = $26
Treadmill = $264
Total $708
You have four 50+ y/o with Level I, II and III services.
Age group sub-total in 2014 = $2,832
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HAZMAT Cost Additions:
SLO City Fire has 6 members on the SLO County HAZMAT Team. The enhanced
HAZMAT Evaluations require a yearly Treadmill Test ($264) regardless of age.
In addition, there is a Lead Exposure Panel ($47) and an Insecticide Exposure
Panel ($26). Together this adds $337 each; times 6 Firefighters = $2,022.
City Fire Estimated Total Cost in 2014:
Firefighters under age 35 = $2,743
Firefighters age 35 – 45 = $9,045
Firefighters age 46-49 = $3,178
Firefighters age 50+ = $2,832
HAZMAT associated = $2,022
Total Cost Estimate 2014 = $19,820
* Please note – your costs ma y be higher, if the initial evaluations indicate a need
for further testing and referrals to help assure good health and clearance for duty.
** Please note – a few Firefighters with histories of positive TB skin tests may
require a QFT-Gold test done at the County Public Health Lab. We do not control
this price. We “pass-through” our cost for this service, to the City. Currently that
charge is about $62. Given the cost saved from the Tb Skin Test the net increase
in cost to the City is about $40 per Firefighter so affected.
Sincerely,
Brian Roberts, MD
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