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HomeMy WebLinkAboutRecommendation of AwardFran McAskill Director Procurement Division Board of County Commissioners July 17, 2013 330 W. Church Street, Room 150 Bartow, Florida 33830 Phone: (863) 534-6757 Fax: (863) 534-6789 Patricia Johnson, CEO, Life Scan Wellness Centers, lifescanhc@aol.com Karen A. Kleinman, Vice President, Professional Health Services, Inc., kakleinman@phsmobile.com Subject: Notice of Recommendation of Award RFP 13-407, Annual Firefighter Physicals Thank you for your participation in the above referenced RFP. The Selection Committee will request the Board of County Commissioners approve their highest scored Proposer, Life Scan Wellness Centers, and to authorize staff to negotiate a contract. Any actual proposer who is allegedly aggrieved in connection with the pending award may contact the Procurement Director. In accordance with the Procurement Procedures any person who wishes to file a protest may do so by submitting a non-refundable cashier's check in the amount of $1,000.00 with their initial protest prior to Monday, July 22, 2013 at 4:00 p.m. Failure to follow the bid protest procedure requirements within the time frames prescribed herein as established by Polk County, Florida, shall constitute a waiver of your protest and any resulting claims. If you should have any questions, please do not hesitate to let me know. Sincerely, glcatt .II4(zai3 itt Fran McAskill Procurement Director (863) 534-6430 ANNUAL FIREFIGHTER,PHYSICALS AGREEMENT THIS ANNUAL FIREFIGHTER PHYSICALS AGREEMENT (the "Agreement") is entered into as of the Effective Date (defined in Section 1, below) between Polk County (the "County"), a political subdivision of the State. of Florida, by and through its Board of County Commissioners, 330 West Church Street, Bartow, Florida 33830, and Life Extension Clinics, Inc., a Florida corporation (the "Vendor"), 1011 N. Macdill Avenue, Tampa, FL 33607. WHEREAS, the County desires to retain the services of a competent and qualified company to perform: annual physicals for the County firefighters and to furnish those services and perform those tasks (collectively, the "Services") as further described in the RFP (hereinafter defined); and WHEREAS, the County has solicited for the Services via an advertised request for proposals and has received two responsive proposals thereto; and WHEREAS, after review and consideration of all responsive proposals, the County intends to engage the Vendor to provide the Services; and WHEREAS, the Vendor remains agreeable to providing the County the Services and represents that it is competent, qualified, capable, and prepared to do so according to the terms and conditions stated herein; NOW, THEREFORE, in consideration of the mutual understandings and covenants set forth herein, the County and the Vendor hereby agree, as follows: 1.0 Effective Date; Term 1.1 This Agreement shall commence on the date (the "Effective Date") of its execution by the County. 1.2 The initial .tertn of this Agreement shall be for -three (3) fiscal years, commencing` on the Effective Date and continuing through September 30, 2015. This Agreement will automatically renew for two (2) one (1) fiscal year periods thereafter at the same terms and conditions unless otherwise terminated in accordance with the terms and conditions stated herein. 1.3 The initial term, together with all exercised renewal terms, are collectively the "Term" of the Agreement. Ighter Physicals_Agreement_-„SBH_Edits July ,29[IFinal 1.4 Polk County's fiscal year runs from. October Ist though September 30th The first fiscal year period for this agreement is FY12/13, which ends on September 30, 2013. Due to this agreement being entered into in August 2013, the first year of service delivery will be extended into the beginning of FY13/14 in order to ensure all physicals can be completed. This will mean that for FY13/14, some firefighters may receive two physicals in order to align with the service delivery plan. 2.0 Vendor Services 2.1 The County does hereby retain the Vendor to furnish the Services as further described in (i) the County's Request for Proposals RFP #13-407, to include all attachments and addenda, and (ii) in the Vendor's responsive proposal thereto (collectively, the "RFP"), all of which are incorporated into this Agreement by this reference. A complete copy of the Scope of Services section of the RFP and Vendor's responsive proposal are attached as a composite Exhibit "A" and made a part of this Agreement. 3.0 Compensation 3.1 In consideration for providing the Services, the County shall pay the Vendor an amount equal to the costs identified on the. Vendor Cost page of Vendor's submittal. When issuing invoices to the County, the Vendor should provide proof that the reporting requirements of the RFP have been met, The Vendor's invoice must reference this Agreement and be submitted on a County approved form. 3.3 The County's acceptance of any invoice or statement shall not constitute evidence of the County's acceptance of the Vendor's performance of the Services or its acceptance of any work. The Vendor's project manager or designated payroll officer shall, by affidavit, attest to the correctness and accuracy of all charges stated in each invoice and statement delivered to the County. 4.0 Vendor's Responsibilities 4.1 The Vendor shall be responsible for the professional quality, accuracy, competence, methodology, and the coordination . of all Services performed pursuant to this Agreement. 1ghter_Physioals_Agreement_- SOH Edits__July_29[1]Final 4.2 The Vendor shall also be responsible for relevant provisions of any other applicable rule, regulation, statute, ordinance, or order which may pertain to the delivery of the Services. 4.3 The County's review, approval, acceptance, or payment for any of the Vendor's Services shall not be construed to: (i) operate as a waiver of any rights the County possesses under this Agreement; or (ii) waive or release any claim or cause of action arising out of the Vendor's performance or nonperformance of this Agreement. The Vendor shall be and will always remain liable to the County in accordance with applicable law for any and all damages the County incurs which are caused by the Vendor's negligent or wrongful performance or nonperformance of any of the Services to be furnished under this Agreement. 5.0 Ownership and Retention of Working Papers and Documents All analyses, reference data, completed reports, or any other form of written instrument or document created or resulting from the Vendor's performance of the Services pursuant to this Agreement shall become the property of the Employee and/or the County as outlined in the RFP. 6.0 Termination 6.1 The County may terminate this Agreement, in whole or in part, at any time, either for the County's convenience or because of the failure of the Vendor to fulfill its obligations under this Agreement, subject to the cure period set forth in Section 26,0, by delivering written notice to the Vendor. Upon receipt of such notice, the Vendor shall: 6.1.1 Immediately discontinue all affected Services unless the notice directs otherwise; and 6.1.2 Deliver to the County all data, reports, summaries, and any and all such other information and materials of whatever type or nature as may have been accumulated by the Vendor in performing this Agreement, whether completed or in process. 6.2 Unless in dispute or subject to the County's right of set-off or other remedy, the Vendor shall be paid for Services actually rendered through the date of termination. 6.3 The rights and remedies of the County provided for in this Section 6 are in addition and supplemental to any and all other rights and remedies provided by law or under this Agreement. Ighter_PhysicalOgreement SBH_Edits; July 29[IIFinal The Vendor warrants that it has not employed or retainedany company or person, other than a bona fide employee working solely for the Vendor to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual or firm, other than a bona fide employee working solely for the Vendor, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from award of or making of the Agreement. For the breach or violation of this provision, the County shall have the right to terminate the Agreement at its sole discretion, without liability, and to deduct from the Agreement price, or otherwise recover, the full amount of such fee; commission, percentage, gift, or consideration. 8.0 Assignment The Vendor shall not assign, transfer, or encumber this Agreement, or any interest herein, under any circumstances, without obtaining the prior written consent of the County, which consent may withheld in the County's exercise of its reasonable discretion. 9.0 Professional Associates and Subcontractors If the Vendor requires the assistance of any professional associates or subcontractors in connection with providing the Services, the Vendor must obtain the prior express written approval of the County, which the County may withhold in its discretion, before any such professional associate or subcontractor may perform any work for the County. If after obtaining the County's approval the Vendor utilizes any other professional associates or subcontractors in the delivery of the Services, then the Vendor shall remain solely and fully liable to the County for the performance or nonperformance of all such professional associates and subcontractors. The failure of the Vendor's professional associates or subcontractors to timely or properly perform any of their respective obligations to the Vendor shall not relieve the Vendor of its obligations to the County under this Agreement. 10.0 Indemnification of County Vendor, to the extent permitted by law, shall indemnify, defend (by counsel reasonably acceptable to County)protect p ect and hold the County, and its officers, employees and agents harmless from, and against any and all, claims, actions, causes of action, liabilities, penalties, forfeitures, damages, losses, and expenses whatsoever (including, without limitation, attorneys' fees costs and expenses incurred during negotiation, through litigation and all appeals therefrom) including, without limitation, those pertaining to the death of or injury to any person, or damage to any property, arising out of or resulting from (i) the failure of Vendor to comply with Ighter Physieals_Agreernent_,„SBH Ed its;_,"July_29[I Final applicable laws, rules or regulations, (ii) the breach by Vendor of its obligations under this Agreement, (iii) the negligent acts, errors or omissions, or intentional or willful misconduct, of Vendor, its professional associates, agents, and employees; provided, however, that Vendor shall not be obligated to defend or indemnify the County with respect to any such claims or damages arising out of the County's sole negligence. 11.0 Innsurance Requirements The Vendor shall maintain at all times the following minimum levels of insurance and shall, without in any way altering its liability, obtain, pay for, and maintain insurance for the coverage and amounts of coverage not less than those set forth below. The Vendor shall provide the County original Certificates of Insurance satisfactory to the County to evidence such coverage before any work commences. The County shall be named as an additional insured on General and Automobile Liability policies. General Liability and Workers' Compensation policies shall contain a waiver of subrogation in favor of the County. The commercial General Liability Policy shall (by endorsement if necessary) provide contractual liability coverage for the contractual indemnity stated in Section 10, above. All insurance coverage shall be written with a company having an A.M. Best rating of at least the "A" category and size category of VIII. The Vendor's self -insured retention or deductible per line of coverage shall not exceed $25,000.00 without the permission of the County. In the event of any failure by the Vendor to comply with the provisions of this Section 11, the County may, at its option, upon notice to the Vendor, suspend Vendor's performance of the Services for cause until there is full compliance. Alternatively, the County may purchase such insurance at the Vendor's expense, provided that the County shall have no obligation to do so and if the County shall do so, the Vendor shall not be relieved of or excused from the obligation, to obtain and maintain such insurance amounts and Comprehensive Automobile Liability Insurance. $1,000,000.00 combined single limit of liability:for bodily injuries, death and property damage resulting from any one occurrence, including all owned, hired, and non -owned vehicles. Commercial General Liability. $1,000,000.00 combined single limit of liability for bodily injuries, death and property damage, and personal injury resulting from any one occurrence, including the following coverages:. Premises and Operations: lghter_Physicals Agreement,-_,SB1-1 Edits_July_29[1]Final Broad Form Commercial General Liability Endorsement to include Blanket Contractual liability (specifically covering, but not limited to, the contractual obligations assumed by the Firm); Personal Injury (with employment and contractual exclusions deleted); and Broad Form Property Damage coverage. Independent Contractors: Delete Exclusion relative to collapse, explosion and underground; Property Damage Hazards; Cross Liability Endorsement; and Contractual liability (specifically covering, but not limited to, the contractual obligations assumed by the Firm) Medical Professional Liability. $1,000,000.00 per claim, $2,000,000.00 aggregate on a per policy year on a claims made basis for bodily injuries, death, and personal injury resulting from any one occurrence. The occurrence date shall be retroactive to the date of the contract. Vendor Consultants shall be covered for any errors or omissions they may make in providing Services to firefighters. Workers Compensation. The Vendor shall provide, pay for, and maintain workers compensation insurance on all employees, its agents or subcontractors as required by Florida Statutes. 12.0 Public Entity Crimes The Vendor understands and acknowledges that this Agreement will be void in the event the conditions stated in Florida Statutes, Section 287.133, relating to conviction for a public entity crime apply to the Vendor. 13.0 Non -Discrimination The Vendor warrants and represents that all of its employees are treated equally during. employment without regard to race, color, religion, gender, age or national origin. 14.0 Vendor's Representatives The Vendor shall designate or appoint one or more Vendor representatives who are authorized to act on behalf of and to bind the Vendor regarding all matters involving the conduct of its performance pursuant to this Agreement. The Vendor shall keep the County continually and effectively advised of Vendor's designated representatives. 15.0 Integration This document incorporates and includes all prior negotiations, correspondence, conversations, agreements or understandings applicable to the matters contained herein and the A.nnuaLFirefighter Physicals_Agreement_=Sbh tdits_July_291 Fin parties agree that there are no commitments, agreements or understandings concerning the subject matter of this Agreement that are not contained in this document or its designated exhibits. Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements, whether oral or written. 16.0 Modifications, Amendments or Alterations No modification, amendment or alteration in the terms or conditions contained herein shall be effective unless agreed to and executed in writing by both parties to this Agreement in a form acceptable to the County. 17.0 Independent Contractor Nothing stated in this Agreement is intended or should be construed in any manner as. creating or establishing a relationship of co-partners between the parties, or as constituting the Vendor (including its officers, employees, and agents) as the agent, representative, or employee of the County for any purpose, or in any manner, whatsoever, The Vendor is to be and shall remain forever an independent contractor with respect to all Services performed under this Agreement. The Vendor shall have no right to speak for or bind the County in any manner. 18.0 Public Records Law The Vendor acknowledges the County's obligations under Article I, Section 24, of the Florida Constitution and under Chapter 119, Florida Statutes, to release public ` records to members of the public upon request and that the constitutional and statutory provisions control over the terms of this Agreement. In association with its performance pursuant to ` this Agreement, the Vendor will not release or otherwise disclose the content of any documents or information that is specifically exempt from disclosure pursuant to all applicable laws, including, without limitation, the HIPAA Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164. 19.0 Compliance with Laws and Regulations In providing all Services pursuant to this Agreement, the Vendor shall abide by all statutes, ordinances, rules, and regulations pertaining to, or regulating the provisions of, such Services, including those now in effect and hereafter adopted. Any violation of said statutes, ordinances, rules, or regulations shall constitute a material breach of this Agreement, and shall Ighter_Physicals_Agreement„,LLSBILEdits _]uly_29[1]Final entitle the County to terminate this Agreement immediately upon delivery of written notice of termination to the Vendor. 20.0 GoverningLaw and Venue This Agreement shall be governed in all respects by the laws of the State of Florida and any litigation with respect thereto shall be brought only in the courts of Polk County, Florida or in the United States District Court, Middle District of Florida, located in Hillsborough County, Florida. 2L0 Notices Whenever either party desires to give notice unto the other, it must be given by written notice, delivered (i) in person, (ii) via registered or certified United States mail, postage prepaid with return receipt requested, or (iii) via nationally recognized overnight delivery service, and addressed to the party for whom it is intended at the place last specified by each party. The place for giving of notice shall remain such until it is changed by written notice delivered in compliance with the provisions of this Section 21. For the present, the parties designate the following as the respective places for giving of notice, to wit: Polk County Government 330 West Church St., Drawer AS05 Bartow, Florida 33830 Attention: Frances McAskill, Procurement Director For Vendor: 22.0 Severability The invalidity, illegality, or unenforceability of any provision of this. Agreement, or the occurrence of any event rendering any portion or provision of this Agreement void, shall in no. way affect the validity or enforceability of any other portion or provision of the Agreement, any void provision shall be deemed severed from the Agreement and the balance of the Agreement shall be construed and enforced as if the Agreement did not contain the particular portion or provision held to be void. The parties further agree to reform. the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision: The provisions of this section shall not prevent the entire Agreement from Life Extension Clinics, Inc. 1011 N. Macdill Avenue Tampa, FL 33607 Attention: Patricia Johnson Annual Firefighter Physicals _Agreement_--,Sbh Edits_ 7uly_291 Fint being void should a provision which is of the essence. of the Agreement be determined to be void. 23.0 Annual Appropriations Vendor acknowledges that during any fiscal year the County shall not expend money, incur any liability, or enter into any agreement which by its terms involves the expenditure of money in excess of the amounts budgeted as available for expenditure during such fiscal year. Accordingly, any agreement, verbal or written, the County may make in violation of this fiscal limitation is null and void, and no money may be paid on such agreement. The County may enter into agreements whose duration exceeds one year; however, any such agreement shall be executory only for the value of the services to be rendered which the County agrees to pay as allocated in its annual budget for each succeeding fiscal year. Accordingly, the County's performance and obligation to pay the Vendor under this Agreement is contingent upon annual appropriations being made for that purpose. 24.0 Unauthorized Aliens The Vendor shall not employ or utilize unauthorized aliens in the performance of the Services provided pursuant to this Agreement. The County shall consider the employment or utilization of unauthorized aliens a violation of Section 274A(e) of the Immigration and Naturalization Act (8 U.S.C. 1324a) and a cause for the County's unilateral termination of this Agreement. When delivering executed counterparts of this Agreement to the County, the Vendor shall also deliver a completed and executed counterpart of the attached "AFFIDAVIT CERTIFICATION IMMIGRATION LAWS" form, 25,0 Vendor Representations 25.1 The Vendor hereby represents and warrants the following to the County: 25.1.1 Vendor is a corporation duly organized and existing in good standing under the laws of the State of Florida with full right and authority to do business within the State of Florida. 25.1,2 Vendor's performance under this Agreement will not violate or breach any contract or agreement to which the Vendor is a party or is otherwise bound, and will not violate any governmental statute, ordinance, rule, or regulation. 25.1.3 Vendor has the full right and authority to enter into this Agreement and to perform its obligations in accordance with its terms. Tghterryhysicals_Agreement; SBH_Edits_July 29[1]Final 25,1.4 Vendor now has. and will continue to maintain all licenses and approvals required to conduct its business, and that it will at all times conduct its business activities in a reputable manner. 25.1.5 Vendor has no obligation or indebtedness that would impair its ability to fulfill the terms of this Agreement. 25.1.6 Vendor has the personnel and experience necessary to perform all Services in a professional and workmanlike manner. 25.1.7 Vendor shall exercise the same degree of care, skill, and diligence in the performance of the Services as provided by a professional of like experience, knowledge and resources, under similar circumstances. 25.1.8 Vendor shall, at no additional cost to County, re -perform those Services which fail to satisfy the foregoing standard of care, the requirements and standards stated in Section 4.0, above, or which otherwise fail to meet the requirements of this Agreement. 25.1.9 Each individual executing this Agreement on behalf of the Vendor is authorized to do so. 26.0 ' Default and Remedy If the Vendor materially defaults in its obligations under this Agreement and fails to cure the same within fifteen (15) days after the date the Vendor receives written notice of the default from the County, then the County shall have the right to (i) immediately terminate this Agreement by delivering written notice to the Vendor, and (ii) pursue any and all remedies available in law, equity, and under this Agreement. If the County materially defaults in its obligations under this Agreement and fails to cure the same within fifteen (15) days after the date the County receives written notice of the default from the Vendor, then the Vendor shall have the right to immediately terminate this Agreement by delivering written notice to the County. Upon any such termination, then, unless in dispute or subject to the County's right of set-off or other remedy, the County shall pay the Vendor the full amount due and owing for all Services performed through the date of Agreement termination. 27.0 LIMITATION OF LIABILITY IN NO EVENT, SHALL THE COUNTY BE LIABLE TO THE VENDOR FOR INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY, OR PUNITIVE DAMAGES OF ANY KIND OR NATURE, INCLUDING LOSS OF PROFIT, lghter Physicals_Agreement _S13H_Edits_,July_29[1]Pinal WHETHER FORESEEABLE OR NOT, ARISING OUT OF OR RESULTING FROM THE NONPERFORMANCE OR BREACH OF THIS CONTRACT BY THE COUNTY WHETHER BASED IN CONTRACT, COMMON LAW, WARRANTY, TORT, STRICT LIABILITY, CONTRIBUTION, INDEMNITY OR OTHERWISE. 28.0 Waiver A waiver by either the County or the Vendor of any breach of this Agreement shall not be binding upon the waiving party unless such waiver is in writing. In the event of a written waiver, such a waiver shall not affect the waiving party's rights with respect to any other or further breach of this Agreement. The making or acceptance of a payment by either party with the knowledge of the other party's existing default or breach of the Agreement shall not waive such default or breach, or any subsequent default or breach of this Agreement, and shall not be construed as doing so, 29.0 Attorneys' Fees and. Costs Each party shall be responsible for its own legal and attorneys' fees, costs and expenses incurred in connection with any dispute or any litigation arising out of, or relating to this Agreement, including attorneys' fees, costs, and expenses incurred for any appellate or bankruptcy proceedings. 30.0 Force Majeure The Vendor shall be temporarily excused from performance if an Event of Force Majeure directly or indirectly causes its nonperformance. An "Event of Force Majeure" shall mean any event which results in the prevention, or delay of performance by a party of its obligations under this Agreement and which is beyond the reasonable control of the nonperforming party. It includes, but is not limited to fire, flood, earthquakes, storms, lightning, epidemic, war, riot, civil disturbance, sabotage, and governmental actions. Within five (5) days after the occurrence of an Event of Force Majeure, the Vendor shall deliver written notice to the County describing the event in reasonably sufficient detail and how the event has precluded the Vendor from performing its obligations hereunder. The Vendor's obligations, so far as those obligations are affected by the Event of Force Majeure, shall be temporarily suspended during, but no longer than, the continuance of the Event of Force Majeure and for a reasonable time thereafter as may be required for the Vendor to return to normal business operations. If excused from performing any obligations under this Agreement due to the occurrence of an Event of Force Majeure, the lghter_Physicals_Agreement -, SB11 Edits_ July_29[1]Final Vendor shall promptly, diligently, and in good faith take all reasonable action required for it to be able to commence or resume performance of its obligations under this Agreement, During any such time period the Vendor shall keep the County duly notified of all such actions required for it to be able to commence or resume performance of its obligations under this Agreement 31,0 Key Personnel The Vendor shall notify the County if any of the Vendor's Key Personnel (as defined, below) change during the Term of the Agreement, To the extent possible, the Vendor shall notify the County at least ten (10) days prior to any proposed change in its Key Personnel. At the County's request, the Vendor shall remove, without consequence to the County, any of the Vendor's contractors, sub -contractors, sub -consultants, agents or employees and replace the. same with an appropriate substitute having the required skill. and experience necessary to perform the Services, The County shall have the right to reject the Vendor's proposed changes in Key Personnel, The followint�individuals shall -be-considered "Key Personnel:" Name: - no,k o, �C� 1�� iY 1( =0 Name C YV'1(V4, `�C(' , ( l Name: 'Dell Oe ( jJ 172 J(t'" Name: i L) t~01 yl CtrY1 (..t) +I 1( 2O () (THE REMAINDER OF THE PAGE IS LEFT INTENTIONALLY BLANK; THE AGREEMENT CONTINUES ON THE FOLLOWING PAGE WITH THE PARTIES' SIGNATURES.) Ighter_Physicals_Agreemenl, -;,SnH gdits_duly_291Il1=inal IN WITNESS WHEREOF,-4the parties hereto have executed this Agreement as of the Effective Date ATTEST:. STACY M. BUTTERFIELD CLERK OF THE BOARD POLK COUNTY, a politicalsubdivision of the State of Florida By: Bye_.. Deputy Clerk Melony Bell, C airman Board of County Commissioners Date Approved by Board:I y ry cop, Review as to form and legal sufficiency: [Print. Name] Ighter Physical s_Agreement,: StiltEcl ,,July29[1Win al He/she pers nally appeared before me at the time of notarization, and is personally �,;rr"(IJ I"3 � 1 (''PYj,SV as identification and did certify to have know. (Type of Identification) in the foregoing instrument and certified the same to be true in all reso�ects,.� Subscribed and sworn to (or affirmed) before me this I -�— (Dat ) Commission Number E�... 2. —0 1—N ; ACKNOWLEDGEMENT OF FIRM, I Ai QIp ORATION i^ STATE OF C�Y`�tCtA, j COUNTY OF lit( 6 y oqI'\ The�f7or nl oing nstrut was iteknovrecInd before me this„._ (Date '(Name of officer or agent, title of officer or a: on behalf of the corporation, pursuant to the powers conferred upon said officer or acorpolsrpcNV.M.Elti fnP alFOfdj .yAu04,Q018 ^20320 8oridtd IMdupA vqarY Alin (0,1111, al Notaryt at yAd re an Notary Sea tune of Note ; ed, tinted or stam Commission Expiration Date .i ly� rf 2x (o ACKNOWLEDGEMENT OF: FIRM, IF A PARTNERSHIP STATE OF COUNTY OF The foregoing instrument was acknowledged before me this By (Name of acknowledging partner or agent) (Date) on behalf of a partnership. He/She personally appeared before me at the time of notarization, and is personally known to me or has produced as identification and did certify to have knowledge of the matters (Type of identification) in the foregoing instrument and certified the same to be true in all respects, Subscribed and sworn to (or affirmed) before me this (Date) Commission Number (Official Notary Signature and Notary Seal) Commission Expiration Date ed ame of Nota ed rinted or stain ACKNOWLEDGEMENT OF FIRM, IF AN INDIVIDUAL STA'i'E OF COUNTY OF The foregoing instrument was acknowledged before me this By (Date) (Name of acknowledging) who personally appeared before me at the time of notarization, and is personally known to me or has produced as identification and did certify to have knowledge of the matters (Type of Identification) in the foregoing instrument and certified the same to be true in all respects. Subscribed and sworn to (or affirmed) before me this (Date) Commission Number (Official. Notary Signature and Notary Seal) Commission Expiration Date (Name of Notary typed, printed or stamped) tghter_Physicals„Agremcni_- SBH Edicsllulyr24[1jPinal la: AFFIDAVIT CERTIFICATION IMMIGRATION LAWS SOLICITATION NO, RFP 13-407 PROJECT NAME: Annual Firefighter Physicals THE COUNTY WILL NOT INTENTIONALLY AWARD CONTRACTS TO ANY PARTY WHO KNOWINGLY EMPLOYS UNAUTHORIZED ALIEN WORKERS;_ CONSTITUTING A VIOLATION OF THE EMPLOYMENT PROVISIONS CONTAINED IN 8 U.S.C. SECTION 1124 a(e) (SECTION 274A(e) OF THE IMMIGRATION AND NATIONALITY ACT ("INA"). THE COUNTY MAY CONSIDER A CONTRACING PARTY'S EMPLOYMENT OF UNAUTHORIZED ALIENS A VIOLATION OF SECTION 274A(e) OF THE INA. SUCH VIOLATION BY THE RECIPIENT OF TIIE EMPLOYMENT PROVISIONS CONTAINER IN SECTION 274A(e) OF THE INA SHALL BE GROUNDS FOR UNILATERAL CANCELLATION OF THE CONTRACT BY THE COUNTY, THE UNDERSIGNED ATTESTS THAT THE COMPANY IS FULLY COMPLIANT WITH ALL APPLICABLE IMMIGRATION LAWS (SPECIFICALLY TO THE 1986 IMMIGRATION ACT AND SUBSEQUENT AMENDMENTS). Company Name: Life E on ''Iinics, Inc. Signature STATE OF; COUNTY OF; r► 30ag Title i ate The f re oing instrutne t was signed and acknowledged before nie this,ay of t (A.G. Cj KYLS, n l 1 who has produced C (Print or Type Name) Type of Identifioa and�Number) - !Pub iio nature etc Te.l t +2.„ v Printed Name 6fNotary Public EE 22032-c4, . �, 2.o16 Notary Commission Number/Expiration 4 + . • •'- STACEV TEIIEKAMP i : 1 *, Nal*ry Publle - tittle of Florida I "* My Cantu EOlees Ai q 4, gol 1 - Caanliiiii # eE *40 1 Bentlail Tbroupi N:Ebnil Notary Atte. Ighter_Physicals;Agreement,-..SBH_Edite ,1uly,291IIPinal 15 as identification, ,2012,by EXHIBIT "A" SCOPE OF WORK The successful Proposer shall provide physical exams to Polk County Fire Rescue Department (PCFR) on an annual basis. The medical requirements are based on National Fire Protection Association (NFPA) 1582 and on in-depth consideration of essential functions. These essential functions are what members are expected to perform at emergency incidents and are derived from the performance objectives stated in NFPA 1001, Standard for firefighting Professional Qualifications. When making his/her assessment of candidate/personnel's ability to perform the job, the factors the physician needs to take into consideration includes but are not limited to: Operating both as a member of a team and independently at incidents of uncertain 'duration. Spending extensive time outside exposed to the elements. Tolerating extreme fluctuations in temperature while performing duties. Firefighters are often required to perform physically demanding work in hot (up to 400F); humid (up to 100%) atmospheres while wearing equipment that significantly impairs body -cooling mechanisms. • Experiencing frequent transition from hot to cold and from humid to dry atmosphere. Working in wet or muddy areas. Performing a variety of tasks on slippery, hazardous surfaces such as on rooftops or from ladders. Working in areas where sustaining traumatic or thermal injuries is possible. Facing exposure to carcinogenic dusts, such as asbestos, toxic substances such as hydrogen cyanide; acids, carbon monoxide, or organic solvents, either through inhalation or skin contact. Facing exposure to infectious agents such as Hepatitis or HIV. Wearing personal protective equipment (PPE) that weighs approximately 50Ibs while performing firefighting tasks. Performing physically demanding work while wearing positive -pressure breathing equipment Performing complex tasks during life -threatening emergencies. Working for long periods of time requiring sustained physical activity and intense concentration. Facing life -or -death decisions during emergency conditions. Being exposed to grotesque sights and smells associated with major trauma and burn victims. Making rapid transitions from rest to near -maximal exertion without warm-up periods: Operating in environments of high noise, poor visibility, limited mobility, at heights, and in enclosed or confined spaces. Using manual and power tools in the performance of duties. Relying on senses of sight, hearing, smells, and touch to help determine the nature of the emergency, maintain personal safety, and to make critical decisions in a confused, chaotic, and potentially life -threatening environment throughout the duration of the operation. 1. Technical Requirements for Firefighter Annual Physical Exam A comprehensive medical examination to include a health risk assessment, a complete medical history review to determine any, health conditions that would prevent, or could be aggravated by, performing the duties of the position, including but not limited to, the ability to carry equipment, wear protective equipment/clothing and meet the physical and psychological demands of the firefighter position. This medical history shall also include any significant changes, job related exposures andnewsymptoms since the previous physical. The Annual Exams shall include: A. Physical Examination: Firefighter physical NFPA 1582 Compliant • Hands-on Physical • Vital Signs • Clinical Breast Examination B. Cardiac Assessment • Echocardiogram • Resting EKG • Abdominal Aorta Ultrasound • Carotid Artery Ultrasound • Cardiac Stress Test with VO2 max calculation (Stress test treadmill electrocardiograms will be supervised by a Physician, Clinical Exercise Physiologist, PA, MSN, or NP) CCancer and Disease Assessment Skin cancer screening • DRE for lower intestinal masses (test optional to the employee) • Hemoccult Test for Colon Cancer Screening • Prostate Ultrasound (MEN ONLY) • Testicular Ultrasound (MEN ONLY) • Thyroid Ultrasound • Liver, Pancreas, Gall Bladder, Bladder, Spleen, and Kidney Ultrasound • Pelvic Ultrasound (WOMEN ONLY) ***Not necessary for post total hysterectomy • Osteoporosis risk assessment (based on age and risk factors) D. Pulmonary Function Test for respirator use E. Lab Tests • Urinalysis • Total Lipid Profile • Complete Blood Count • Comprehensive Metabolic Panel • Thyroid Stimulating Hormone (TSH) • CA-125 Ovarian Cancer blood test (for WOMEN) • PSA Prostate Specific Antigen blood test (for MEN) • Diabetes tests (Glucose and Hemoglobin Al C) • Tuberculosis screening, annually by QuantiFERON®--TB Gold In -Tube test (QFT-GIT) Hepatitis C Test F. TITMUS Vision Test Visual acuity corrected vision shall be to at least 20/30 Snellen in each eye • Color vision • Depth perception Peripheral vision- Visual field performance shall be 140 in the horizontal meridian combined Night blindness- A history of night blindness should be evaluated to determine employee's capacity to perform essential tasks at night or in the dark or low settings. G. Hearing Exam • - Audiometric exam H. Personal consultation • Consultation with Physician, PA, MSN, or NP to review test results and receive recommendations for medical interventions and counseling for disease management. Behavioral modification recommendations for: Tobacco cessation • Stress management • Diet and nutrition plan • Healthy heart • Diabetes management Healthy mind, healthy body information . Fitness Evaluations per Fire Service Joint Labor Management Wellness - Fitness Initiative • Fitness and Agility evaluation • Muscular Strength evaluation • Muscular Endurance evaluation • Cardiovascular Aerobic endurance evaluation • Resistance evaluation • Stretching/Flexibility evaluation • Body composition analysis • Exercise Prescription • Nutritional analysis • Weight management goals K. Additional Services (Priced separately) Chest x-ray: Optional annually, required a minimum every five (5) years • Respirator Fit Testing (SCBA Face piece Fit test/N-95 Respirators) • Hepatitis B Test (antigen) • Hepatitis B Titer (antibody) Hepatitis B Vaccine (3 per series) Hepatitis A Test (antigen) Hepatitis A Titer (antibody) Hepatitis A Vaccine (2 per series) PPD Test Minimum Qualifications. Personnel Requirements: The successful Proposer's physician and/or medical director shall be board certified with experience in occupational medicine health care to Fire, Rescue and EMS Agencies with a minimum of (5) five year experience. The sonographer's personnel shall be registered diagnostic medical. sonographers. Provide a detailed biography of the provider(s). The successful Proposer shall develop a detail staffing plan that ensures that an adequate number of full and/or part-time staffing is trained and available the personnel meet performance criteria and adhere to strict safety and security measures. The staffing plan shall include duties and responsibilities for assignedposition, staffing each method to be used. The staffing plan is to be submitted with the proposal submission. • The successful Proposer Project Managers and/or Supervisors shall have excellent communication skills and be capable of directing and coordinating with the designated County staff. • The successful Proposer Project Managers and/or Supervisors shall constantly use their experience and training to properly guide the program. To provide an adequate number of personnel specifically trained, experienced and licensed in the all areas of the project. Provide other qualified licensed professionals as needed. The County reserves the right to direct the successful Proposer to rearrange work schedules or annual work plan to meet the immediate needs of the County. This shall include weekend work and staffing. The successful proposer must have the capability of being mobile so as to perform the exams at various locations throughout the county. A copy of the complete examination and test results must be provided to. the employee either in person or via U.S. Mail within 30 days of the exam. A Fit -for -Duty exam report stating whether the employee is medically fit to perform the essential duties of a firefighter and provide results of Hepatitis titers/Screenings, must be provided for each employee within 14 days of the exam. If the employee is found to be unfit for duty, the County shall be notified by phone within twenty four (24) hrs of the exam, and providing a written notification with three (3) days of any tests that reveal conditions that could place the employee or teams in immediate danger by continuing unrestricted duty. The final evaluation shall be reviewed and signed by a licensed Physician, NP, MSN, or PA. The Proposer shall develop samples of reporting and are to be submitted with the proposal submission. The County reserves the right to request, modify or alternate reports throughout the term of the Agreement. The successful Proposer will be responsible for performing these physicals at various sites around the county covering multiple shifts. If not utilizing their own mobileunits to provide the physicals, the successful Proposer may utilize County owned sites, if available, as a project location. Should the successful Proposer use the County owned facilities, they shall be responsible for all public utilities, phone lines, insurance, mobile vehicle and or portable equipment capability. The successful Proposer shall also be responsible for maintaining all County supplied facilities in a neat, clean and functional manner, and will be responsible for any damages beyond normal wear and tear, and/or vandalism. The successful Proposer shall be responsible for the compliance to all Federal, State and local statutes and regulations pursuant to the safe and proper storage of all regulated substances, materials, and equipment at the successful Proposer's sole expense. The successful Proposer shall be responsible for transport of all equipment, fuel, materials, and supplies to and from the site. Comprehensive Safety and Security Program: Safety and security ; is a prime consideration to the County staff. A variety of emergencies may occur that could adversely affect, endanger or inconvenience the County personnel or its information; the ` successful Proposer shall design a comprehensive safety and security program in accordance with the Health Insurance Portability and Accountability Act (HIPPA) that conforms to the validity of a test and/or results. ` The safety and security plan is to be submitted with the proposal submission. The safety and security program should address at a minimum, but not be limited to the following: a. Processes and procedures for employee safety and security. b. Processes and procedures for facilities and equipment security. c. Emergency Preparedness Plan. d. Safety equipment. e. Coordination and reporting to the County's Risk Management Office regarding accidents and /or damages. f Records confidentiality procedures. g. Testing safety and accuracy. Subcontracting:'; Subcontracting and/or assigning of any and/or all portions of this agreement are subject to County review and approval. The successful Proposer shall perform required services through its own employees or subcontractors. The successful Proposer shall include the subcontractor's name, location, equipment and personnel with the proposal submission. Medical laboratory: The Medical laboratory shall meet all equipment,' location and personnel requirements as established by Department of Transportation regulations (49 CFR 40, 59, FR 4300, as amended) and be properly licensed. The successful Proposer shall provide a facility and certified technicians to collect blood and urine specimens.