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1. 03/21/2018 AgreementCKevin Madok, CPA Clerk of the Circuit Court & Com troller — Monroe Count Florida Y1 DATE: March 28, 2018 TO: Debbie Lofberg Emergency Services FROM: Pamela G. Hancock, D.C. SUBJECT: March 21st BOCC Meeting Attached is an electronic copy of Item C7, Contract with Life Extension Clinics, Inc. to perform annual physical examinations of Monroe County Fire Rescue personnel in accordance with NFPA 1582, for your handling. Should you have any questions, please feel free to contact me at ext. 3130. Thank you. cc: County Attorney_ Finance File KEY WEST 500 Whitehead Street Key West, Florida 33040 305-294-4641 MARATHON 3117 Overseas Highway Marathon, Florida 33050 305-289-6027 PLANTATION KEY 88820 Overseas Highway Plantation Key, Florida 33070 305-852-7145 PK/ROTH BUILDING 50 High Point Road Plantation Key, Florida 33070 305-852-7145 CONTRACT FOR SERVICES � s Mow* THIS AGREEMENT is made and entered into on the day of 2018 by and between MONROE COUNTY, a political subdivision of the State of Florida whose address is 1100 Simonton Street, Florida 33040 (hereinafter referred to as "County"), and Life Extension Clinics Inc., a business having its primary business location at: 1011 N. MacDill Ave., Tampa, Florida 33607 (hereinafter the "Contractor"). WITNESSETH: WHEREAS, the County is desirous of obtaining the services of a knowledgeable and qualified individual or entity to perform physical examinations for Monroe County Fire Rescue staff, and WHEREAS, the provision of such services shall mutually benefit the parties hereto and the residents of Monroe County, Florida. NOW THEREFORE, in consideration of the covenants herein contained, it is mutually agreed between the parties as follows: 1) SCOPE OF THE WORK: The Contractor, with the exception of a treadmill to be provided by the County, shall furnish all labor, materials, equipment, machinery, tools and apparatus to perform all work or services specified in Exhibit 1, Request for Proposal (RFP) #17- 601 and any addenda to the RFP, attached hereto and made a part hereof by this reference and hereinafter referred to as the "work" or "services". Unless expressly modified by this Agreement or future amendments to this Agreement, the terms and conditions of the RFP and any addenda will be binding on the parties. 2) TERM: This Agreement shall become effective on the date of execution, for a term of two (2) years. At the end of this term, the County has the option of renewing this agreement for two (2) one year terms. Should the Contractor wish to renew the Agreement, it should relay that information to the County in writing at least 60 days .prior to the expiration of the 2-year term. 3) PAYMENTS: The County shall pay the Contractor for work or services provided under this Agreement as provided in Exhibit 2 to this Agreement and made a part of this Agreement by this reference. The County reserves the right to deduct from any Contractor invoice an amount for defective or nonconforming work or for work not provided but invoiced. The County shall remit payment in accordance with the Florida Prompt Payment Act, Florida Statutes Section 218.70 et seq. 4) INDEMNIFICATION: The Contractor shall indemnify and hold harmless the County and its agents and employees from and against all claims, damages, losses and expenses, including attorney's fees arising out of or resulting from the performance of its work under this Agreement, where such claim, damage, loss or expense is caused, in whole or in part, by the act or omission of the Contractor, or anyone directly or indirectly employed by the Contactor, or anyone for whose acts any of them may be liable, regardless of whether or not it is caused in part by a party indemnified thereunder. In any and all claims against the County, or any of its agents or anyone directly or indirectly employed by the Contractor, or anyone for whose acts any of them may be liable, indemnification obligation under this paragraph shall not be limited in any way by a limitation on the amount or type of damages, compensation or benefits payable by or for the Contractor, under workers' compensation acts, or other related policies of insurance. The parties acknowledge specific consideration has been exchanged for this provision. 5) MODIFICATIONS TO AGREEMENT: This Agreement, together with any exhibits, task assignments and schedules, constitutes the entire agreement between the County and the Contractor and supersedes all prior written or oral understandings. This Agreement and any exhibits, task assignments and schedules may only be amended, supplemented or canceled by a written instrument duly executed by the parties hereto. 6) INSURANCE: The Contractor, at its own expense, shall keep in force and at all times maintain during the term of this Agreement: a. Professional Liability Insurance: Professional Liability Insurance issued by responsible insurance companies and in a form acceptable to the County, with combined single limits of not less than One Million Dollars b. General Liability Insurance: General Liability Insurance issued by responsible insurance companies and in a form acceptable to the County, with combined single limits of not less than One Million Dollars ($1 for Bodily Injury and Property Damage per occurrence. C. Automobile Liability Insurance: Automobile Liability coverage shall be in the minimum amount of One Million Dollars ($1,000,000) combined single limits for Bodily Injury and Property Damage per accident. d. Workers' Compensation Coverage: Full and complete Workers' Compensation Coverage, as required by State of Florida law, shall be provided. e. Insurance Certificates: The Contractor shall provide the County with Certificate(s) of Insurance on all the policies of insurance and renewals thereof in a form(s) acceptable to the County. Said Liability Policies shall provide that the Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on all policies, except for Workers' Compensation. The County shall be notified in writing of any reduction, cancellation or substantial change of policy or policies at least thirty (30) days prior to the effective date of said action. All insurance policies shall be issued by responsible companies who are acceptable to the County and licensed and authorized under the laws of the State of Florida. 7) ATTORNEY'S FEES: In the event of any legal action to enforce the terms of this Agreement each party shall bear its own attorney's fees and costs. 8) GOVERNING LAW: This Agreement shall be governed, interpreted and construed according to the laws of the State of Florida. 9) ' COMPLIANCE WITH STATUTES: It shall be the Contractor's responsibility to be aware of and comply with all federal, state and local laws. 10) VENUE: Venue for any legal action by any party to this Agreement to interpret, construe or enforce this Agreement shall be in a court of competent jurisdiction in and for Monroe County, Florida and any trial shall be non jury. 11) ASSIGNMENTS: Contractor shall not assign any portion of this Agreement without the written permission of the County. 12) TERMINATION: If either party fails or refuses to perform any of the provisions of this Agreement or otherwise fails to timely satisfy the provisions hereof, either may notify the other parry in writing of the nonperformance and terminate the Agreement or such part of the Agreement as to which there has been delay or a failure to properly perform. The Contactor may cancel the Agreement, for good cause, upon ninety (90) days prior written notice to the County. The County retains the right to terminate the Agreement, in part or in its entirety, with or without cause upon thirty (30) days prior written notice. Any work completed or services provided prior to the date of termination shall, at the option of the County, become the property of the County. The County is only responsible for payment for (work completed or services provided) prior to the effective date of termination. 13) INDEPENDENT CONTRACTOR: The Contractor shall perform the services under this Agreement as an independent contractor and nothing contained herein shall be construed to be inconsistent with this relationship or status. Nothing in this Agreement shall be interpreted or construed to constitute the Contractor or any of its agents or employees to be the agent, employee or representative of the County. 14) RIGHT TO AUDIT RECORDS: In performance of this Agreement, the Contractor shall keep books, records, and accounts of all activities related to the Agreement, in compliance with generally accepted accounting procedures, as adopted by the Department of Financial Services, as set forth in Rule 691-61.0012, Florida Administrative Code, as amended or superseded from time to time, or the Auditor General. Books, records, and accounts related to the performance of this Agreement shall be open to inspection during regular business hours by an authorized representative of the office and shall be retained by the Contractor for a period of three (3) years after termination of this Agreement for accounting related records and for other public records, five (5) years after termination of this Agreement, or for any longer periods of time as may be required by applicable retention schedules. All books, records, and accounts related to the performance of this Agreement shall be subject to the applicable provisions of Chapter 119 and Section 401.30, Florida Statutes. No reports, data, programs or other materials produced, in whole or in part for the benefit and use of either party, under this Agreement shall be subject to copyright by the other party in the United States or any other country. 15) PUBLIC ACCESS. Public Records Compliance. Contractor must comply with Florida public records laws, including but not limited to Chapter 119, Florida Statutes and Section 24 of article I of the Constitution of Florida. The County and Contractor shall allow and permit reasonable access to, and inspection of, all documents, records, papers, letters or other "public record" materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and Contractor in conjunction with this contract and related to contract performance. The County shall have the right to unilaterally cancel this contract upon violation of this provision by the Contractor. Failure of the Contractor to abide by the terms of this provision shall be deemed a material breach of this contract and the County may enforce the terms of this provision in the form of a court proceeding and shall, as a prevailing party, be entitled to reimbursement of all attorney's fees and costs associated with that proceeding. This provision shall survive any termination or expiration of the contract. The Contractor is encouraged to consult with its advisors about Florida Public Records Law in order to comply with this provision. Pursuant to F.S. 119.0701 and the terms and conditions of this contract, the Contractor is required to: (1) Keep and maintain public records that would be required by the County to perform the service. (2) Upon receipt from the County's custodian of records, provide the County with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. (3) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the contractor does not transfer the records to the County. (4) Upon ' completion of the contract, transfer, at no cost, to the County all public records in possession of the Contractor or keep and maintain public records that would be required by the County to perform the service. If the Contractor transfers all public records to the County upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the County, upon request from the County's custodian of records, in a format that is compatible with, the information technology systems of the County. (5) A request to inspect or copy public records relating to a County contract must be made directly to the County, but if the County does not possess the requested records, the County shall immediately notify the Contractor of the request, and the Contractor must provide the records to the County or allow the records to be inspected or copied within a reasonable time. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS, BRIAN BRADLEY, AT (305) 292-3470 16) UNAUTHORIZED ALIEN WORKERS: Monroe County will not intentionally award a publicly funded contract to any contractor who knowingly employs unauthorized alien workers, constituting a violation of the employment provisions contained in 8 U.S.C. Section 1324a(e) Section 274A(e) of the Immigration and Nationality Act "INA". The County shall consider a contractors intentional employment of unauthorized aliens as grounds for immediate termination of this Agreement. 17) FEDERAL TAX ID NUMBER: The Contractor shall provide to the County their Federal Tax ID Number or, if the Contractor is a sole proprietor, a Social Security Number. 18) EMPLOYMENT: The Contractor shall not engage the services of any person or persons now employed by the County, including any department, agency, board or commission thereof, to provide services relating to this contract without written consent from the County. 19) PUBLIC ENTITY CRIMES: A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a public entity, and may not transact business with any public entity in excess of the threshold amount provided in s.287.017 for CATEFORY TWO for a period of thirty six (36) months from the date of being placed on the convicted vendor list. 20) CONSTRUCTION OF AGREEMENT: The parties hereby acknowledge that they fully reviewed this Agreement, its attachments and had the opportunity to consult with legal counsel of their choice, and that this Agreement shall not be construed against any party as if they were the drafter of this Agreement. 21) CONTINUED MANAGEMENT BY THE NAMED PARTIES: Continuation of the Agreement is contingent on continued management by Dr. Anthony Capasso, Medical License #ME6951. Noncompliance with this provision is grounds for the County to terminate the Agreement for default. The County can only agree to substituted management by a written modification signed by both parties. 22) Notices - Any notice of other communication from either party to the other pursuant to this agreement is sufficiently given or communicated if sent by registered mail, with proper postage and registration fees prepaid, addressed to the parry for whom intended, at the following addresses: For County: Emergency Services Attn: Chief James Callahan 490 63rd Street Ocean, Suite 140 Marathon, FL 33050 For Contract to: CEO Life Extension Clinics, Inc. Ms. Patricia Johnson 1101 N. MacDill Avenue Tampa, FL 33607 23) Nondiscrimination. Contractor agrees that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any parry, effective the date of the Court order. Contractor agrees to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VII of the Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the ' basis of handicaps; 4) The Age Discrimination Act of 1975; as amended (42 USC ss. 6101-6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968, (42 USC s. et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as may be amended from time to time, relating to nondiscrimination based of disability; 10) Monroe County Code Chapter 14, Article II which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identify or expression, familial status or age; 11) Any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. 24) Severability: If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. Contractor and County 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. 25) Binding Effect: The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of Contractor and County and their respective legal representatives, successors, and assigns. 26) Authority. Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. 27) Adjudication of Disputes or Disagreements. Contractor and County agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If no resolution can be agreed upon within 30 days after the first meet and confer session, the issue or issues shall be discussed at a public meeting of the Board of County Commissioners. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement by Florida law. 28) Cooperation. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, Contractor and County agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. Contractor and County specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. 29) Covenant of No Interest. Contractor and County covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and the only interest of each is to perform and receive benefits as recited in this Agreement. 30) Code of Ethics. County agrees that officers and employees of the County recognize and.will be required to comply with the standards of conduct for public officers and employees. as delineated in Section 112.313, Florida Statutes, regarding, but not limited to solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 31) No Solicitation/Payment. Contractor and County warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, 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 it, any fee, commission, percentage, gift or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, Contractor agrees that County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift or consideration. 32) Non -Waiver of Immunity: Notwithstanding the provisions of Sec. 768.28, Florida Statues, the participation of the Contractor and County in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. 33) Privileges and Immunities: All of the privileges and immunities from liability, exemptions from laws, ordinances, and. rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of . any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 34) Legal Obligations and Responsibilities: Non -Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except 'to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida Constitution, State Statute, and case law. 35) Non -Reliance by Non -Parties: No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement to enforce or attempt to enforce any third -party claim or entitlement to or benefit of any service or program contemplated hereunder, and the Contractor and County agree that neither the Contractor nor the County or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. 36) Attestations. Contractor agrees to execute such documents as the Lessor may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug - Free Workplace Statement. 37) No Personal Liability. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. 38) Execution in Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK. = Ili °'duly autlii WHEREOF, each party has caused this agreement to be executed by a SEAL 'Q j ATTEST::=;KEVIN MADOK, CLERK w �t`-- ..... �O N 1U W_ LrJr� a 72,1: C= r�7 STATE OF FLORIDA BOARD OF COUNTY COMMISSIONERS OF MONRO CO Y, F DA By Mayor/Chairman LIFE EX TE SIGN C , INC. By G� Title: COUNTY OF MONROE / S rn to (or affirmed) and subscribed before me this � day of , 2018, by Pfi 7"IkiA \ Personally Known OR Produced Identification Type of Identification Produced::El ��/ •``1�l 1 , �/�,�/ S(� ' Signature of Notary Public - State of ( g Y Florida) /9 J/0/ �l (/ �� " (Print, Type, or Stamp Commissioned Name of Notary Public) YADAVID A. �o LLI NOTARY PUBLIC STATE OF FLORIDA Comm# GG005564 Expires 10/8/2020 ;4c R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 03/06/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 0. E. Wilson Insurance, Inc. 1475 Belcher Rd S Largo FL 33771 CONTEACT PHONE 727 535-0524 FAQ o. 727 536-9828 E-MAIL cinda@oewilson.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Auto -Owners Insurance Company 18988 INSURED Life Extensions Clinic,lnc. DBA LifeScan 1011 N. Macdill Ave Tampa FL 33607 INSURERB: Admiral Insurance Company 24856 INSURERc: Transportation Insurance Company 12408 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDY� MM/DDYEXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ®OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 100,000 MED EXP (Any oneperson) $10,000 X X 20690745 11/10/2017 11/10/2018 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X 4159162800 09/18/2017 09/18/2018 X PROPERTY DAMAGE $ NON -OWNED HIRED AUTOS X AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ PER OTH- C AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) N /A X WC 6 56600287 11/29/2017 11/29/2018 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below BFWORKERSCOMPENSATION Medical Professional Liability E0000037691-01 05/31/2017 05131/2018 2,000,000 Aggregate Retroactive Date: 5/31/2001 2,000,000 Each Claim DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is additional insured on the general liability and auto liability A OV D Y RISI'AANAGEMENT with repect to work performed by the insured. BY Medical Professional Liability Additional Coverages: Sexual Abuse $1,000,000 Each Claim/$1,000,000 Aggregate DAT " Network Security & Data Privacy Liability $1,000,000 Each Claim/$1,000,000 Aggregate WAIVER W, ygg_ CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton St ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 AUTHORIZED REPRESENTATIVE � —" — > © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Exhibit 1 -VVI a► - -I. lb Request for Proposal Title: I Due Date: Wednesday, August 9, 2 17 2:00 p.m. EST LIFE EXTENSION CLINICS, INC. dba, Life Sean Wellness Centers 1011 North MaeDill Avenue Tampa, Florida 33607 (813) 876-0625 Patricia Johnson, CEO TAB 1: Letter of Transmittal TAB 2: Personnel Requirements TAB 3: Reporting Capabilities TAB 4: Mobile Testing TAB 5: Comprehensive Safety and Security Program TAB 6: Cost TAB 7: subcontractors (Attachment B) TAB 8: Medical Laboratory TAB 9: Proof of Insurance Polk County RFP 17-601 Firefighter Annual Physicals TAB 1: LETTER OF TRANSMITTAL Legal Name: DBA: Corporate Address: Testing Site: Phone Number: Authorized Representative: Email: Incorporated: Medical Director: Medical Licensee: Life Extension Clinics, Inc. Life Scan Wellness Centers 1011 N. MacDill Avenue Tampa, FL 33607 On -site at location(s) determined by POLK COUNTY Phone: (813) 876-0625 Fax: (813) 876-0653 Patricia Johnson, CEO lifescanhc@aol.com Florida, August 1998 Anthony L. Capasso, M.D., P.A. FL ME69518 To: Polk County Re: Request for Proposal: Annual Firefighter Physicals Solicitation#: RFP-17-601 Due Date: August 9, 20017 at 2:00 PM Local Time ADDENDUMS: Life Scan acknowledges receipt of Addendum #I On behalf of Life Scan Wellness Centers, I am pleased to present this response to your request for proposal for RFP 17-601 Firefighter Annual Physicals to provide the proposed Project Services according to the Scope of Services. Life Scan proposes to provide an on -site program at a location designated by Polk County with the options to utilize any of our other Life Scan Centers as needed. An on -site program can help to ensure an expedient time frame for services as well as provides an option to keep employees on -duty resulting in a reduction in costs, time away from the job, or even overtime. Life Scarfs background is in professional medical services specifically for public safety departments with over nineteen years' experience in the development and implementation of programs for state, municipalities and counties to fit their specific needs. We have recognized the vital importance of combining the key components of health, welhiess, and fitness to generate the healthiest most productive employees. LIFE SCAN PUBLIC SAIFE, TY PHYSICALS Life Scan specializes in providing government agencies with public safety physical exams that comply with NFPA 1582, the LAFF/LkFC Wellness Fitness Initiative, OSHA, and FDLE as well as incorporating an advanced level of medical assessments for the early detection of cancer, cardiovascular diseases, and other potentially catastrophic illnesses. Our Life Scan model of "ultrasound -aided physical exams" for Public Safety Officers has been incorporated into the medical standards for over 150 fire service and law enforcement departments. As a result, we have the proven Ability to identify cardiovascular disease, aneurysms, diabetes, and cancer more accurately and in much early -stages in the disease. process resulting in a substantial, long-term disability, absenteeism, and health care cost savings to the employer and the potential for lives saved. Experts consider public safety to be among the most stressful and hazardous of all professions with long- term exposure to toxic materials and infectious disease; high -levels of physical demands, frequent spontaneous fluctuations in blood pressure resulting from the "fight to flight" response, exposure to emotionally devastating events, and the effect of shift work. Studies confirm that the average firefighter Polk County RFP 17-601 Firefighter Annual Physicals and officer has almost three times the incident of heart disease, lung disease, and cancer and dies an average of 12 years before other public employees. With the ever-increasing occupational medical risks, counties and cities must look towards new methods of prevention and intervention to protect the health and ensure the longevity of their most valuable assets ... their employees. Most public safety personnel are aware of the importance of being physically fit, yet many have undetected medical issues or lack the endurance and strength to efficiently perform their jabs, putting themselves, their peers, and citizens at risk. In professions, as demanding and hazardous as firefighting and law enforcement being medically, physically, and mentally fit will provide your employees with the capability to perform optimally, decrease stress and stress -related health and emotional problems, and greatly reduce the incidence of work related illnesses and injuries. Life Scan has a distinctive approach to occupational medicine, The Life Scan public safety physical is an integrated medical approach to occupational exams that combines NFPA 1582, OSHA Respirator Medical and Mask Fit Testing, and FDLE physicals with early detection of the major diseases such as heart disease, stroke, cancer, diabetes, and aneurysms before they reach a catastrophic level. It provides your employees with a thorough assessment of their health as well as recommendations for achieving and maintaining long-term health, appropriate intervention, behavioral modifications, and methods to reduce health risks. Each Life Scan physical exam follows state and federal guidelines with the added value benefit of ultrasound imaging assessments of the internal organs and cardiovascular system more extensive laboratory blood profiles, diet and nutritional analysis, and a state-of-the-art fitness evaluation. A personal wellness plan with these recommendations will be provided along with a copy of the medical and fitness assessments. The Life Scan Wellness Program also includes a comprehensive fitness evaluation based on NFPA 1583 and the WFI recommendations. our clinical exercise physiologists have the expertise and experience to assess the physical fitness levels of each employee in relationship to their cardiovascular and overall health condition. Our physiologists will recommend fitness goals and a Fitness Prescription as well, as diet and nutritional improvements, Life Scan and our medical staffing are experienced and knowledgeable in all aspects of the scope of services. As an on -going program of Health, Wellness, and Fitness, Life Scan will continue to be your team dedicated to identifying areas of concern, monitoring the recommended interventions and programs, and assuring that your employees attain and maintain the level of health and well-being that is crucial to perform their jobs optimally and greatly reduce the chance for illness and injury. Thank you for the opportunity to respond to this RFP for Polk County Fire Rescue. Sincerely, ........... Patricia 3o n, CEO Polk County RFP 17-601 Firefighter Annual Physicals THE FOLLOMNG SECTION SHOULD BE COMPLETED Alf ALL PROPOSERS: (SUBMITTAL PAGE) I Company Name:, DBA/Fictitious Name (if CURRENT W9 SHOULD BE SUBMITTED WITH BID. A0 -)(o TIN#:—D kc, 1011 N 'ZY10'!L I )IR Lue-no(I / Orr (Street No or PO Box Nuber) (Street (City) 0 k_1 "D 7 (County) j (State) (Zip Code) Contact Person: f'_ :�r'l e_-� � � 1-J o 6 k--� Phone Number: Cell Phone Number. 1 0 Email Address:- 0 co Type of Organization: 1.1 Sole Proprietorship —Partnership Non -Profit — Sub -Chapter Joint Venture L/" Corporation LLC LLP Publicly Traded Employee Owned State of Incorporation The Successful vendor must complete and submit this section prior to award. The Successful vendor must invoice usfng the company name listed above. 24 RCVMd G&W17 July 31, 2017 i r r � This addendum is issued to clarify, add to, revise and/or delete items of the RFP Documents for this work. This Addendum is a part of the RFP Documents and acknowledgment of its receipt should be noted on the Addendum. Contained within this addendum: Aced/Replace Ken Brush This Addendum sheet should be signed and returned with your submittal. This is the only acknowledgment required. Title: Company.„ .. u F RFP #17-601 FIREFIGHTER ANNUAL PHAMWW', ADDENDum #1 Notice of Request for Proposal "RFP Packages may be obtained from the Procurement Division, 330 West Church Street, Room 150, Bartow, Florida, 33830, (863) 534-6757 or downloaded from our Website at S i & Respondents must submit one (1) c rlginai and Seven (7) copies of the proposal or to 2:00 p.m. on the receiving date. Proposals 0 Is will be publicly opened and read at 2:00 p.m, Replace with: "RFP packages may be obtained from the Procurement Division, 330 West Church Street, Room 150, Bartow, Florida, 33830, (863) 534-6757 or downloaded from our website at �m �en t�- �bl d s. Respondents must submit one (1) Ik n �re�rn6n'p� e our MCU r a proposal 0 to? les. the fV oolpn prior p.m. on the receiving date. Proposals adate." r le f parcel. .00 P a C,91_ Proposals will ng'�"'www, 0 v -COPn 'a Pe d� als will be publicly opened and read at 2:00 p.m. ' and S en 0 must be submitted o receiving date. COMPANY QUALMCATIONS-General Corporate: Number of years in business: 19 years Medical Director: Anthony Capasso, M.D. Number of years in practice: 23 years Number of years as Medical Director for Life Scan: 13 years Life Scan's specialty and background is in the area of prevention -based occupational, medical services for government agencies with a specialty in public safety. We have over fourteen years experience in the development and implementation of programs for county, and state public safety departments to fit their specific needs. We have recognized the vital importance of combining the key components of health, wellness, and fitness to produce the healthiest, most productive employees. After researching and developing a program that is specifically designed to meet the needs of public safety, we opened our first on -site wellness center in 2001 for the City of Jacksonville. Since then we have opened three Life Scan Wellness Centers (only open to contracted government clients) and offer on -site services to over 150 government agencies in Florida and the Southeastern states. The Life Scan program provides annual fit for duty and post offer exams, respiratory protection programs, vaccines, and general employee exams at the same time integrating a model of early detection and prevention. Life Scan is currently providing the following services to over 150 County, and Municipal, and State government agencies: • NFPA 1582 Physicals for Police and Firefighters • NFPA 1583 Fitness for Police and Firefighters • UFF/IAFC Health and Wellness Initiative • FDLE Police Physicals • DOT and CDL Physicals • Hazmat Physicals • SWAT Team Physicals • Bomb Squad Physicals • Pre- Employment Public Safety Physicals • OSHA Respirator Physicals • OSHA Respirator Mask Fit Testing • Fit for Duty Testing • On -site Program for all medical testing • On -site X-ray services • On -site blood draws * Infectious Disease testing and vaccines Added value services including the Life Scan ultrasound -aided physical exams that complement to Public Safety Physical Examinations Polk County RFP 17-601 Firefighter Annual Physicals Life Scan Professional Contributions to Public Safety Health: In recognition of their outstanding accomplishments and understanding of the unique needs of fire fighters and law enforcement officers, Patricia Johnson and Tammy Torres, on behalf of Life Scan Wellness Centers, were appointed the Medical Advisors to the • Major Cities Chiefs' Association • National Sheriffs Association FBI LEEDA • FBI National Executive Institute Life Scan provides Firefighter Educational Seminars, CEU courses, and professional articles to: • Florida Fire Chiefs • Florida Professional Firefighters • Fire Rescue International • International Firefighter Smoke Symposiums • Florida Firefighter Safety and Health Conferences • Florida Cancer Survivor Network Polk County RFP 17-601 Firefighter Annual Physicals PRINCIPALS, MANAGEMENT, AND PHYSICIAN SUPERVISORY TEAM: Patricia Johnson, CEO. Patricia is the cc -founder of Life Scat and will be the liaison between the City and Life Scan. Patricia will oversee contractual issues, ensure proper invoicing, and attend meetings. Michael J, Terraria, CFO. Mike is the co-founder of Life Scan and serves as corporate counsel and Chief Financial Officer. Mike is an attorney in Tampa and started his law career as an assistant state attorney in Hillsborough County and was lead partner in his law firm for over twenty years. Pam Desmaires, ARNP-BC, is the Life Scan Wellness Center Clinical Director and Project Manager. She is responsible for the supervision of the medical specialists and for the continuing education as well as medical procedures and protocol for the Life Sean Wellness Center medical program. Pam will ensure quality control over medical reporting and records and manage scheduling timelines. Pam has developed the medical protocol for the Life Scan ultrasound -aided physical exam program and has extensive experience with NFPA 1582 guidelines and interpretation including annual and candidate medical clearances. Medical Director: Anthony Capasso, M.D. Dr. Capasso has over 20 years in private medical practice. He is fully experienced in workers' compensation, post offer employment physicals, firefighter and police physicals and medical clearance, HAZMAT medical clearance, occupational medicine, and internal medicine. Dr. Capasso is the supervisory medical director and advises with medical clearance review. Life Scan is a nationally recognized expert and educator regarding the health and fitness of police and firefighters. Life Scan has advised NFPA 1582 and the IAFF/IAFC Wellness Fitness Initiative Committees regarding firefighter health and fitness. Polk County RFP 17-601 Firefighter Annual Physicals CL-RRICULUM VITAE ANTHONY L. CAPASSO, D. Florida Medical License: ME69518 EDUCATION 1984-1987 Ohio State University, Columbus, Ohio, Bachelor of Science —Biology Cum Laude. 1984-1986 Cleveland State University, Cleveland, Ohio. POST GRADUATE TRAINING 1988-1990 Ohio State College of Medicine, Columbus, Ohio 1991-1993 University of Alabama School of Medicine, Birmingham Alabama, M.D. 1993-1994 University of Florida Health Science Center, Jacksonville Florida; Internal Medicine Internship. 1994 University of Hawaii Integrated Medical Residency Honolulu, Hawaii; Internal Medicine Residency 7/l/94 - 12/4/94 1995-1996 University of Florida Health Science Center, Jacksonville Florida, Internal Medicine Residency. Graduation July 1996 VIRIX141 "I MKIM I'll 1984-1987 Dean's List 1985 Summa Award, University College, Ohio State University. 1987 Graduate Cum Laude, College of Arts and Sciences, Ohio State University. 1989 Honorary Letter from the Department of Anatomy for outstanding performance, Ohio State College of Medicine. CERTIFICATION Diplomat of the National Board of Medical Examiners, June 1993 Diplomat ABIM, August 1998 LICENSURE State of Florida ME 0069518 1984-1987 National Key Honor Society, Ohio State University 1988-1993 American Medical Students Association 1991-1993 Tuscaloosa County Medical Association 1991-1993 Larry Mayes Society 1993-,1997 American Medical Association 1994-1997 ACP Member 1999-present Duval County Medical Society EMPLOYMENT 2007-present Life Scan Wellness Centers -Medical Director 2003-present Hospice of Jacksonville —Associate Medical Director 1997-present Smart for Life Jacksonville -Medical director 2002-present Anthony L. Capasso M.D. P.A.-private practice 2001-2003 University Of Florida — Clinical Assistant Professor 1999-2000 Premier Family Care - Internal Medicine 1998-1999 Jacksonville Emergency Consultants - Emergency Medicine 1997-1998 Premier Family Care - Local Tenum 1996-1997 South Beaches Medical - Internal Medicine 1996-1998 Barnen Venus M.D.P.A. - CCU intensivist I� 8 2. 4 8 61 STA•T `0F A � a Po DEPkiT,IMI 4T' CIF` HEALTH 9 DATE OCENSE° NO., CONML NO. Lo W 111D312815 ME 69518 5W182 �v l'1SA111xDICAI DOCTOR ' iarlllrid bekAv has inlet all requIremertted js ns the °!l he Iand ruled of state of FidMa�. ' C WIMWn Date: JANUARY 31, 2010 1ACOOMLLE BEACH, FL 32250 • A Rich ..lohn H. Arrrlstronp, i1 D FA GOVERNOR STATE SURGEON GENERAL, []ISPLAYIFNEDUIRED BY LAW n E . , f ON DATE: JANUARY 31, 2018 yaw l,*seso nznb r i' = iM16 plec use it<ia an eormopwdence wuith Yaw board lewuncil. &r ,h licealtrre to solely rn iar aadbh►i tltrt department in wall all Of the Uotnane"i currsut nm!Uat oddmo onA tttsritice locatk,a addresn. If'you ttm got received Your renewal uatiat: 94 4WO prW to wWiratiaa date ahawn an ale peens, picaac call It}50I 465-0393. Use thlt action in n*Mnow clwrepe. Name chWW& Mqt✓ft k2W 419eumei►tatiatt ahaari09 dW restac chNW-=Please MWM aura th accongm nlea thb ,f mw a =mxdW license. a diva = decree or a court order. Medical El'ual$V Assurance o5n* you dse coomdenec cr s ral enlist aervicea, Them services ZWe YOU I'm abs"y to rear your lacedon addneaaes sand updwo your pno4le Inlbrmadow 1. 00 to 2.. Click an Trveider SmicW A. Click an'Ih my UW Beans e" 4. Selectym r pr ices S. tks6er the user 0 old paswprd that seta provided in you _ y9w initial tiornpe and click "Spt in using our Meet= set 6. lryuu do nw. know your user ID and l+rgsword, click an Met Loon Help??' or call our custmw Contact Center at (830) MAUL TO;DEPARI'MENT OF HEAE"TH IMPORTANT ANNO E?tV4RION OF MEDICAL QUAL rff ASSURANCE LICEKSURE SUPPORT SERVICES UNIT THE DEPARTN NT OF HEAL P.O. BOX III= YOUR CONTINUING EDUCA1 TALLAHASSEE, FLORIDA 323144= THE? ` IME OF LICENSE RENE 13 NAME CHANCE (ATTACH LEGAL DOCUMENTATION) TO LEARN MORE, PLEASE VI FROM: LAST i±tlW MIDDLE TOC T i lsT LIDD .E phoboapy or am or the updat !roar mailing and practice WILL. NOW REVIEW Y RECORDS AT Certifications Registered Nurse Practitioner In the State of Florida, license number 2551642ARNP Certified Adult Nurse Practitioner from the American Nurses Crederitialing Center Registered Nurse in the State of Florida and Massachusetts Basic I-Ife Support (BLS) Certification Basic Life Support Instructor Advanced Cardiac Life Support Highlights • American Nurses Association (ANA) • Florida Nurses Association (FNA) Professional Experience Life Seen Wellnew Centers • Completed AAAASF accreditations • Completed two JCAHO accreditations 2012 to Present Director Clinical and Medical Operations Lead ARNP: Provide physical assessment, medical clearances, and plan of care to adults in law enforcement and fire rescue positions. Obtains kftdous disease laborator results and educates patients on infectious diseases. Administering immunizations as needed/ requested. Provide counseling of patients on risk factors, nutrition, medication, Smoking cessation, physical activity, and disease management Promote health screenings and healthy living. Clinique of Plastic Surgwy 2008 to 2012 ARNPIClinical Manager Expertly managed all surgery services, including planning, scheduling and coordination, determination of procedures and procurement of supplies and equipment. Assessed need for, ordered, obtained and interpreted appropriate lab tests. Provided pre-infra-PACU care of patients. Managed clinical and support staff in patient care activities. University of South Florida Adjunct Faculty Instructor for College of Nursing 20031o2012 USMARNS Plastic sur'"ry 2005 to 2006 ARNP/Practice Manager Expertly managed all surgery services, including planning, scheduling and coordination, determination of procedures and procurement of supplies and equipment. Assessed need for, ordered, obtained and Interpreted appropriate lab tests. Provided pre intra-PACU care to surgical patients. Managed clinical and support staff In patlerd care activities. RNI/Rellef Charge Nurse; CVTU, Endoftopy CVTU: Maintain and recover immediate postoperative open heart patients in CVTU. Endoscopy; Evaluate and manage schedule for both outpatients and hospitalized patients. Manage patient transfers and Immediate recovery of patients. Education University of South Florida Master of Science, Nursing University of South Florida Bachelor of Science, Nursing t_;T 7 _"N MMANCC � w2004004M t#RTIPMATI ON CoMMOM 1WM 4M IJ2015 #0 4II rums of Adult Nurse Practitioner Ammrdod W* Pameb L. Dowmmla, ANP43C DEANNA M. srLVA, RDMS, RVT CILKICAL EXPEP.WNCE Life Scan Wellness Centers Tampa, Florida Registered Efitrasound Technologist October 2014-Present 9 Experience performing wellness screening exams for law enforcement officers and firefighters throughout the state of Florida & Ultrasound screening studies include echocardiogram, carotid arteries, thyroid, abdominal organs, pelvic, prostate, and testicular * Responsible for training and coaching all new hires as well as students in company protocols and general ultrasound training , Responsible for creating training manual, presentations, and training of new technologist Edward White Hospital St. Petersburg, Florida Registered Virasound Technologist April 20124X-tober 2014 • Crossed4rained in cardiac sonography with experience m echocardiograms and TEE Experience scanning general, vascular, and cardiac ultrasound in a busy hospital setting including in -patient, out -patient, emergency room, and operating room services Proficient in assisting in radiology procedures including PICC lines, central lines, biopsies, paracentesis and thoracentesis EDUCATION Associates of Science Central Florida institute Major: Diagnostic Medical Sonography Graduated: October 2008 • Member of the National Technical Honor Society (Chi Phi Iota Chapter) Bachelor of Science University of Tampa Major; Biology Graduated: May 2005 Member of the National Science Honor Society AMMMMAWAMOCUMMOMM DEANNALuSUA FEMA) FNTM CaTrAPHLUM i Ml wxs mm"tN 133478 2"o 12i12017 4�als Ar�pf��at� zf*751 -k :11111] J, • ARDMS registered in specialties Abdomen and OB/GYN. • BLS certified with the American Heart Association. • Eight years' experience with patient care. • Two years clinical experience in various local hospitals and clinics. • Regis" eligible for specialties Echocardiography, Vascular, and Neurosonology. Clinical Experience * AB, OB/GYN, Small Parts e High Risk Perinatal Protocol * Paracentesis/ Thoracentesis * Echocardiography, TEE e Vascular, PVR Professional Experience Life Scan Wellness Centers Tampa, Florida Registered Ultrasound Technologist October 2014-Present 0 Experience performing wellness screening exams for law enforcement officers and firefighters throughout the state of Florida 6 Ultrasound screening studies include echocardiogram, carotid arteries, thyroid, abdominal organs, pelvic, prostate, and testicular 0 Responsible for training and coaching all new hires as well as students in company protocols and general ultrasound training * Responsible for creating training manual, presentations, and training of new tech nologist Education • Associates of Science In Diagnostic Medical Sonography Broward College, Coconut Creek FL. May 2012 • Bachelor of Arts and Sciences in Psychology University of South Florida, Tampa FL Dec 2005 ZMMAWARM MMICAMONS To OW COMFIrmoms ROM%M owim) RvT(vnROCSOLE) conwimm 0 CEFMRED SIB ON 157M OL"M 2011 twimt? Ch-sorwp4mmsutmat . ......... ........ . . .... .... 3, ' 4"', S v , U E `3 U- Providier, wxcmwft amosw ft cowftvs aw am WAWAFiWm Idm JAk* c) DETAILED STAFFING PLAN The Life Scan program is designed specifically for public safety and the entire medical staff has extensive knowledge and experience in providing firefighter physicals. The medical staff works in teams and each of them is experienced in all aspects of the scope of ser►=ices and the Life Scan program including NTPA 1582, NFPA 1583, FDLE, OSHA Respiratory Standard, the Wellness Fitness Initiative fitness evaluations, annual medical clearances, and reporting processes. Staffing: • The Life Scan Staffing will include three (3) Life Scan employees that are fully trained and experienced in public safety Life Scan physicals using an integrated, team approach. • Each team member is a direct employee of Life Scan and has undergone extensive training with Life Scan to fully -understand the technical, clinical, Life Scan procedures, and individual protocols of the assessments and medical clearances. All Life Scan medical staffing receives annual, recurrent training in areas such as ACLS certification, Public Safety Disease Risks, Diabetes, Hazmat testing, Infectious Diseases, Blood borne Pathogen and Safety Protocols, Medical Reporting updates, NFPA 1582 updates, Wellness Fitness Initiate program, and Life Scan clinical updates. Mid -Level Practitioner ()VP, MSN, or PA) Life Scan mid -level practitioners perform the on -site annual and pre -employment physicals, clinical assessments, administer the infectious disease program, and medical clearances under the supervision of Dr. Capasso. Life Scan mid -level practitioners have extensive experience providing medical clearance, pre -placement employment physicals, fitness for duty, NFPA 1582 and FDLE Medical exams, the WFT, and OSHA Respirator Medical Clearance. They each have a thorough understanding of the unique needs, physical requirements, and mental stress related to the profession of firefighter and corrections personnel. ACLS Certified Ultrasound Technician The Life Scan registered ultrasound technicians are fully cross -trained in all modalities of medical ultrasound and interpretation including vascular, head, abdominal, and general ultrasound as well as receive extensive training in the Life Scan protocols and patient education. The Life Scan ultrasound team provides a key component to the overall health assessments, early detection testing, and educadon of our patients. Polk County RFP 17-601 Firefighter Annual Physicals Clinical Exercise Physiologist The Life Scan clinical exercise physiologists are experienced in clinical cardiac, testing and interpretation., lung capacity (pulmonary function) testing and interpretation, firefighter and correctional officer fitness evaluations, diet and nutrition, body composition, and all aspects of NTPA 1582, NLFPA 1583, and the WFI. All Life Scan physiologists are trained and experienced in OSHA Respirator Medical Testing and OSHA Mask Fit Testing protocol. ACLS Certified Polk County RFP 17-601 Firefighter Annual Physicals U 11 Six (6) References from other Governmental Agencies that have utilized Life Scan for i Similar Services: 1. Brevard County Fire Rescue Contact: Marvena Petty Phone: (321) 633-2056 x 56414 Email: marvena.petty@brevardfl.gov Performance Period: 2012 to Present ,Number of ANNUAL physicals; 550 Service Provided: LIFE SCAN Firefighter Annual and Candidate Physicals e NFPA 1582 Annual and Candidate Physicals for Firefighters * NFPA 1583 Fitness Evaluation Firefighters * 1AFFWC Health and Wellness Initiative * Life Scan ultrasound and advanced medical assessments for disease detection and prevention a Hazmat and Specialty Team Physicals * On -site program for all medical testing, blood draws, and X-rays * Infectious Disease testing and vaccines * OSHA Respirator Physicals for Public Safety * OSHA Respirator Mask Fit Testing for Public Safety 2. St Petersburg Fire Rescue and St. Petersburg Police Department Contact: Fire Chief James Large Phone: (727) 893-7058 Email: James.Large@stpete.org Number of ANNUAL physicals: 330 Performance Period: 2008 to present Service Provided: LIFE SCAN Annual and Candidate Police and Firefighters: • NFPA 1582 and FILE Annual Physicals • Candidate Physicals for Police and Firefighters • NFPA 1583 Fitness Evaluation for Police and Firefighters • L4,FFAAFC Health and Wellness Initiative • Life Scan ultrasound and advanced medical assessments for disease detection and prevention • Hazmat, Swat Team, and Specialty Team Physicals • On -site program for all medical testing, blood draws, and X-rays Infectious Disease testing and vaccines OSHA Respirator Physicals for Public Safety • OSHA Respirator Mask Fit Testing for Public Safety Polk County RFP 17-601 Firefighter Annual Physicals 2. Largo Fire Rescue Contact: Fire Chief Shelby Willis Phone: (727) 587-6740-2005 Email: marven&petty@brevardfl.gov Performance Period: 2012 to Present Number of ANNUAL physicals: 125 Service Provided: LIFE SCAN Annual and Candidate Physicals: * NFPA 1582 Annual and Candidate Physicals for Firefighters * NFPA 1583 Fitness Evaluation Firefighters * IA.FF/IAFC Health and WcUncss Initiative • Life Scan ultrasound and advanced medical assessments for disease detection and prevention • Hazmat and Specialty Team Physicals • On -site program for all medical testing, blood draws, and X-rays • Infectious Disease testing and vaccines • OSHA Respirator Physicals for Public Safety • OSHA Respirator Mask Fit Testing for Public Safety 3. Broward Sheriff's Fire Rescue Contact- Assistant Chief Todd Leduc Phone: (954) 831-8291 or (954) 321-4109 Email.- Todd—Ieduc@sheriff.org Number of ANNUAL physicals: 650 Performance Period: 2014 to Present. Service Provided: LIFE SCAN Annual Firefighter Phsyicals: • NFPA 1582 Annual Physicals for Firefighters • NFPA 1583 Fitness Evaluation Firefighters • IAFF/IAFC Health and Wellness Initiative • Life Scan ultrasound and advanced medical assessments for disease detection and prevention • Hazmat and Specialty Team Physicals • On -site program for all medical testing, blood draws, and X-rays • Infectious Disease testing and vaccines • OSHA Respirator Physicals for Public Safety • OSHA Respirator Mask Fit Testing for Public Safety Polk County RFP 17-601 Firofighter Annual Physicals 4. Panama City Fire Department Contact: Chief Scott Flitcraft Phone- (850) 872-3053 Email: sfliteraft@pcgov.oTg Number of ANN7UAL physicals 75 Performance Period: 2016 to Present. Service Provided: LIFE SCAN Annual Firefighter Physicals: * NTPA 1582 Annual Physicals for Firefighters • NFPA 1583 Fitness Evaluation Firefighters • IAFF/IAFC Health and Wellness Initiative • Life Scan ultrasound and advanced medical assessments for disease detection and prevention • Herat and Specialty Team Physicals • On -site program for all medical testing, blood draws, and X-rays • Infectious Disease testing and vaccines OSHA Respirator Physicals for Public Safety OSHA Respirator Mask Fit Testing for Public Safety 5. Fort Lauderdale Fire -Rescue Contact: Jo -Ann Lorber, EFO,CFO,CEM Battalion Chief/Assistant Fire Marshan Phone: (954) 828-6809 Email: JLorber@fortlauderdale.gov Number of ANNUAL physicals: 450 Performance Period: 2017 to Present. Service Provided: LIFE SCAN Annual Firefighter Physicals: • NFPA 1582 Annual Physicals for Firefighters • NFPA 1583 Fitness Evaluation Firefighters • IAFF/IAFC Health and Wellness Initiative • Life Scan ultrasound and advanced medical assessments for discase detection and prevention • Hazmat and Specialty Team Physicals • On -site program for all medical testing, blood draws, and X-rays • Infectious Disease testing and vaccines • OS14A Respirator Physicals for Public Safety • OSHA Respirator Mask Fit Testing for Public Safety Polk County RFP 17-601 Firefighter Annual Physicals Survey Questionnaire — Polk County RFC' 17-6111, Fireflghter Annual Physicals q y (Name of Perm 0"Je"stavey) (Namof aunt Company/Firm) Photo *qumbw:.,�:A� Email: rip-� ``O Subject Pat Perfmnow Surwey of - . Rate esci ®f the erit"i2 OD a WSW of 1 to 10 l t ;you wen TM UddW (and would hire the flreaftilhGdoai *pit) and i that ww* verb unuMed (ad WO never hire the tirt®d$"uai "*n). Pl aaee Me each of the crkerW to the bed oty+eer lowwieke. If You do not have refiicient knowie fte of prof perfomanee to a particular area, ieeve 1t b6nL NO CRITERIA UNIT SCORE i Ability to manage cost (1 10) Ability to maintain pro)ect schedule (complete on- time/earl Quality of workmanship (� . 4 Professionalism and ability to complete exams for all Fire and EMS positions (1-1fl 5 Ability to communicate with Client's staff timely 6 Ability to resolve issues promptly (1-10) 7 Ability to follow reguiremnts based an National fire Protection A;tsociation standards (1-10) $ Ability to maintain proper documentation and eomplet timely r Appropriate application of technology used for the mobile testing.: __ (1-10) 10 rail Client satis ctlori and comfort level in hiring (1-20) 11 Ability to offer solid recommendations based on exam result (1-10) 12 Ability to facilitate consensus and commitment to the plan of action ainon staff`:. Printed. Name of Evaluator Signal= o Evalusior 4p` Picric fIM Or Mmatii the: camplmd survey to: ac 4a . 27 ReWW omwia Survey Questionnaire, -- Polk County RFP 17-01, Fire hter Annual Physicals Toua {Names of ec m rt via!" (hda a of .t mt m y r ) Errw l: M wOWd hire Me iamiladliftmi maim) and I rsp that ym we, Ym ammtM rol (slid rn++ANd offer Mm tM 51"DOW&MI aP10 Mtn rate neb of The aftrh to d w beg arym 1w*wkftw_ if PU de 49t harf =Mdut knowlecip of past perbmwft in a pater area, iaare Id hispk. Sla dhr Work hqw Pbm., Ompktaj. NO iRi'TEMA UNIT Styli 1 Ability to manage east 2 to main in project sdteduls t •Ability Nme/� f 6140) J//� fir' 3 Quality of workmanship 4 Professionalism and ability to -complete exams for oil Fire and EM�M 5 Ability to comrnunk-ate with Client's staff timely 6 Ability to resolve Issues promptly 17 y AbilitytoWre d an f+latlanal i=1re �.,-... Pr'dtect�lt n sU t1-1�P 1/0 13 A bIIllty to maintain proper documentation and complete ti� ) / / g Appropriate application of technology used for the mobile /0 � �� id gall Client satisfaction and comfort level In hiring (1-iQy 11 Ability to oar solid m-commendations based on earn result (:.-ii)j %' 12 Ability to facilitate consensus and comrnittr_:nt to the plan of among / action staff / Printed Natrte of Evaluator SIP046—OfEvalumrz 4 Pdcase fbx or ctuall the compkW lzurwey to. , cal a Ff c •v . cam,.* i. 27 OBfdafls 14 PA i °rw r WTI 1 04 I ii77 ' ' I ,-• r a ,., .t . i „ r 1 Ability to rrMrAp cog{x-1oj 2 A blii4y to rnsintaln project sdwdrde tcornplete on. (1- ) 3 Qmailiy of Workmanship (1- 4 end!: " �lan and ab [itV to ccmi a foral fire ddom 5 AWAYto communicate with aterr_t''a sufftimely 11-10) 6 Ability to M80*0 Imes prompdy 7 Ability to Blow —r"uW&nwft taxed on National we Protedlon Auodaum sonderft {i sad 1 B Ability to malIftin proper documentation and cow -1v� ,rid g � r apt n of Whr iclogy used for #** Mvbge n -� �' 1ti li clem sat n and con t levei In hiring 13 Abliftto oftr solid recorr rx i on mresult 1-1D .�. l lr—i ..3q '$1' ,; l y it ., • �...I' �� .AAA " tl r &WM ,q t, r I 4 Y Iee . Cad A 60 ate each of am .i .Ir Eanc of 1. t WoUld him� 1 -A �-1 a Ai � r ,.6 bed . I Y f''� do r_1 f. MWV of pot PN*MkMft f 1- 1 Similar 1ark n d r 0 e Ability to manage cost — AbI tyto maintain prnject on QuaIIty of workmanship Professionalism and abllity to ccmpiet eexams fbr all Fire 5 Ability to communicate with i~iient's staff timely 5 Ability to resolve Issues .Drom y 7 Ability to follow requirements based on National Firer -PratacfionAssrociWtlon standards Abrllty to maintain paper documes n .and connDh (1-10) y ! for the mobile Appropriate applicn—Mon of � - testing 1-1Q} R W 0 10 Overall Client satisltlon and comfort level in hiring- 11 Ability to offer solid recommendations based can exam � result 12 Ability to facilitate consensus and commitment to the plan of action arnong fti-1o} P&ted WAMA cf E a2 A v r 5 of EXPIUMOr Picric lz Or c"l the cumplelal survey €o: 27 aa�oaris Survey Question alm Polk County RFP 17-0 , Firefigliter Anumd Physic 1 TO, I Rmama ft 3way) V (Now ofCiion paay/Firmi _. R 1 1 •. i -VFQ �. •.r�g'Si it N:�1TiB}. Cost of Sorvirec toe pigs: Rate eaeb dthe aiWk on a Mb of l to lfr, with iti rciwom log drat yen wort very ad" (and «ram hire the firmfindkidual again) and t repruenfing that you men vary urraathi ed OM would Raver Aire the fire ndivi dal again). Plume rate ON& at tl<e criteria to the but of your know age. It you do not haw suffideat knowledge of pant p,er formu ce to a particular ar a, Wye it bloolG 1. �.MR77 I NO CRrfEM umrr scow i Ability to manage cost 2 Ability to maintain project schedule (complete on- tines/ea 3 Quality of vuoftanship (1-10) 4 Profiessionalism and ability to complete urns for all Fire and EMS positions i1-1 } 0 74 5 Ability to communicate with Client's staff timely 6 Ability to resolve issues promptly1-�} 7 Ability to follow requirements based on National Fire Protection Association standards (1-10) S Abilityto maintain proper documentation and complete timely ( -20) 9Ap propriate application of technology used for the mobile � i1.1p} 10 Overall Client satisfaction and comfort level In hiring 11 Ability to offer solid recommendations based on err► result (1-10} /0 12 Ability to facilitate consensus and commitinent to the plan of action among-staffCi-ZQ} �l ,, MC444— Nuted Name of Evaluator Sigma of Evaluator Plcssc fax or small the completed survey t(f: T�� ' j� keo 27 �s Survey Questionnalm — Polk County RFP 17-601, Fhvfthter Annual PhyBicais To: Marne offt"n completing —Ourvey) (Name of Client Company/Firm) Phone Number-, A6—q- F-Mail.- —J�Ir b 6 itr (Ic-e2aL -� Subject, Put Pouf Cost of Services: D "31 S, ot r4ar", Ewe Complete, 0 1-t — t ;0 a to ' 4' " ' - '-" r 1� - ' ,1.... - - - - - _ . _ _._ ...ran __ , _ _ __ _ __ _ __ _, f the "Iterb OB It BeAk Of I to 10, With 10 repmenting that you WOM MY Ud3fied (and would hire tb'fimVU&"R' z9aln) and I "Pr""ft that Y" wm verY unsatisfied (zad Would now bire the fIrmA#AvWuj agsljjPleas rate eacbafthe criteria to the best of your knowlefte. if You do not have sufficient knowledge of Put Performance in a Particular area, leave k blank. Similar Work Project Name: -.-Date Completed., NO CRITERIA UNIT SCORE I Ability to manage cost (1.10) 10 2 Ability to maintain Project schedule (complete on- time/early(lYt�j 10 3 Quality of workmanship 1(1-10) 4 Professionalism and ability to complete exams for ail Fire and -- EMS positions to 5 Ability to communicate with Client's staff timely I b 6 Ability to resolve issues promptly (1-10) 7 Ability to follow requirements based on National Fire Protection Association standards 10 Ability to maintain proper documentation and complete timely 9 Appropriate application of technology used for the mobile testis z (1-10) I'D 10 Overall Client satisfaction and comfort level In hiring 11 Ability to offer solid recommendations based on exam result 1 (2-10) 12 Ability to facilitate consensus and commitment to the plan of action among staff (1-10) ( A I L Printed Name of Evaluajo'j Signaum/bT Evaluator Pl=c fax or email the completed survey to: 27 Re*W O&W15 M VA *111 M V V All Life Scan reports are customizable based on the individual needs and requirements of each department. Employees: Each employee will receive copies of his Life Scan examination and test results on the day of their Life Scan exam to include a summary form, lab results, EKG, exercise data, ultrasound reports and images of abnormal studies, patient educational handouts, and personal wellness plan. Polk County Fire Rescue: • PCFR will receive a FIT FOR DUTY exam report and results of Hepatitis Titers/Screenings within 14 days of the exams. • Final Evaluations will be reviewed and signed by a licensed Physician, NP, MSN, or PA. • PCFR will be notified by phone within 24 hours for any employee that is found to be NOT FIT FOR DUTY, Reporting Samples include: MWOMINGIUVA! 11490100" Life Scan will provide samples of patient chart forms and patient results upon request. Polk County RFP 17-601 Firefighter Annual Physicals LIFE CAN FIRE DEPARTMENT CLEARANCE FORM Wellness Centers AND OSHA RESPIRATOR CLEARANCE Employer:- EOLK Cffi�'TY FIRE FESCUE — Patient Last Name,.- -- First Name' Patient IID/SS#:--- .-- Exam Date: EMPLOYEE MEDICAL QUALIFICATION. The examination of this employee must include a complete physical examination at a level of specificity in accordance to 2013 N.F.P.A. 1582 guidelines with the purpose of determining whether there is any medical or physiological reason that may impair the employee's ability to perform the essential functions of his or her job. Disabilities, impairment, or limitations identified by the examination, which would prevent the employee from performing the essential functions of the position, will be reported to their employer. The reviewing medical personnel should note all abnormalities which might predispose the employee to injury or aggravation of the condition due to the nature of the duties and tasks required of a firefighter employee. [3 MEDICALLY QUALIFIED: Bond on the results of the annual medical examination, I find this individual to be CLEARED under O.S.H.A. 1910.156, O.S.H.A. 1910.134, O.S.H.A. 1910.120 regulations and the guidelines set forth by 2013 edition of N.F.P.A. 1582. "T"I 31111111111111111 0 NOT XMDICALLY QUALIFIED. Based on the results of the annual medical examination, I find this individual is NOT CLEARED under O.S.H.A. 1910.156, O.S.H.A. 1910.134, O.S.H.A. 1910.120 regulations and the guidelines set forth by 2013 edition of N.F.P.A. 1582. This patient must be examined by a medical specialist for follow up evaluation and final clearance. The evaluation should include confirmation, diagnosis, and/or treatment of the following: OSHA RESPIRATOR CYE R.4NCEs This medical evaluation determines any limitations as described in O.S.H.A. 1910.134 with regard to respirator use as related to the medical condition of the employee, or relating to the workplace conditions in which the respirator will be used, including whether or not the employee is medically able to use a respirator. o MEDICALLY QUALIFIED TO WEAR A RESPIRATOR. The above listed individual IS in compliance with O.S.TLA. 1910.134.There are no restrictions on respirator use related to the medical condition of the employee. C NOT MEDICALLY QUALIFIED TO WEAR A RESPIRATOR. A follow up examination is needed to make a final determination for respirator clearance. Based on the results of medical examination, the above listed individual is NOT CLEARED to wear a respirator based on O.S.H.A.'s standard 1910.134. Medical Practitioner Information: Print lVa"W.- Signatury Anthony L. Capasso, MR. P.A. Medical Der Lionse Nuoiber ME 69518 LIFIE SCAN RESPIRATOR MASK FIT CLEARANCE FORM Wellness Centers Employer: POLK COUNTY FIRE RESCUE Date: Employee Information List Name: Mask Fit 'rest(ForUse Only) First Name: Occupation: Respirator Medical Clearance: 0 Pass El Fail Date of Medical Clearance: Vision Correction Required- 0 Yes 0 No If yes, what type correction used when wearing a respirator: El Contact Lenses F Glasses 0 None Fit Testing Results (For Clinical Use Ody) Test Date. If No, give reason: Test Completed: 0 Yes n No Respirator Type: El N95 Paper 11 Full Face Negative Pressure 11 Half Face Negative Pressure Make: Model: Style: Wm. Mask Fit Test Date; Fit Test Protocol Used: Qmgati hative 0 PortaCount Model Number: Serial Number: 0 Dynamics Occupational Fit Tester Model Number: Serial Number; Overall Fit Factor: 0 Pass El Fail Notes: (For Clinical Use Only) Comments: Signatures Print Patient Name Print Clinician Name Patient Signature Clinician Signature TAB 4: MOBILE TESTIN G a) Mobile Testing Location: Strategies: Life Scan has the capability, experience, direct full-time medical staffing, and equipment to provide on -site physical exams at on -site location (s) provided by Polk County Fire Rescue. # All set-up, equipment, and associated costs will be the responsibility of Life Scan. All equipment maintenance will be performed by Life Scan and will be kept clean and sanitized. All equipment will be kept in optimal working order or repaired/replaced within a reasonable time frame. Life Scan maintains backup of all equipment as well as service contracts to ensure timely replacement as needed. • Life Scan has the proven capability of providing all services on -site within the loc,ation(s) provided by Polk County Fire Rescue (not a motorized vehicle): * Physical Exam as outlined in the Scope of Services * Blood, (supplies included) * Chest x-rays • Equipment: All equipment used for the Life Scan program is state of the art and owned by Life Scan. The equipment is portable and easily set up by the Life Scan stafE Life Scan will bring portable exam tables as well as all the equipment necessary to completely provide the comprehensive medical and fitness exams. • Ultrasound Units: Terason • EKG Stress Units; Welch Alyn, Laptop computer based • Treadmill: Will be a stationary unit at the Polk County Fire Rescue locations • Fitness Testing equipment: provided by Life Scan • Audiometry Equipment: Welch Alyn audiometer • Vision: Titmus Vision Screener • X-ray: On -site mobile services (Mobilex) • Blood draws at any LabCorp Patient Service Center in Florida or on -site at location(s) provided by FCFR Polk County RFP 17-601 Firefighter Annual Physicals b) Scheduling Timeline: 1. Scheduling: Patient scheduling will be coordinated by PCFR to meet the needs of the department. The hours of operation, number of days and program dates will be determined by PCFR according to shifts/work hours of the employees and the number of annual firefighter physicals required, 2. Life Scan will be able to proceed with the scheduling of physicals on October 1, 2017. A. Life Scan will schedule 9 patients per day, 5 days per week (45 patients) in consecutive weeks to accommodate the successful completion of annual firefighter physicals. WEE=, 1. 450-500 physicals 19 per day = approximately 11 weeks to complete the pro - a. Additional days will be provided as necessary to accommodate completion of all firefighter physicals at no additional cost to the County, 2. Implementation Strategy A. Phase 1: Site visit with PCFR by Life Scan management team 1. Discuss program components and requirements 2. Determine space requirements and coordinate on -site program a. Minimum 4 rooms with waiting area • Physical exam • Cardiopulmonary/fitness evaluations • Ultrasound exams • Hearing and Vision area 3. Plan time line 4. Review and approve Patient Packet 5. Review and approve blood draw program and LabCorp requisitions 6. Review Fit for Duty and Respirator Medical Clearance Reports 7. Review and approve reporting system B. Phase 2: Schedule dates for blood draws and physicals 1. Nine patients per day in three intervals of three patients each a. Example: 3at8:00,3@1l:00am,and 3@2pm b. Start time will be determined by PCFR Polk County RFP 17-601 Firefighter Annual Physicals c. Each physical exam will require 3 hours (3 patients will rotate between 3 portions of the program including ultrasound, physical, and cardiopulmonary/fitness. C. Phase 3: Blood draws (2-5 weeks prior to physicals) 1. On -site at any location (s) provided by PCFR 2. LabCorp Patient Service Centers a. Phlebotomists are certified technicians b,. Facility meets all requirements established by DOT and is properly licensed. D. Phase 4: Life Scan Physicals 1. Firefighter Physicals 2. Medical Requirements based on N_-FPA 1582 a. Essential Functions per NFPA 1001 for firefighting professional qualifications NZOWIF"'WIMM" "M c) Scheduling Timeline for second fiscal year: Same formula as above within 12 months after the initial physicals. Polk County RFP 17-601 Firefighter Annual Physicals LIFE SCAN COMPREHENSTVE SAFETY AND SECURITY POLICY The Life Scan Comprehensive Safety and Security Policy is a safety management plan designed to maintain a safe environment free of hazards and reduce risk of injuries for patients and employees. a. Processes for employee safety and security; 1, New employee orientation and education program and annual recurrent trait i g that addresses Safety Procedures: i. Blood borne pathogen policy (Exhibit A) I Biohazard waste policy (Exhibit B) iii. Fire Safety b. Processes and procedures for facilities and equipment security 1. Life Scan will coordinate with the on -site facility manager to determine what County procedures and processes are for specific site as well as best manner to secure equipment during program. c. Emergency Preparedness Plan 1. Life Scan will coordinate with the on -site facility manager to determine what County procedures and processes are for specific site. d. Safety Equipment 1. Life Scan routinely maintains and tests all equipment. Any equipment utilized will be tested prior to program start on -site. e. Reporting to County Risk Management regarding accidents and/or damages I - Life Scan management will receive any accident or damage reports and report them directly to County Risk Management per County procedures, f. Records Confidentiality 1. Life Scan will coordinate with the on -site facility manager to determine an on -site secure area to store records during program. 2. Life Scan stores all patient records in a secure facility in their corporate office with access limited to authorized Life Scan employees, 3. Life Scan follows all HIPPA, State, and local guidelines regarding patient confidentiality and will review the process with the County prior to scheduling. Polk County RFP 17-601 Firefighter Annual Physicals I I. LIFE SCAN WELLNESS; CENTERS SAFETY DEPARTMENT REFERENCE - PATHOGEN EXPOSURE Patricia Johnson, DATE: CONTROL PROCEDURES SOP I President Se 22,2003 0005 'To The Occupational Safety and Health Administration (OSHA) reports that 5..6 million employees in the United States are at -risk of exposure to blood Marne pathogens where they work. This Bloodbome Pathogen (BBP) Exposure Control Procedure is designed to protect all Life Scan Wellness Centers' employees. The authority having jurisdiction for this grocedure is derived from the Cade of Federal Regulations 1910.1030 and Florida De artment of Health Code cites Cha ter 64E-16 of the Florida Administrative Codes. This procedure includes the following key elements: A. Identification of ,Job Classifications and tasks where there is exposure to blood and other potentially infectious materials. B. Methods of Compliance including; -Universal precautions, -Engineering and work practice controls, -Personal protective equipment, -Housekeeping C. Training of Employees. E. Post -Exposure Evaluation. F. Procedures for evaluation of circumstances of an exposure incident. G. It will be the responsibility of the Life Scan illness Centers' Safet Department to maintain this procedure. Life Scan Wellness Centers' Bloodborne Pathogen Exposure Control Procedure will be accessible to all -The recognition of tasks, which may involve exposure -An explanation of their use and limitations of methods to reduce exposure. These include engineering controls, Work practices, and personal Protective equipment (PPE) offered at no cost to all full time and part time employees. -information on the types, use, location, handling, decontamination and disposal of PPE. An explanation of the basis of selection of PPE. -Information on the hepatitis 13 vaccination (HBV) to include efficacy, safety, method of administration, benefits and that it is offered at no cost to all full time and part time employees. An explanation of the procedures to follow if an exposure incident occurs, including the method of reporting and medical follow up, The Record Information - Employee training records shall be maintained in Human Resources at a minimum for the duration of employment, These records shall include the following: -The dates of the BBP training sessions, -An outline describing the materials presented, -The names and qualifications of persons conducting the sessions. -The names and job titles of all persons attending the training sessions and signature of each employee. Life Scan Wellneim Centers will be responsible for maintaining training records. The new at -risk full or part time employee will be notified that training is required at the time of employee orientation. Life Scan Wellness Centers will be responsible for completing an annual review of the Blood bome Pathogen training procedure and program, updating it as necessary. 91 Disposable gloves used shall not be washed or re -used after contamination. Disposable gloves shall be replaced as soon as their protective ability is compromised, such as being tom or punctured. Gloves shall be used for handling contaminated waste and for clean-up procedures. For any at -risk employee who has allergic sensitivity, Wellness Centers will provide hypoallergenic gloves, or powderless gloves, at not cost to the employee. Housekeeping, Engineering and Workplace Controls Hand washing facilities with antiseptic soap or single use antiseptic towelettes will be provided for immediate use after contamination. At -Risk employees will wash hands immediately after removing gloves. Eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses is prohibited in work areas where exposure to BBP is possible. Labels and other warnings, as specified in Code of Federal Regulations 1910.1030(g), will be affixed to contaminated materials to warn others. Life Scan Wellness Centers will monitor the Blood borne Pathogen program for contaminated material to be defined as Bio-Hazardous Waste. Contaminated waste will be handled in the fallowing manner: A. All contaminated waste will be placed into appropriately marked medical waste storage containers. The Jacksonville Sheriffs Office will contract with a certified biomedicalwaste disposal company to dispose of waste for Life Scan Wellness Centers. B. In areas where there is to be a clean up of infectious waste material the following procedure should be followed: I. Put on gloves and ether PPE protective equipment as necessary, Post wet floor signs if available. Apply a tuberculocidal disinfectant over the potentially infectious material in accordance with label directed use. 2. Clean up the contaminated material with disposable paper towels and place and seal in a plastic bag to be disposed of as biomedical waste. 0 If the employee declines the vaccine (Exception 4), the employee must sign the Hepatitis B declination form attached hereto_ Once completed, this form must be included in the employee's human resource medical file. The term "no cost to the employee" means there will be no out of pocket expense to the employee. If a routine booster dose(s) of Hepatitis B vaccine is recommended by the U.B. Public Heats Service at a future date, a boaster will be made available to all employees in the same manner as described above for Hepatitis B vaccination. POST EXPOSURE EVALUATION AND FOLLOW UP If employees follow the prevention guidelines as presented in this policy, an exposure incident to a BBP should be a rare event. However, if the employee does have an exposure incident it shall be reported, investigated and documented. Employees who have been exposed to BBP shall report the incident through normal Worker's Compensation (WC) procedures; by first notifying their supervisor, completing incident report and WC First Report of Injury report. After exposure, all costs of care will be treated as a workman's compensation incident. Titers (or retesting of immunization) will be offered after completion of the series if five years has elapsed since completing the series. PROCEDURE FOR EVALUATION OF AN EXPOSURE INCIDENT When an exposure incident occurs, it will be the responsibility of Life Scan management to investigate the circumstances, develop an incident report, distributing it to the President of Life Scan Wellness Centers Sanitary Napkin Disposal - OSHA considers the disposal of sanitary napkins an effective engineering control against exposure to blood. Sanitary napkins do not require bio-hazardous labeling or disposal. Plant Service Workers (PSW) will be provided and It is mandated that gloves be worn when handling trash with waste bags being kept away from the body. EXHIBIT B Life Scan Wellness Centers Biohazard Waste Plan - Employee Education (Florida Administrative Code 64E-16) Life Scan educator will provide an initial (within 30 days of employment) and yearly education for all employees on the proper handling and disposal of Biohazard NVaste. Objectives: The employee will be able to: identify 'sharps' and 'non -sharps' which is designated as a 'biohazard' identify the 'Point of Origin' at the clinic and onsite properly prepare and store completed 'sharps' container(s) and/or 'bio-hazard' red bag(s) for scheduled disposal demonstrate Universal Precautions when handling all potential 'biohazard' materials locate the 'Bio-Hazard' binder containing the most current Health Department guidelines, up to date employee signed education, previous surveys and be prepared with this information for an onsite Health Department survey properly cl= up a 'bio-hazard' spill a- Sharps are considered any needle that has been contaminated with blood whether is be from a blood draw, vaccine injection or a PPD test. b. Non -sharps (absorbent or non -absorbent) item(s) that are considered "soaked" in blood or other bodily fluids considered potentially a 'biohazard'. They may be disposable rubber gloves, extension tubes used for blood draws, gauze and/or band -aids. Scant amount of blood is not considered a'biohazard'. 11. Universal Precautions All personnel will need to use proper hand washing before and after the blood draw. Gloves must be worn during a blood draw and when coming in contact with a contaminated surface(s) with bodily fluids. III. Point of Origin and Sharps Disposal a. Point of Origin is a room where biohazard waste is generated such as the designated room for blood draws. When working "off site" an area will is designated away from potential exposure to other people. After utilizing a needle on a client whether it is from a blood draw, vaccine or PPD testing, there must be a sharps container within a short distance from the person providing these services. All needles will be single use and properly disposed of immediately. There should be no cross contamination of vaccine or PPD substances or materials. Any potentially contaminated materials will be documented and disposed of immediately in a Bio-Hazard container. EXHIBIT C. LIFE SCAN EQUIP-M%NT MAINTAINANCE PROGRAM: Life Scan has routine maintenance and calibration of all medical equipment on an annual basis according to the recommendations of the manufacturers. All equipment maintenance will be performed by Life Scan and will be kept clean and sanitized. All equipment will be kept in optimal working order or repaired/replaced within a reasonable time frame. Life Scan maintains backup of all equipment as well as service contacts to ensure timely replacement as needed. Polk County will have the ability to inspect all equipment Temon, Ultrasound Unit with Sony Printer Welch Alyn Easy One Spirometry Unit Welch Alyn EKG/Stress Unit Welch Alyn Audiometry Unit Titmus Vision Tester Polk County RFP 17-601 Firelighter Annual Physicals A Cost per employee for all requirements and items to be performed annually as defined in the RFP Document Cost shall be inclusive of all costs associated with the annual physical exam including overhead, indirect costs, etc. Other costs for additional services to be used by the County on a case by case basis. The prices below must be separate and will = be included in the cost scoring criteria. Chest X-Ray: Optional annually, required a minimum every five (5) years $65.00 Dtor Fit Testing (SCBA Face piece Fit -95 Respirators) $40.00 Hepatitis B Test (antigen) $55.00 ir lepatitis B Titer (antibody) $30.00 B Vaccine (3 per series) $ 65.00 each A Test (antigen) $55.00 itis A Titer (antibody) $30.00 A Vaccine (2 per series) $ 65.00 each PPD Test, $15.00 Attachment "B" SOLICITATION NO.: RFP 17-601 PROJECT NAME: Firefighter Annual Physicals POLK COUNTY WILL NOT INTENTIONALLY AWARD COUNTY CONTRACTS TO ANY CONTRACTOR WHO KNOWINGLY EMPLOYS UNAUTHORIZED ALIEN WORKERS, CONSTITUTING A VIOLATION OF THE EMPLOYMENT PROVISIONS CONTAINED IN 8 U-S.Ce SECTION 1324 a(e) {SECTION 274A(e) OF THE IMMIGRATION AND NATIONALITY ACT (-IW). POLK COUNTY MAY CONSIDER THE EMPLOYMENT BY ANY CONTRACTOR OF UNAUTHORIZED ALIENS A VIOLATION OF SECTION 274A(e) OF THE INA. SUCH VIOLATION BY THE RECIPIENT OF THE EMPLOYMENT PROVISIONS CONTAINED IN SECTION 274A(e) OF THE INA SHALL BE GROUNDS FOR, UNILATERAL CANCELLATION OF THE CONTRACT BY POLK COUNTY. BIDDER ATTESTS THAT THEY ARE FULLY COMPLIANT WITH ALL APPLICABLE IMMIGRATION LAWS (SPECIFICALLY TO THE 1986 IMMIGRATION ACT AND SUBSEQUENT AMENDMENTS), STATE OF: � COfTNW OF: Th foregoing instrument as signed and acknowledged before me this day of 4 20, by L�"�` LL Z ; LZ who (Print or Type Name) has produced as identification. ype of Ideaicatian and Number) Notary Public Signature Attachment "B" SU113CONTRACTOR A/c vq -e-- '(SUBWTTAL PAGE) k Please list below the name and address of subcontractors to be used in conjunction with this RFP (If applicable). OA LabCorp Regional Office: Laboratory Corporation of America 5610 W. LaSalle Street Tampa, FL 33607 Life Scan will provide an on -site blood draw program. Life Scan patients are also able to have blood draws done at any LabCorp patient Service Center within the United States. LabCorp Patient Service Centers within 25 miles of Bartow: 1. LabCorp 2142 1, EDGEWOOD DR LAKELAND, FL 33803 2. LabCorl? 1120 HAvENDALE BLVD NW WINTER HAVEN, FL 33 881 # I qR 11 =�� 111111111111M411 - - 4. LabCorp 607 s ALEXAN-DER ST STE 107 110 PLANT CITY, FL 33563 5. LabCorp 2209 NORTH BLVD W STE B DAVENPORT, FL 33837 Polk County RFP 17-601 Firefighter Annual Physicals r A 5 K.- *p Ap"c- I ooj��C- �M 9 *];3 8 *�� W � - n- ►M kvy', LA CERTIFICATE OF LIABILITY INSURANCE DATE(' 0810312017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUR1;R(3), AUTHORED REPRESENTATIVE OR, PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. 0 SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endomemant. A statement on this certificate does not confer lights to the Certificate holder In lieu of such endom a . PRODUCER 0. E. Wilson Insurance, Inc. 1475 Belcher Rd S Largo FL 33771 Ewf__ --_ 727 5 72 536-9835 cindlIgWison.corn _ Auto -Owners Insurance Com -__ 18988 INSURED Life Extensions Clinle,inc. 1011 N. Macdili Ave Tampa FL 33607 Admiral Insurance Com _ Z48N INSMR D nc,f. rc 1rlru0100 Rp-wi []N Nuumtw THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - TYPE OF INSURANCE DR MM NUMBER CY EFP f A X C.OMMERCIaf..9"MAI... ABILMY AI MM84 ADE 1 X I' 00CUR U DAMAGET ii f 1 000 000 100 000 10 000 _ - 20690745 IIMO111'6 11110117 1000 000 AGG BATE LIMITAPPU PER 0i}0Q130 000 000 X POLICY JPEnCx LOC T 3 OTHERF AVTOMOWLE LIABILITY COMSINED SIMM LIMIT $1 000Z990 _�. BODILY INJURY tPW WSW4 S A X ANY AUTO, ALL OWNED RULED AUTOS AUTOS FED X HIRE7 AUTOS AUTOS 4159162800 09iM Shf 6 B9M9h17 BODILY INJURY (Per ent) x I DPEA'i1" D/�MIAC�E ; 3 UMr L A L" OCCUR EXCESS UAB 3 WORKM COMPEMKTION AER MM ME TH AND 9MPWYEW LvMLrFy AW PF.M F3I iManddary In KM NIA . ' ACCIDENT EL QUASE. EA EMPLOYE -. f! dpc�a raider LL - - - Poucy LIMIT S Medical Professional Liability E0000037591-01 05131MT 05/31/16 3,000,000 Aggregate B Retroactive Date: 513112001 Each Claim 2,tI00,090 DESCRIPTION OF OPOIATI NHS 1 LOCATIONS IYENICLES (ACORD 101,,odd Ramer Sdwdude, maybe MaeMtl If mm Mace to MWI1041j contractorlicensing@polk-county.net Sexu*I Abuse $1,000,000 Each Cla"l,000,000 Aggregate Network Sccurity S Data Privacy Liability $1,0 0,000 Each Claim/S1,000,000 Aggregate Palk County 330 west Church Street.. Bartow, FL 33830 Phone: (863)604-6080 SHOULD ANYOFTHEABOVEDESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I ACORD 26 (2014/01) The AGORD name and logo are registered marks of ACORD _ ACOWOr. CERTIFICATE OF LIABILITY INSURANCE RATE �' 10/31/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERA(M AFFORDED BY THE POLICIES BELLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU'M A CONTRACT BETWEEN THE ISSUING INSURIMSh AUTHORIYIED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: R the certlRcele holder Is an ADDITIONAL INSURED, the pol"Ies) n%M he enrlorsoO, IF 4U®ROGATION !S WAIVED, guijm to the Dsr m and candlgons of the policy, rartein pollclas my mqufm an andonmrANd. A sbftnwnt on this carhft m does not Confer rights to tha tmrrNeate holder In Neu of such endersmlEYs WoL PAR. PrizioGroup insurance servi a, Inc. 5402 W. Laurel St. Sulte 220 Tampa I?L 33607 Id Xxtension Clinics, Inc 1011 IN ItaacDill Ave 73rc+rt>v^A-'Ii1t 6Q1gr . COM Tampa M 33607 lmmti COVERAGES - CErM It`_ATFNIIMRFE2+CI,1610A1154ONS cMAIMInuuiWaco. 1823)Ba5-4911 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONp TI41NS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TOE OF I NIURANOE IKIMIrIERrCIAI.OPAL LVAUW EACH OCCURRENCE CLAIMS -MADE Ll O=m Pam l ! MW W 0ay ay ¢era PEMONAL A ADV INXRY aENL AGGREOATE L NT APPLIES PER; C-3ENERAL AGMEGATE ! POLICY PRN9DUM - CO1APf iP Add ! �- OTHER: - AU4iiId LELIABILM cow JFA i MY ALPTfI TIDILY INAIRY OW"fw) e ALL D MED SCHEDUM BOOILY INA IRY (PorN) e ALrTOG AUT O HIRER AUTOS AU1fOSTY I}_ 11 f@CQI I i �, umBRILZSS _--- _ - EACH OCCLMRENCE LlA$ y�LM AGGRIUIATL mETrumv,# - S womem 7m A"0111140YOWI.JABLITYYIN SPETA ILL. EA iA=DENT 1.000,000 ANY PROPAIETCRI►ARTN NIA. A InN 1=600936 05 �11129/2019 11/20/2017 ELDwA$E-EAEmPLOY 1 _ 1.t1Q0 0O0 ca> A7wNs ELiNSM PM Lerrr s 1 OD@D0 G E G�gPlrQN Gr[itA7gFle f t#4K,A71dlN! t V p.... N 7fI, ABddpnal WNwxden er:MrtlWs, Y'r. sirrlOaW If man apses I. nql ACORD 26 (2014101) JURBIS M1011 8H0= ANY OF THE ABOVE" EiM{GRIEIFSI POLICtn ne CANCELI.E D EtM;OgJE THE EXPIRATION DATE THEREOF NOME V4LL. SE DEuvgReo IN ACCORDANCE WITH THE POLICY PROVISION& AUTHORIEW nlPaisANTAIVE lE 311sasser #AO77187/ 01OW2014 A 1�7t?C CORPORATION. The ACORD Varna and logo are mglstered merh of ACORD All righft newmed. Four, (Rev. December 201) of Iha TrsaxXy krt Revenue Iiervisna. Request for Taxpayer Identification Number and Ceriification Name (w shown on your IMOM M nsu Life E)ftnsim Climes, kw. v-w— ;mavydisnxwded arift . Sett Wanness Craters -'71AM-p.. ■ ■ give Form to the rester. Do not send to the Imo. £xct pak- ® ismitedhstaycorrpany.I tertturtaxc ixnnt ccrporeh;On, - +�rpcnniu�.�' airw�ra�i ) Addremn Clnur+' '. aural. sad VL a 1011 tl oM Mai Avenue FL 33607 I SOON[ Enter your TIN to the appropriafo box. The TIN provided must match the name given the 'Name' line to avoid backup wh hholding. For' this is your 30OW seeudW number (SM. However, for a residast fin, sale pllyPMata. or dinuagardmd *44, we the Part I instructions on page & For other entities, it Is ywx employer tdeatisoetion number (EW). If you do not have a number, see Now to Set a 77N an Pap 3. xas Nofiss. b the sorouunt If lira me m than one name, see the chart on e 4 for 9 l On whose k �"� number to enter: - i 3 5 3 O Under penalties of pajur/, I cerilly that 1. The number shown on this form is my tAffect taxpayer Identification number (a I am waiting for a rssmtnn to be isttued to ►rye}® and 2. 1 arty not subject to backup withholding because. (a) I am exempt from backup wktihhollikhg. or (b) I Rave cast been nontliked try rile Internal Revenue Service QRS) that I am subject to backup wlfh OkIli ng me raeuit of a failure to repeat all interest or or (c) the IRS has nodfled me that k ern no khngmr subject to backup withholding, nerd 3. 1 am a U.S. cii or other U.S. person (defNned below). C because you have failed to Interest paki, ealulsition at Ingtructlons on papgenerally, payments r I C / You must crom out Rom 2 above iE you have been notiliad by the wso that YOU are cnrrenilyr subjr+ot to baOlap witFnfnruldirril' report at lrrtereat and divkdands on your tax n ri umn For raw aatate transactions, Item 2 does not apply. For mortgage wtentu tQ„ l rty, cancellation of debt. contri to an indvidual retirement arrangement 0", and .. , Atvlrt are not reouired to eight, the but you musk provide ytwu correct TIN. See the Section rel wx*s are to the Internal Revenue Code unless otherwise Purpose of Form A penton who la required io f o an Information rntum wM fhe IRS must obi your Cor eot taxpayer iderRlfilcadan number (nN) to report, for exampie, Irncarrne paid to you, rash estate transactions. mortgage Interest you paid, goqutsstion or abandonment of Secured of debt, or contributions you mi to an IRk Use Fan W=8 only it you are a U.S. parson Onduding It resident Wien). to provide your co TIN to the Psi mQuesilrsg it (the requester} and. when applicable. to: 1. Car* that the TIN you are gluing is correct (or you are wetting for a number to be issued), 2. Certify that you are not subject to backup Withholding, or to this Form W-g. VoRnMon of a U.S. parson. For federal tax pnlepoams, You are consilharedl a U.S. person if you a'C • An IndMdual who is a U.S. chbhon or U.S. resident alien, • A partnerthip, corporatioll, company. Or won created or orgofted in the United Stains or under the laws of the United States, a An asiats (Other then a foielgn ei or • A domestic trusl (as defined in Regulations sestina 301.7701-7). Speedalni for partenrshtps that conduct a trams or business in ft United States arc generally roWinW to pay a withholding tax on any foreign partners' eher s of Income: from such bualnees. Furtlher, in cartain oases where a Form W-8 has rot been received, a psrtnemit ip is rKored to presume that a partner is a foreignn person„ and pay the wifhhoidlrng talc. Therefore, if you are a U.S. parson than b it in a conducting a meta or bua6heos In the United 3. Okdm exempsorh from backup withholding d You are a U.S- exempt States, provIde Form W-g to the partneraNp to establish pur U.S. payn.. if appkicable, you are also car"Ing that as a U.S. person. Your status and avoid withholding on your sham Of psrumrsfilp Income. atlacable share of any pwbmmhtp khcorne Iron a U.S.. Irate or buelness is not subject to the withholding tax on foreign ' share Of Off connected hhcome. U. No. t4e iX FDmn1N�(PIS.12-20+1j C -1 , -01 NWIDENT.M.1, PRICING WORKSTIEET Our standard testing on Page One and additional testing on Page Two. Life Scan Firefighter Physical: $395.00 QuantiFeron Gold: $ 60.00 Hawar at Tests: $127.00 w M.1 YF-O ml- Hemlifis C: $ 55.00 Total: $657.00 Polk County RFP 17-601 Firefighter Annual Physicals EXHIBIT 461311 RATES Life Scan Wellness Centers 2018 Polk County Comprehensive Physical Exam Physical Exam (NFPA 1582 Compliant) included Vision (Titm us) included Hearing Exam included Skin cancer assessment included Personal Consultation with review of testing results included Cardio Pulmonary Assessment Echocardiogram (Heart Ultrasound) included Resting EKG included Treadmill Stress Test with EKG included Carotid Arteries Ultrasound included Aortic Aneurysm Ultrasound included Pulmonary Function Test included Cancer and Disease Assessment Thyroid Ultrasound included Liver, Pancreas, Gall Bladder, Spleen, & Kidney Ultrasounds included Bladder Ultrasound included Pelvic Ultrasound for Women (external, Ovaries and Uterus� included Testicular Ultrasound for Men included Prostate Ultrasound for Men Included Blood and Laboratory Tests QuantiFeron Gold (TB Blood Test) included Hepatitis C Test included Hemoccult Test included Urinalysis included Lipid Panel included Diabetes Tests (Hemoglobin AlC and Glucose) included Complete Blood Count included Comprehensive Metabolic Panel included Thyroid Panel included PSA (men) included LCA-125 (women) included QuantiFeron Gold included Testosterone (Men) NEW for this RFP (added $20.00) included Fitness Program (NFPA 1582 Guidelines) Fitness and Agility Evaluation included Body Composition Analysis included Stretch ing/Flexability/Endurance Analysis included Nutrition and Diet Recommendations included Personal Fitness Recommendations included Medical Clearances OSHA Respirator Medical Clearance included Firefighter Medical Clearance included TOTAL $510.00 Polk County 2018 Additional Tests HAZMAT Tests (Cholinestrese and Heavy Metals) $120 Chest X-Ray with Radiologist review $65 Hepatitis A Test $55 Hepatitis B Test $55 Hepatitis A Titer $30 Hepatitis B Titer $30 Hepatitis A Vaccines each shot (2 series) Each $60 Hepatitis B Vaccines each shot (3 per series) Each $60 PPD $15 LOSHA Respirator Mask Fit Testing (Portacount) -.-$35 Exhibit 2 Life Scan Wellness Centers MONROE COUNTY 2018 Comprehensive Physical Exam $ 395.00 Physical Exam NFPA 1582 compliant) included Comprehensive Hands-on Physical with Vital Signs Vision (Titmus) included Audiometry included Skin Cancer assessment included Mental and Behavioral Health Questionnaire included Sleep Disorder Questionnaire included Personal Consultation with review of testing results included Cardio Pulmonary Assessment Echocardiogram Heart Ultrasound included Resting EKG included Treadmill Stress Test with EKG included Carotid Arteries Ultrasound included Aortic Aneurysm Ultrasound included Pulmonary Function Test s iromet included Cancer and Disease Assessment Thyroid Ultrasound included Liver, Pancreas, Gall Bladder, Spleen, & Kidney Ultrasounds included Bladder Ultrasound included Pelvic Ultrasound for Women Ovaries and Uterus included Testicular Ultrasound for Men included Prostate Ultrasound for Men Included Blood and Laboratory Tests Hemoccult Test included Urinalysis included Lipid Panel included Diabetes Tests (Hemoglobin Al C and Glucose) included Complete Blood Count included Comprehensive Metabolic Panel included Thyroid Panel included PSA (men) included Testosterone (Men) included CA-125 women included Fitness Evaluation NFPA 1583 Guidelines Aerobic Capacity Evaluation included Body Composition Analysis included Muscular Strength Evaluation Muscular Endurance Evaluation Flexibility Test included Nutrition and Diet Recommendations included Personal Fitness Recommendations included Medical Clearances OSHA Respirator Medical Clearance included Firefighter Medical Clearance included TOTAL $395.00 Exhibit 2 Additional Tests Available Chest X-Raywith Radiologist review 65.00 Lumbar X-Raywith Radiologist review 65.00 Hepatitis A Test (antigen) 55.00 Hepatitis B Test (antigen) 55.00 Hepatitis C Test (antigen) 55.00 Hepatitis A Titer(antibody) 30.00 Hepatitis B Titer (antibody) 30.00 Hepatitis A Vaccine 2 Series 60.00 Each Hepatitis B Vaccine 3 Series 60.00 Each HIV Test 40.00 ABO Blood Type 22.00 OSHA Respirator Mask Fit Testing (Portacount) 35.00 Cholinestrese and Heavy Metals (Hazmat) 120.00 QuantiFeron Gold (TBlood Test for TB 60.00 PPD Test 15.00 The Life Scan Pricing is based on Location being provided by the City, County, or Union. A surcharge will be added based on the operational cost for Life Scan to provide space or increased cost of on -site locations.