Item C07County of Monroe
<r
BOARD OF COUNTY COMMISSIONERS
�1
Mayor David Rice, District 4
IleOI1da Keys
��x
tt0.
Mayor Pro Tem Sylvia J. Murphy, District 5
Danny L. Kolhage, District 1
P f,<
George Neugent, District 2
a
Heather Carruthers, District 3
County Commission Meeting
March 21, 2018
Agenda Item Number: C.7
Agenda Item Summary #3961
BULK ITEM: Yes DEPARTMENT: Emergency Services
TIME APPROXIMATE: STAFF CONTACT: Steven Hudson (305) 289-6020
N/A
AGENDA ITEM WORDING: Approval to enter into a contract with Life Extension Clinics, Inc.
("LifeScan") to perform annual physical examinations of Monroe County Fire Rescue personnel in
accordance with NFPA 1582.
ITEM BACKGROUND: NFPA 1582 recommends all active firefighters, regardless of age, to
have an annual physical and stress test. Currently, these physicals are being performed by two
physicians, one in Key West and one in Marathon. Many of our firefighters do not live in Monroe
County, therefore scheduling these physicals, which can take up to five hours including drive time to
and from the doctor, can be challenging. Life Scan will provide these services at a significantly
reduced cost ($395 per physical, down from the current cost of $570 per physical). Changing to this
vendor is expected to save the County approximately $30,000 per year, as well as providing more
comprehensive medical testing and evaluation of personnel. Each $395 physical includes a stress
test and the County will provide a treadmill for this purpose. The program can be expanded to other
County departments and constitutional offices if desired. Life Scan provides all labor, materials,
equipment, machinery, tools and apparatus to perform all work and services. They operate from a
mobile medical unit, which will be located at a centralized site within the County that is convenient
for firefighters. The duration of each physical is approximately two hours, and Life Scan is able to
conduct three physicals in each two-hour time slot. Under the County's Purchasing Policy, this
contract would fall under Chapter 7(E) "Piggybacking", as outlined in Exhibit 1 (attached to
contract), Request for Proposal (RFP) 417-601 with Polk County, FL.
PREVIOUS RELEVANT BOCC ACTION: None
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
Life Scan Response Polk County 2018
Monroe County FR — Life Scan agreement 2018
COI Monroe County 2018 udpated
FINANCIAL IMPACT:
Effective Date: 3/21/18
Expiration Date: 3/20/20
Total Dollar Value of Contract: Approx. $130,640
Total Cost to County: Estimate approx. $30,000 annual savings
Current Year Portion: $65,320
Budgeted: Yes
Source of Funds: Emergency Services Operating Budget /530316
CPI:
Indirect Costs: N/A
Estimated Ongoing Costs Not Included in above dollar amounts:
Revenue Producing:
Grant:
County Match:
Insurance Required:
Additional Details:
If yes, amount:
A total of $94,195 is currently budgeted in FYI for Annual Physicals covering approximately
165 career and volunteer firefighters at $570 each. A change to this vendor would reduce the
cost per physical to $395, providing an annual savings of $28,875 for more comprehensive
services and medical evaluations.
03/21/18 141-11500
Annual Physicals
03/21/18 101-11001
Annual Physicals
03/21/18 404-63100
Annual Physicals
03/21/18 001-12001
Annual Physicals
03/21/18 148-14000
Annual Physicals
03/21/18 148-12000
Annual Physicals
Total:
FIRE & RESCUE CENTRAL $50,310.00
MEDICAL AIR TRANSPORT $6,715.00
FIRE & RESCUE KW AIRPORT $5,135.00
FIRE ACADEMY $1,185.00
FIRE MARSHALL $1,185.00
FIRE & RESCUE COORDINATO $790.00
$65,320.00
REVIEWED BY:
Gary Boswell Completed 03/02/2018 10:07 AM
Pedro Mercado
James Callahan
Budget and Finance
Maria Slavik
Kathy Peters
Board of County Commissioners
Completed
03/02/2018 3:29 PM
Completed
03/06/2018 1:33 PM
Completed
03/06/2018 2:28 PM
Completed
03/06/2018 2:34 PM
Completed
03/06/2018 2:50 PM
Pending
03/21/2018 9:00 AM
CONTRACT FOR SERVICES
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. MacDilI 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 party 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 party 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 party, 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.
IN WITNESS WHEREOF, each party has caused this agreement to be executed by a
duly authorized representative.
(SEAL)
ATTEST: KEVIN MADOK, CLERK
STATE OF FLORIDA
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
M
Mayor/Chairman
LIFE EXTE SION C
LaNle$ I INC By YA r�-"jyi
Title: Ozr--)4�zll
COUNTY OF MONROE
Sw—om to (or affirmed) and subscribed before me this day of 2018, by
Personally Known OR Produced Identification
Type of Identification Produced D/,
- 21�lj (Signature of Notary Public - State of Florida)
/ I
/Q/ A (Print, Type, or Stamp Commissioned Name of
Notary Public)
1-7
MOM =,A- -I.
Request for Proposal Title:
�:WAIIJI
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
Foos Number: ` m
R 1 1 •. i - / *I. #.
role Now).
Cost of Servicru: n &D ire pLgts:
Rate eaer dewaiWk a Mk l tol 10, with 10 rtp emdog that you Wert ve ry nd" (and
.router hire the firmfindkidual wain) mW t representing that you men very urrrathi ed (oar! would
Raver biro tha firulladMdUOI again. Plume rata ON& of tlw criorfa to the but of your know1odge. It
you do not have suffideat knwbdge of pad performance to a pardeular area, Wye it blouL
1. �. MR r:
NO
CRrfEM
umrr
scow
i
Ability to mane cost
2
Ability to maintain project schedule (complete on-
tines /ea
- 1 p}
3
Quality of workmanship
1 - 10}
4
Professionalism and ability to complete urns for all Fire
and EMS positions
0
5
Ability to communicate with Client's staff timely
6
Ability to resolve issues promptly
-�}
7
Ability to follow requirements based on National Fire
Protection Association standards
{ -}
S
Abi lity to maintain proper documentation and complete
(
,�
A
Appropriate a
application of technology used far fire mobile
�
10
Overall Client satisfaction and comfort level in hiring
1
11
A bility to offer solid recommendations based on exam
result
- }
/ 0
112
Ability to facilitate consensus and commitment to the plan
of action amon
Ci -ZQ}
�l
Nuted Larne of Evaluator ` "
Sigma of Evaluator
It
Please fix or mTWI the completed survey To! A - - ^ .' 1 � t , e ow
27
t>s
Survey Questionnntre Folk County
RFP 17.601, Fhvfthter Annual Pbyaicais
(Nurse of ft"n completing survey) (Name of Client Company/Firm)
Phone Number - , A6-q- �2�,�• �a 't�'�
e
Subjects P ast Performance rsf.
1.�.
a a.R -n•. iii�s.+.11n. ar i�V.:rA)YM .: :iwp�a:y�...1....yry- ny....+.Mk WW'.�I PtF'n•"W +++n- wl.AiriW` +hw+�
...ran .. ar w...msnn+e. -. v.+ -r .raw •uusrrxas w..a4e'ar —+we
Cost of Services: D "31 S, r4ar
mate to Ol *c "Iterfa O It sulk of li to iii, Wft 10 repmenting Mat you WOM very Ud3fled (and
Would hire tb fi al ate) and 1 rP tlhut yaru wm Y u tfafled (anal would
now bire the fIrmA#AvWuj again pleas gate eaacb of the criteria to the best of your keowlefte. if
You do not bane sufficient knowledge of Pu t performance in a particular area, leave k blank.
Similar Work Project Nacre: Date Compleud:
NO
1
2
CRITERIA -
-
Ability to manage coast
Ability to maintain project schedule (complete on-
time/early
uxrr
(1.10)
scoRE
l �
10
3 Quality of workmanshi
Professionalism and ability to complete exams for all Fire
and EMS Positions
(1 -101
to
5 Ability to communicate with Client's staff timely
(. )
l t)
6 Ability to resolve issues promptly
(
to
7 Ability to follow requirements based on National Fire
Protection Association standards
Cl_1p�
i Q
Ability to maintain proper documentation and complete
timely
(1101
9 Appropriate application of technology used for the mobile
test ing
(1-10)
I'D
10 Overall Client satisfaction and comfort level In hiring
( 1 -10)
11 Ability to offer stand recommendations based on exam
result
(1 -10)
t
12 Ability to facilitate consensus and commftment to the plan
of action among stall
(
to J
_lo- mr. L-0100e'r
Printed Name of Evaluator S isnatumlor Evelttatcrr
Pl=c fax or email the completed survey to:
M VA *11 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:
MWOM 1 1 4 90100"
Life Scan will provide samples of patient chart forms and patient results upon request.
Polk County RFP 17-601 Firefighter Annual Physicals
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 3 11 1 11 1 1 11 11 11 11 1
❑ 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 CLEARANCE 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.
G 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 Di=Wr
Lionse Nuoiber ME 6951 8
LIFIE SCAN RESPIRATOR MASK FIT CLEARANCE FORM
Wellness Centers Employer- POLK COUNTY FIRE RESCUE
Date:
Employee Information
List Name:
Occupation:
Mask Fit Test (For Use Only)
Respirator Medical Clearance: ❑ Pass ❑ Fail. Date of Medical Clearance:
Vision Correction Required- ❑ Yes ❑ No
If yes, what type correction used when wearing a respirator:
❑ Contact Lenses ❑ Glasses ❑ None
Fit Testing Results (For Clinical Use Ody)
Test Date.
Test Completed: ❑ Yes ❑ No
If No, give reason:
Respirator Type: ❑ N95 Paper ❑ Full Face Negative Pressure ❑ Half Face Negative Pressure
Make: Model:
Style: Size:
Mask Fit Test Date;
Fit Test Protocol Used: QMARti
itative
❑ PortaCount Model Number: Serial Number:
❑ Dynamics Occupational Fit Tester Model Number: Serial Number;
Overall Fit Factor: ❑ Pass ❑ Fail
Notes: (For Clinical Use Only)
Comments:
Signatures
Print Patient Name
Print Clinician Name
Patient Signature
Clinician Signature
First Name:
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 (Mob ilex)
• 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
program-
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
1. 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
#005
11011111
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 Wellness Centers' Safet
De partment 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 home 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
Ml contract with a certified biomedical waste 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 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.
657.00
!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),
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 Ide icatian and Number)
Notary Public Signature
STATE OF: �
COfTNW OF:
Attachment "B"
SU113CONTRACTOR A/c vq -e--
' PAGE)
k
Please list below the name and address of subcontractors to be used in conjunction with this RFP
(If applicable).
LabCorp
Regional Office:
Laboratory Corporation of America
5610 W. LaSalle Street
Tampa, FL 33607
Lif S can w ill provide an on-site blood draw program. Li S can pa are also able to have
blood draws done at any LabCorp p at i ent S erv i ce C 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 ALEXANDER 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
%6 \ 1
►M
A
5 K.- *p Ap"c- I ooj��C- �M
9 *]; 3
k
LA
CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
C €RTIFICATE 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 INSURER(S), 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 term and condi lone 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 endorsemHlt(S),
PRODUCER
O. E. Wilson Insurance, Inc.
1 476 Belcher Rd S
Largo FL 33771
INSURED
Life Extensions Clinle,inc.
9497 N. Macdlll Ave
Tampa FL 33607
Insurance
M
OVERAGES CERTIFICATE NUMBER: REVISION NUMISEK: _
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.
X COMMERCIAL.GENr�1U UANLrrY
A MA M84 ADE 1 X 1 00CUR
30690745 71r70r76 77../70/17
Li
GATELJMITAPPU PER:
XT. OUGY JPERtx LOC
OTHERF
AUTO LE LIABILITY
A X ANY AUTO
ALL O LED RULED 4159162800 0917 6 hf 6 0911&M7 HIRES?AUTOS AUTOS NED
AUTOS AUTOS
UMLU LIAe OCCUR E]rC LiAS r., AIUS%
(
3
OOMLSNEO SIN LE LIMIT $1
BODILY INJURY IPerperamg 5
BODILY INJURY (Per smWent) S
PROPERTY DAMAC`S S
3
Medical Professional Liability E0000037591 -01 0513IMT 10613I MS 3,000,000 Aggregate
B Retroactive Date: 513112007 2,000,000 Each Claim
DESMPTION OF OPERATIC A 1 LOCATIONS I VINICLES (ACORD ,bt, Ads#eoErat Rwaaft Schedule, may be aaaeMd If mom apses to r
contractorlk arleingojxAk- county,net
Sexual Abuse $1,000,000 Each Cla"1,000,000 Aggregate
Network Security S Data Privacy Liability $1,000,000 Each Claim/#7,000,000 Aggrsgats
Palk County
330 west Church Street..
Bartow, FL 33630
Phone: (863)604-6080
SHOULD ANYOFTHEABOVEDESCRIBED POLICIES SE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
6
ACORD 26 (2014/01) The ACCORD name and logo are registered marks of ACORD
ACOWOr CERTIFICATE OF LIABILITY INSURAN DAM
A%-� 10/31/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO tMA11ON ONLY AND COWERS 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 INSURIMS), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMMRT : R the aerflftnim holder Is an ADDITIONAL INSURED, the pol"les) nxM be anclarselt, IF 4U®ROGATION !S WAIVED, guijm to
tlm tElim and cnndlgons of the policy, rartehl pollclas my mqufm an andonmrA d. A sbftnwnt on this EarItflGm do" not Confer rl0hls to tha
Eserdflcate holder In Neu of such endersmRke WoL
EAR.
Priiworc 1p insurance servima, Inc.
5402 W. Laurel St.
Suits 220
Tampa I? 33697
Id Xxtension Clinics, Inc
1011 IN WlacDill Ave
33607
I813Iaa5
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISM BEI.6W HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTrH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 19 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONOM15I+IS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BMN REDUCED BY PAID CLAIMS.
ACORD 26 (2014101)
IM1ie"1S M1011
echatlWl, my to x0mclod If man Apses N aqW"
73rc+rt>v^A -'Ii1t 6Q1gr
.COD
SHLEULC) ANY OF THE ABOVE 0=148FSI POLICtn ne CANCELI.E D Etii:FOgE
THE EXPIRATION DATE THEREOF NOME V4LL SE oEuv rReo IN
ACCORDANCE WITH THE POLICY PROVISIOtN&
AUTHOREW nVIVOISEANTAINE
l E 211sas #AO77 187/
01OW2014 A �7C?C CORPORATION.
The ACORD clams and logo are mglstered marks of ACORD
All rISIEts I°ewmed.
COMIMERCM& 40NOIAL LEA Uff
CLAIMS-MADE Ll I
_...
i
_...
EEACH OOOL iRENCE
�
MED W QWW am
PERSONAL A ACV INJURY
aENL AIGRE ATE LANT APPLIES PER;
POLIC JECT L�l Lor.
L'EENERAL AGGREGATE
!
PRODUCTS - WupAOP AoG
s
�-
OTHER:
-
AUTGII41BILE WARM
i
MY AM
K0LYINJURY(Pnrp.1w)
e
ALL 0 MEO SCHEDUM
ALrTOG AUT a
HIRED AUTOS p
BODILY INJURY(Por> N)
e
TY
S
11f@CQI I i �,
- -- _
EACH OCCU RREW E
AGORNIA"EL
R #
S
A
A" LGIIll.ITY Y
ANY PROPRIEYCWIPARTN
�rwhuray#s Nll)
IA A .
1
2=600936 05 '
11122/2019
0/2017
S
4EACHA#CdOFJET
7.,.1)00,
EE_ DISEASE. EA EuPLtYM
!. , n' An
ACORD 26 (2014101)
IM1ie"1S M1011
echatlWl, my to x0mclod If man Apses N aqW"
73rc+rt>v^A -'Ii1t 6Q1gr
.COD
SHLEULC) ANY OF THE ABOVE 0=148FSI POLICtn ne CANCELI.E D Etii:FOgE
THE EXPIRATION DATE THEREOF NOME V4LL SE oEuv rReo IN
ACCORDANCE WITH THE POLICY PROVISIOtN&
AUTHOREW nVIVOISEANTAINE
l E 211sas #AO77 187/
01OW2014 A �7C?C CORPORATION.
The ACORD clams and logo are mglstered marks of ACORD
All rISIEts I°ewmed.
Font,
(Rev. DecarnbW 20 1)
of lha Trssarxy
c3
0
a
Request for Taxpayer
Identification Number and Certification
GWe Form to the
rester. Do not
Se nd 10 the III.
Name (w shown on your ,rams M row
Life E)ftnsim Clinics, kw.
r-. —;� wift ria".
Scare Weiiness Centers
-,71 1 iiiii!
M p.. ■ ■
® ttmirO N bay carrh^any En±erttae ixtn t corporstan, - +�rPcnniu�. �' ai rani )►
AddrM Dena w, MWA- end VL -
1011 filoM Macdjl! Avenue
FL 33607
F—pt pay-
.........._..� -- l �srt ssaarrgr rssnmr
Enter yaurTlN to the appropriats box. Ttw*nN provided must match the reams given on the ' Name' ire
to avoid backup whhholding. For' this is your social Security (SM. However, for a
resfdcnt fin, sale proPftlor, or dhMardsd *44, we the Part I instructions on pale '& For other
erWes, it Is your employer kleatisoetion number (EW). If you do not have a number, see Now to Set a
77N an Pap 3. ides
No4ss. p the somfflt 14 lira mare th ar
an e name, see the chart on e 4 for 9 1 on whose k � "�
nor nbw to enter: 5 S - i 3 5 3 O
Under penalties of perjury, I cer* that
I
no tifi e d try ft Revenue
1. The number shown on this form is my O=M taxpayer identification number (or I am wafdrrg for a rdxs n to been iSSUSd to me), and
2. 1 Burr not subject to backup withholding beeauae: (a) I am exempt from backup withholding. or (b) I stave ncst bsert
Service (IRS) that I am subject to backup wlethokting m reside of a tallure to r9W all interest or or (c) the IRS has nodflad me that i am
no larger subject to backup wNhholding. end
C
because you have failed to
InW=t paid, ealulsition at
g
irwiructions on pap en e r ally, payments other
You must tifi
out Rom 2 above K you have been noed by the 1ft<S tat h You ere c�rentlyr aubjr ct to backup wlthfxnlding
report all k tsreat and dvidsnds on yoke' tax return. For reef satate tranw"ons, item 2 does not apply. For mortgage
rrtrw r tQ„ r rty, cancellation of debt. contri to an individual retirement arrarr 0mel t 0", and
.. , rrlvlrl are not reoulred to SW go tart you musk provide Yore otrrsct TIN. See the
Section rak wx*s are to the Internal Revenue Code unless otherwise
3. Claim exerr p*m from backup withhWwv ff You are a U.S. "emP St _,._..,.� o h t to establish your U.S.
are also osctlfying that as a U.S. Person. your States, provide Form W d to on pnr s hahiP
payee. N applicable, You status and avoid wvitttfalding on your attars of partnership Income.
allocable share of any ktcorne IMm a U.S.. trade or business
is not subject to the wkhholdkV tax on foreign ' share of
g! carutected hncome.
U. No. te4"31yi Ferri lN-� l 12-20 11)
3. 1 am a U.S. ckbm or other U.S. person (defiled below).
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
Ha war at Tests: $127.00
w M. F-TO ml-
Hemlifis C: $ 55.00
Total: $657.00
Polk County RFP 17-601 Firefighter Annual Physicals
EXHIBIT 46
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)
$65
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
Each $60
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
L OSHA Respirator Mask Fit Testing (Portacount)
-$35
CERTIFICATE OF LIABILITY INSURANCE DATE(
�.... -- 03!06!2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI:
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE1
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEI
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 t4
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to th,
certificate holder in lieu of such endorsement(s).
PRODUCER 1C9NTACT
0. E. Wilson Insurance, Inc.
I INSURER F:
PH °NE
(727) 535 -0524 FAX N.), (727) 536 -9828
1475 Belcher Rd S
ADDRESS:
cinda @oewilson.com
Largo FL 33771
COVERAGES CERTIFICATE NUMBER:
REVISION NUMBER:
INSURERS AFFORDING COVERAGE
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOI
NAIC #
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM
INSURERA:
Auto - Owners Insurance Company
18988
INSURED
INSURER B:
Admiral Insurance Company
24856
Life Extensions Clinic,lnc. DBA LifeScan
INSURER C
Transportation Insurance Company
TYPE OF INSURANCE
12408
1011 N. Macdill Ave
POLICY NUMBER
INSURER D:
MM /DD /YYYY
LIMITS
Tampa FL 33607
X
INSURER E
CERTIFICATE HOLDER CANCELLATION
@ 1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD I ^A^
I 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 PERIOI
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI;
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR
ADDL
SUBR
POLICY EFF
POLICY EXP
LTR
TYPE OF INSURANCE
POLICY NUMBER
MM /DD /YYYY
MM /DD /YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS ®OCCUR
DAMAGE TO RENTED
$ 1009000
-MADE
'RE MSES e
r
X
X
20690745
11/10/2017
11/10/2018
MED EXP ( Any one p erson)
$10,000
PERSONAL &ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X
PRO
POLICY F—] ❑ LOC
JECT
PRODUCTS - COMP /OP AGG
$ 2,000,000
rL
OTHER:
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
$ 1, ® ® ®, ® ®®
A
X
ANY AUTO
BODILY INJURY (Per person)
$
CD
ALL OWNED
SCHEDULED
X
4159162800
09!18!2017
09!18!2018
BODILY INJURY (Per accident)
$
AUTOS
AUTOS
X
X
NON -OWNED
PROPERTY DAMAGE
$
HIRED AUTOS
AUTOS
$
UMBRELLA LAB
EACH OCCURRENCE
$
H OCCUR
EXCESS LAB
CLAIMS -MADE
AGGREGATE
$
L
D RETENTION
$
WORKERS COMPENSATION
PER I OTH-
AND EMPLOYERS' LIABILITY Y / N
STATUTE
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$ 1,000,000
C
OFFICER/MEMBEREXCLUDED? ®
N/A
X
WC 656600287
11/29/2017
11/29/2018
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
+-+
Medical Professional Liability
E0000037691 -01
05/31/2017
05/31/2018
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
with repect to work performed by the insured.
Medical Professional Liability Additional Coverages:
Sexual Abuse $1,000,000 Each Claim /$1,000,000 Aggregate
Network Security & Data Privacy Liability $1,000,000 Each Claim /$1,000,000 Aggregate
CERTIFICATE HOLDER CANCELLATION
@ 1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD I ^A^