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Item D03
� D.3 � � �, BOARD OF COUNTY COMMISSIONERS County of Monroe � ��r�i �r � s�� Mayor Heather Carruthers,District 3 The Florida.Keys Mayor Pro Tem Michelle Coldiron,District 2 Craig Cates,District 1 David Rice,District 4 Sylvia J.Murphy,District 5 County Commission Meeting April 15, 2020 Agenda Item Number: D.3 Agenda Item Summary #6535 BULK ITEM: Yes DEPARTMENT: Emergency Services TIME APPROXIMATE: STAFF CONTACT: Steven Hudson (305) 289-6020 N/A AGENDA ITEM WORDING: Approval for the first of two optional one year contract extensions with Life Extension Clinics, Inc. ("Life Scan") to perform annual physical examinations of Monroe County Fire Rescue personnel in accordance with NFPA 1582. ITEM BACKGROUND: MCFR is seeking approval to renew our existing contract with Life Scan for the first of two (2) optional one-year terms. By opting to renew the contract for an additional year, the current cost of$395 per physical will remain the same and will avoid any potential increase in cost. NFPA 1582 recommends all active firefighters, regardless of age, to have an annual physical and stress test. Life Scan provide these services at a cost of$395 per physical. Each physical includes a stress test. The County will provide a treadmill. 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. PREVIOUS RELEVANT BOCC ACTION: Previous BOCC approval on 03/21/18 (Item C.7) provided for an initial 2-year term with the option to renew the contract for two (2) one-year terms. CONTRACT/AGREEMENT CHANGES: Life Scan contract extension for first of two optional one-year extensions. STAFF RECOMMENDATION: Approval DOCUMENTATION: Life Extension Clinics - First Renewal Agreement 2-24-2020 Life Scan Expires 3-20-20 Life Scan COI Packet Pg. 104 D.3 FINANCIAL IMPACT: Effective Date: 3/21/2020 Expiration Date: 3/20/2021 Total Dollar Value of Contract: Approx. $97,600 Total Cost to County: $97,600 Current Year Portion: $97,600 Budgeted: Yes Source of Funds: Emergency Services Operating Budget/530316 CPI: No Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: No If yes, amount: N/A Grant: No County Match: No Insurance Required: Yes; $1,000,000 Professional Liability, $1,000,000 General Liability, $1,000,000 Automobile Liability, Florida Statutory Workers' Compensation Additional Details: Refer to the notes below. A total of$97,600 is currently budgeted in FY20 for Annual Physicals covering approximately 247 career and volunteer firefighters at$395 each. 03/21/20 141-11500 FIRE& RESCUE CENTRAL $76,630.00 Annual Physicals 03/21/20 101-11001 MEDICAL AIR TRANSPORT $7,110.00 Annual Physicals 03/21/20 404-63100 - FIRE& RESCUE KW AIRPORT $5,135.00 Annual Physicals 03/21/20 148-12000 FIRE& RESCUE COORDINATO $3,555.00 Annual Physicals 03/21/20 001-12001 FIRE ACADEMY $2,765.00 Annual Physicals 03/21/20 148-14000 FIRE MARSHALL $2,370.00 Annual Physicals Total: $97,565.00 REVIEWED BY: James Callahan Completed 02/28/2020 11:47 AM Pedro Mercado Completed 02/28/2020 11:52 AM Budget and Finance Completed 03/02/2020 8:26 AM Maria Slavik Completed 03/02/2020 9:41 AM Kathy Peters Completed 03/02/2020 4:14 PM Board of County Commissioners Completed 03/18/2020 9:00 AM Packet Pg. 105 D.3.a RENEWALFIRST CONTRACTFOR SERVICES LIFE EXTENSIONICI I S, INC. MONROECOUNTY THIS FIRST RENEWAL AGREEMENT is made and entered into on the day of ,2020 by and between MONROE COUNTY,a political subdivision of the State of Florida whose address is I 100 Simonton Street, Florida 3 (hereinafter referred to as 0 "County"), and Life Extension Clinics Inc., a business having its primary business location at: 10 11 N. MacDill Ave., Tarnpa, Florida 33 (hereinafter the "Contractor"). WI SS T° a F REAS. on the 2 156 of March 2018 the parties entered into an agreement (hereafter Original Agreement) forte provision of physical examinations for Monroe County Fire Rescue staff, and WHEREAS, the Original Agreement provided for two (2) one-year renewal terms; an WHEREAS,pursuant to the terms of the Original Agreement,the Contractor has informed Ca the County in writing of its desire to renew the Agreement; and CD N CD WHEREAS, the parties find that it woulde mutually beneficial to enter into this first renewal agreement: cV NOW THEREFORE, IN CONSIDERATIONof the mutual promises and covenants set � forth below. the parties agree as follows-, Section . In accordance with Paragraph of the Original Agreement, the County my exercises the option to renew the Original Agreement for the first of the two ( ) ore-year terms, This term will commence on March 21, 2020 and terminate March 20, 2021. Section . Except as set forth in Section I of this First Renewal Agreement, in all other respects, 2 the terms and conditions set forth in the Original Agreement remain in full farce and effect. REMAINDERTHE I . X Packet Pg. 106 D.3.a IN WITNESS WHERE-OF, each party has caused this agreement to be executed by a duly authorized representative, (SEAL) F COUNTY COMMISSIONERS ATTEST: KEVIN MADOK, CLERK OF MONROE COUNTY, FLORIDA Y _ m Mayor/Chairmanc I � _� ° wzSl ., 1 YES, INC, X A � w ., �Citic® Nry Putft Stwo or STATE OF: k,' � JendimrL Connelty My COMMSOM Go 327022 Subscribed and sworn to (or affirmed) before me, by means of 0 physical presence or 0 online cv . r cv notarization, on t (date) by (name of affiant). He personally known to me or has produced� (type of identification) as identification. 0 ROE C EY v, ED S si E ASSIST NTY A RN N Date X Packet Pg. 107 C°URTB 00 o: Kevin Madok, CPA .. .... Clerk of the Circuit Court& Comptroller— Monroe Count Florida •ROE COUNT. Y1 LO µy M DATE: March 28, 2018 ca TO: Debbie Lofberg Emergency Services E FROM: Pamela G. Hancock, D.C. E 0 U SUBJECT: March 21st BOCC Meeting Attached is an electronic copy of Item C7, Contract with Life Extension Clinics, Inc. to perform annual physical examinations of Monroe County Fire Rescue personnel in accordance with NFPA 1582, for your handling. 0 Should you have any questions,please feel free to contact me at ext. 3130. Thank you. c 0 LL cc: County Attorney i Finance F File c cv cv r9 x KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING 500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road Key West,Florida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plan 305-294-4641 305-289-6027 305-852-7145 305- Packet Pg. 108 D.3.b CONTRACT FOR SERVICES �s Mow* LO THIS AGREEMENT is made and entered into on the `% day of ca 2018 by and between MONROE COUNTY, a political subdivision of the State of Florida whose c address is 1100 Simonton Street, Florida 33040 (hereinafter referred to as "County"), and Life W Extension Clinics Inc., a business having its primary business location at: 1011 N. MacDilI Ave., Tampa, Florida 33607 (hereinafter the "Contractor"). 0 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 LU 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 ca CD 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 2 under this Agreement as provided in Exhibit 2 to this Agreement and made a part of this LU 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, Packet Pg. 109 D.3.b 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 I le LO 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 ca 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 ca minimum amount of One Million Dollars ($1,000,000) combined single limits for Bodily Injury and Property Damage per accident. N 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 E 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 Packet Pg. 110 D.3.b 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. LO 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. ca 0 8) GOVERNING LAW: This Agreement shall be governed, interpreted and construed E 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. 0 12) TERMINATION: If either party fails or refuses to perform any of the provisions of this Agreement or otherwise fails to timely satisfy the provisions hereof, either may notify the other parry in writing of the nonperformance and terminate the Agreement or such part of the Agreement as to which there has been delay or a failure to properly perform. The Contactor may LU 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. c, 13) INDEPENDENT CONTRACTOR: The Contractor shall perform the services under ca this Agreement as an independent contractor and nothing contained herein shall be construed to W N 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. 2 . x LU 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 Packet Pg. 111 D.3.b 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 I le LO 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 CO 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 0 contract and the County may enforce the terms of this provision in the form of a court c proceeding and shall, as a prevailing party, be entitled to reimbursement of all attorney's fees Ch 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. c 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. CO (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 a 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 Packet Pg. 112 D.3.b 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 I le LO 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 ca 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' 0)- the information technology systems of the County. 0 (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 2 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. ca 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. Packet Pg. 113 . D.3.b 20) CONSTRUCTION OF AGREEMENT: The parties hereby acknowledge that they fully reviewed this Agreement, its attachments and had the opportunity to consult with legal I le LO counsel of their choice, and that this Agreement shall not be construed against any party as if they were the drafter of this Agreement. ca 21) CONTINUED MANAGEMENT BY THE NAMED PARTIES: Continuation of the c 0 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: c For County: For Contract to: Emergency Services CEO Life Extension Clinics, Inc. Attn: Chief James Callahan Ms. Patricia Johnson 2 490 63rd Street Ocean, Suite 140 1101 N. MacDill Avenue Marathon, FL 33050 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, CD ca - 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 Packet Pg. 114 D.3.b 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) Ile LO 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 CO 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. 0 25) Binding Effect: The terms, covenants, conditions, and provisions of this N Agreement shall bind and inure to the benefit of Contractor and County and their respective legal X 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 S 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. LU 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 Packet Pg. 115 D.3.b specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. I le LO 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 CO with its performance under this Agreement, and the only interest of each is to perform and receive benefits as recited in this Agreement. 0 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. c 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 y r_ 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 LU 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 CO 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, X LU 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. Packet Pg. 116 D.3.b 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 I le 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 ca 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 0. Constitution, State Statute, and case law. 0 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. r_ 36) Attestations. Contractor agrees to execute such documents as the Lessor may N reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug- X 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 ca CD 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. X THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK. 2 Packet Pg. 117 D.3.b ,n IN'41V•ITNESS WHEREOF, each party has caused this agreement to be executed by a 'duly autliofized;xepresentative. 0 BOARD OF COUNTY COMMISSIONERS ATTEST.:°KEVIN MADOK, CLERK OF MONRO CO TY, F DA By c, Mayor/Chairman O i_ ..J LIFE EXTE SIGN C , INC. CC w ..... t~ a v�o By c oo r7 Title: L. wt1 a 72,T. ems.: STATE OF FLORIDA COUNTY OF MONROE / S P/27 n to (or affirmed) and subscribed before me this day of , 2018, by >/kilt \ Personally Known OR Produced Identification Type of Identification Produced��/ •``1�l 1 , �/�,�/S(� 1T (Signature of Notary Public - State of Florida) 1 � /9J/0/�l (/4 � � " (Print, Type, or Stamp Commissioned Name of ca W Notary Public) CD CD '�(ARYAo DAVID A. LLI NOTARY PUBLIC y STATE OF FLORIDA Comm#GG005564 r"'r✓ct its' Expires 10/8/2020 N .OE COU AT ��a1fED S D MERCA PFDRO � ASSISTANTC UNTY ,3 I Date Packet Pg. 118 D.3.b ;4c R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)' I 33/06/2018 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 POLICIE: 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 t� LO 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 CONTACT E 0.E.Wilson Insurance,Inc. PHONE 100 727 535-0524 FAQ o. 727 536-9828 c 1475 Belcher Rd S E-MAIL cinda@oewilson.com Largo FL 33771 INSURERI AFFORDING COVERAGE NAIL# INSURER A: Auto-Owners Insurance Company 18988 INSURED INSURERB: Admiral Insurance Company 24856 O Life Extensions CHI DBA LifeScan INSURERc: Transportation Insurance Company 12408 U 1011 N.Macdill Ave INSURER D Tampa FL 33607 INSURER E: INSURER F: �. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 0) 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. INSTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDY� MM/DDYEXP LIMITS O X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A 0. CLAIMS-MADE ®OCCUR DAMAGE TO RENTED $100 000 X X 20690745 11/10/2017 11/10/2018 MED EXP(Any oneperson) $10,000 PERSONAL&ADV INJURY $1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,00U X POLICY PRO I PRODUCTS-COMP/OP AGG $2,000,000 wo JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Fa accident) person BODILY INJURY U A X ANY AUTO ( P ) $ cu ALL OWNED SCHEDULED X 4159162800 09/18/2017 09/18/2018 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE O X HIRED AUTOS X AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ U EXCESS LIAB CLAIMS-MADE AGGREGATE $ ) DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE FIR ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 C OFFICER/MEMBER EXCLUDED? ❑N N/A X WC 6 56600287 11/29/2017 11/29/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 100 ,W If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1,000,00U CD B Medical Professional Liability E0000037691-01 05/31/2017 05131/2018 2,000,000 Aggregate CD Retroactive Date:5/31/2001 2,000,000 Each Claim M DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) rr Certificate holder is additional insured on the general liability and auto liability A OV p Y RISK�v1ANAGEMENT with repect to work performed by the insured. Medical Professional Liability Additional Coverages: BY _ M Sexual Abuse $1,000,000 Each Claim/$1,000,000 Aggregate DATE " Network Security&Data Privacy Liability$1,000,000 Each Claim/$1,000,000 Aggregate WAIVER W, _ ygg_ CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BECANCELLED BEFOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I O 1100 Simonton St ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 AUTHORIZED REPRESENTATIVE � —" — > ©1988-2014 ACORD CORPORATIO ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Packet,Pg. 119 Exhibit 1 D.3.b LO IFE ca SCAN E Wellness Centers 0 RFPRESPONSE: POLK COUNTY Request for Proposal Title: X FIREFIGHTER ANNUAL PHYSICALS P 17-601 Due Date: Wednesday, August 9, 2 17 2:00 p.m. EST W N N LIFE EXTENSION CLINICS, INC. dba: Life Sean Wellness Centers 1011 North MaeDill Avenue Tampa, Florida 33607 (813) 876-0625 Patricia Johnson, CEO Packet Pg. 120 EXHIBIT Aii LO s Centers 0 0 TABLE OF +CO1'ti TEWS TAB 1: Letter of Transmittal �- TAB 2: Personnel Requirements TAB 3: Reporting Capabilities o TAB 4: Mobile Testing L. 0 TAB 5: Comprehensive Safety and Security Program .2 TAB 6 Gast x TAB 7: Subcontractors(Attachment B) TAB 8: Medical Laboratory 0 TAB 9: Proof of Insurance TAB 10: Additional Information CD ca N U Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 121 D.3.b TAB 1: LETTER OF TRANS AL Legal Name: Life Extension Clinics,Inc. DBA: Life Scan Wellness Centers Corporate Address:. 1011 N.MacDill Avenue Tampa,FL 336077 Testing Site: tan-site at location(s)determined by POLK COUNTY ca Phone Number: Phone:(813)876-0625 Fax:(813)876-0653 0 Authorized Representative: Patricia,Johnson,CEO Email: lifescanhc(rol.com Incorporated: Florida.,August 199$ Medical Director: Anthony L.Capasso,M.D.,P.A. Medical License: 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 ADDEEN UMS: Life Scan acknowledges receipt of Addendum#1 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. 0 Life can's background is in professional medical services specifically for public safety departments with over nineteen years' experience in the development and implementation of proms for state, municipalities and counties to fit their specific needs. We have recognized the vital importance of combining the key components of health,wellness,and fitness to generate the healthiest,most productive employees. LJFE SCAN PUBLIC SAIFETY PHYSICALS ca CD Life Scare specializes in providing government agencies with public safety physical exams that comply with NFPA 1582,the IAFF/IAFC 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 v, other potentially catastrophic illnesses. Our Life Scan model of"ultrasound-aided physical exams" for 2 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 cast 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 effects of shift work. Studies confirm that the average firefighter Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 122 D.3.b and officer has almost tree tunes the incident of Dart 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 LO 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 jobs,putting themselves.,their peers,and citizens at risk. 0 In professions, as demanding and hazardous as firefighting and law enforcement, being medically, ° physically, and mentally fit will provide your employees with the capabilitytoperform optimally, decrease str.s 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 FILE 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, 0 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 gabs 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. ca CD cv Sincerely, cV LU Patricia 3o n,CEO Polls County RFP 17-601 Firefighter Annual Physicals Packet Pg. 123 D.3.b THE FOLLO MlNG SECTION SHOULD BE COMPLETED Alf ALL PROP[)SERS. LO (SUBMITTAL PAGE) Company Name: l , ca DBAIFicttious Name (if applicable): a NOTE: COMPANY NAME MUST MATCH LEGAL NAME ASSIGNED TO TIN NUMBER.. CURRENT W9 SHOULD BE SUBMITTED WITH BID. 0 TIN#: _ loll 7-a m (Street No or PO Box Nu ber) (Street Pa me) >_ (City) 01 L Ly Lr n .. 0-o (County) (State) (Zip Code) 2 Contact Person: � ` J o Phone Number: Cell Phone Number. 1 0 w Email Address: °-( i LL_,a-) c Type of Organization: Sale Proprietorship Partnership Non-Profit Sub-Chapter ) Joint Venture , Y Corporation LLC LLP Publicly Traded Employee Owned ca CD State of Incorporation F/_ � y The Successful vendor must complete and submit this section prior to award. The Successful vendor must invoice usfng the company name listed above. 24 Revised GQW 7 Packet Pg. 124 D.3.b July 31, 2017 POLIO COUNTY, A POLITICAL SUBDIVISION OF THE STATE OF FLORIDA ALO ADDENDUM #1ca .FP #17- 01 Firefighter Annual Physicals This addendum is issued to clarify, add to, revise and/or delete items of the RPP 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/Replaces 0 Ken gush Procurement Specialist Procurement Division! This Addendum sheet should be signed and returned with your submittal. This is the only acknowledgment required. Signature. 6 ca 4 _ Printed Name: -- t Tale: M Company. ' .. U U Packet Pg. 125 D.3.b RFP #17-601 FIREFIGHTER ANNUAL PHYSICALS t3L"1 ND[am #1LO CO ADD/REPLACE Notice of Request for Proposal "RFP packages may be obtained from the Procurement Division, 330 West Church Street, Pi Room 150, Bartow, Florida, 33830, (863) 534-6757 or downloaded from our website at °/ oi � ur� ,n c ite/loin wines ids. Respondents must submit one (1) c rlginai and Seven (7) copies of the proposal prier to 2:00 p.m. on the receiving date. Proposais must be submitted in a �sQaled" parcel. Proposals will be publicly opened and read at 2:00 m. an receiving date." p• Replace:with. "RFP packages may be obtained from the Procurement Division, 330 West Church Street, Room 150, Bartow, Florida, 330, (83) 534757 or downloaded from our website at s:/1 of � c ) co res 11 uro p our nt ids, Respondents must submit one (1) o " lnal and Seven p" of the proposal prior to 2;00 p,m. an the receiving date. Proposals must be submitted in a "sealed" parcel. PrraPosals will be publicly opened and read at 2:00 P.M. on receiving date." c CD CO N Packet Pg. 126 D.3.b TAB 2: PERSONNEL REQUIRENIMNTS LO COMPANY QHALI�+'ICATTONS-General Corporate: Number of years in business: 19 years ca Medical Director: .Anthony Capasso,M.D. Plumber of years in practice: 23 years E 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 ern-site wellness center in 2001 for the City of Jacksonville. Since then we have opened.three Life Scan Wellness Centers(only open to contracted goverment 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 0 • UFFIIAFC Health and Wellness Initiative • FDLE Police Physicals • DOT and CDL Physicals • Hazmat Physicals • SWAT Team Physicals • Bomb Squad Physic W • Pre-Employment Public Safety Physicals • OSHA Respirator Physicals • OSHA Respirator Mask Fit Testing • Fit for Duty Testing • Orr-site Program for all medical,testing • On-site -racy 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 UP 17-601 Firefighter Annual Physicals Packet Pg. 127 D.3.b r�. Life Scan Professional Contributions to Public Safety Health: ' In recognition of their outstanding accomplishments and understanding of the unique needs of CO fire fighters and laic 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 Instigate 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 0 0 X 0 CD CO N X Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 128 D.3.b r�. LO to PRINCIPALS,MANAGEMENT,AND PHYSICIAN SUPERVISORY TEAM: ca Patricia Johnson, CEO. Patricia is the cc-founder of Life Scan and will be the liaison between the City and Life Scan. Patricia will oversee contractual issues, ensure proper invoicing, and E attend meetings. Michael .l. Terrana, CPC?. Mike is the co-founder of Life Scann and serve 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, ' -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 Sea 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 Scam ultrasound-aided physical exam program and has extensive experience with NFPA 1582 guidelines and interpretation including annual and candidate medical clearances. N 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 Scare is a nationally recognized expert and educator regarding the health and fitness of � police and firefighters. Life Scan has advised NFPA 1582 and the IAFFIIA.FC Wellness Fitness ) Initiative Committees regarding firefighter health and fitness. CD ca N X c c Polk County RF'P 17-601 Firefighter Annual Physicals Packet Pg. 129 D.3.b CL-RRICULUM VITAE r�. LO ANTHONY L. CAP SSO, WLD. Florida Medical License. ME69518 0 EDUCATION 1984-I987 Ohio State university, Columbus,Ohio. Bachelor of Science--Biology 0 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 HONORS AND AWARDS 0 1 84-1983 Dean"s List 1985 Surmma Award,University College, Ohio State University. 1987 Graduate Curry 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 ca N Diplomat of the National Board of Medical Examiners,June 1993 Diplomat ABIM, August 1998 LICENSURE State of Florida ME 0069518 Packet Pg. 130 D.3.b MEMBERSELIPS r�. 1984-1987 National Key Honor Society, Ohio State University ' 1988-1993 American Medical Student's Association I991-1993 Tuscaloosa.County Medical Association ca 1991-1993 Larry Mayes Society c 1993-1997 American Medical Association 1994-1997 ACP'Member 1.999-present Duval County Medical Society 0 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 w 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 c 1998-1999 Jacksonville Emergency Consultants -Emergency Medicine 1997-1998 Premier Family Care-Local Tenum 199 -1997 South Beaches Medical - Internal Medicine 1996-1998 Barnen Venus M.D.P.A. CCU intensivist x 0 CD ca N x LU Packet Pg. 131 D.3.b , a r DEpkij,IMI 4T'CIF`HEALTH . .' DIVISION OF SAE fcAL QOALrry ASSUmm E DATE OCENSE NO., CONTI"t4L NO. Lo WLO 111D312815 ME 69518 5W182 � v .-he MWICAL DOCTOR ierntid bekAv has met all requlremer t61y1 ' js he Ims and ruled of the state of Florida. 'I !Iplr€l#I Date: JANUARY 31, 201 IAC00WLLE BEACH FL 32250 �I Rick Scott V Johns H.Armstrong,MD, FA GOVERNOR STATE SURGEON GENERAL. c DISPI.AY'IFNEDUIRED BY LAW " E . nON DATE:JANUARY 31,2018 Yaw`Lie mse nw=ibw Is W tllt#1>116 P uae 44,1A SU eurmaWdence wwilk yaw hoard Je nimil.Finch utemsm is solely mponsim for nodbh►i dw department In wrd" RX the lioemsee'i cutrsut mailing address and Practice location address. If you h we not rc"tvad Your rmnewml natict:94 dWa prim to tj it mWitation date ataown oa a41wemr pkwe call 14350I 465-0393. Use thla tatimt to repot now chatipe.lfiattu cies¢tteea regltials k2W tiacunnemttttlaat ahoering the now chsu{e.=Plowsm awake sots w pbafteopy Orem or the itdlaiwtng accampeoiea this Rigors:a=mjdW'Became.w diva=decree or a court order. Medical EludiV Assurance alters you list coomnience of wftrgi oullrat aervieca,Them sertrim give,you the ability to mmw your Ut enw.updam yaw matLLeB and pad � lacedom addniance and updwe your pro ie lalbrmatloo, I.00 to 2..Click an Rrv.ider tlmtwieea' Ca A.Click on'Wtiagrc sq'Uioenw CJ 4.Seleetymr S.Rafe°the user[D send peavagod diet was prmkW in you at yortr initial license and click'Sign In udaa our teeter, �-- 6.ltyou do ued know your attar ID and pmsswacde elicit an Met Lsgin Help,or call+our cum r Contact Center at(1330) Bti-tks95 for aasiatttttee, N N r7 MAUL TO;DERAARI TENT OF i1F.ALT F DPJt =OF MEDICAL QUALITY ASSURANCE I�PCIRTA�IT ANNa CEMENT LICENSURE SUPPORT SERVICES UNIT THE DEPARTWIENT OF HEALTI WILL NOW REVIEW P.O.SQX YOUR CONTINUING EDUCAT RECORDS AT TALLAHASSEE.FLORIDA 32314+ip2Q THE TIME ilt�e OF LICENSE REN AL. � NAME CMMOR(ATTACH LEGALDOCUMENTATION) TO LEARN MORE.PLME ms :& FROM: — --- LAST RR8T MIDDLE TOC {ST l tiST LAID lL.E Packet Pg. 132 D.3.b Pamela L. Desmarais, MS, ARNP-BC LO Certifications ca Registered Nurse Practitioner In the State of Florida,.license number 2551642ARNP Certified Adult Nurse Practitioner from the American Nurses Credentialing Center Registered Nurse in the ate of Florida and Massachusetts Basic tlfe Support(BLS)Certification Basic Life Support Instructor Advanced Cardiac Life Support Highlights • American Nurses Association (ANA) • Completed AAAASF accredltations • Florida Nurses Association (FNA) * Completed two JCAHO accreditations Professional Experience Life Scan Wellness Centers 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 k factious disease lab orator 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 Surgery 2008 to 2012 ARNP1Clinical 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 c staff in patient care activities. Unlverslly of South Florida 2003 to 2012 Adjunct Faculty Instructor for College of Nursing i4farrcadiS Plastic S'ur�,'"ry 2005 to 2006 ARNPJPractice 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 patient care activities. RNiRellef Charge Nurse,CVTU,Endo"opy 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 Unliversity of South Florida Master of Science,Nursing University of South Florida Bachelor of Science, Nursing Packet Pg. 133 D.3.b r�. LO ca to w 0 STATE OF FU)WA A= - �i OF NO&TH F® OP MIgLL"L" OW UMME Nib- MONOUIS' I AW EE �- r* �al�of �MbR�1/4�111RdFbnde, Jw Si,=5 P'AMELAtM COMM DESMARAIS° 0 IMMANC�r-�"" R# �, wn e�erta� 2DO4004M t#RTIPMATION COMMOM 1WW 4M V2015 lb 411 tuna of Adult Nurse Practitioner AmfdW W* Ponleb L.Dn=mis,ANP43C N N x Packet Pg. 134 D.3.b DEANNA M. SILVA$ RIMS, RVT Ile LO CLLKICAL EXPEIxWNCE Life Scan Wellness Centers Tampa,Iloridacc Registered Efitrasound Technologist October 2014-present Experience performing wellness screening exams for lain'enforcement officers and firefighters throughout the state of Florida e Ultrasound screening studies include echocardiogram,carotid arteries,thyroid, abdominal. organs,pelvic,prostate,and testicular c • 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 i]Itrasound Technologist April 20124X-tober 2014 • Crossed-trained 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 morn services Proficient in assisting in radiology procedures including PICC lines,central lines, N biopsies,paracentesis and thoracentesis x EDUCATION Associates of Science Central Florida Institute o Major:Diagnostic Medical Sonograpl<y Graduated: October 2008 • Member of the National Technical Donor Society ) (Chi.Phi Iota Chapter) Bachelor of Science University of Tampa Major:Biology Graduated: May 2005 • Member of the National Science Honor Society M cv cv X LU Packet Pg. 135 D.3.b r�. LO ca to { j t0 AlEaAEi� � '✓ DEA"M SUA ewnvmaxm 1l IA E DEA i m 0 x 0 CJ ca CD CJ CJ cv cv r9 x u Packet Pg. 136 D.3.b Reem Regno, ARMS r�. LO Qualifications • ARDMS registered in specialties Abdomen and OB/GYN. ca • BLS certified with the American Heart Association. e 0 • Eight years' experience with patient care. • Two years clinical experience in various local hospitals and clinics. • Registry eligible for specialties Echocardiography,Vascular,and Neurosonology. Clinical Experience • AB, OB/GYN,Small Parts • High Risk Perinatal Protocol • Paracentesis/Thoracentesis • Echocardiography,TEE • Vascular, PVR 0 Professional Experience Life Scan Wellness Centers Tampa,Florida X Lu Registered Ultrasound Technologist October 2014-Present +' 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 ca CD Responsible for creating training manual, presentations,and training of new tech nologist y Education • Associates of Science In Diagnostic Medial Sonography Broward College, Coconut Creek FL. May 2012 • Bachelor of Arts and Sciences In Psychology University of South Florida,Tampa FL Dec 2005 Packet Pg. 137 D.3.b LO to � l w AAtAMM 1FICMZOWTO COMFIT rtsnt8 c i CEFMRND SNU FRPIM ON E 2011 14Bimt? Ch- wamera at r L r, ." r v d ar, _ [� Tlo, ow ;. u■coWftVsaw MdA6 M h wqa�y cuhsAm d�rAmr Nmtrl gmNa Lb S*pW MW MM P4gpr fry U 0 tJ ca CD U J tJ tJ N CD M X U J U Packet Pg. 138 D.3.b c) DETAILED STAFFING PLAN Ile LO The Life Scan program is designed specifically for public safety and the entire medical staff has 0 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 services and the Life Scan program including N'FPA 1582, NFPA 1583, FDLE, OSHA Respiratory Standard, the Wellness Fitness Initiative fitness evaluations,annual medical clearances, and reporting processes. Staffing: c • The Life Scam 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 Scary and has undergone extensive � training with Life Scan to fully understand the technical, clinical, Life Scan procedures, and individual protocols of the assessments and medicall clearances. c • All Life Scan medical staffing receives annual, recurrent training in areas such as ACLS certification, Public Safety Disease Risks, Diabetes, Hazat testing, 0 Infectious Diseases, Blood borne Pathogen and Safety Protocols, Medical e Reporting updates, NFPA 1582 updates, Wellness Fitness Initiate program, and Life Scan clinical updates. X Mid-Level Practitioner()WV MS1V,or PA) Life Scan maid-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 raid-level practitioners have extensive experience providing medical clearance,pre-placement employment physicals, fitness for duty,NFPA, 1582 and FDLE Medical exams,the WFI, 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.. A.CLS Certified N Ultrasound Technician The Life Scan registered ultrasound technicians are fully cross-trained in all modalities of medical ultrasound and interpretation including vascular,heart,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 educ:adon of our patients. Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 139 D.3.b r�. Clinical Exercise Physiologist LO The Life Scan clinical exercise physiologists are experienced in clinical cardiac testing and interpretation., lung capacity(pulmonary function)on) testing and interpretation,firefighter and ca correctional officer fitness evaluations, diet and nutrition,body composition, and all aspects of NTPA 1582,L FPA 1583,and the W FT. All Life Scan physiologists are trained and experienced in OSHA Respirator Medical Testing and OSHA Mask Fit Testing protocol. ACLS Certified 0 c 0 X 0 CD ca N X U Polls County RFP 17-601 Firefighter Annual Physicals Packet Pg. 140 D.3.b d) Six (6)References from other Governmental Agencies that have utilized Life Scan for Similar Services: LO 1. Brevard County Fire Rescue ca e 0 Contact:Marvena Petty E Phone: (321) 633-2056 x 56414 Email:marvena.petty@brevardfl.gov Performance Period: 2012 to present c dumber of ANNUAL physicals; 550 Service Provided: LIFE SCAN Firefighter Annual and Candidate Physicals • NFPA 1582 Annual and Candidate Physicals for Firefighters • NFPA 153 Fitness Evaluation Firefighters • IAFFIIAFC Health and Wellness Initiative • Life Scan ultrasound and advanced medical assessments for disease detection _ and prevention c • Hazmat and Specialty Team Physicals • On-site program for all medical testing,blood draws,and X-rays 0 • Infectious Disease testing and vaccines e • OSHA Respirator Physicals for Public Safety • CSHA.Respirator Mask Fit Testing for Public Safety x LU 2. St,Petersburg Fire Rescue and.St.Petersburg Police Department Contact: Fire Chief James Lark 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 W • NFPA 1583 Fitness Evaluation for Police and Firefighters • IAFFAMC Health and Wellness Initiative • Life Scan ultrasound and advanced medical assessments for disease detection and.prevention • Hazamat, Swat Tom,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 Packet Pg. 141 D.3.b 2. Largo Fire Rescue Contact: Fire Chief Shelby Willis LO Phone: (727) 587-6740-2005 Email: marven&petty@brevardfl.gov ca Performance Period: 2012 to Present e 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 e • IAFF/IAFC Health and WcUncss Initiative • Life Scan ultrasound and advanced medical assessments for disease detection a, and prevention • Hazmat and Specialty Team Physicals • On-site prom for all medical testing,blood draws,and -rays • Infectious Disease testing and vaccines • OSHA Respirator Physicals for Public Safety • OSHA respirator Mask Fit Testing for Public Safety 0 3. Rroward Sheriff's Fire Rescue Contact: Assistant Chief Todd Leduc Phone: (954) 831-8291 or(954)321-4109 Email: Todd�Leduc@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 ) • IAFFIIAFC Health and Wellness Initiative • Life Scan ultrasound and advanced medical assessments for disease detection and prevention • Hazrnat and Specialty Teats Physicals ca • On-site program for all medical testing,blood draws,and X-rays • Infectious Disease testing and vaccines • OSHA Respirator Physicals for Public Safety y • OSHA Respirator Mask Fit Testing for Public Safety 2 x Folk County RFP 17-601 Fitofighter Annual Physicals Packet Pg. 142 D.3.b 4. Panama City Fire Department I le LO Contact. Chief Seat Flitcraft Phone- (850) 872.-3053 ca Email: sfliterafa pcgov.org c Number of ANNUAL physicals 75 Performance e Period: 2016 to Present. Service Provided: LIFE SCAN Annual Firefighter Physicals: * NTPA. 1:582 Annual Physicals for Firefighters • NFPA 153 Fitness Evaluation.Firefighters • IAFFOI FC 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 01 • Infectious Disease testing and vaccines OSHA Respirator Physicals for Public Safety o OSHA respirator Mask Fit Testing for Public Safety 0 5. Fort Lauderdale Fire-Rescue � x Contact: Jo-Ann Lor ,er,EFO,CFD,CEM Battalion Chief/Assistant Fire Marshall � Phone: (954) 828-6809 Email: JLorberfortlauderdale.gov Number of ANNUAL physicals: 450 Performance Period: 2017 to Present,. Service Provided: LIFE SCAN Annual FireFgbter Physicals: ) • NFPA 152 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 `a and prevention CD • Hazmat and Specialty Team PhysicalsCD • On-site program for all medical testing, blood draws,,and X-rays y • 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 Packet Pg. 143 D.3.b Survey Questionnaire—Polk County RFP 17-MI,Fireflghter Annual Physicals LOm_ . (Nam of Peraau campl+eft�rJ (Nan of Client Co y/Fir ) acaa Frail« � x� � � r � VA 4 Subject Part Perftrmam Survey of- ���.� � � XX �X�`� � , ��� � „ ���" �{� � � e - N8) COO of� ' h # Buz, Date Comtrtete Rate each®f#hc erit"i2 aID 0 reek of 1 to 10,with l t;you weans yM Udgiled(gad would hire the 8rtnliodhiduai*pin)and 7 MMMONItIVII that You War*very unuMed(ad pro — new hire the ftBfindWuai apin). Plem r0*each Of the erkerW to the bed of your lowwieke. N you do not have=f4dent knowiefte of peat p sdomanee in a Articular srvs4 ieeve 1t biank. 3)_�.�r�y �t �g}$1lniiar Work Nam: n 1. . .� �l . ik, V NO CRITERIAUNITSCORE 1 Ability to manage cost Ability to maintain pro)ect schedule(complete on- 2 tirne/earl (1- � Quality of workmanship �- Professionalism an d ability to complete exams for all Fire and EMS positions (1-10 5 Ability to communicate with Client's staff timely 6 ability to resolve Issues promptly (1-10) e, 7 Ability to follow reguirernents based on National Fire Protection A;tsociatlon standards (1-10) Ability to maintain proper documentation and complete r Appropriate application of technology used for the mobile N testing.: (1-10) { N 10 gall Client satls ctl ri and comfort level in hiring (1-20) � Ability to offer solid recommendations based on exam 11 result (1-10) Ability to facilitate consensus and commitment to the plan n1Z of action amRg staff (1- � ..}' Printed Name of Evaluator Sigoatum o Evalwitor 4p` E Icasc fIM ctlmali tht WMplMd survey to: ' RsftW O&WIs Packet Pg. 144 D.3.b r�. Survey Questionnaire,--Polk County LO �'o LLAriqoua (Nana~of ftmen eofpIding .. (Fiance ff .tt myrna) E Ph=Number ca Email: 0 ALS SN SwV$Yo s y � Cot of Savlcft:� �el��tbo esftle of I bu d,W#b 10, rqprwwft that Y"were VW (Mad WaWd hire W ArmftdMWksl spin)and I rep 010tya,P ware Ym ummtk of(sod+N++ANd offer Mm the ffmdu&VMGAI 600- Mtn rate feel►of the erhperia to the beet of ymr Ic *wkdg& it YOU de Put bar*onflidut knowledw of Iv*perlteramroce in a pater awls here It bkok. Similar Walk Pn*a _ ..._ ,lla ... ..., ... �.n... NO UNIT SCORE N 1 Ability to manage east (1-10) :L37 Ability to maintain projt►ct schedule com lette on- "_ � LU 3 Quality of workmanship (i- A Professionalism and ability to-complete exams for all Fire 4 and EMS positions 5 Ability to communkate with Client's staff timely 6 Ability to resolve Issues promptly >7 3 Abiiity to follow ireme d a_n,. an a.l Fire Protection Standards (�-�-�M� 1/0 Abilityto n _lntalnI PerdocImton_andcomplete tirn _ ca / dale apPl cet10n of technology used for the mobile testing ( �) �+0 CD ., u Ne-- id. Overall Client satisfaction and comfort level In hiring n Ability to oftr solid recommendations based an tarn 1 remelt (1- ) ,/� X LU L12 Ability to facilitate consensus and commitment to the plan of action among°staff R ...� - J Printed Name of Evaluator gr of Evaluator Plcasc fbx or txI the oompieIrwey to. ,�. c�1C e7 ostdsns Packet Pg. 145 D.3.b an QU nx —Polk County Ile RF'P'17-604 FfmVtor Annual ,n To: l� tca Afie ofl 4 ( f Glut - c 'E�I_ sojak pea ft*muw sw"Y of. C. cog O(W4. ,..,y� r Mrs dot11Y�C1{I • (and WOR �amd 1 rqwmmgft tw 1"wwo*07plan wad rub ammb o!'ffi .climb W the beg arf r i c SIB Work P40 Now. t - Uxff 1 AbOlty to rmrage cM y {1.1L1) p a blitty m nrrtaln CbWtde(Co-- rmkft on. {1- 0 3 amalk of workmnship �1� ? 4 Hallam End abtllt�r to t�mplete emm for al Fire 0 and EMS padoom 5 AbMWto cormmunh a w*h amnfa atefFtimely 11-10) 6 Ablllty to r&so*e i"Im rompdy ) Ability to ftftw MQUhmefft based an Natloftai era �1 Protnctlon Assodations n 1-s Q) 16 B Ability to maintain proper documeftmon and car s n of t hi calogy used for ttre mobge 10 Oworall Ciler>t WtWaMn and COME art level In hiring ( y Ablfttooftr soda rOCOm andad cm ter» -- 1I remit - (1 itt A5 LU AWlity io fo c3Drasenm and ant to the.phrn of actlan arnom no (1- ) Tj_ + _ Printed Nub orEvduator Siguatum of Bvaluatw Pj=w fim of OWO dw C mnvq to 7 Re awls Packet Pg. 146 D.3.b Survey QueNfl"Wn—Polk Con r RFP 17-01,ftiflOter Annmd phy"h Ile LO c of pmoo"wag�VGWY) —&—b-ow � � S�GG ca PhoftNumber.- E-» { ) sue;Pet ilia J?eia ` cmwft.-La Bata each of dw cowk ea:uale of i to ll! wJtJri]@ woald 6Jre 8rtr�M�J lbat Y"WWO r�=d$lkd NMI M WO theth1w 4 �w WIM very l< •►� - do emk have }" J fade Gad of the to the bet of ywr U you Jpru 'WV of PW J 10 a PAWKr area,Ime it bhumL S4imiler Work Phdm Nwma: NQ C.tiTEiq 5i f _�E c 1 Ability manage cost - } } .2 Abt ity r maintain project edule tlrn earl tt�rttpiete on 3 Quality of workmanship Professionalism and ablitty to complete earns tOr Ali Fine and EMS positions (1-10) 5 Ability to communicate with Clients staff timely ca �1-1fJ) 5 Ability to resolve Issues promptly (1-1Q) ) 7 Ability to follow recquinernertts based on National Fire _P n Assaci00 standards $ AbtIMV to maintain proper docume n sa com'PI to timely 0 9 Appropriate application of hW Used for the mobile W WON 1-113} 1D Overall Client satisf ctlon and wmfbit level in hfring 1_ Zi Ability to otter solid recorn nundations cn rn v, result 12 Ablilty to facilitate consensus and commitment to the plan of action ama (1-10) Printed Nadu of Eva}fir 5 of altstoe Plcasc iz Or OWI the uUMPIEW survey€o.- 27 aeoeris Packet Pg. 147 D.3.b r�. RFP 17-0 ,Firefigliter Anumd Physicto 16.01 ,01.-rr CO TO., mami _ - of Per; R&a y) (N vrfCiien paay/Firm) Ahaae Aiuraixr: c Subs Past Parfonnea tei survey o Cost ofBavicw!& ( plats: Rota e94 Offtafteria an a mb of l tol 10,with 10 rqwamtfog drat ye a wort vein UWW(sad 01 .ouM hire the finudindkidual voice)mW I rOPMendult that you Men Very utMthi ed OM would Dever bim tea firm adIM&Oi MOW, P1800 rate cave of tlw erkterk to the but of your knowledge, It you do not ieaw+sufffe l eat knwbdp of pant p,erfoemance to a particular ark Wye ft blouL Similar Work Pnede ct Name- Dane C*Wpta k:. NO CRrf VRIA umrr scow N i Ability to manage cast � Ability to maintain project schedule(complete on- 3 Quality of Woftanship 1.�p 4 Professionalism and ability to complete exams for all Fire and EMS positions f 140) 0 5 Ability to Communicate with Client's staff timc4y 6 Ability to resolve issues promptly 7 Ability to follow requirements based on National Fire Protection Association standards Ability to maintain S timely pro documentation and complete (1-20) CO Appropriate a CD pplicatlon of technology used for moitlle te$ti - � n, CD 10 OvOrall Client satisfaction and cOmftxt level In hiring O¢ 11 Ability to offer solid recommendations based on exam result (1.-10) / 0 32 Ability to facilitate consensus and commitment to the plan of action amon Printed Flame of Evaluator SI gnatmv of Evaluator It Ple an fax or mTndl the completed survey To! T�^ �' -�+� �t k� tss 27 Or` X 0 Packet Pg. 148 D.3.b Survey Questionnalm Folk County Ile LO r ` RFP 17.601,Fhvfthter Annual Phyaic its To: ca (lame of Person completing aurveY) (Name of Client Company/Firm) Phone Number-, ��-1- �2�,�• �a 't�'� l rttali __ Irb Subjects Past Performance Survey of. .l Cost of Services: t , b, Complete:__ 11- 0 1 VI_ Rate e#ciw ol:the n teria O a reek of li to 10,with 10 MPfumdufi that you warm very aatbfied(aad would hire tbifirmAndiviftal again)gad 1 r4IRMIcuft that You weremy umdefled(arid would now byre the firwA#AvWuIj again Mae"rate each of the criteria to the best of your knowie fte. if You do not have auflldent knowledge of past performance is it particular area,leave It blank. Similar Work Project Nacre: DWU Completed: c NO CRITERIA - UNIT SCORE 1 Ability to manage cost (1•10) 10 _ Ability to maintain project schedule(complete on- �` LU tlmtlearl 3 Quality of workmanship Professionalism and ability to complete exams for all Fire 4 and EMS positions to 5 Ability to communicate with Client's staff timely l b 6 Ability to resolve issues promptly 7 Ability to follow requirements based on National Fire Protection Association standards ( _ pj 10 Ability to maintain proper documentation and complete timely Appropriate application of technology used for the moiaile CD testing (1-10) iv 10 Overall client satisfaction and comfort level In hiring l Ability to offer solid recommendations based on exam result (1-10) tLU Ability to facilitate consensus and commitment to the plan of action among staff _��•-A�aN �l�.�e �ai��xl,�c�,�ems, Printed Name of Evaluator SiPMuMI Evaluator � Pl=c fax or email the completed Survey to: � 27 RevkW tt6ki8rls Packet Pg. 149 D.3.b r�. LO Co to w 0 u E w c 0 C Co CD cv cv r9 x u Packet Pg. 150 D.3.b TAB 3: REPORTING CAPABILITIES LO .,All Life Scan reports are customizable based on the individual needs and requirements of each department. 0 Employees: E 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 FAIR 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: • FIT FOR DUTY/OSHA RESPIRATOR MEDICAL CLEARANCE � • OSHA MASK FIT TESTING REPORT 0 Life Scan will provide samples of patient chart forms and patient results upon request. ) CD to N Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 151 - - D.3.b FLLIFE CAN FIRE DEPARTMENT CLEARANCE FORM AND OSHA RESPIRATOR CLEARANCE Wellness Centers Employer: EOLK Ct) 'TY FIRE RESCUE - LO Patient Last Name-. First lame: Patient.IIIISS : __ ._ -- _ Exam Date:- D EMPLOYEE MEDICAL QUALIFICATION. The examination of this employee must include a complete f 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 exa ination,which would prevent the employee from performing,the essential functions of the position,will be reported to their note all abnormalities which might predispose the employee to employer.The reviewing medical personnel should � injury or aggravation of the condition due to this nature of the duties and tasks required of a firefighter employee. MEDICALLY QUALIFIED: Based 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. 19 10.120 regulations and the guidelines set forth by 2013 edition of N.F.P.A. 1582. ❑ MEDICALLY QUALIFIED WITH THE FOLLOWING RECOMMENDATIONS: D - - D ❑ NOT AMICALLY 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. 152. 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: D tJ 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.H.A,191p.134.There are no restrictions on CD respirator use related to the medical condition of the employee. c44 r9 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 Nanw. Signature Anthony L.Capasso,M.D.,P.A. Medical Der Lionse Nuonber:ME 69518 Packet Pg. 152 D.3.b LIFIE SCAN RESPIRATOR MASK FIT CLEARANCE FORM Wellness Centers Employer:. POLK COUNTY FIDE RESCUE Date: LO Employee Information List Name: First Name: ID/SS#. DOB: Occupation: Mask Fit Test (For Clinical Use Only) ca W 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 ❑ Masses ❑ None Fit Testing_Results (For Clinical Use Onlv) -- c 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: 0 Mask:Fit Test Date; _- - Fit Test Protocol Used: QMARtitative ❑ PortaCount Model Number: Serial Number: ❑ Dynamics Occupational Fit Tester Model Number: -_ Serial Number; Overall Fit Factor: ❑ Pass ❑ Fail CD ca N Notes: (For Clinical Use Only) Comments: Signatures Print Patient Name Patient Signature Print Clinician Name Clinician Signature Packet Pg. 153 D.3.b TAB 4: MOBILE TESTI G a) Mobile Testing Location: LO Strategies: + Life Scan has the capability, experience,direct full-time medical staffing,and equipment to provide can-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. e + All equipment maintenance will be performer)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 time 01 loeation(s)provided by Palk County Fire Rescue(not a motorized vehicle): * Physical Exam as outlined in the Scope of Services Blood,,D�rawws(supplies included) o Chest x`-i ays e • 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 staff Life Scan will bring portable exam tables as well as all the equipment necessary to completely provide the comprehensive medical and fitness exams. 0 U • Ultrasound Units: Terason o EKG Stress Units; Welch Alyn,Laptop computer based ) • Treadmill: will be a stationary unit at the Palk..County Fire Rescue locations c Fitness Testing equipment:provided by Life Scan • .Audiometry Equipment: Welch Alyn audiometer o Vision: Titmus Vision Screener o X-ray: On-site mobile services (1vlcbilex) • Blood draws at any LabCorp Patient Service Center in Florida or on-site at 04 location(s)provided by FCFR X Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 154 D.3.b r�. b), Scheduling Timeline: LO 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 ca be determined by PCFR according to shifts/work hours of the employees and the o number of annual firefighter physicals required, 2. Life Scan will be able to proceed witb the scheduling of physicals can 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. B. Example: 1. 450-500 physicals f 9 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 ca Hearing and Vision area. 3. Plan time line ca 4. Review and approve Patient Packet CD 5. Review and approve blood draw program and.LabCorp requisitions CD 04 6. Review Fit for Duty and.Respirator Medical Clearance Reports, Ch 7.. Review and approve reporting system 2 . X B. Phase 2: Schedule dates for blood draws and physicals 1. Nine patients per day in three intervals of three patients each ) a. Example: 3 at 8:40,3 @ 11:00 am, and 3 a 2 pm b. Start time will be determined by PCF'R. Palk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 155 D.3.b c. Each physical exam will require 3 hours (3 patients will rotate between 3 portions of the program including ultrasound, physical, and cardiopulmonary/fitness. LO In C. Phase 3.Blood draws (2-5 weeps prior to physicals) 1. On-site at any location(s)provided by PCFR. 2. LabCorp Patient Service Centers 0 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:ttFPA 1582 a. Essential Functions per'NFPA 1001 for firefighting professional qualifications L. E. Phase 5: Reporting per PCFR Requirements c) Scheduling Timeline for second fiscal year: Same formula as above within 12 months after the initial physicals. 0 In N X LU Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 156 D.3.b LIFE SCAN COMPREHENSPVE SAFETY AND SECURITY POLICY r�. The Life Scan Comprehensive Safety and Security Policy is a safety management plan LO designed to maintain a safe environment free of hazards and reduce risk of injuries for patients and employees. ca a. Processes:for employee safety and security; e 0 1. New employee orientation and education program and annual recurrent tr ,in%ng 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 Pfau. 1. Life Scan will coordinate with the ran.-site facility manager to determine what County procedures and processes are for specific site. C d. Safe 'Equipment - � 'cn 1. Life Scan routinely maintains and tests all equipment. Any equipment utilized a will be tested prior to program start on-site. c e.. Reporting to County Risk Management regarding accidents and/or damages 1. Life Scan management will receive any accident or damage reports and report there directly to County Risk Management per County procedures.. c 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. C) 2. Life Scan stares all patient records in a secure facility in their corporate office with access limited to authorized Life Scan employees. ca 3. Life Scan follows all HIPP,A., State,and local guidelines regarding patientCD confidentiality and will review the process with the County prior to scheduling. X c c Polk County RIFP 17-601 Firefighter Annual Physicals Packet Pg. 157 D.3.b EXHIBIT A r�. le LO LIFE SCAN WELLNESS; CENTERS SAFETY DEPARTMENT ca [PATHOGEN UBJECT: LOODBORNE PROVED Ric EFFECTIVE REFERENCE: EXPOSURE Patricia Johnson, � DATE: CONTROL PROCEDURES SOP I President Sept.22,20013 #005 E INTRODUCTION � 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 procedure is derived from the Cade of Federal Regulations 1910.1030 and Florida De artxnent of Health Code cites Cha ter 64E-16 of the N Florida Administrative Codes. This procedure includes the following key elements: LU 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, ca -Housekeeping CD C. Training of Employees. D. Hepatitis B Prevention. 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 Department to maintain this procedure. Life Scan Wellness Centers' Bloodborne Pathogen Exposure Control Procedure will be accessible to all 1 Packet Pg. 158 D.3.b -The recognition of tasks, which may involve exposure. Ile LO -An explanation of their use and limitations of methods to reduce exposure. These include engineering controls, work practices, and CO personal protective equipment (PPE) offered at no cost to all full time and part time employees. E -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 B 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. 0 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. CO CD Life Scan Wellness Centers will be responsible for maintaining training records. The new at-risk fall or part time employee will be notified that training is required at the time of employee orientation. X Life Scan Wellness Centers will be responsible for completing an annual review of the Blood bome Pathogen training procedure and program, updating it as necessary. � 3 Packet Pg. 159 D.3.b Disposable gloves used shall not be washed or re-used after contamination. Disposable gloves shall be replaced as soon as their LO protective ability is compromised, such as being tom or punctured. Gloves shall be used for handling contaminated waste and for clean-up ca procedures. 0 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. 0 Contaminated waste will be handled in the fallowing manner: A. All contaminated waste will be placed into appropriately marked ) medical waste storage containers. The Jacksonville Sheriffs Office will contract with a certified biomedical waste disposal company to dispose of waste for Life Scan Wellness Centers. ca CD B. In areas where there is to be a clean up of infectious waste material the following procedure should be followed: N I. Put on gloves and ether PPE protective equipment as necessary, Post wet floor signs if available. Apply a tuberculocidal disinfectant over the potentially infectiousLU 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. 5 Packet Pg. 160 D.3.b 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 LO 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 ca employee. If a routine booster dose(s) of Hepatitis B vaccine is recommended by the U.B. Public 0. 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. ca 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 0 treated as a workman's compensation incident. Titers (or retesting of immunization) will be offered after completion of the series if five N years has elapsed since completing the series. � X 0 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 CD ca OTHER UNREGULATED WASTE 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. OSHA does not generally consider discarded feminine hygiene products, used to � absorb menstrual flow, to fall within the definition of regulated waste. The intended 7 Packet Pg. 161 D.3.b EXHIBIT B Life'Scan Wellness Centers Biohazard Waste Plan-Employee Education (Florida Administrative Cade 64E-16) LO Life Scan educator will provide an initial (within 30 days of employment) and yearly education ca 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 `faint of Origin' at the clinic and onsite properly prepare and stare completed`sharps' container(s)and/or`bio-hazard' red bag(s)for scheduled disposal a 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 a properly clean up a `bio-hazard' spill 0 I. Bio-hazard Sharp and Non-sharps 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 ether 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. Cloves must be worn during a blood dray and when corning in contact with a ca contaminated surface(s)with bodily fluids. CD N III. Point of Origin and Sharps Disposal a. Point of Origin is a roam 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 roust 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. Packet Pg. 162 D.3.b EXHIBIT C. _ LIFE SCAN EQUIP.M%NT MAI TAINANCE PROGRAM: L Life Scan has routine maintenance and calibration of all medical equipment on an annual basis according to the recommendations of the manufacturers. ED 0 All equipment nuiintenance 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. Fife Scan maintains backup of all equipment as well as service contracts to ensure timely replacement as needed. �i Poly County will have the ability to inspect all equipment. +T�1YffllM`lNhlk4'�'Ad 4�'+ t- li I�,r�ll�i�'.I Jli IY I �� Ilil I Qi IYtI III�� U r i) d w cv cv Terason Ultrasound Unit with Sony Printer Welch.Alyn Easy One Spirometry Unit x Welch Alyn EKG/Stress Unit Welch Alyn Audiometry Unit Titmus Vision Tester Polk County RFP 17-601 Firefightcr Annual Physicals Packet Pg. 163 D.3.b r�. LO ca to w 0 u E w c 0 c ca CD cv cv r9 x u Packet Pg. 164 D.3.b Attachment "A" COST PAGE G (STJ-BN TrAL PAGE) LO Cost per employee for all requirements and items to be performed annually as defined 1 e in the RIP Document. Cost f shall be inclusive of all costs $ 657.00 Per Employee associated with the annual ' physical exam including overhead,indirect costs,etc. i Otlter 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)yews $ 65..4d Ua- Respirator Fit Testing(SCB.A Face piece Fit TestfN-95 Respirators) $ 40.00 Hepatitis B Test(antigen) $ 55.00 Hepatitis B Titer(antibody) $ 30.00 Hepatitis B Vaccine(3 per series) $ 65.00 each Hepatitis A Test(antigen.) $ 55.00 Hepatitis A;Titter(antibody) $ 30.0 111epatitis A Vaccine(2 per series) $ 65.00 each JPPD Test $ 5.00 Attachment "B" SUBCONTRACTOR Packet Pg. 165 D.3.b AFFIDAVIT CERTIFICATION IMMIGRATION LAWS Ile LO SOLICITATION NO.: RFP 17-601 PROJECT NAME: Firefighter Annual Physical cc 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). W 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), C parka w � Sig kfure Title bag STATE OF: COUNTY OF: Th foregoing instrument as signed and acknowledged before me this-2ley of 0 , by ��"r�L i A- who (Print or Type Name) has produced as identif'cation. ype of Identification and Number) U a.. Notary Public Signature '✓ f . Odn ed Name of Notary Public y DAVID A.CAS EW � NOTARY PUBLIC S'A F.OF FLORIDA Nota iration Packet Pg. 166 D.3.b Attachment "B" r�. LO SUBCONTRACTOR (SLBNUTTAL PAGE) ca Please list below the name and address of subcontractors to be used in conjunction with this RPP (If applicable). I, o 2. 0 0 3. x 4. 0 5. ca N 6. � x Packet Pg. 167 D.3.b TAB 8 MEDICAL LABORATORY r�. LabCorp Regional Office: Laboratory Corporation of America ca 5610 W.LaSalle Street Tampa,FL 33607 Life Scan vain provide an on-site Mood draw program. Life Scan patients a also able to have blood draws done at any LabCorp Patient Service Center within the United States. LabCorp Patient Service Centers within 25 miles of Bartow: 1. LabCorp 2142 E EDGEWOOD,DR LAKELAND,FL 33803 � 2. LabCorp 1120 HA.VENDALE BLVD NW WINTER HAVEN,FL 33881 3. LabCorp 3131 L.AKEI AND HILLS BLVD STE 1 LAKELAND,FL 33805 4. LabCorp y 607 S ALEXANDER ST STE 107 110 PLANT CITY,FL 33563 5. LabCorp 2209 NORTH BLVD W STE B DAVENPORT,FL 33837 0 ca CD cv cv Polk County RFP 1.7-601 Firefighter Annual Physicals Packet Pg. 168 dug. 1 2017 3;23Pfi 11ne 808-—p. 2'- —,. D.3.b [ITT LO to 04*41� t p +F 017 BEAN E F WX-D, .04r1 r� tuE .. •ry '. i' . , Fog lim Ill I +AEI �[ a , eail as lilljllliiiill V M� 410 7 ,y ' ' ! 0't T2Q Ab7•f)l OY 1, iCa tdN YIROWW i t7i lDft3MS S`lt'PF�11� F�?LiQtiY�"tG7. T.t�"f3J,t9� �.. �rrtl��gi;thAM .�G� �iild'1!lP�t>�5' ( ¢tq LIMNALM s;yPow N J�0 dr F+Etf"SUP'°{,41(3'�, .. '� q� '�'•4• :P�k1�I$� �i'� CVIS19,'t]R7�4�,�+'gRW+q���; Gr,��l► Packet Pg. 169 D.3.b r�. LO ca to w 0 u E w c 0 c ca CD cv cv r9 x u Packet Pg. 170 D.3.b CERTIFICATE OF LIABILITY INSURANCE 109:10"11my"Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS —CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(8), 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, sublect to I the terms and conditions of the policy,certain policies may require an endorsement. A statement on this cartifloste does not confer lights to the certiflcste holder In lien of such endorse a. PRODUCER _ __ --- q� O.E.Wilson Insurance,Inc. 2,W(727)--- l2 536-9828 1475 Belcher Rd S cindlIgWison.corn Largo FL 33771 _ .Auto-Owners Insurance Corn -_- 18968 INSURED - Admiral Insurance Com '' 24M O Life Extensions Clinle,lnc. - Ca 1011 N.Macdlli Ave _ __ E Tampa FL 33607 , F® - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD >_ INDICATE). 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. MR I TYPE OF INSURANCE � X COMMERCIAL GENERAL UABILMY U 1 I01I 0m BMAMAORENTED A M M8 DE 1 X I e UR ETD A 100 000 20690746 11MO1116 /1110117 00,000 _- 1 000 000 aATEI]MITAPPLIR, 2,000, QIIO X PMJGY JPERO L 2.000.000 OTHERF �T s �+ AUTOMOBILE LIABLt Y - aoMBNED SIMM LIMIT $1 000 990 A Ix ANY AUTO BODILY INJURY IIPw PO SWO ffi ALL OWNED OULED 4159162800 01pMSM6 09118M7 LILYINJURY(Per eta)x HIRE?AUTOSAUTOS AUTOS �( NON-OWNED PROPERTY DAMAQF AUTOS 3 0 -- O Ul l"IRB 1 L" OCCUR C, EXCESS LiAS 3 U WOMM"COMPDNUTION I PER TH AND 9MPLOYEW L vML.rfY V �1 AWY PROPRIETORIPARTNEWEXECUrIYE[ { AOrADENT N NIA A IxC�LDa �-i EMPLOYE 6 "• (Manddery In KM EL QUASE-EA tJ t! dpGll�a tlf)da! EL ---PO'lCY 4'Mrr Medical Professional Liability E0000037591-01 0513IMT 05/31/18 2,000,000 Aggregate B Retroactive Date:513112001 2,000,000 Each ClaimCD N DE&GnIPTION OF OPOIATIONS 1 LOCATIONS lvEnlCL"(ACORD 10i,Adder Rrrrtada Schedule,may be saaehad U m raj N contractorlk nsingopoik-county,nst cy Sexuai Abuse $1,000,000 Each Cla"l.000,000 Aggregate Network Sccurtty 8 Data Privacy Liability$1,0 0,000 Each Claim/S1,000,000 Aggregats x CERTIFICATE HOLDER CANCELLATION O Polk County SHOULD ANYOFTHEABOVEDESCIBBED POLICIES BE CMCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 330'West Church Street ACCORDANCE WITH THE POLICY PROVISIONS. tv Bartow,FL 33830 AUTO REPRESMTAUM Phone:(863)604-6080 O 01988.2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The AGORD dame and logo arse registered marks of ACORD Packet Pg. 171 D.3.b °NCO CERTIFICATE OF LIABILITY INSURANCE DATE A%-� 10/31/2016 - TMIS CERTIFICATE IS ISSUED AS A MATTER OF MFORMA11ON ONLY AND COWERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES � BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITIJTI+ A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCE&AND THE CERTIFICATE HOLDER, LO IMPORTANT: R the aerfflcsIe holdlaf Is an ADDITIONAL INSURED,the Polly ka)nxwk he elldorEsoO, IF 4U®ROGATION!S WAIVED,85 to Ilm WM and CandIgons of the poky,Cartddn pollclas my mqufm an endon:e AW. A sbftnwnt on thW DerII u tMI does not iCORflir"011ft to the w5 dMeate holder In Neu of such enda s P CT Valerie Oontryan-wheeler Primofty la Insurance Services, .Inc. I'IINHNE (813)288-8270am iI c NoI (Mu9I665-t911 5402 W. Laurel St. MMwheeler8primegroup na.aamt _ Suite 220 INSU"Al AFFORDING COMERAW tIAMM Mp Tamps FL 33607 _ m�5 1 Preferred Lnat ar-as Ca 10346 C rNsiIREA s Xd Xxtension Clinics, Inc tl�UFOaMC_ '✓ 1011 N WadDill Ave Da E M E: h- Tampa FL 33607 Ote COVERAGES - -CERTIFICATE NUMBERCL1610311640 Ri_W'ISIONNlJfiI ER: >- 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 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOM15148 OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. aR "- — - LTR TOE OF INSURANCE --__ CQa111RRi0A1M.41MIGNIAL LMAIWIFY EACH 00OU iRENC E CLAIMS-MADE L]M l ! 0. Mw IMP ofwam em PERSONAL A ACV INXRY eENL AIGRECIATE L NT APPLIES PER GENERAL EGATE ! POLICY JECT L L4C PRODU-- S_COIAP0 P AGO 3 N OTHER: �- AU4i5IdCBILE MIABILM coma ANY AUTO SwLY INJURY(PM" ) i LU ALL D NED SCHEDULED � ALFTOR AI PiGi0 B€OILYINJURY(Poracddw) i HIRER AUTOS AUIfOS C TY i 0 EACH CSCCURREMCE Ei DEs6 LIAMM AeORNlA72 # IDEol R - TIM7N Ir AND L WILRY ANY PROPRIETGWPARTN YIN A 13 Z=600936 05 �11/29/2019 11/20/2017 F-L L AaE.EAEMPLOY 1100010 DMIO CJ Alwnaa r»emw EL POLH,YLeArr t 1,000 t3GI1 CD VIII&C P'TMON as ai iRAT1DW f 10C.A7XM t> ...I&DRRC W Adda"Rs mft ScMdWs,my he Wmalod I<mm Awes N n9W" CCD V r9 CERTIFICATE HOLDER CANCELLATION T BMGM=ANY OF THE ABOVE 016301410FSI POLICIES ISE CANCELI.E D BgFM FM TM]RHA'.TIONAL PT7,I=SE8 THE EXPIRA7MM3N DATE THEREOF, NONCE tiNtL BE DEUVgRto IN ONLY ACCORDANCE IN"THE POLICY PROVISIOlN& AUTHOREW MVISSENTAIVE __---- E 211sasser #AO77187/ e✓' 0 1988-2014 ACORID CORPORATION. All righft Meserved. ACORD 26(2014101) The ACORD name and logo trs registered marks of ACOPM INlle?JC�pt�7i Packet Pg. 172 D.3.b Request for Taxpayer rew Ft�tar f�the Form r testsr.Da lief rl® (Rev.Decarr,i�201) identification Number and Certification vand Ito the III$. LO fSwVWSM of the Traaarxy k,ta Fi[aer�Sadv�+e _ Mama Ire Shown on y insart0 tax,relsarrj Life Extension Gllrft%ink. CO &,sines,ny wft non*.It from Aimee g� Lifrt art Wellness centers Check kxex for tedeMai c can mention 0 lip 0 Trusa/astats Ind3srPdumilede Proprietor exampt p0. am E ® tlrni W sabMy cwrparry.En+ertlee#ax c lion I co t cn. - +�rPcnniun. __�.._�.._ U War on inshCOM4 F - e name and address(epfift* Adrtrear Owrnber,sb*K and apt.Or same n04 1I)11 North 4flaedill Avenue - aw,e#ate,and OF e Turry�a, FL �3f3Ii7 _ _ � Ust aeaount numb")tyre ppmw 4 Twwsw ld&;6ftc. bw HUMber M : ri ar rlgr aranber Eater your TIN In the appropriate box.The I IN provided must match the r given the`Nauss`line to avoid backup withholding.For i this you WOW se+urlty number(SM.However,fora 0. reakkni:Sum male proprlStor,or dienmardvd*44,we the part l Inoftotions on pW&For other I -MWOW.it is your erne number(EiN).If you do not have a number,see!iCnw to fret a � [E 77N an page 3. n-fum—bor Nols.If the ao=mt im In more than one name,see the chart on page 4 for guicielnes an whose � number to enter. G - 3 r52 2 8 Under penalties of perjury,I certify that 1. The number shown on ails form Is my correct taxpayer identification ouster(or I am waiting for a nhember to be Moved to me),and U 2. lam rot subject to backup withholding because.(a)i arms exempt from bwkup withhWft;.or(b)I have not been notMed by the Internal lieventre Service QRS)that 1 am subject to backup widhhokfing n a raeuk Of a failure to repent all Yttereat or or(a)the IRS has rtodfled me that i an no longer subject to backup willftiding.and 3. i am a U.S.citizen or other U.S.parson(d of ned below). C you must out Item 2 above it you have been rtot4fted by the M that You are ourrontly not ape to For mp wethtwc>>dirrg because You have failed to report as lrhtsreat arnd dividends an yon.o'tax re1um.For real amtate trarrasatiorrm.(tern 2 does not'apply.Far mortgage Interest paid,acquisition or r .cancellation of debt,contri to an individual retiramord arrarrgeneent ply,and get`,p�other irrterost . arm not required to the but you musk provide year crt�rrtxs TIN.See the ingtructiorm on page 4, - ca tla,wraoa General 1 Iri uCtitlrts Nets,ti a g ves a or tkl r Frnrn vlt-sl m rartPnast . your TIN,you must use the requalets font I It Is substentiPslly similar Section references are to the Internal Revenue Code unless otherwise to this Farm W-g. tV CD noted. l o"nitian of a U.S.person.For federal tax purpcxr ss,you are Pt,rpoSe of Finn ca a U.S.parsers If you arm r� A poison who Is required icy file an Information return with the IRS must `� �"��a�a U.S.cittmp or.or ssoresic iati alien, cn obtW your OWT0 t taxpayer IderAl�atlon number('nN)to report,for •A partnership, ,oarnpano or a arsrt United t example,Incorne paid to your,real 64tate brarmMOO ha,mortg "Interest In the United States or under the leers of item United States, You paid,aoq uisition or abandonment of wed PFDPWtV,MOOkbOn r An estate(Other then a tarelgn estate,or of debt,or oontrfttia-you shade to an lRk .A domestic trust(aa d8filmd In riegulaticna section 301.7701 Use Form W=s onlly It you are a U.S.POW"(Indud ing It resident f rigs for pannarslt ps that Conduct a trams Or � Wien),to provide your cam TIN to the person rs4uesiing It(tlte business in fire United States arc generally rOWIn d to MY a withhai l requester)and.when applicable,to: tax on arry forsO partners,share of income from such businns. 1.OwIlity that the TIN you are givN is Correct(or you are waft V for a Furtlher,I1 Cartsln own where a Forst W-8 has not been received,a number to be issued), partnership is required to presume that a pPatner Is a foreign person. 2.Car*that you are not subject to backup withtwlding, and pay the withholklirrg hex.Therefore,If you am U.S.person fret[a a 3.Claim exeemp*m from backup wefhhaWY9 If you are a U,�.exempt ptner in a coto the pea trade or txes6Psas rh the U.S. E Staten,p Pettit W-g to the partrtaraitiP to establish your U.S. pate&if applicable,you are also certifying#bet as a U.S.person,your status and avoid withholding on your Share of partnership Income. allocable re akable sham of any erne Iron a U,5,.UWat or businen � is nut subject to the wkhholdkhg talc on foreign _ share of effw&corutacted Ire TTW. Gs#,No.t414'311t FrMrn1N-! (Pig,d2-adr++) Packet Pg. 173 D.3.b TAD 10: CO FFIIDENTUL ADDITIONAL INFORMATION LO ca Our standard testing on Page One and additional testing on Page Two. Life Scan Firefighter Physical: $395.00 QuantiFeron Gold: $ 60.00 Hazmat Tests: $ 127.00 Testosterone: $ 20.00 c He ml t s_C: $ 55.00 L. c x Total: $ 657.00 0 CD ca N Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 174 D.3.b EXHIBIT 461391 RATES LO Life Scan Wellness Centers 2018 Polk County ca Comprehensive Physical Exam Physical Exam(NFPA 1582 Compliant) -- included Vision (Titmus) 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 included o Ultrasounds Bladder Ultrasound included 0 Pelvic Ultrasound for Women (external, Ovaries and Uterus included Testicular Ultrasound for Men included w Prostate Ultrasound for Men Included Blood and Laboratory Tests - CJ QuantiFeron Gold (TB Blood Test) included Hepatitis C Test included cv Hemoccult Test included Urinalysis included cn Lipid Panel included x Diabetes Tests(Hemoglobin A1C and Glucose) included Complete Blood Count included Comprehensive Metabolic Panel included Thyroid Panel included PSA men included CA-125(women) included o Packet Pg. 175 D.3.b QuantiFeron Gold included Testosterone(Men) NEW for this RFP (added $20.00) included LO Fitness Program (NFPA 1582 Guidelines) Fitness and,Agility Evaluation included ca - _ - Body Composition Analysis included StretchingfFlexabilitylEndurance Analysis - included Nutrition and Diet Recommendations _ included 0 Personal Fitness Recommendations included Medical Clearances E OSHA Respirator Medical Clearance included Firefighter Medical Clearance included TOTAL $510.00 Palk County 2018 Additional Tests HAZMAT Tests(Cholinestrese and Heavy Metals) $1 20 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 $`i 5 OSHA Respirator Mask Fit Testing (Portacount) $35 ca cv cv r9 Packet Pg. 176 D.3.b Exhibit 2 Life Scan Wellness Centers MONROE COUNTY 2018 Comprehensive Physical Exam $ 395.00 r�. Physical Exam NFPA 1582 compliant) included LO Comprehensive Hands-on Physical with Vital Signs Vision (Titmus) included Audiometry included ca 0 Skin Cancer assessment included Mental and Behavioral Health Questionnaire included a, Sleep Disorder Questionnaire included Personal Consultation with review of testing results included E Cardio Pulmonary Assessment �? Echocardiogram Heart Ultrasound included Resting EKG included Treadmill Stress Test with EKG included Carotid Arteries Ultrasound included Aortic Aneurysm Ultrasound included Pulmonary Function Test s iromet included 01 Cancer and Disease Assessment c Thyroid Ultrasound included Liver, Pancreas, Gall Bladder, Spleen, & Kidney Ultrasounds included Bladder Ultrasound included c Pelvic Ultrasound for Women Ovaries and Uterus included .2 Testicular Ultrasound for Men included Prostate Ultrasound for Men Included Blood and Laboratory Tests Hemoccult Test included Urinalysis included Lipid Panel included Diabetes Tests (Hemoglobin Al C and Glucose) included Complete Blood Count included Comprehensive Metabolic Panel included ) Thyroid Panel included PSA(men) included Testosterone (Men) included CA-125 women included Fitness Evaluation NFPA 1583 Guidelines cV Aerobic Capacity Evaluation included Body Composition Analysis included Muscular Strength Evaluation Muscular Endurance Evaluation x Flexibility Test included Nutrition and Diet Recommendations included Personal Fitness Recommendations included ) Medical Clearances OSHA Respirator Medical Clearance included Firefighter Medical Clearance included TOTAL $395.00 Packet Pg. 177 D.3.b Exhibit 2 LO 0 Additional Tests Available Chest X-Raywith Radiologist review 65.00 Lumbar X-Raywith Radiologist review 65.00 c Hepatitis A Test(antigen) 55.00 Hepatitis B Test(antigen) 55.00 Hepatitis C Test(antigen) 55.00 Hepatitis A Titer(antibody) 30.00 Hepatitis B Titer(antibody) 30.00 Hepatitis A Vaccine 2 Series 60.00 Each Hepatitis B Vaccine 3 Series 60.00 Each HIV Test 40.00 ABO Blood Type 22.00 OSHA Respirator Mask Fit Testing (Portacount) 35.00 Cholinestrese and Heavy Metals (Hazmat) 120.00 v, QuantiFeron Gold (TBlood Test for TB 60.00 PPD Test 15.00 The Life Scan Pricing is based on Location being provided by the City, County, or Union. A surcharge will be added based on the operational cost for Life Scan to provide space or increased cost of on-site locations. CO cv cv r9 x Packet Pg. 178 D.3.c AC Ro 13V CERTIFICATE OF LIABILITY INSURANCE DATE,MM/DDrYYYY) k---- 101128/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the I le certificate holder in lieu of such endorsement to PRODUCER l ACT Cinch roves Wilson Insurance,Inc. PHONE ,- ,727 5354524 72 3 9 1475 Belcher Rd S L cindaOoewilson.com Largo FIL 33771 O, OY A. Auto a Insurance Company 18 INSUREDAdmiral Insurance Com 285 Life Extension Clinics,lnc.DBA Life Scan Wellness Centers T nce, tin Insurance Co „pang R M 12408 1011 N.Macd1II Ave O Tampa FIL 3607 - .. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: u 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. INN TYPE OF INSURANCE L " B` PO C1P PO if LIMITS COMMERCIAL GENERAL LIABILITY INC1000000 A CLAIMS-MADEOCCUR D GE O RELATE 109,9 X X 062312-20690745 111101201 `11110}2020 1.10,900 J19? 00 ID trL AGG TE UMIT I PER N F 2 00 LILY JEL T LOCI I' MIAt�pAA ..n OMOBILE LIABILITY_ COMBI SINGLE"MIT $1 000,a 0 . A v BODILY IWURY(Per person) $ ALL OWNED SCHEDULED AUTOS O5 X X 4159162 Q 9}18}2$919 09i1 B} 02 BODILY INSURY(Per adai'I $ HIRED AUTOS NON-OWAUTOS PRO .... .........AMAGE S � LU IS _ � UMBRELLA LIAR _-_ OCGUR t 1v �+C:waU "�4E EXCESS LIAR r ;IAT $ O WORKERSCOMPENSATION ......... ...... ...... ....... X hfl �Tld- ! _ _ D EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERtEXECUTrVE E,L EACHA L Ur 1 000 0 C OFFOCERIMEMBER CLUDED? ,N t A X WC 6 56600287 111 12019 11129120201 (Mandatory In NH) t LL,OICa Ca.EiPLL?'tEE. 1, 0 <000 K ".describe undue 1 as Medical Professional Liaili E0000037691gy 0 }31}219 05111220 2, 00,000 Aggregate _ Retroactive Data.513112001 2, 00,000 Each Claim W I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES,ACORD 101,Additional Remarks Schedule,may be attached if more apace isrequired) Certificate holder Is additional Insured on the general liability and auto liability tJ A With reect tow performedthe Insured. 3. E91�T Medical Professional Liability Additional Coverages., WAIV NIA Sexual Abuse ,000,000 Each Clai } 1,0 0,000 Aggregate IlNetwork,SecurlbLEa Privac Lla ill 1 000 000 Each Clai f 1 000,000re ate CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton St ACCORDANCE WITH THE POLICY PROVISIONS. ¢ Key West,FL 33040 AUTHORIZED REPRESENTATIVE s 4SK>' 1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Packet iPg. 179