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Item I2
� L2 � � �, BOARD OF COUNTY COMMISSIONERS County of Monroe , �r�l Mayor Heather Carruthers,District 3 Mayor Pro Tem Michelle Coldiron,District 2 The Florida Keys Craig Cates,District I \J? David Rice,District 4 Sylvia J.Murphy,District 5 County Commission Meeting April 15, 2020 Agenda Item Number: I.2 Agenda Item Summary #6547 BULK ITEM: No DEPARTMENT: Fire & Ambulance District 1 Board of Governors TIME APPROXIMATE: STAFF CONTACT: Steven Hudson (305) 289-6020 9:30 AM BOARD OF GOVERNORS 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 the 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. 1917 L2 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 11:56 AM Pedro Mercado Completed 02/28/2020 12:23 PM Budget and Finance Completed 03/02/2020 8:25 AM Maria Slavik Completed 03/02/2020 9:31 AM Kathy Peters Completed 03/02/2020 4:16 PM Packet Pg. 1918 L2 Board of County Commissioners Completed 03/18/2020 9:00 AM Packet Pg. 1919 1.2.a FIRST RENEWAL AGREEMENT CONTRACTFOR SERVICES LIFE EXTENSIONLI 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 a "County"), and Life Extension Clinics Inc., a business having its primary business location at: 1011 N. MacDill Ave., Tarnpa, Florida 33 (hereinafter the "Contractor"). N WI SS T° a WHEREAS, on the 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 W the County in writing of its desire to renew the Agreement; and CD CD WHEREAS, the parties find that it woulde mutually beneficial to enter into this first N renewal agreement: 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, Q the terms and conditions set forth in the Original Agreement remain in full farce and effect. REMAINDERTHE I . X Packet Pg. 1920 1.2.a E IN WITNESS 'III-WHERE-OF, each party has caused this agreement to be executed by a duly � authorized representative, (SEAL) F COUNTY COMMISSIONERS ATTEST: , CLERK OF MONROE COUNTY, FLORIDA By 0 Mayor/Chairmanc c LIFE zSl I IDS, INC, 0 CJ Title® 2 Nalary Putft Stwo of F S7" 1IE C3 I k. JandfarL Connelty cv Subscribed and sworn to (or affirmed) before me, by means of 0 physical presence or 0 online cv notari tion. o t (date) by (name of fflant). H .S � personally known to me or has produced� (type of identification) as identification. 0 RaE CY ED S E PE o ASSIST NTY RN - Date zo -- Lu Packet Pg. 1921 C°UR" L2.b 00 o: Kevin Madok, CPA .. .... Clerk of the Circuit Court& Comptroller— Monroe Count Florida •ROE COUNT. Y1 LO M LO µy M DATE: March 28, 2018 ca TO: Debbie Lofberg c Emergency Services c FROM: Pamela G. Hancock, D.C. SUBJECT: March 21st BOCC Meeting 0 E Attached is an electronic copy of Item C7, Contract with Life Extension Clinics, Inc. to perform annual physical examinations of Monroe County Fire Rescue personnel in accordance with NFPA 1582, for your handling. �- Should you have any questions,please feel free to contact me at ext. 3130. Thank you. 0 LL x cc: County Attorney Finance File 0 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. 1922 L2.b CONTRACT FOR SERVICES �s Mow* LO M THIS AGREEMENT is made and entered into on the day of 2018 by and between MONROE COUNTY, a political subdivision of the State of Florida whose ca address is 1100 Simonton Street, Florida 33040 (hereinafter referred to as "County"), and Life r- Extension Clinics Inc., a business having its primary business location at: 1011 N. MacDilI Ave., Tampa, Florida 33607 (hereinafter the "Contractor"). 0 WITNESSETH: W E 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: c 1) SCOPE OF THE WORK: The Contractor, with the exception of a treadmill to be provided by the County, shall furnish all labor, materials, equipment, machinery, tools and LU 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 0 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 two (2) one year terms. Should the Contractor wish to renew the Agreement, it should relay thatCD information to the County in writing at least 60 days.prior to the expiration of the 2-year term. 3) PAYMENTS: The County shall pay the Contractor for work or services provided under this Agreement as provided in Exhibit 2 to this Agreement and made a part of this 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. 1923 L2.b including attorney's fees arising out of or resulting from the performance of its work under this LO Agreement, where such claim, damage, loss or expense is caused, in whole or in part, by the act 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 or anyone directly or indirectly employed by the Contractor, or anyone for whose acts any of c 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 c parties acknowledge specific consideration has been exchanged for this provision. W E 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: c c a. Professional Liability Insurance: Professional Liability Insurance issued by responsible insurance companies and in a form acceptable to the County, with combined single limits of not less than One Million Dollars b. General Liability Insurance: General Liability Insurance issued by responsible insurance companies and in a form acceptable to the County, with combined single limits of not less than One Million Dollars ($1 for Bodily Injury and Property Damage per occurrence. C. Automobile Liability Insurance: Automobile Liability coverage shall be in the minimum amount of One Million Dollars ($1,000,000) combined single limits for Bodily `a Injury and Property Damage per accident. N d. Workers' Compensation Coverage: Full and complete Workers' Compensation y Coverage, as required by State of Florida law, shall be provided. X e. Insurance Certificates: The Contractor shall provide the County with Certificate(s) of Insurance on all the policies of insurance and renewals thereof in a ) form(s) acceptable to the County. Said Liability Policies shall provide that the Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on all policies, except for Workers' Compensation. The County shall be notified in writing of any reduction, cancellation or substantial change of policy or policies at least thirty (30) days prior to the effective date of said action. All insurance Packet Pg. 1924 L2.b policies shall be issued by responsible companies who are acceptable to the County and LO 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 8) GOVERNING LAW: This Agreement shall be governed, interpreted and construed according to the laws of the State of Florida. 9)' COMPLIANCE WITH STATUTES: It shall be the Contractor's responsibility to be c aware of and comply with all federal, state and local laws. E 10) VENUE: Venue for any legal action by any party to this Agreement to interpret, construe or enforce this Agreement shall be in a court of competent jurisdiction in and for Monroe County, Florida and any trial shall be non jury. 11) ASSIGNMENTS: Contractor shall not assign any portion of this Agreement without the written permission of the County. - 12) TERMINATION: If either party fails or refuses to perform any of the provisions of this Agreement or otherwise fails to timely satisfy the provisions hereof, either may notify the other parry in writing of the nonperformance and terminate the Agreement or such part of the Agreement as to which there has been delay or a failure to properly perform. The Contactor may 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. 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 '✓ 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 14) RIGHT TO AUDIT RECORDS: In performance of this Agreement, the Contractor LU 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. 1925 L2.b three (3) years after termination of this Agreement for accounting related records and for other LO public records, five (5) years after termination of this Agreement, or for any longer periods of 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 c 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 0 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 01 unilaterally cancel this contract upon violation of this provision by the Contractor. Failure of the Contractor to abide by the terms of this provision shall be deemed a material breach of this contract and the County may enforce the terms of this provision in the form of a court proceeding and shall, as a prevailing party, be entitled to reimbursement of all attorney's fees and costs associated with that proceeding. This provision shall survive any termination or expiration of the contract. X The Contractor is encouraged to consult with its advisors about Florida Public Records Law in order to comply with this provision. Pursuant to F.S. 119.0701 and the terms and conditions of this contract, the Contractor is required to: ) (1) Keep and maintain public records that would be required by the County to perform the service. (2) Upon receipt from the County's custodian of records, provide the County with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. (3) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the ) duration of the contract term and following completion of the contract if the contractor does not transfer the records to the County. (4) Upon,completion of the contract, transfer, at no cost, to the County all public records in possession of the Contractor or keep and maintain public records that would be Packet Pg. 1926 L2.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 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' the information technology systems of the County. 0 (5) A request to inspect or copy public records relating to a County contract must be .0 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 0. PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS, BRIAN BRADLEY, AT (305) 292-3470 - c 16) UNAUTHORIZED ALIEN WORKERS: Monroe County will not intentionally award a publicly funded contract to any contractor who knowingly employs unauthorized alien workers, constituting a violation of the employment provisions contained in 8 U.S.C. Section 1324a(e) Section 274A(e) of the Immigration and Nationality Act "INA". The County shall consider a contractors intentional employment of unauthorized aliens as grounds for immediate termination of this Agreement. 17) FEDERAL TAX ID NUMBER: The Contractor shall provide to the County their Federal Tax ID Number or, if the Contractor is a sole proprietor, a Social Security Number. 18) EMPLOYMENT: The Contractor shall not engage the services of any person or ca 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. 1927 L2.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 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. 21) CONTINUED MANAGEMENT BY THE NAMED PARTIES: Continuation of the c 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. c W E 22) Notices - Any notice of other communication from either party to the other pursuant to this agreement is sufficiently given or communicated if sent by registered mail, with proper postage and registration fees prepaid, addressed to the party for whom intended, at the following addresses: For County: For Contract to: 0 Emergency Services CEO Life Extension Clinics, Inc. Attn: Chief James Callahan Ms. Patricia Johnson 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, ca CD 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. 1928 L2.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) LO 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. c 0 c 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 c any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and W 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 Agreement shall bind and inure to the benefit of Contractor and County and their respective legal representatives, successors, and assigns. 26) Authority. Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. 27) Adjudication of Disputes or Disagreements. Contractor and County agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If no resolution can be agreed upon within 30 CD 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. X 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. 1929 L2.b specifically agree that no party to this Agreement shall be required to enter into any arbitration LO proceedings related to this Agreement. 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 c receive benefits as recited in this Agreement. 30) Code of Ethics. County agrees that officers and employees of the County recognize c and.will be required to comply with the standards of conduct for public officers and employees. as delineated in Section 112.313, Florida Statutes, regarding, but not limited to solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 31) No Solicitation/Payment. Contractor and County warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay c any person, company, corporation, individual, or firm, other than a bona fide employee working Ch 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, exemptions from laws, ordinances, and. rules and pensions and relief, disability, workers' LU 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. 1930 L2.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 participating entity from any obligation or responsibility imposed upon the entity by law except 'to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida Constitution, State Statute, and case law. 0 35) Non-Reliance by Non-Parties: No person or entity shall be entitled to rely upon the E 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. 0 36) Attestations. Contractor agrees to execute such documents as the Lessor may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug- Free Workplace Statement. 37) No Personal Liability. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or ) accountability by reason of the execution of this Agreement. 38) Execution in Counterparts. This Agreement may be executed in any number of 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. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK. Packet Pg. 1931 L2.b LO M LO IN'41VITNESS WHEREOF, each party has caused this agreement to be executed by a 'duly autliofizedxepresentative. BOARD OF COUNTY COMMISSIONERS ATTEST.:°KEV1N MADOK, CLERK OF MONRO CO `�Y, F DA a =` By c Mayor/Chairman "u E may: LIFE EXTE SIGN C By (= LU Ct Title: = �_: m r�, z. d == STATE OF FLORIDA COUNTY OF MONROE S} rn to (or affirmed) and subscribed before me this day of , 2018, by ,P/27 >/'icilt \ Personally Known OR Produced Identification Type of Identification Produced�D/ •``)Cl � (Signature of Notary Public - State of Florida) 1 � /9J/0/�l (/4 � � (Print, Type, or Stamp Commissioned Name of ca W Notary Public) CD N N YADAVID A.�o LLI NOTARY PUBLIC y STATE OF FLORIDA 2 Comm#GG005564 Expires 10/8/2020 N .OE COU AT �; 'jMvrlf p 1fED S PFDRO MERCAD ASSISTANT C UNTY ,3 I Date Packet Pg. 1932 L2.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. to IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject b to 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 CONEACT (, 0.E.Wilson Insurance,Inc. PHONE 727 535-0524 FAQ o. 727 536-9828 1475 Belcher Rd S E-MA IL cinda@oewilson.com Largo FL 33771 INSURERI AFFORDING COVERAGE NAIL# C INSURER A: Auto-Owners Insurance Company 18988 INSURED INSURERB: Admiral Insurance Company 24856 0. Life Extensions CIIf11C,Ir1C.DBA LifeScan INSURERc: Transportation Insurance Company 12408 C 1011 N.Macdill Ave INSURER D: W Tampa FL 33607 INSURER E: E- INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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/DDY� LIMITS t8 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 0 A CLAIMS-MADE ®OCCUR DAMAGE TO RENTED $1 OO,000 X X 20690745 11/10/2017 11/10/2018 MED EXP(Any oneperson) $10,000 L_ PERSONAL i£ADV INJURY $1,000,000 O GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO- LOC PRODUCTS-COMP/OP AGG $2,000,000 N OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Fa accident) $1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ¢ ALL OWNED SCHEDULED X 4159162800 09/18/2017 09/18/2018 BODILY INJURY(Per accident) $ t8 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS $ O $ (� UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ U DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE 1 -1 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 00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 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 cv r9 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is additional insured on the general liability and auto liability g ty A OV p Y RISI'�ANAGEMENT with repect to work performed by the insured. BY Medical Professional Liability Additional Coverages: Sexual Abuse $1,000,000 Each Claim/$1,000,000 Aggregate DAT Network Security&Data Privacy Liability$1,000,000 Each Claim/$1,000,000 Aggregate WAIVER WA yes— CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BECANCELLED BEFOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I U 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. 1933 Exhibit 1 L2.b Ln M LO ca 0 IFE SCAN Wellness Centers 0 E RFPRESPONSE: POLK COUNTY 0 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 LIFE EXTENSION CLINICS, INC. dba: Life Sean Wellness Centers 1011 North MaeDill Avenue ) Tampa, Florida 33607 (813) 876-0625 Patricia Johnson, CEO Packet Pg. 1934 EXHIBIT Aii L2.b LO M d h en w s Centers 0 TABLE OF +CO1'TE-N`TS E TAB 1: Letter of Transmittal TAB 2: Personnel Requirements TAB 3: Reporting Capabilities TAB 4: Mobile Testing TAB 5: Comprehensive Safety and Security Program e C 0 TAB 6 Gast TAB 7: Subcontractors(Attachment B) TAB 8: Medical Laboratory TAB 9: Proof of Insurance TAB 10: Additional Information CD ca N U Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 1935 L2.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 33607 Testing Site: tan-site at location(s)determined by POLK COUNTY Phone Number: Phone:(813)876-0625 Fax:(813)876-0653 0 Authorized Representative: Patricia,Johnson,CEO Email: lifescanhc(rol.com . Incorporated: Florida.,August 1998 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. Ch 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 k p employees on-duty resulting in a reduction in costs,time away from the job,or even overtime. 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, 0 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 y 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, 0 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 0 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. 1936 L2.b and officer has almost three 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 capability to perform optimally, decrease str.s and stress-related Health and emotional problems, and greatly reduce the incidence of work related illnesses and injuries. 0 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 Mess 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 Ch 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 LU diet and nutritional improvements, Life Scan and our medical staffing are experienced and knowledgeable in all aspects of the scope of services. As an on-going program of Health, Wellness, and Fitness, Life Scan will continue to be your team dedicated to identifying areas of concern,monitoring the recommended interventions and programs, and assuring that your employees attain and maintain the level of health and well-being that is crucial to ) perform their gobs optimally and greatly reduce the chance for illness and injury. Thank you for the opportunity to respond to this RFP for Polls County Fire Rescue. ca CD cv Sincerely, X u, Patricia 3o n,CEO Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 1937 L2.b LO THE FOLLO MlNG SECTION SHOULD BE COMPLETED Alf ALL PROP[)SERS. LO (SUBMITTAL PAGE) Company Name: L��_ SA-) jl1k) . ca DBAIFicttious Name (if applicable): 0 NOTE: COMPANY NAME MUST MATCH LEGAL NAME ASSIGNED TO TIN NUMBER.. CURRENT W9 SHOULD BE SUBMITTED WITH BID. TIN#: _ W (Street No or PO Box Nu ber) (Street acne) (City) L( o cplc-\ 0--o 0 l R-, _ (County) j (State) (Zip Code) Contact Person: N� 1-J �,s. . 0 Phone Number: �_ Cell Phone Number. 1 0 w Email Address: °-( �f_ .S"'co i LLI c co I)-) � Type of Organization: 0 Sale Proprietorship Partnership Non-Profit Sub-Chapter Joint Venture , Y Corporation LLC LLP Publicly Traded Employee Owned 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. 1938 L2.b July 31, 2017 POLIO COUNTY, A POLITICAL SUBDIVISION OF LO L M THE STATE OF FLORIDA ALO ADDENDUM #1 ca .FP #17- 01 Firefighter Annual Physicals 0 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/Replace 0 lien Brush Procurement Specialist Procurement Division! This Addendum sheet should be signed and returned with your submittal. This is the only acknowledgment required. Signature: 6:�a Printed Name: -- Title: N Corripany. Packet Pg. 1939 L2.b RFP #17-601 FIREFIGHTER ANNUAL PHYSICALS LO L t3L"1 J"�D[am #1 LO ADD/REPLACE 0 Notice of Request for Proposal "RFP packages may be obtained from the Procurement Division, 330 'llMl'est Church Street, 0 Room 150, Bartow, Florida, 33830, (863) 534-6757 or downloaded from our website at °/ cl � n ,n c ite/loin pines ids. Respondents must submit one (1) crlginai and Seven �7) copies of the proposal prier to 2:00 p.m. on the receiving date. Proposals must tie submitted in a �sQaled" parcel. proposals will be publicly opened and read at 2:00 an receiving date." p.m. �- Replace with. "RFP packages may be obtained from the Procurement Division, Room 150, Bartow, Florida, 33830, 330 West Church Street, {863) 534757 or downloaded from our website at his:/1 cl � c ) co 11s rnen our nt ids, Respondents must submit one (1) o " lnal and Seven p" of thmcue proposal prior to 2:00 p.m. on the receiving date. Proposals must be submitted in a "sealed" part. Proposals will be publicly opened and read at 2:00 p.m. Ch on receiving date. CO c CD N N Packet Pg. 1940 L2.b TAB 2: PERSONNEL REQUIRENIMNTS LO M LO COMPANY QHALI�+'ICATTONS-General Corporate: ca Number of years in business: 19 years ca Medical Director: .Anthony Capasso,M.D. e Plumber of years in practice: 23 years Number of years as Medical Director for Life Scan: 13 years . Life Scan's specialty and background is in the area of prevention-Based occupational, medical services for government agencies with a specialty in public safety. We have over fourteen years U experience in the development and implementation of programs for county, and state public E 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. C c 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 • UFFIIAFC Health and Wellness Initiative ca • FDLE Police Physicals • DOT and CDL Physicals • Hazmat Physicals • SWAT Team Physicals • Bomb Squad Physic • Pre-Employment Public Safety Physicals • OSHA Respirator Physicals • OSHA Respirator flask Fit Testing • Fit for Duty Testing • Orr-site Program for all medical,testing X • 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 RFP 17-601 Firefighter Annual Physicals Packet Pg. 1941 L2.b M Life Scan Professional Contributions to Public Safety Health: In recognition of their outstanding accomplishments and understanding of the unique needs of fire fighters and laic enforcement officers,Patricia Johnson and Tammy Torres, on behalf of Life CO Scan Wellness Centers,were appointed the Medical Advisors to the • Major Cities Chiefs' Association • National Sheriffs Association FBI LEEDA o • FBI National Executive Instigate W E 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. 1942 L2.b LO M LO to PRINCIPALS,MANAGETMENT,AND PHYSICIAN SUPERVISORY TEAM: Patricia Johnson, CEO. Patricia is the cc-founder of Life Scan and will be the liaison between ca 0 the City and Life Scan. Patricia will oversee contractual issues, ensure proper invoicing, and 0 attend meetings. Michael ,l. Terrana, CFO. Mike is the co-founder of Life Scann and serves as corporate counsel o and Chief Financial Officer.. Mike is an attorney in Tampa and started his law career as an W assistant state attorney in Hillsborough County and was lead partner in his law firm for over E twenty years. Pam, Desmaires, ' -BC, is the Life Scan WellnessCenter Clinical. Director and Project �- Manager. She is responsible for the supervision of the medical specialists and for the continuing education as well as medical procedures and protocol for the Life Sean.Wellness Center medical program. Pain will ensure quality control over medical reporting and records and manage scheduling timelines. Pam has developed the medical protocol for the Life Scan ultrasound-aided physical exam program and has extensive experience with NFPA 1582 guidelines and 0 interpretation including annual and candidate medical clearances. o r_ 0 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. 0 U Life Scan is a nationally recognized expert and educator regarding the health and fitness of police and firefighters. Life Scan has advised NFPA 1582 and the IAFFIIA.FC Wellness Fitness c Initiative Committees regarding firefighter health and fitness. CD ca X c c Polk County RF'P 17-601 Firefighter Annual Physicals Packet Pg. 1943 L2.b CL-RRICULUM VITAE LO M LO ANTHONY L. CAP SSO, WLD. Florida Medical License. ME69518 ca EDUCATION 1984-I987 Ohio State university, Columbus,Ohio. Bachelor of Science--Biology Cum Laude. c 1984-1986 Cleveland State University, Cleveland,Ohio. W E 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 c 1995-1996 University of Florida health Science Center, Jacksonville Florida, Internal.Medicine Residency. Graduation July 1996 x LU HONORS AND AWARDS � 1 84-1987 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 CD Diplomat of the National Board of Medical Examiners,June 1993 N Diplomat ABIM, August 1998 LICENSURE State of Florida ME 0069518 Packet Pg. 1944 L2.b MEMBERSELIPS LO M LO 1984-1987 National Key Honor Society, Ohio State University 1988-1993 American Medical Student's Association 1991-1993 Tuscaloosa.County Medical Association 1991-1993 Larry Mayes Society ca 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 2002-present Anthony L. Capasso M.D. P.A.-private practice 2001-2003 University of Florida—Clinical Assistant Professor _ 1999-2000 Premier Family Care- Internal ?Medicine 1998-1999 Jacksonville Emergency Consultants -Emergency Medicine 0. 1997-1998 Premier Family Care-Local Tenum 199 -1997 South Beaches Medical - Internal Medicine 1996-1998 Barnen Venus M.D.P.A. CCU intensivist c 0 CD ca N x LU Packet Pg. 1945 L2.b , a r DEpkij,Ml 4T'CIF`HEALTH . .' DIVISION OF SAE fcAL QOALrry ASSURANCE ?ATE. OCENSE NO., CONTROL NO. Lo WLO 111D312815 ME 69518 5W182 � v .-he MWICAL DOCTOR ierlitid b'ekAv has met all requltemerftx)f ® j he Ims and rules of ft state of1qrlrlda. I !cplrst Date: JANUA,RY 31, 201 r► ITI'tth-'L CAPASSO 1351 13TH AVE SOUTH SUITE 110 • � �" � 'Y 0 1ACOOMLLE BEACH,FL 33354 * Rick Scoff V Johns H.Arlllstrortg,MD, FA GOVERNOR STATE SURGEON GENERAL. L. DISPI.AY'117`REGUIRED BY LAW n .2 E . ,f ON DATE:JANUARY 31,2018 Yaw`Hesse nw=ib °Is W S 16 P use it<in SU eurmapauieflce wuilh yaw board 1egnmil.belt Uterus is solely rem for nodMm that departmat its wrd" the linwneee°s currsut smiting address and Practice location addresa. if you agave not,rceetved your ranewel mowe 94 dttya prim w wwty ian date oo thls lkem� wx pkaae call 14350I 480-0393. � Use thla wellan b repot now chsege.lfime cllatVA regttiM k2W document don shoving die now t;haap.=Pin"makes tints a pbeu"m araem or am kdlstvlttg accaospeoiea this Ragas:a mma rrimite license.a divom decree or a courtorder. Medics)Qwd*Assurmwe*On*you tarn commdence or*Mral aullawt actvk=,Them sertricea give you titc sbitity to mmw your Ut enw.updam Yaw matLLeB and pad lacedom addmems and updwo your pna6ls lafbrmadoo, I.00 to 2..Click an Troorider tlerwicW A.Click a *Nknw UW Uioenw 4.stlectyaur S.Enter the our[D send psawspod dmt sns prmkW in you at Yew initial liOraae and clack'Bign In uslag our ttectere m 8.lfyou do mat know your taus ID and pmssNncdr elicit an Met i,m5in Help,or call our cum Contact center at(1330) 8ti-0595 for mmistanot, N N r7 MAIL TO;DEPARTMENT OF i1F.ALTH QlV4SIODt OF MEDICAL QUALITY ASSURANCEIMPORTANT ANNO CEMENT LICEKl1UR SUPPORT SERVICES UNIT THE C31AP�kFIT IVT�}F H WILL NOW REVIEW P.O.SQX 6329 YOUR CONTINUING EDUCATX N RECORDS AT TALLAHASSEE,FLORIDA 32314+ip2Q THE TIME iI1I�e OF LICENSE REN AL. NAME CHMOR(ATTACH LEGAL DOCUMENTATION) -rO LEARN moRE,PLESE ms tm m FROM: LAST RR8T MWOLE TOC {ST i liST WEICL.E E DK 2103,6t98 Packet Pg. 1946 L2.b Pamela L. Desmarais, MS, ARNP-BC LO M _ LO Certifications Registered Nurse Practitioner In the State of Florida,license number 2551642ARNP ca 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 0 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 laborator results and educates patients on infectious diseases.Administering immunizations as needed/requested. Provide counseling of patients on risk factors, nutrition, medlcatlon, 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 staff in patient care activities. r� Unlverslly of South Florida 2003 to 2012 Adjunct Faculty ) Instructor for College of Nursing ManGadls Plasdc S'urpry 2005 to 2006 ARNPJPractice Manager M 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 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. 1947 L2.b LO m LO ca to c c c 0 STATT OF FLOWA , �u►IkW IF HMLTH OW UMME NO A EE 'rile AM MONURN id�of � P!AM t"M COMM DESMARAIS, r ' TIfFIE c IMMANCC s � w eww*w2DO4004M t#RTIPMATI ON COMMOM 1WW 4M V2015 lb 411 Mama of Adel#Nunm Prac Toner ) ,1 mfdW W* Ponleb L.Daarn mla,ANP43C N N x Packet Pg. 1948 L2.b LO DEANNA M. SILVA$ RIMS, RVT r9 LO CLLKICAL EXPEI.WNCE Life Scan Wellness Centers Tampa,Florida Registered�itrasound Technologist October 211I4-present e Experience performing wellness screening exams for lain'enforcement officers and firefighters throughout the state of Florida o e 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 U 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 .2 +� Experience scanning general,vascular,and cardiac ultrasound in a busy Hospital 0. setting including in-patient,out-patient,emergency room,and operating morn 0 services Proficient in assisting in radiology procedures including PICC lines,central lines, biopsies,paracentesis and thoracentesis x EDUCATION Associates of Science Central Florida institute Major:Diagnostic:medical.Sonography 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 cc CD cv cv X LU Packet Pg. 1949 L2.b LO m LO ca to c 0 AlEaAEi� � W DEA"M SUA CROMMIAMP um mm"m IN478 2mo 12WrA 17 0 X U 0 ca CD J N N M X U J U Packet Pg. 1950 L2.b Reem Regno, ARMS LO M LO Qualifications • ARDMS registered in specialties Abdomen and OB/GYN. ca • BLS certified with the American Heart Association. e • Eight years' experience with patient care. • Two years clinical experience in various local hospitals and clinics. • Registry eligible for specialties Echocardiography,Vascular,and Neurosonoiogy. e Clinical Experience • AB, OB/GYN,Small Parts • High Risk Perinatal Protocol • Paracentesis/Thoracentesis • Echocardiography,TEE • Vascular, PVR Professional Ex Parlance Life Scan Wellness Centers Tampa,Florida Registered Ultrasound Technologist October 2014-Present Lu +' 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 newCD technologist 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. 1951 L2.b LO m LO to � l c c ZMMAWARM MnFICMZOW To FiDNI%M O%om)R47 ) U twrm f R1FR� F dsi 28t9 twimt7 L i r E3 O _. ._ lmow i ur a MdA6 lfwuafim hm� wqa ft U 0 tJ ca CD U J N CD M X U J U Packet Pg. 1952 L2.b c) DETAILED STAFFING PLANLO LO The Life Scan program is designed specifically for public safety and the entire medical staff has extensive knowledge and experience in providing firefighter physicals. The medical staff works in teams and each of them is experienced in all aspects of the scope of 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: • The Life Scan Staffing will include three (3) Life Scan employees that are fully u 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 medical.clearances. • All Life Scan medical staffing receives annual, recurrent training in areas such as ACLS certification, Public Safety Disease Risks, Diabetes, Hazat testing, Infectious Diseases, Blood borne Pathogen and Safety Protocols, Medical Reporting updates, NFPA 1582 updates, Wellness Fitness Initiate program, and Life Scan clinical updates. X Mid-Level Practitioner()VP,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 ca the profession of firefighter and corrections personnel.. ACLS 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 educadon of our patients. Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 1953 L2.b LO Clinical Exercise P1tsiologht LO The Life Scan clinical exercise physiologists are experienced in clinical cardiac testing and interpretation., lung capacity(pulmonary function) 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 E 0 c X 0 CD ca N X U Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 1954 L2.b d) Six (6)References from other Governmental Agencies that have utilized Life Scan for Similar Services: LO 1. Brevard County Fire Rescue ca Contact:Marvena Petty Phone: (321) 633-2056 x 56414 Email:marvena.petty@brevardfl.gov Performance Period: 2012 to present 0 dumber of ANNUAL physicals; 550 .0 Service Provided: LIFE SCAN Firefighter Annual and Candidate Physicals E • NFPA 1582 Annual and Candidate 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 01 • Hazmat and Specialty Team Physicals • On-site program for all medical testing,blood draws,and X-rays • Infectious Disease testing and vaccines • OSHA Respirator Physicals for Public Safety • OSHA Respirator Mask,Fit Testing for Public Safety N x 2. St,Petersburg Fire Rescue and.St.Petersburg Police Department � Contact: Fire Chief James Lark Phone: (727) 893-7058 Email: James.Large@stpete.org ca Number of ANNUAL physicals: 330 Performance Period: 2008 to present ) Service Provided: LIFE SCAN Annual and Candidate Police and Firefighters: • NFPA 1582 and FDLE Annual Physicals • Candidate Physicals for Police and Firefighters ca • NFPA 1583 Fitness Evaluation for Police and Firefighters CD • IAFFAMC Health and Wellness Initiative • Life Scan ultrasound and advanced medical assessments for disease detection and.prevention • Haamat, 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. 1955 L2.b 2. Largo Fire Rescue LO Contact: Fire Chief Shelby Willis LO Phone: (727) 587-6740-2005 Email: marven&petty@brevardfl.gov Performance Period: 2012 to Present ca Number of ANNUAL physicals: 125 E Service Provided: LIFE SCAN Annual and Candidate Physicals: • NFPA 1582 Annual and Candidate Physicals for Firefighters • NFPA 1583 Fitness Evaluation Firefighters • IAFF/IAFC Health and WcBncss Initiative 0 • Life Scan ultrasound and advanced medical assessments for disease detection E 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 3. Rroward Sheriff's Fire Rescue c 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 • Hazmat 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 Polk County RFP 17-601 Fitofighter Annual Physicals Packet Pg. 1956 L2.b 4. Panama City Fire Department LO LO Contact. Chief Seat Flitcraft Phone- (850) 872-3053 Email: sfliterafa pcgov.org 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 0 • IAFFOIFC Health and'Fellness Initiative • Life Scan ultrasound and advanced medical assessments for disease detection and prevention • Herat and Specialty Team Physicals • On-site program for all medical testing, blood draws,and X-rays • Infectious Disease testing and vaccines OSHA Respirator Physicals for Public Safety OSHA Respirator Mask Fit Testing for Public Safety 0 0 5. Fort Lauderdale Fire-Rescue 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 Firefighter Physicals: • NFPA 152 Annual Physicals for Firefighters • NFPA 1583 Fitness Evaluation Firefighters • IAFF/AFC Health and Wellness Initiative • Life Scan ultrasound and advanced medical assessments for discase detection ca and prevention CD N • Hazmat and Specialty Team Physicals CD • 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. 1957 L2.b Survey Questionnaire—Polk County RFP 17-MI,Fireflghter Annual Physicals LO _. LO To: (Name of Perm _' ) R1f Cifent Company/Firm) W ca La. VA Subject Part Perf rmam Survey of- ��.�e'� � fi t •�} ° W COO of Serows.. w# `.-. Date Complcta �l i y Rate erIIM2 aID 0 WSW of 1 to 19,With 19 reprelsooftl dMt you were w UWW(and � would hire the firmftdividuret*pit)and 7 ropramting that you wev VOT unuMed tad worrdd n hire tI uai aXAanj. Pkm roue each of ttkerW to the be4 of your lunowierige4 If you da Get have WOMIOM kaawk a of Prof PErforrr,ewafx In a pardcalar were,ierevre it Mane Similar Work Pnc ea Name §i NO #:glEM Uhllfl` SCORE U_ 1 Ability to manage cost (1 } Ability to maintain Project schedule(complete on- 2 time/earl X LU 3 Quality of workmanship (1- } Professionalism and ability to complete exams for all Fire and EMS positions 5 Ability to communicate with Client's staff timely 6 Ability to resolve Issues promptly 11_10 7 Ability to follow requirements based on National Fire Protection A;tsociatlon standards (1-19) Ability to maintain proper locum e"Won and complete $ timely r Appropriate application of technology used for the mobile testis.: (1- 0) #r 10 gall Client satin ctlon and comfort level in hiring (1-20) y 11 Ability to offer solid recommendations based on exam result (1-10) Ability to facilitate consensus and commitment to the plan 12 of action amen staff '�V 2* IJ Printed Name of Evaluator g goatw+c o l;val r PIcasc fIM Or Mmall the campleted survey to: . �7 Reftw ti6Hwia Packet Pg. 1958 L2.b LO Survey Questionnaire,--Polk County LO RFP 17-01,Fire titer Annual Physicals ua c {Names of (Name of .t ant ,. myrne) Email: c kip*Sr Cot of Savlcft:� gad!*GCi, a!o a asftie of 190 19,w#b 10 tbad you were very # _ wOWd hhV the AmwWWWWi spin)and I rep that yemwe, VMg (algid WMM of"hire tM 5Md dl a6010- Men raft neb of the Criteria to dw beg of ymr imewi a dg& if YOU do atat We=41dent knowledw of past perbmwft is a peter area lam id bko k. Slmilar Work Pwjea Compktaj. 0 UNff SCORE 1 Ability to manage east (1-10) 2 Ability to maintain project schedule icamplets (i-six) 3 Quality of workmanship Professionalism and ability to complete exams for aH Fire and EMS positions c 5 Ability to communicate with Client's staff timely �Z- ) ' 6 Abil to ity rexohra issues prrcrmptiy ��ip� � Abifity to follow requirements i �_ Standards d an f+latianai Ire /0 Protection t1-�pP Abilityto rnalntaIn _ ,.� >3 tirn i�per documerttatlon and mt�lete (1-1{f) �/�1 � . ca 9 �riate a�ppliratian Of teftplogy used for the mobile � �� �+0 id Overall Client satisfaction and comfort level In hiring (1-iQy y 11 Ability to offer solid recommendations based on exam result (1-10) L12 Abilityto facilitate co nsensuss and commitment to the plan - of action among staff Pr Md Name of Evaluator S! of Evaluetor Picric fbx or anall the aompierwey to. ,, . cal 27 a ,r c�v RoWW Odsns Packet Pg. 1959 L2.b ,an —Polk County LO RF'P'17-604 Ft ter An andLO fs�e ofl , fcHavi - 4 � tyl jj cog of �y� r hin do r t you Won W (and do i + lcaatr plan rub agwb o!'ffi*. 10 the beg eF r „ It l a.pi r SrAW4 Iwo It SINUff Work QwU_Oj L. no 0 SENA uxfr 1 Ability torten a CM Ability to nViintain project$09dule(Cc on- ti (1-10) r 7-3 LU Qmailty of workmanship 4 and ft*0 nallsrn and abddlty to complete exws for all Firepodoaft - 1 5 Abft to communicate wdth aierrt's Staff timely 11-10) 6 Ability to isst+es rompdy Ability to ftlloW roriu based an Natlaral FTra � p'rotihm Asi dat G n stance s SQL B Ablltty to MlInWin proper do�meftmon and cam 1.9ti) qr W s n of tfthnologv used for file nwvbge2- CD 10 li Cdient s3tWaMn Ind wnfOrt level In hiring y ig Abi ty to offer solid recomrnandadom baed .� result (l lit 12 AWldty to% c�ortsar us and'comn�st *nt to the.phtn A5 of action a stf {1-lf} OP ��.. � ot`&ctl»r Pj=w fim of awo tdw COMPIM6 MWVOYto 7 Re awls Packet Pg. 1960 L2.b Survey QueNfl"Wn—Polk Con r LO RFP 17-01,ftiflOter Aan ad! LO TW., �- 1�t Of Pam+nomPMag=MrMVGJ+1 �. ca JIB Put perhmanx iv u '?Ci7Cx`un l{ n ,. c Cost of ser kx --�--. Date Raft each of the cowkea a Malk of 1 to 1 ,wish]@ wow d hire RrmAs mat rests T eatlatieet(and q hire tho th1w end J 11 ywa WIM very (=d w"M you do eerk beve PIMS rate Gash af'tb to the beet of r u Jaaa>f►'Wr*f PW lw hu a PAWKr area,leave It bhumL Slimiler Work Phdm Nwma: JIiIQ C.ti�'Eg'iq - �. ttIT SWRE c 1 Ability to manage cost - } } 1W111tyto meIntaIn project edule tt'OItlpiete an N tlrn earlyj 1D} 3 Quality of workmanship 4 Professionalism and ability to ccmpiete terns for all Fine and EMS Positions 10 5 Ability to communicate with Client's staff timely 0 6 Ability to resolve Issues.prom 7 Ability to follow requirement$based on National Fire -P n Assoclatbn standards $ AbtIICy to maintain paper documentatl+ n aarJ co ' fete timely Appropriate application of stogy used for the mobile ca W i WON1-113} CD r1D Overall Client satisf#cklun and comfort level in hfring - � A Ony to offer solid recommendations bued on exam result 12Ab111ty to facilitate consensus and commitment to the,plan of action ama s rff (t- ) 5 of aluator Plcasc f8z or=Wl the cumpletW slJy to.. 27 � oseau�s Packet Pg. 1961 L2.b LO Survey QuesSou alm Polk County LO RFP 17-0 ,Firefigliter Anumd Physic J ae au yl (N a ofClien pvay FI m) c Aaae Aiura#arr: _ Subs Past Parf rance Survey of � Lam°��f'�ti �I t��� /�"' ' 3 U Cost of BDMGW MDoB OW plats: �- RzU eaeb ofewaiWis an a mb of l tol 10,with 10 Mwomflog drat yan Wert very=WW(and «ram alre the UnKftdtvMll a0afo)WW t r6rr a that you wen very urramthi ed(gat!would Dever airs tea firO adtr dUOI MOW. PIANO rats ON&of the erkerk to the but of your know1wigc It You do not imw+suffleleat knwbdp of peat performunce to a(raardeular area,Wye ft blonlG Similar V4' c Proeast Name- Date t :. 0 NO CRrf EM umrr S i Ability to manage cast .2 2 Ability to maintain project schedule(complete on- time/ea (1-1Ci) 3 Quality of Woftanship (1-10) Profiessionalism and ability to complete exams for all Fine and EMS positions (1-1.0) 0 ca 5 Ability to communicate with Client's staff timc4y (1-20) 6 Ability to resolve issues promptly 1-1 ) 7 Ability to follow requirements based on National Fire Protection Association standards (1-10) S timelity ly Appropriate to maintain proper documentation and complete Appropriate a pplicatlon of technology used for fire mobile i1.1p) 10 OvOrall Client satisfaction and comfort level in hiring {1- l zo f 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 among 14.10) Larne of Evaluator Sigrrat of Evaluator Please fex or mmail the completed survey ta : T -+ /t kC�a.Yt 2 or ' a Packet Pg. 1962 L2.b Survey Questionnntre Folk CountyLO LO r ` RFP 17.601,Fhvfthter Annual Phyaic is 04arne of Person completing auWey) (Name of Client Company/Firm) Phone Number-, btu � -1v r � , Subject,Past Performances of 9 Cost of services: t , b, Complete: 1-t- .-o 113_ __.._... ..�.,. ..��.mom :: ........., .�_.�_ .�.�..,.�.._.�..�,�.�..,�......_....d � Rate e#ciw of the criteria O a reek of li to 10,with 10 re umdug that You ware very aatbfled(aad would hire tb'flnnAR&vWuR1 aria)and 1 rep that you wemmy umadefled(and would now We the firmAnAvNual again Mae"rate each of the criteria to tiers beet of your knowlr fte. If you do not have auflfdient knowledge of part,pwformance in a particular area,leave it blank. Similar Work Project Nacre: NO CR17EfilA - UNIT SCORE 1 Ability to manage cost (i-10} l U� _ Ch - _ r- Ability to maintain protect schedule(complete on- 2 2 time/earl (1_ip, 3 Quality of workmanship Professionalism and ability to complete exams for all Fire and EMS positions ( ' to 5 Ability to communicate with Client's staff timely ( . to 6 Ability to resolve issues promptly ) 7Ability to follow requirements based on National Fire Protection Association standards ( _ip� i Q Ability to maintain proper documentation and complete timely ca 9 Appropriate application of technology used for the molalie testis (1-10) ivCD 10 Overall Client satisfaction and comfort level In hiring {1-1t7) to � 11 Ability to offer solid recommendations based on exam result (1-10) t LU eLAbility to facilitate consensus and commitment to the plan 1-it► of action among staff Printed Name of Evaluator SiPMuMl Evaluator Pl=c fax or email the completed survey to: � 27 pAnftw t► GBrls Packet Pg. 1963 L2.b LO m LO ca to c c c 0 E w 0 c c ca CD cv cv r9 x u Packet Pg. 1964 L2.b TAB 3: REPORTING CAPABILITIES LO M LO .,All Life Scan reports are customizable based on the individual needs and requirements of each department. 0 Employees: c 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. 0 wellness plan.. E Polls County Fire Rescue: • PCFR will receive a FIT FOR DUTY exam report and results of Hepatitis Titers/Screenings within 14 days of the exams. • Final Evaluations will be reviewed and signed by a licensed Physician,NP, MSN,or PA. • PCFR will be notified by phone within 24 hours for any employee that:is found to be NOT FIT FOR DUTY, c c Reporting Samples include: X • 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 N Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 1965 - L2.b FLLIFE CAN FIRE DEPARTMENT CLEARANCE FOR1M'I AND OSHA RESPIRATOR CLEARANCE Wellness Centers Employer: EOLK Ct) 'TY FIRE RESCUE LO LO Patient Last Name: First Name: Patient.IIIISS : — _ Exam Date: c EMPLOYEE MEDICAL QUALIFICATION. The examination of this employee roust include a complete f physical examination at a level of specificity in awordance to 2013 N.F.P.A. 1582 guidelines with the purpose of determining whether there is any medical or physiological reason that may impair the employee's ability to perform the essential functions of his or her job. Disabilities,impairment,or limitations identified by the examination,which e would prevent the employee from performing,the essential functions of the position,will be reported to their employer.The reviewing medical personnel should note all abnormalities which aright predispose the employee to W 5 injury or aggravation of the condition due to the 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. 1910.120 regulations � and the guidelines set forth by 2013 edition of N.F.P.A. 1582. ❑ MEDICALLY QUALIFIED WITH THE FOLLOWING RECOMMENDATIONS: - - D ❑ NOT AMICALLY QUALIFIED. Based on the results of the annual medical examination,I find this individual is NOT CLEARER under O.S,H.A. 1910.156,O.S.H.A. 1910.134,O.S.H.A. 1910.120 c 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 U 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 T 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 '✓ respirator use related to the medical condition of the employee. CD 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; Arithsmy L.Capasso,M.D.,P.A. Medical Der Lionse Nuoiber:ME 69518 Packet Pg. 1966 L2.b LIFIE SCAN RESPIRATOR MASK FIT CLEARANCE FORM Wellness Centers Employer:. POLK COUNTY FIDE RESCUE LO Date: LO Employee Information List Name: First Name: c ID/SS#. DOB: Occupation: Mask Fit Test (For Clinical Use Only .... __ . Respirator Medical Clearance: ❑ Pass ❑ Fail Date of Medical Clearance: W Vision Correction,Required. ❑ Yes ❑ No If yes,what type correction used when wearing a respirator: a ❑ Contact Lenses ❑ Masses ❑ None Fit Testing_Results (For Clinical Use Onlv) - 01 Test Date: Test Completed. ❑ Yes ❑ No If No, give reason: Respirator Type: ❑ N95 Paper ❑ Full Face Negative Pressure ❑ Half Face Negative Pressure Make: Model: Style: Size: Mask:Fit Test Date; _- - Fit Test Protocol Used: uantitative ❑ PortaCount Model Number: Serial Number: ❑ Dynamics Occupational Fit Tester Model Number: -_ Serial Number; Overall Fit Factor: ❑ Pass ❑ Fail ca CD N Notes: (For Clinical Use Only) Comments: Signatures Print Patient Name Patient Signature Print Clinician Name Clinician Signature Packet Pg. 1967 L2.b TAB 4: MOBILE TESTI G a) Mobile Testing Location: LO Strategies: + Life Scan has the capability, experience,direct full-time medical staffing,and Co equipment to provide can-site physical exams at on-site location(s)provided by e Palk County Fire Rescue. All set-up,equipment,and associated costs will be the responsibility of Life Scan. 0 + All equipment maintenance will be performed by Life Scan and will be kept clean E 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 locations)provided by Palk County Fire Rescue(not a motorized vehicle): o Physical Exam as outlined in the Scope of Services o Blood,,D�rawws(supplies included) o Chest x-rays • Equipment: All equipment used for the Life Scan program is state of the art and owned by Life Scan. The equipment is portable and easily set up by the Life Scan 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 • 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 y X Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 1968 L2.b LO M 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 number of annual firefighter physicals required, C 2. Life Scan will be able to proceed AAb the scheduling of physicals can October 1, 2017. 0 A. Life Scan will schedule 9 patients per day, 5 days per week (45 patients) in W 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- s. Additional days will be provided as necessary to accommodate completion of all firefighter physicals at no additional cost to the County. o 0 2. Implementation Strategy X 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 e a. Minimum 4 rooms with waiting area • Physical exam • Cardiopulmonary/fitness evaluations ■ Ultrasound exams • Hearing and Vision area. 3. Plan time line M 4. Review and approve Patient Packet CD 04 5. Review and approve blood draw program and.LabCorp requisitions CD 6. Review Fit for Duty and.Respirator Medical Clearance Reports 7.. Review and approve reporting system B. Phase 2: Schedule dates for blood draws and physicals 1. Nine patients per day in three intervals of three patients each ) a. Example: 3 at 8:40,3 @ 11:00 am, and 3 a 2 pm b. Start time will be determined by PCFR Palk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 1969 L2.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. ' In C. Phase 3.Blood draws (2-5 weeps prior to physicals) 0 1. On-site at any location(s)provided by PCFR. 2. LabCorp Patient Service Centers a. Phlebotomists are certified technicians 0 b. Facility meets all requirements established by DOT and is W 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 0 E. Phase 5: Reporting per PCFR Requirements 0 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. 1970 L2.b LIFE SCAN COMPREHENSPVE SAFETY AND SECURITY POLICY 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 1. New employee orientation and education program and annual recurrent train%ng that addresses Safety Procedures: i. Blood borne pathogen policy(Exhibit A) c I Biohazard waste policy(Exhibit B) W iii. Fire Safety E 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. 01 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. 0 d. Safety Equipment 1. Life Scan routinely maintains and tests all equipment. Any equipment utilized will be tested prior to program start on-site. e.. Reporting to County Risk Management regarding accidents and/or damages 1. Life Scan management will receive any accident or damage reports and report there directly to County Risk Management per County procedures.. f. Records Confidentiality � 1. Life Scan will coordinate with the on-site facility manager to determine an on-site secure area to store records during program. 2. Life Scan 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 patient 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. 1971 L2.b EXHIBIT A LO LO LIFE SCAN WELLNESS; CENTERS SAFETY DEPARTMENT � c, SU13JECT: LOODBORNE PROVED BY: EFFECTIVE REFERENCE: PATHOGEN EXPOSURE Patricia Johnson, � DATE: CONTROL PROCEDURES SOP l President Sept.22,20013 #005 E INTRODUCTION The Occupational Safety and Health Administration (OSHA) reports that 5..6 million 01 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 Department of Health Code cites Cho ter 64E-16 of the Florida Administrative Codes. N 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 `D 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' E Bioodborne Pathogen Exposure Control Procedure will be accessible to all � 1 Packet Pg. 1972 L2.b LO -The recognition of tasks, which may involve exposure. LO -An explanation of their use and limitations of methods to reduce exposure. These include engineering controls work practices, and personal protective equipment (PPE) offered at no cost to all full time and part time employees. -Information on the types, use, location, handling, decontamination and disposal of PPE. An explanation of the basis of selection of PPE. E -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 N 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 y new at-risk full 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 home Pathogen training g procedure and program, updating it as necessary. 3 Packet Pg. 1973 L2.b Disposable gloves used shall not be washed or re-used after LO 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. 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. c Labels and other warnings, as specified in Code of Federal Regulations 1910.1030(g), will be affixed to contaminated materials to warn others. Life Scan Wellness Centers will monitor the Blood borne Pathogen program for contaminated material to be defined as Bio-Hazardous Waste. Contaminated waste will be handled in the fallowing manner: ca 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 B. In areas where there is to be a clean up of infectious waste materialCD the following procedure should be followed: 40 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 infectious LU 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. 1974 L2.b If the employee declines the vaccine (Exception 4), the employee must sign theLO .� 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 employee. If a routine booster dose(s) of Hepatitis B vaccine is recommended by the U.B. Public Heats Service at a futures date, a boaster will be made available to all employees in the same manner as described above for Hepatitis B vaccination. POST EXPOSURE EVALUATION AND FOLLOW UP E If employees follow the prevention guidelines as presented in this policy, an exposure incident to a BBP should be a rare event. However, if the employee does have an exposure incident it shall be reported, investigated and documented. Employees who have been exposed to BBP shall report the incident through normal Worker's _ Compensation (WC) procedures; by first notifying their supervisor, completing incident report and WC First Report of Injury report. After exposure, all costs of care will be treated as a workman's compensation incident. 0 Titers (or retesting of immunization) will be offered after completion of the series if five years has elapsed since completing the series. X 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 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. 1975 L2.b EXHIBIT B Life'Scan Wellness Centers Biohazard Waste Plan-Employee Education LO (Florida Administrative Cade 64E-16) ' Life Scan educator will provide an initial (within 30 days of employment) and yearly education for all employees on the proper handling and disposal of Biohazard NVaste. ca 0 Objectives: a The employee will be able to: identify `sharps' and `non-sharps' which is designated as a`biohazard' U - 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 demonstrate Universal Precautions when handling all potential 'biohazard' materials locate the 'Bio-Hazard' binder containing the most current Health Department guidelines,up to date employee signed education,previous surveys and be prepared with this information for an onsite Health Department survey properly 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 a 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 W 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. 1976 L2.b EXHIBIT C. LO LIFE SCAN EQUIP-M%NT M INTAINANCE PIt "zRAM: LO Life Scan has routine maintenance and calibration of all medical equipment on an annual basis according to the recommendations of the manufacturers. ED All equipment maintenance will be performed by Life Scan and will be kept clean and sanitized. All equipment will be kept in optimal working order or repaired/replaced within a reasonable time frame. Fife Scan maintains backup of all equipment as well as service contacts to ensure timely replacement as needed. e Poly County will have the ability to inspect all equipment. E z- ,Z. .r +. 0 - +T�1YffllM`lN hl �d 4�'+� -.t' {t W r6. 4' ,F r U) r t3 t N N Termon 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. 1977 L2.b LO m LO ca to c c c 0 E w 0 c c ca CD cv cv r9 x u Packet Pg. 1978 L2.b Attachment "A" COST PAGE LO M (STJ-BN TrAL PAGE) LO Cost per employee for all " requirements and items to be performed annually as defined 1 ca e in the RIP Document. Cost shall be inclusive of all costs 657.00 Per Employee associated with the annual I ' physical exam including 0 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 Respirator Fit Testing(SCBA 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.) $ 55.01} W Hepatitis A,Titter(antibody) $ 30.0 CD 111epatitis A Vaccine(2 per series) $ 65.00 each JPPD Test $ 15.00 x Attachment II II CO TRACTOR Packet Pg. 1979 L2.b AFFIDAVIT CERTIFICATION _ IM MIGRATION LAWSM r9 LO SOLICITATION NO.: RFP 17-601 PROJECT NAME: Firefighter Annual Physical cc POLK COUNTY WILL NOT INTENTIONALLY AWARD 'COUNTY CONTRACTS TO ANY c 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 ACTT(-IW). c U POLK COUNTY MAY CONSIDER THE EMPLOYMENT BY ANY CONTRACTOR OF W 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), r.w Sig kfure Title a y STATE OF: COUNTY OF: Th foregoing instrumentas signed and acknowledged before me this day of 2021, by " "i-L= L2 who (Print or Type flame) ca has produced r` as identification. ype of Identification and Number) a.. Notary Public Signature CV CD Pnn ed Name of Nota ry Public � � DAVID A.CAS EW � NOTARY PUBLIC S'A F.of FLORIDA x Nota irat on Packet Pg. 1980 L2.b Attachment "B" LO M 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, 0 E 2. �- 3. 0 x 4. 0 5. N 6. a x Packet Pg. 1981 L2.b TAB 8 MEDICAL LABORATORY -� M LabCorp Regional Office: ca Laboratory Corporation of America ca 5610 W.LaSalle Street c 0 Tampa,FL 33607 Life Scan will provide an on-site M m. blood draw program. Lire Scan patients are also able to have wa blood draws done at any LabCorp Patient Service Center within the "united States, e LabCorp Patient Service Centers within 25 miles of Bartow: E i. 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 0 0 4. LabCorp 607 S ALEXANDER ST STE 107 110 PLANT CITY,FL 33563 N 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. 1982 dug. 1 2017 3;23Pfi 11n" 808--p. 2.—_,. L2.b LO to t�r�F� per MOW f' ? A � F' 1EPJC* 'pia a 1C► -2�`- V�41T O Or r LO T •N11 7 ' BEAN E FAPOgR VD, .04r1 t� a I rrE tub tuEl , Fog Ill,I 1A I & b 410 c !�0't�T2Q� AbJi`f)lCtl1'1 '6dt�I �' �?7Ttii/ � • MOGYSfin 1 �6; ca s Pear I � trrr{fignrs Pow fta FOR, U J :Pkli $ t CL,` iVIS19'UR74Gr, l► TOM fiMAMWJW. Packet Pg. 1983 L2.b LO m LO ca to c c c 0 E w 0 c c ca CD cv cv r9 x u Packet Pg. 1984 L2.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), AUTHOREDLO REPRESENTATIVE OR,PRODUCER,AND THE CERTIFICATE HOLDER. LO IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the policy(les) must be sndolauld. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this cartlflcate does not confer lights to the certlficste holder In lien of such endorse s. PRODUCER 0 O.E.Wilson Insurance,Inc. 727_-5364M FAx 727 536-9825 1475 Belcher Rd S Man. cindlIgWison.corn O Largo FL 33771 _ Auto-Owners Insurance Corn -_- 18988 WSURED Admiral Insurance Com '' 2400 0. Life Extensions Clinlc,lnc. ENSURERC! _ O 1011 N.Macdlli Ave Tampa FL 33607 E COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AHOVE 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 SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - TYPE OF INSURAMM DR ISIM NUMBER F5Y EFP X COMMERCIAL GENMAL..UABILrrY U 1 000 aaa BNAMAOA MAIM8 DE 1 X I'00CUR ETO 100 aaa O 20690745 IIMO116 11110117 00,000 0. 1 aaa a0a SATE L]MITAPPJJ PER, 12,000,Oaa O X P JGY JPERtd L aaa aaa OTHERF T S AUTOMOBILE LIABILITY 22ALSINEDfliaM LIMIT $1 000 aaa A A ANY Ate, BODILY INJURY arQoraan) ffi ALL OWNED OULED 4159162800 09MS f6 ailt18M7 BODILYINJURYPer „)x HIRF7 AUTOSAUTONAUTOS nur N-OWNED IYdDPERTY DAMAc+F 3 3 UMBRELLA LIAa - HC.LAJM tX3CUR EXCESSUA0Ca Ogg - t8 NIDRRERE COMPDMATION PfR ME TM U AND JIMPLOYEW LIABILny AW P EMBER IDG _L NIA 1 T tMandalcry In MlH7 — PLOYE fs daua tndsr EL --.POKY JJMIT Medical Professional Liability E0000037591-01 05131MT 05/31/16 2,000,000 Aggregate B Retroactive Date:5/3112001 2,000,000 Each Claim N DEIICRIPTION Of OplatATIONS 1 LOCATIONB I VENMES(ACORD 10t,Additional Rwwaft Schedule,may be a taehed N mom apses to rr contractorlk nsing@poik-county.not r7 Sexuai Abuse $1,000,000 Each CialMd1,080,000 Aggregatt y Network Security 8 Data Privacy Liability$1,00,000 Each Claiml#1,000,000 Aggregate x to CERTIFICATE HOLDER _CANCELLATION O Polk County SHOULD ANYOFTHEABOVEDESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 330 West Church Street ACCORDANCE WITH THE POLICY PROVISIONS. Bartow,FL 33830 1 AUTWWMD ttEPIEIrrA'tawE Phone:(863)604-6080 O 01988.2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The AGORD name and logo are registered marks of ACORD Packet Pg. 1985 L2.b °NCO CERTIFICATE OF LIABILITY INSURANCE 0"TE A%-� 10/31/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO tMAT1ON 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 LO BELLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CIONSTITtFM A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIYIEDLO REPRESENTATIVE OR PRODUCE&AND THE CERTIFICATE HOLDER, IMPORTANT: R the coroftsfi6 holder Is an ADDITIONAL INSURED,the Polly ka)mawt be endorEsoO, If 9U®ROGATION!S WAIVED,gubjM to CJ IIm truss and condlgons of the policy,rartdn pollclas my mqufm an endonmrA ld. A sbftnwnt on this carditeat6 does not Confer dghls to tha wrt"Itate holder In Neu of such enda _ • P9100um CT Valerie 79c+rt>yan-wheeler Primec I Insurance Se s, .Inc. IoNare (s13)211f3-827©Ion;wa am, it c Nat:Ia23)U5-�9ai 0 5402 W. Laurel St:. MywIteelereprimegroup ns.comt Suits 220 SIZU"AlA 6W COVMAM NArca Tamps BL 33607 _ 'M 1 PreferredXuagrar.06 Ca 10346m 0. arsuw*a Xd Xxtension Clinics, Znc O 1011 N WadDill Ave INeII Da .� Tampa FL 33607 aK6 F® COVERAGES CERTIFICATE NUMBER;ma6103116405 - REVISI©NNUAWER: 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 0) 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 CLAMS. TYPE OF RGURAISM tam NUVAM _-__ UWT6 Iti DOMIrp9RrCIAI.SAL LllALRY EACH OCCURRENCE CLAIMS-MARE L] llrT4.,l E , MW W QWWwopm= PEMONAL.S AOV INXRY O e6NL AIGRE ATE L UT APPLIES PER: L')ENERAL AGMEi7ATE ! Y IECT L�l LOC PRODUCTS_E1aPACP AGO ! O OTHEFL — i- fA AUTZIIdWLE LJABIM cow - IF i ANY ALIM RMLY INJURY(PM"PWW) i ALL OWNED EIILaLILER AUTOS AUia BOOELYIN"YIPMataidanll i HIRER AU= AUTMTY = tO - I Fitt S6 L1Ab EACH URRM4CE cLAI IeA,oe AGGRIUIATL1001 # R # E t8 7m -_-- A"0440YOWI.JABLITY YIN AWPR0PA1MrRMARTN NtR. ILL.EACHACdpFFJIT � 7.,©00,08$ InNVMLUDM" 82G26QI1a36 05 �11lze/sald il/:I$/2017 ESL A$E-EAEmPLOY 1_ >L.t1Q0 d00 W=tffww .I- caF ATIONSbNOW EJ_ PULH;YLerrr s 1 OR@ titan W CD N E EI4'RIPll41r a'arr!iRAT1 Dw d y 0rA7x"11 ...N 7fI,AlUft"IbWw U%*6cNW Ws,my he slpalod I<mm apses I.nqui" Cv r7 x CERTIFICATE HOLDER CANCELLATION � 8M0=ANY OF THE ABOVE"0=14 IFSI POLICIES Ere CANCELI.E D BgFM FM 1MRNAT10K+AL PT7,I=SE8 THE EXPIRATION DATE THEREOF wo FCE WILL. BE DEUvgRSD IN ONLY ACCORDANCE WITH THE POLICY PROVISION& - G3 AUTHOREW W4015501TAINE E E11sasser #AO77187/ .F, 01988-2014 ACORD CORPORATION. All r hft nese+V& A0OR0 26(20J4101) The ACORD name and logo aTe mglstemd marks of ACORD INl10?JC�pt�7i Packet Pg. 1986 L2.b " Request for Taxpayer F to the L Form r�ew ieatsr.Da rtat , (Rev.Deconbef 201) Identification �llta�er and Certification send to the IRS. LO M DwWWOM of the Treeaxy k,t Ftever�Sarviau _ Mauna(es shown on year motors tax,natural Life Exttensior►Cllrft%Irdc. t3atslsaess wm nurse.If froth ataays CO g� Lifrt art Wellness centers c Check app"riats box for federal teas tkhrr; ❑lrtdIt�,eutst>>t`rxrsprl ❑ C cat+ 91 s rattan CI Iota p Tru�/eatste exampt lfabttt cart + ttrs fit a ilon t corpareton.t3- corPcnativaa.Pctraereroil► � P ® t y may- __._w__.._.____�..__�.._ � am � © atltar fee k'O�► - e rumrrie and erddveerw�� W Inumber,sty.and APL Or vA10-a 1 Q11 North Maedill Avenue aw,etm,fawned OF Tar^ + FL 336ii7 _ _ Ust euxaotrnt numb")rare ppmww du T ldertlificatlon HUMber M!g Enter your MN In the appropriate box.The TIN provided must rfratch the rrarre glvrn on the-Name line to avoid backup whhholding.Forindividuale,this is your 30OW ssouritY tramcar(SM.However,for a resident ern,sale fortsPr4etor,or die ar tity'.we the Part I instruc ticna on p�&For other :D] -E] 0. amities,it is yaw tspkhyw letantificatIon rnurtber(EiN).if you do not haw a number,see Haw to Sef a nAt an pap 3. L` Note=h the at5aanent lain more than one name,owes the chart on fa 4 for guklelines an rrltoee t "� riu mbar to enter. S -' 3 5 310121 2 1 1111-3111111117 Under penalties of perjury,I certify that 1. The number shown on this form is my Doff t taxpayer identification nua*er(or I am waiting for a rawsaber to be issued to me}®and 2. 1 am root subject to backup withholding because.(a)I am exempt from backup wlthholrlbrg.or(b)I have root been notified by the Internal Revenue Service QRS)that I am subject to backup w#dhhok#krg se a re"of a failure to report all Y7tereat or or(o)the IRS has rtodfled me that i an no IOW subject to backup withhodng.end 0 3. 1 am a U.S.citteen or other U.S.person(deflned below). tJ Ceralftar6m You must cross out Item 2 above K you have been notified by the M that Y*u ens currently subject to backup withhotdi rag becauee you have failati to report at interest Bred divide on your taut mtum.For rest salsas transactions,ham 2 dose not apply.For mortgage irrterast paid,acquisition or i ,cancellation of debt,contri to an Individual ratirarrOnt errart�grxneerat PAN,and get`,p�other iraerest . era not required to slat the but you must provide youa correct TIN.See the irgtructiom on pass 4. Sign of Hwe Wt. ► toe.► General Instructions your if a, gives th nast a or �h Form W-9 to rsgti ._ your TIN,you must use the requaWs loom a it is substantially similar Section references are to the Internal Revenue Code whktss athsnarrse to this Farm W-9. noted. Do"nifian of a U.S.parson.For federal true purpOdaes,You are CD Purpose of FOnn ca a U.S.person it you roc: •An Individual who is a U.S.citfnen or U.S.resident allan, cn A parser who Is required Ira file an information Tatum with the IRS mint ` company.car won created or � obtain your Oonect taxpayer number(nN)to report,for A ip, COfPDmtkxlexampk,trrcartre paid to you,real vetete tra haaucdons.mort�arge Iritervat In the United States or under the taws of tfw United States, you paid,aoquiadtion or absncionnnent of seWN(I proparty,canoelletion r An estate(Other then a toielgn sstatel,or of debt,or contributions You shade to an IRk .A domestic trust(ate defined In iieguletkans section 301.7701-7). Use Form W=9 Only If YOU are a U.S.POW" iing It resident partnerships that conduct a tram or afto),to provide your corm TIN to the person requesting It(dneSpecialbusinew in tl��United Start generaly rOWIn d to fey a wilhhOld requesireri and.when applicable.to: tax on any foreiprr partners'*trans of income from such business. 00 1.Car*that the TIN you are giving is correct(or you are waltkhg for a Furdher,in certain oasis where a Form W-8 has not been received,a number to be issued), ptrrtrteftlhip is required to presume that a partner Is a foreign person. 2.t3asrtity ithat you are not subject to taeecltup vritlatroidlrtg, and pay the wttrhold ng tax.Therefore.If you are a U.S.parson drat b a partner in a caomfuct#ng a buia or business rh the United 3.Claim exen> *m from backup wakhhoWY9 If You are a U-S-axenspt States,provide Form W-g to the partnership to satablith your U.S, payee.if applicable,you are also cartifylhg fleet as a U.S.person,your avoid status and id withholding on your share of pwartneretrlp Income. allocable shamof any khcame from a U.S..trada or Wain= � is nut subject to the withholdnV tan on foreign partners'share of elfw&connected hhcome. Cst.No.1Ifl4"3fyi Ferrell FSIPr ,n2- +t) Packet Pg. 1987 L2.b TAD 10: CONFIL1ENTUL ADDITIONAL INFORMATION LO m LO ca Our standard testing on Page One and additional testing on Page Two. 0 E Life Scan Firefighter Physical: $395.00 QuantiFeron Gold: $ 60.00 Hazmat Tests: $ 127.00 Testosterone: $ 20.00 Heml tis C: $ 55.00 0 c Total: $ 657.00 0 CD ca N x LU Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 1988 L2.b EXHIBIT 461391 t M RATES ' Life Scan Wellness Centers 2098 Polk County Comprehensive Physical Exam o Physical Exam(NFPA 1582 Compliant) included 0 Vision (Titmus) included Hearing Exam included o 0 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 included76 Carotid Arteries Ultrasound included Aortic Aneurysm Ultrasound included 0 Pulmonary Function Test included C Cancer and Disease Assessment . Thyroid Ultrasound included Liver, Pancreas, Gall Bladder, Spleen, & Kidney Ultrasounds included Bladder Ultrasound included Pelvic Ultrasound for Women (external, Ovaries and o Uterus included Testicular Ultrasound for Men included Prostate Ultrasound for Men Included Blood and Laboratory Tests - QuantiFeron Gold (TB Blood Test) included _ Hepatitis C Test included Hemoccult Test included cv Urinalysis included Lipid Panel included x Diabetes Tests(Hemoglobin AlC and Glucose) included Complete Blood Count included Comprehensive Metabolic Panel included Thyroid Panel included PSA(men) included CA-125(women) included Packet Pg. 1989 L2.b QuantiFeron Gold included LO Testosterone(Men) NEW for this RFP (added $20.00) included LO Fitness Program (NFPA 1582 Guidelines) Fitness and,Agility Evaluation - included Body Composition Analysis included o StretchingfFlexabilitylEndurance Analysis included Nutrition and Diet Recommendations - included Personal Fitness Recommendations included o Medical Clearances E OSHA Respirator Medical Clearance included Firefighter Medical Clearance -included w 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 x $55 Hepatitis B Test $55 Hepatitis A Titer $30 0 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 cv cv r9 LLJ Packet Pg. 1990 L2.b Exhibit 2 Life Scan Wellness Centers MONROE COUNTY 2018 Comprehensive Physical Exam $ 395.00 LO Physical Exam NFPA 1582 compliant) included LO Comprehensive Hands-on Physical with Vital Signs Vision (Titmus) included Audiometry included Skin Cancer assessment included c Mental and Behavioral Health Questionnaire included Sleep Disorder Questionnaire included Personal Consultation with review of testing results included Cardio Pulmonary Assessment c Echocardiogram Heart Ultrasound included E Resting EKG included Treadmill Stress Test with EKG included Carotid Arteries Ultrasound included Aortic Aneurysm Ultrasound included Pulmonary Function Test s iromet included Cancer and Disease Assessment Thyroid Ultrasound included Liver, Pancreas, Gall Bladder, Spleen, & Kidney Ultrasounds included Bladder Ultrasound included Pelvic Ultrasound for Women Ovaries and Uterus included - Testicular Ultrasound for Men included c Prostate Ultrasound for Men Included N 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 ca Fitness Evaluation NFPA 1583 Guidelines Aerobic Capacity Evaluation included Body Composition Analysis included Muscular Strength Evaluation Muscular Endurance Evaluation E 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. 1991 L2.b Exhibit 2 LO m LO CO Additional Tests Available Chest X-Raywith Radiologist review 65.00 Lumbar X-Raywith Radiologist review 65.00 Hepatitis A Test(antigen) 55.00 0 Hepatitis B Test(antigen) 55.00 E 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 0 OSHA Respirator Mask Fit Testing (Portacount) 35.00 Cholinestrese and Heavy Metals (Hazmat) 120.00 QuantiFeron Gold (TBlood Test for TB 60.00 PPD Test 15.00 The Life Scan Pricing is based on Location being provided by the City, County, or Union. A surcharge will be added based on the operational cost for Life Scan to provide space or increased cost of on-site locations. c CO cv cv r9 x Packet Pg. 1992 1.2.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 to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. to to PRODUCER C eCT Linda roves Wilson Insurance,Inc. 114PAUEON& 727 53 5 d__ _"® FAx 72 3 9 1475 Belcher Rd S L cindaOoewilson.com Largo FIL33171 0, 1Y O A. Auto-Owners Auto-Owners Insurance Company '18988 INSURED Admiral Insurance CO any 285 Life Extension Clinics,lnc.DBA Life Scan Wellness Centers T ns o, tIon Insurance Co „pang R,. ..__ 12408 1011 N.Macd1II Ave Tampa FIL 3607 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: E THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 0) 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. iL TYPE OF INSURANCE LIMITS X, COMMERCIAL GENERAL LIABILITY %1.000,000 _. DAMAGE TO RENTED A CLAIMS- X vccuR m - . �1!0 {100 _ X X 062312-20690745 111101201 f 1111012020 1.10,900 9? QO .2 19N9&A RV00 trL AGG TE LIMIT I PER N T F DD LILYPF JE LOCI 1 - `MIAt�pAA .. I $ OMOBILE LIABILITY_ C MBINED SINGLE LIMIT $1 coo A A O i BODILYINJURY(Perperson) $ uj ALL OWNED SCHEDULED P _:. Auros os X X 4159162 00 911812019 091181 020 BODILY INJURY(Per a denl"I $ HIRED AUTOS OS PRO ....................AMAGE $ cJ AUMBRELLA LIAS, UR Fi�+C:w:aD 2.$ LESS r ;'IN � AT r O ..WORKERSCOMPENSATION _. X I�LI D PLOYES'LI I ANY PROPRIETORIPARTHERIEXECUTWE EL E&fla.C"DENT �"..;i.l.'000'000 C OFFOCERIMEMBER CLUDED? MN NIA X WC 6 56600287 111 12019 1112912020I (Mandatory In NH) Oi"G a Ca.EJiPI.Qjf.11,00 <0 N .describe undue 1 000,00 Medical Professional Liability E0000037691-03 0513112019 051 112020 2, 00,000 Aggregate _ Retroactive Data.513112001 12,000,000 Each Claim 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 Ap¢ AQ With repect tow perfo the Insure . BY DA Medical Professional Liability Additional Coverages., W,AIV NIA )� Sexual Abuse ,000,000 Each Clai 1 1,0 0,000 Aggregate Network,SecurlbLEa P'riyac Lla ill 1 00 000 Each Clai f 1 000,000r 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 (B 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 Pg. 1993