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Item C15 C.15' i�` County of Monroe �y,4 ' ?, "tr, BOARD OF COUNTY COMMISSIONERS Mayor Michelle Coldiron,District 2 �1 nff `_ll Mayor Pro Tem David Rice,District 4 -Ile Florida.Keys Craig Cates,District 1 Eddie Martinez,District 3 w Mike Forster,District 5 County Commission Meeting March 17, 2021 Agenda Item Number: C.15 Agenda Item Summary #7920 BULK ITEM: Yes DEPARTMENT: Emergency Services TIME APPROXIMATE: STAFF CONTACT: James Callahan (305) 289-6088 NA AGENDA ITEM WORDING: BOCC approval for the second 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 for the period 03/21/2021 through 03/20/2022. ITEM BACKGROUND: MCFR is seeking approval to renew our existing contract with Life Scan for the second of two (2) optional one-year terms. By opting to renew the contract for an additional year, the current cost of$395.00 per physical will remain the same and will avoid any 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$395.00 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: BOCC approval on 03/21/2018 (Item C.7)provided for an initial 2-year term with the option to renew the contract for two (2) one-year terms. BOCC approval on 04/15/20 (Item D.3) for the first of two optional one-year terms to expire on 04/15/2021. CONTRACT/AGREEMENT CHANGES: Life Scan contract extension for second of two optional one-year extensions. STAFF RECOMMENDATION: Approval Packet Pg. 530 C.15 DOCUMENTATION: Life Extension Clinics - 2nd Renewal Expires 3-20-2022 Life Extension Clinics - 1st Renewal Expires 4-15-2021 Life Extension Clinics - Original Agreement Expires 3-20-2020 Life Scan COI - Received 02-25-2021 FINANCIAL IMPACT: Effective Date: 03/21/2021 Expiration Date: 03/20/2022 Total Dollar Value of Contract: $69,200.00 Total Cost to County: $69,200.00 Current Year Portion: $69,200.00 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, attached Additional Details: Refer to the notes below. A total of$69,200.00 is currently budgeted in FY21 for Annual Physicals covering approximately 175 career and volunteer firefighters at$395.00 each. 03/18/21 141-11500 - FIRE& RESCUE CENTRAL $52,000.00 Annual Physicals 03/18/21 101-11001 - MEDICAL AIR TRANSPORT $6,800.00 Annual Physicals 03/18/21 404-63100 - FIRE& RESCUE KW AIRPORT $5,200.00 Annual Physicals 03/18/21 148-12000 FIRE& RESCUE COORDINATO $2,800.00 Annual Physicals 03/18/21 001-12001 FIRE ACADEMY $1,200.00 Annual Physicals 03/18/21 148-14000 FIRE MARSHALL $1,200.00 Annual Physicals Total: $69,200.00 REVIEWED BY: Pedro Mercado Completed 03/01/2021 8:47 AM Packet Pg. 531 C.15 James Callahan Completed 03/01/2021 11:03 AM Purchasing Completed 03/01/2021 11:34 AM Budget and Finance Completed 03/01/2021 3:04 PM Maria Slavik Completed 03/01/2021 3:17 PM Liz Yongue Completed 03/01/2021 3:46 PM Board of County Commissioners Pending 03/17/2021 9:00 AM Packet Pg. 532 C.15.a E SECOND RENEWAL AGREEMENT CONTRACT FOR SERVICES LIFE EXTENSION CLINICS,INC. MONROE COUNTY THIS SECOND RENEWAL AGREEMENT is made and entered into on the 17th day0. - of March , 2021 by and between MONROE COUNTY, a political subdivision of the State of Florida whose address is 1100 Simonton Street, Florida 33040 (hereinafter referred to as "County"), and Life Extension Clinics Inc., a business having its primary business location at: W 1011 N. MacDilI Ave.,Tampa, Florida 33607 (hereinafter the "Contractor"). WITNESSETH: WHEREAS, on the 21" of March 2018 the parties entered into an agreement (hereafter Original Agreement) for the provision of physical examinations for Monroe County Fire Rescue staff,and 0 WHEREAS,the Original Agreement provided for two (2)one-year renewal terms; and WHEREAS,pursuant to the terms of the Original Agreement,the Contractor has informed the County in writing of its desire to renew the Agreement; and ca WHEREAS, the parties find that it would be mutually beneficial to enter into this first N renewal agreement; N NOW THEREFORE, IN CONSIDERATION of the mutual promises and covenants set y forth below,the parties agree as follows: 0. LU Section 1. In accordance with Paragraph 2 of the Original Agreement, the County exercises the option to renew the Original Agreement for the second of the two(2) one-year terms. This term will commence on March 21,2021 and terminate March 20,2022. Section 2. Except as set forth in Section 1 of this First Renewal Agreement, in all other respects, the terms and conditions set forth in the Original Agreement remain in full force and effect. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK. X Packet Pg. 533 C.15.a E IN WITNESS WI ERI O1', each party has caused this agreement to be eXCcuted by a duly authorized representative. (SEAL) BOARD OF COUNTY COMMISSIONERS 01 A"I TF ST: KEVIN ILfiADOK, CLERK. OF N40NROE COUNTY. FLORIDA By 11 y ... Deputy Clerk Mayor/Chairman 0 0 LIrI L I N- SIO . NS, INC.3i # VY , t ' E€ A fi I i P � Oj ASSIST; SI ATTORNEY Date 2/24/21 0 S'I'ATE OF: r—t COUNTY OF Subscribed and sworn to (or affirmed) before me, by means of P1 physical presence or ❑ online -- cv cv notarization. on rv, ? (elate) by F cAjr t ` 6 r) (name of affiant). 1-le CISh is (personally know to me or has produced (type of' LU identification) as identification. aQ hletary Public Stets ofIond7 Jennifer L Gcannelly w tviy Commisaion GCy 327822 or re expires 04f25&/20 23 U J J X J U Packet Pg. 534 ,IWURYQ C.15.b Kevin Madok, CPA Clerk of the Circuit Court& Comptroller—Monroe County, Florida 6c~'eoe coo�4 DATE: April 23, 2020 TO: Chief James Callahan Fire Rescue/EMS Cheri Tamborski Executive Administrator FROM: Pamela G. Hanco C. X SUBJECT: April 15t'BOCCBOG meetings Attached is an electronic copy die following item for your handling: D3/I2 1st Renewal Agreement, first of two optional one-year contract extensions,with Life ) Extension Clinics, Inc. to perform annual physical examinations of Monroe County Fire Rescue personnel in accordance with NFPA 1582. Should you have any questions, please feel free to contact me at(305) 292-3550. N N LO X X cc: County Attorney Finance File 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 Plantation Key,Florida 33070 305-294-4641 305-289-6027 305-852-7145 305- packet Pg. 535 C.15.b E FIRST RENEWAL AGREEMENT CONTRACT FOR SERVICES LIFE EXTENSION CLINICS, INC.. MONROE COUNTY 01 0 THIS FIRST RENEWAL AGREEMENT is made and entered into on the 151h day of April .2020 by and between MONROE COUNTY,a political subdivision of the State of Florida whose address is 1100 Simonton Street, Florida 33040 (hereinafter referred to as 0 "County"),y }, and Life Extension Clinics Inc.,[nc., a business having its primary business location at: 1011 N. MacDill Ave.,'Pampa, Florida 33607 (hereinafter the "Contractor"). o WITNESSETH: WHEREAS, on the 2151 of March 2018 the parties.entered into an agreement (hereafter Original Agreement) for the provision of physical examinations for Monroe County Fire Rescue staff, and 0 WHEREAS,the Original Agreement provided for two(2) one-year renewal terms;and WHEREAS,pursuant to the terms of the Original Agreement,the Contractor has informed the County in writing of its desire to renew the Agreement;and ca WHEREAS, the parties rind that it would be mutually beneficial to enter into this first `_ N renewal agreement: cv LO NOW THEREFORE, IN CONSIDERATION of the mutual promises and covenants.set forth below, the parties agree as follows: X Section 1. In accordance with Paragraph 2 of the Original Agreement, the County exercises the LU _ option to renew the Original Agreement for the first of the two (2) one-year terms. This term will commence on March 21,2020 and terminate March 20,2021. Section 2. Except as set forth in Section 1 of this First Renewal Agreement. in all other respects, the terms and conditions set forth in the Original Agreement remain in full force and effect. THE REMAINDER OF THIS PAGE'"HAS BEEN INTENTIONALLY LEFT BLANK. Packet Pg. 536 C.15.b E gggq 4N WITNESS WHEREOF, each party has caused this agreement to be executed by a duly author g representative. � BOARD OF COUNTY COMMISSIONERS ATTEST JKEVIN MADOK CLERK OF MONROE COUNTY FLORIDA o i=�` By By:` Mayo Chai n a Deputy Clerk 0 s a LIFE- • tSIO 6 ''LINICS, INC. •N CD M :j ,�.. _> Title. -C T !__J o O �atr Notary Pub6C Sgti of F*Wa ??'ATE O�: __ oi"I G� JeWer L Canneby My Commission GG 927822 COUNTY OF: Hi 1 )!;I , 0 1, U Subscribed and sworn to (or affirmed) before me, by means of 0 physical presence or CI online -- cv notarization, on 2co Z 0 LO (date)by (name of affiant). I-Ie s personally known to me or has produced (type of LU identification)as identification. O ROE COU r EY M:KWE S y BOARD OF GOVERNORS OF FIRE P E ASSIST. b Nry A RN AND AMBULANCE DISTRICT 1 OF �,.� F��,v«,,.�N MONROE COUNTY, FLORIDA �' t' `� _"� '` 2v By: . IN MAI�PK.CLERK ; TT Mayor/Chairperson > , DEPUTY CLERK Packet Pg. 537 C.15.b A a' CERTIFICATE OF LIABILITY INSURANCE 01/2812 zo DTTYm E THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS h® 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not conferrights to the certificate holder In lieu of such endorsements. PRODUCER ACT Cinda Groves 0.E.Wilson Insurance,Inc 727 535.0524 P 727 536-9828 1475 Belcher Rd S L cind090OW1150n.com Largo FL 33771 Auto-Owners Insurance Company 18988 INSURED iwsumg am Admi I Insure ce Company 24856 O Life Extension Cllnics,lnc.DHA Life Scan Wellness Centers I=gjg c Transportation Insurance Company 12408 ) 1011 N.Macdill Ave O Tampa FL 33607 C O COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: y C 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 CONTRACTOR 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, I TYPE OF INSURANCE L su-SHPOLICY mmmonnrffl POU EXP LIMITS X COMMERCIAL GENERAL UABILITY EACHOCCURRENCE 31i008,000 C DAMAGE TO RENTED 100 000 0 A CLAIMs.wwE ®OCCUR �y X X 062312-20690745 11/1012019 1111012020 . 10,00 C AOVS1,000,000 O sNLAGG LIMITAPP 1 SPER: 'As2.000.000 ) X POLICY JECT IN Loc P P 2 000 000 s AUrOMOBME UABILI T COMBINED SINGLE UMn $1 000 000 A X ANY AUTO BODILY UMURY(Pow paaanl S ALLOWNED SCHEDULED X X 4169162800 0911812019 0911812020 BODILY MURY(Per oeddeM) $ AUTOS AUTOS PROPERTY DAMAGE r X HIRED AUTOS N AUTOS s SCD UM13RELLALIAB OCCUR GHO.CUaI<T'NOE §,vLO r EXCESS UA13 Id y 622BEDATr WORKERS COMPENSATION x P(R OTFp1q. AND EMPLOYERS'LIABILITY YL UTIVE C OFf,CEWh1F8E°R EXC�LUDFED7� N NIA X WC 6 56600287 1112912019 1112912020 E. CIO&NMM S1,000,000 (Mandatory In NH) 331,000,000 X s desaibeunder 1 c. Y wi 1 000000 cts B Medical Professional Liability E0000037691-03 0513112019 0513112/20 2,000,000 Aggregate Retroactive Date:5/3112001 2,000,000 Each Claim C DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101.Additional Remum Schedule,may be it MIA LlCertificate holder Is additional Insured on the general liability and auto liabilityGwith repect to work performed by the insured. ( 2 Medical Professional Liability Additional Coverages: Sexual Abuse $1.000,000 Each Clalmi$1,000,000 Aggregate C Network Security&Data Privacy Liabill $1 000 000 Each Clalml 1 000,000 Aggregate CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LU 1100 Simonton St ACCORDANCE WITH THE POLICY PROVISIONS. Key West,FL 33040 AUTHORIZED REPRESENTATIVE C O 01988-2014 ACORD CORPORATION. Ail rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Packet Pg. 538 C°URTB C.15.0 00 o: Kevin Madok, CPA Clerk of the Circuit Court& Comptroller— Monroe County, Florida �R°E COUNT p� W DATE: March 28, 2018 TO: Debbie Lofberg Emergency Services 0 FROM: Pamela G. Hancock, D.C. U- SUBJECT: March 21st BOCC Meeting o Attached is an electronic copy of Item C7, Contract with Life Extension Clinics, Inc. to X perform annual physical examinations of Monroe County Fire Rescue personnel in accordance with NFPA 1582, for your handling. 0 Should you have any questions,please feel free to contact me at ext. 3130. Thank you. ca cv cc: Countv Attornev Finance File x x LU 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. 539 C.15.c CONTRACT FOR SERVICES �s Mow* THIS AGREEMENT is made and entered into on the day of 2018 by and between MONROE COUNTY, a political subdivision of the State of Florida whose address is 1100 Simonton Street, Florida 33040 (hereinafter referred to as "County"), and Life Extension Clinics Inc., a business having its primary business location at: 1011 N. MacDilI Ave., Tampa, Florida 33607 (hereinafter the "Contractor"). WITNESSETH: - WHEREAS, the County is desirous of obtaining the services of a knowledgeable and qualified individual or entity to perform physical examinations for Monroe County Fire Rescue staff, and 0 WHEREAS, the provision of such services shall mutually benefit the parties hereto and the residents of Monroe County, Florida. ) NOW THEREFORE, in consideration of the covenants herein contained, it is mutually agreed between the parties as follows: 1) SCOPE OF THE WORK: The Contractor, with the exception of a treadmill to be W \ provided by the County, shall furnish all labor, materials, equipment, machinery, tools and apparatus to perform all work or services specified in Exhibit 1, Request for Proposal (RFP) #17- 601 and any addenda to the RFP, attached hereto and made a part hereof by this reference and y hereinafter referred to as the "work" or "services". Unless expressly modified by this Agreement 0. or future amendments to this Agreement, the terms and conditions of the RFP and any addenda LU will be binding on the parties. 2) TERM: This Agreement shall become effective on the date of execution, for a term of two (2) years. At the end of this term, the County has the option of renewing this agreement for two (2) one year terms. Should the Contractor wish to renew the Agreement, it should relay that information to the County in writing at least 60 days.prior to the expiration of the 2-year term. 3) PAYMENTS: The County shall pay the Contractor for work or services provided under this Agreement as provided in Exhibit 2 to this Agreement and made a part of this U 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. LU 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, E Packet Pg. 540 C.15.c including attorney's fees arising out of or resulting from the performance of its work under this Agreement, where such claim, damage, loss or expense is caused, in whole or in part, by the act or omission of the Contractor, or anyone directly or indirectly employed by the Contactor, or anyone for whose acts any of them may be liable, regardless of whether or not it is caused in part c by a party indemnified thereunder. In any and all claims against the County, or any of its agents or anyone directly or indirectly employed by the Contractor, or anyone for whose acts any of them may be liable, indemnification obligation under this paragraph shall not be limited in any a way by a limitation on the amount or type of damages, compensation or benefits payable by or for the Contractor, under workers' compensation acts, or other related policies of insurance. The parties acknowledge specific consideration has been exchanged for this provision. 5) MODIFICATIONS TO AGREEMENT: This Agreement, together with any exhibits, task assignments and schedules, constitutes the entire agreement between the County and the Contractor and supersedes all prior written or oral understandings. This Agreement and any exhibits, task assignments and schedules may only be amended, supplemented or canceled by a written instrument duly executed by the parties hereto. 6) INSURANCE: The Contractor, at its own expense, shall keep in force and at all times maintain during the term of this Agreement: a. Professional Liability Insurance: Professional Liability Insurance issued by `a CD responsible insurance companies and in a form acceptable to the County, with combined single limits of not less than One Million Dollars N b. General Liability Insurance: General Liability Insurance issued by responsible insurance companies and in a form acceptable to the County, with combined single limits of not less than One Million Dollars ($1 for Bodily Injury and Property Damage per occurrence. C. Automobile Liability Insurance: Automobile Liability coverage shall be in the minimum amount of One Million Dollars ($1,000,000) combined single limits for Bodily Injury and Property Damage per accident. d. Workers' Compensation Coverage: Full and complete Workers' Compensation Ch Coverage, as required by State of Florida law, shall be provided. e. Insurance Certificates: The Contractor shall provide the County with Certificate(s) of Insurance on all the policies of insurance and renewals thereof in a form(s) acceptable to the County. Said Liability Policies shall provide that the Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on all policies, except for Workers' Compensation. The County shall be notified in writing of any reduction, cancellation or substantial change of policy or policies at least thirty (30) days prior to the effective date of said action. All insurance Packet Pg. 541 C.15.c policies shall be issued by responsible companies who are acceptable to the County and licensed and authorized under the laws of the State of Florida. 7) ATTORNEY'S FEES: In the event of any legal action to enforce the terms of this Agreement each party shall bear its own attorney's fees and costs. 8) GOVERNING LAW: This Agreement shall be governed, interpreted and construed 0 according to the laws of the State of Florida. 2 0 9)' COMPLIANCE WITH STATUTES: It shall be the Contractor's responsibility to be aware of and comply with all federal, state and local laws. y 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. 0 U 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 CD ca - Agreement as to which there has been delay or a failure to properly perform. The Contactor may cancel the Agreement, for good cause, upon ninety (90) days prior written notice to the County. The County retains the right to terminate the Agreement, in part or in its entirety, with or without cause upon thirty (30) days prior written notice. Any work completed or services provided prior to the date of termination shall, at the option of the County, become the property of the County. The County is only responsible for payment for (work completed or services provided) prior to the effective date of termination. E 13) INDEPENDENT CONTRACTOR: The Contractor shall perform the services under this Agreement as an independent contractor and nothing contained herein shall be construed to be inconsistent with this relationship or status. Nothing in this Agreement shall be interpreted or construed to constitute the Contractor or any of its agents or employees to be the agent, employee or representative of the County. . 14) RIGHT TO AUDIT RECORDS: In performance of this Agreement, the Contractor shall keep books, records, and accounts of all activities related to the Agreement, in compliance - with generally accepted accounting procedures, as adopted by the Department of Financial Services, as set forth in Rule 691-61.0012, Florida Administrative Code, as amended or LU 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 E Packet Pg. 542 C.15.c three (3) years after termination of this Agreement for accounting related records and for other public records, five (5) years after termination of this Agreement, or for any longer periods of time as may be required by applicable retention schedules. All books, records, and accounts related to the performance of this Agreement shall be subject to the applicable provisions of c Chapter 119 and Section 401.30, Florida Statutes. No reports, data, programs or other materials produced, in whole or in part for the benefit and use of either party, under this Agreement shall be subject to copyright by the other party in the United States or any other country. 2 0 15) PUBLIC ACCESS. Public Records Compliance. Contractor must comply with r- Florida public records laws, including but not limited to Chapter 119, Florida Statutes and N Section 24 of article I of the Constitution of Florida. The County and Contractor shall allow and permit reasonable access to, and inspection of, all documents, records, papers, letters or other "public record" materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and Contractor in conjunction with this contract and related to contract performance. The County shall have the right to unilaterally cancel this contract upon violation of this provision by the Contractor. Failure of the Contractor to abide by the terms of this provision shall be deemed a material breach of this contract and the County may enforce the terms of this provision in the form of a court proceeding and shall, as a prevailing party, be entitled to reimbursement of all attorney's fees and costs associated with that proceeding. This provision shall survive any termination or M expiration of the contract. N The Contractor is encouraged to consult with its advisors about Florida Public Records Law in order to comply with this provision. y 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 0 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 LU 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. 543 C.15.c required by the County to perform the service. If the Contractor transfers all public records to the County upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the County, upon request from the County's custodian of records, in a format that is compatible with' a the information technology systems of the County. U- r- (5) A request to inspect or copy public records relating to a County contract must be N 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 LU provide the records to the County or allow the records to be inspected or copied within a reasonable time. 0 IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS, BRIAN BRADLEY, AT (305) 292-3470 16) UNAUTHORIZED ALIEN WORKERS: Monroe County will not intentionally `a CD 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 N 1324a(e) Section 274A(e) of the Immigration and Nationality Act "INA". The County shall Ch consider a contractors intentional employment of unauthorized aliens as grounds for immediate 0. termination of this Agreement. 17) FEDERAL TAX ID NUMBER: The Contractor shall provide to the County their Federal Tax ID Number or, if the Contractor is a sole proprietor, a Social Security Number. 18) EMPLOYMENT: The Contractor shall not engage the services of any person or persons now employed by the County, including any department, agency, board or commission thereof, to provide services relating to this contract without written consent from the County. 0 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 LU 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 W placed on the convicted vendor list. Packet Pg. 544 C.15.c 20) CONSTRUCTION OF AGREEMENT: The parties hereby acknowledge that they �- fully reviewed this Agreement, its attachments and had the opportunity to consult with legal counsel of their choice, and that this Agreement shall not be construed against any party as if they were the drafter of this Agreement. c 21) CONTINUED MANAGEMENT BY THE NAMED PARTIES: Continuation of the Agreement is contingent on continued management by Dr. Anthony Capasso, Medical License #ME6951. Noncompliance with this provision is grounds for the County to terminate the 2 Agreement for default. The County can only agree to substituted management by a written c modification signed by both parties. 22) Notices - Any notice of other communication from either party to the other pursuant to this agreement is sufficiently given or communicated if sent by registered mail, with proper postage and registration fees prepaid, addressed to the party for whom intended, at the following addresses: c For County: For Contract to: Emergency Services CEO Life Extension Clinics, Inc. Attn: Chief James Callahan Ms. Patricia Johnson 490 63rd Street Ocean, Suite 140 1101 N. MacDill Avenue `a Marathon, FL 33050 Tampa, FL 33607 N N 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 E applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VII of 2 the Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681-1683, and 1685 -1686), which prohibits discrimination on the basis of sex; 3) Section . 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits y 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. 545 C.15.c financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as may be amended from time to time, relating to nondiscrimination based of disability; 10) Monroe County Code Chapter 14, Article II which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identify or expression, familial status or age; 11) Any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of,this Agreement. 24) Severability: If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, X LU condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. Contractor and County agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken ) provision. 25) Binding Effect: The terms, covenants, conditions, and provisions of this CO Agreement shall bind and inure to the benefit of Contractor and County and their respective legal representatives, successors, and assigns. N N 26) Authority. Each party represents and warrants to the other that the execution, y delivery and performance of this Agreement have been duly authorized by all necessary County 2 0. and corporate action, as required by law. LU 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 2 between representatives of each of the parties. If no resolution can be agreed upon within 30 days after the first meet and confer session, the issue or issues shall be discussed at a public meeting of the Board of County Commissioners. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as I may be provided by this Agreement by Florida law. 28) Cooperation. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, Contractor and County agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. Contractor and County Packet Pg. 546 C.15.c specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. 29) Covenant of No Interest. Contractor and County covenant that neither presently has 0. any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and the only interest of each is to perform and receive benefits as recited in this Agreement. 2 0 30) Code of Ethics. County agrees that officers and employees of the County recognize and.will be required to comply with the standards of conduct for public officers and employees. as delineated in Section 112.313, Florida Statutes, regarding, but not limited to solicitation or LU acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of U public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 31) No Solicitation/Payment. Contractor and County warrant that, in respect to itself, it ) has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working CO 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 N 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. 2 X LU 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 E any commercial liability insurance coverage, self-insurance coverage, or local government 2 insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. 33) Privileges and Immunities: All of the privileges and immunities from liability, exemptions from laws, ordinances, and. rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of . any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and LU 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. 547 C.15.c 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 a Constitution, State Statute, and case law. 35) Non-Reliance by Non-Parties: No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service or program contemplated hereunder, and the Contractor and County agree that neither the Contractor nor the County or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the ) purposes contemplated in this Agreement. 36) Attestations. Contractor agrees to execute such documents as the Lessor may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug ca - Free Workplace Statement. N N 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. E 38) Execution in Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. ' THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK. Packet Pg. 548 C.15.c IN'VITNESS WHEREOF, each party has caused this agreement to be executed by a ''duly autliofized;xepresentative. .�� : .(SEAL)' BOARD OF COUNTY COMMISSIONERS ATTEST --KEV1N MADOK, CLERK OF MONRO CO TY, F DA � a By Mayor/Chairman 2 X Mp = C.3 LIFE EX SION C LUc am a oo By�_ N Lu ) (= J-04= Title: 72,1: STATE OF FLORIDA ca COUNTY OF MONROE / CD S rn to (or affirmed) and subscribed before me this day of , 2018, by fl >/ki/t \ Personally Known OR Produced Identification N N Type of Identification Produced��/ •``1�l 1 , �/�,�/S(� � (Signature of Notary Public - State of Florida) � 1 /9 Jl�A (/��//" (Print, Type, or Stamp Commissioned Name of Notary Public) YADAVID A.�o NOTARY PUBLIC LLI y STATE OF FLORIDA Comm#GG005564 Expires 10/8/2020 COU N p E1fED S PEDRO MERCAD ASSISTANT C UNTY ,3 I Date m Packet Pg. 549 C.15.c ;4c R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)' 1 1 03/06/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI: CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE: BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEI REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject ti _ 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 CONTA ECT �-' 0. 0.E.Wilson Insurance,Inc. PHONE 727 535-0524 FAQ o. 727 536-9828 1475 Belcher Rd S E-MAIL cinda@oewilson.com O Largo FL 33771 INSURERI AFFORDING COVERAGE NAIL# U INSURER A: Auto-Owners Insurance Company 18988 L_ INSURED INSURERB: Admiral Insurance Company 24856 O Life Extensions CHI DBA LifeScan INSURERc: Transportation Insurance Company 12408 1011 N.Macdill Ave INSURER D: Tampa FL 33607 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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. 0 INSTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDY� MM/DDY� LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 U 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 PERSONAL&ADV INJURY $1,000,000 (� GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X JECT POLICY PRO LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ CD AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 CD N A X ANY AUTO BODILY INJURY(Per person) CD $ ALL OWNED SCHEDULED X 4159162800 09/18/2017 09/18/2018 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ PEXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 DED RETENTION$ $ 0) WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ANY C OFFICER/MEMBER EXCLUDED?ECUTIVE N/A X WC 6 56600287 11/29/2017 11/29/2018 E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Medical Professional Liability E0000037691-01 05/31/2017 05131/2018 2,000,000 Aggregate CID Retroactive Date:5/31/2001 2,000,000 Each Claim r DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is additional insured on the general liability and auto liability A OV D Y RISI'ANAGEMENT _ with repect to work performed by the insured. BY CJ Medical Professional Liability Additional Coverages: Sexual Abuse $1,000,000 Each Claim/$1,000,000 Aggregate DAT Network Security&Data Privacy Liability$1,000,000 Each Claim/$1,000,000 Aggregate WAIVER W, v s— X CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I 1100 Simonton St ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 AUTHORIZED REPRESENTATIVE � —" — > ©1988-2014 ACORD CORPORATIO T-""--J-" ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD PaCket,Pg. 550 Exhibit 1 C.15.c IFE SCAN c c Wellness Centers U) 00 0 RFPRESPONSE: POLK COUNTY Request for Proposal Title: CD CD N FIREFIGHTER ANNUAL PHYSICALS P 17-601 y X Due Date: CD 2 Wednesday, August 9, 2 17 2:00 p.m. EST LIFE EXTENSION CLINICS, INC. dba: Life Sean Wellness Centers 1011 North MaeDill Avenue Tampa, Florida 33607 (813) 876-0625 Patricia Johnson, CEO Packet Pg. 551 EXHIBIT Aii C.15.c titers 0 0 TABLE OF +CO1'ti TEWS x TAB 1: Letter of Transmittal TAB 2: Personnel Requirements TAB 3: Reporting Capabilities TAB 4: Mobile Testing TAB 5: Comprehensive Safety and Security Program TAB 6 Gast CD 04 ca TAB 7: Subcontractors(Attachment B) CD 04 04 TAB 8: Medical Laboratory TAB 9: Proof of Insurance TAB 10: Additional Information Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 552 C.15.c TAB 1: LETTER OF TRANSMITTAL 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 Authorized Representative: Patricia,Johnson,CEO 0 Email: lifescanhc@aol.com ) Incorporated: Florida.,August 1998 Medical Director: Anthony L.Capasso,M.D.,P.A. Medical License: FL ME69518 To: Polk County X Re: Request for Proposal: Annual Firefighter Physicals Solicitation#: RFP-17-601 Due Date: August 9,20017 at 2:00 PM Local Time 0 ADDEEN UMS: Life Scan acknowledges receipt of Addendum#1 Can 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. ca Life Scan proposes to provide an on-site program at a location designated by Polk County with the '✓ options to utilize any of our other Life Scan Centers as needed. An on-site program can help to ensure an expedient time frame for services as well as provides an option to keep employees on-duty resulting in a `V 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 2 over nineteen years' experience in the development and implementation of proms for state, municipalities and counties to fit their specific needs. We have recognized the vital importance of LU combining the key components of health,wellness,and fitness to generate the healthiest,most productive employees. LHIC, SCAN PUBLIC SAIFETY PHYSICALS Life Scan 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 other potentially catastrophic illnesses. Our Life Scan model of"ultrasound-aided physical exams" for Public Safety Officers has been incorporated into the medical standards for over 150 fire service and law enforcement departments. As a result, we have the proven ability to identify cardiovascular disease, aneurysms,diabetes,and cancer more accurately and in much early-stages in the disease..process resulting in a substantial, long-term disability, absenteeism, and health care cast savings to the employer and the potential for lives saved. X 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. 553 C.15.c and officer has almost tree tunes the incident of Dart disease, lung disease, and cancer and dies an average of 12 years before other public employees. With the ever-increasing occupational medical risks, counties and cities must look towards new methods of prevention and intervention to protect the health and ensure the longevity of their most valuable 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. 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, a decrease stress and stress-related Health and emotional problems, and greatly reduce the incidence of work related illnesses and injuries. o Life Scan has a distinctive approach to occupational medicine, The Life Scan public safety physical is an N 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 acomprehensive fitness evaluation based on NFPA 1583 ca and the WFI recommendations. Our clinical exercise physiologists have the expertise and experience to assess the physical fitness levels of each employee in relationship to their cardiovascular and overall health condition. Our physiologists will recommend fitness goals and a Fitness Prescription as well as diet and nutritional improvements, r9 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 0. 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. Sincerely, R _ CJ Patricia 3o n,CEO x LU Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 554 C.15.c THE FOLLO MlNG SECTION SHOULD BE COMPLETED Alf ALL PROPOSERS: (SUBMITTAL PAGE) o Company Name: �µ A- ro � DBAIFicttious Name (if applicable): NOTE: COMPANY NAME MUST MATCH LEGAL NAME ASSIGNED TO TIN NUMBER.. CURRENT W9 SHOULD BE SUBMITTED WITH BID. - TIN#: ` N Mca�L, F),dt ±Ualor a n LU (Street No or PO Box Nu ber) (Street Pa me) (City) L Ly LIQ 0 cplc-\ 0-0 0 ML, F (County) j (State) (Zip Code) � Contact Person: R T- c Y , o - Phone Number: _ Cell Phone Number. cV Email Address: °- �f- S"'co i - -,a-) c , co W) cV Type of Organization: Sale Proprietorship Partnership Non-Profit Sub-Chapter Jolnt Venture � Y Corporation LLC LLP E Publicly Traded Employee Owned ,Fl0 State of Incorporation .. The Successful vendor must complete and submit this section prior to award. The Successful vendor must invoice usfng the company name listed above. X 24 Revised G&W 7 Packet Pg. 555 C.15.c July 31, 2017 POLIO COUNTY, A POLITICAL SUBDIVISION OF THE STATE OF FLORIDA A ADDENDUM #1 .FP #17- 01 Firefighter Annual Physicals This addendum is issued to clarify, add to, revise and/or delete items of the RPP Documents for this work. This Addendum is a part of the RFP Documents and acknowledgment of its receipt should be noted on the Addendum. Contained within this addendum: Aced/Replaces Ken gush ca Procurement Specialist CD Procurement Division! CD This Addendum sheet should be signed and returned with your submittal. This is the only acknowledgment required. Aptt Signature: Printed Name: Tale: Company. tJ J Packet Pg. 556 C.15.c FIREFIGHTER ANNUAL PHYSICALS t3L"1 ND[am #1 ADD/REPLACE 0 Notice of Request for Proposal 0 "RFP packages may be obtained from the Procurement Division, 330 'llMl'est Church Street, Room 150, Bartow, Florida, 33830, (863) 534-6757 or downloaded from our wehsite at °/ cl � n ,n c ite/loin pines ids. Respondents must submit one (1) c rlginai and Seven �7) copies of the proposal prier to 2:00 p.m. on the receiving date. Proposals must lae submitted in a �sQaled" parcel. Proposals will be publicly opened and read at 2:00 p.m. an receiving date." Replace:with. "RFP packages may be obtained from the Procurement division, Boom 150, Bartow, Florida, 33830, 330 West Church Street, {863) 534757 or downloaded from our website at his:/1 cl � cC ) co r11 a rnen our nods, Respondents must submit one �1) a o " lnal and Seven p" of the proposal prior to 2;00 pp an the receiving date. Proposals must be submitted in a "sealed" parcel. Proposals will be publicly opened and read at 2:00 p.m. on receiving date." N N x LU x LU Packet Pg. 557 C.15.c TAB 2: PERSONNEL REQUIRENIMNTS COMPANY QHALI�+'ICATTONS-General Corporate: c Number of years in business: 19 years Medical Director: .Anthony Capasso,M.D. Plumber of years in practice: 23 years 0 Number of years as Medical Director for Life Scan. 13 years ) 2 0 Life Scan's specialty and background is in the area of prevention-based occupational, medical services for government agencies with a specialty in public safety. We have over fourteen years experience in the development and implementation of programs for county, and state public safety departments to fit their specific needs. We have recognized the vital importance of combining the key components of health, wellness, and fitness to produce the healthiest, most productive employees.. After researching and developing a program that is specifically designed 2 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 government clients) and offer on-site services to over 150 government agencies in Florida and the Southeastern states. The Life Scan program provides annual fit for duty and post offer exams, respiratory protection programs, vaccines, and general employee exams at the same time integrating a model of early detection and prevention. Life Scan is currently providing the following services to over 150 County, and Municipal,and ca State government agencies: N • NFPA 1582 Physicals for Police and Firefighters • NFPA 1583 Fitness for Police and Firefighters y • UFFIIAFC Health and Wellness Initiative • FDLE Police Physicals • DOT and CDL Physicals • Hazmat Physicals E • SWAT Team Physicals • Bomb Squad Physic • Pre-Employment Public Safety Physicals • OSHA Respirator Physicals • OSHA Respirator Mask Fit Testing 0 • Fit for Duty Testing y • Orr-site Program for all medical,testing • On-site -racy services • On-site blood draws • Infectious Disease testing and vaccines Added value services including the Life Scan ultrasound-aided physical exams that complement to Public Safety Physical Examinations LU Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 558 C.15.c Life Scan Professional Contributions to Public Safety Health: 0 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 Scan Wellness Centers,were appointed the Medical Advisors to the • Major Cities Chiefs' Association • National Sheriffs Association FBI LEEDA • FBI National Executive Instigate - Life Scan provides Firefighter Educational. Seminars,CEU courses,and professional articles to: • Florida Fire Chiefs • Florida Professional Firefighters • Fire Rescue International • International Firefighter Smoke Symposiums • Florida.Firefighter Safety and Health.Conferences � • Florida Cancer Survivor Network CD ED CD N X X Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 559 C.15.c PRINCIPALS,MANAGEMEWO AND PHYSICIAN SUPERVISORY TEAM: Patricia Johnson, CEO. Patricia is the cc-founder of Life Scat and will be the liaison between the City and Life Scan. Patricia will oversee contractual issues, ensure proper invoicing, and 0 attend meetings. 2 0 Michael .l. Terrana, CFO. Mike is the co-founder of Life Scann and serve as corporate counsel and Chief Financial Officer.. Mike is an attorney in Tampa and started his law career as an .N assistant state attorney in Hillsborough County and was lead partner in his law firm for over � twenty years. Pam Desmaires, ' -BC, is the Life Scan Wellness Center Clinical. Director and Project Manager. She is responsible for the supervision of the medical specialists and for the continuing education as well as medical procedures and protocol for the Life Sea Wellness Center medical program. Pam will ensure quality control over medical reporting and records and manage scheduling timelines. Pam has developed the medical protocol for the Life Scam ultrasound-aided ) physical exam program and has extensive experience with NFPA 1582 guidelines and interpretation including annual and candidate medical clearances. Medical Director: Anthony Capasso, M.D. Dr. Capasso has over 20 years in private medical ca practice. He is fully experienced in workers' compensation, post offer employment physicals, firefighter and police physicals and medical clearance, HAZMAT medical clearance, occupational medicine, and internal medicine. Dr. Capasso is the supervisory medical director and advises with medical clearance review. Life Scare is a nationally recognized expert and educator regarding the health and fitness of police and firefighters. Life Scan has advised NFPA 1582 and the IAFFIIA.FC Wellness Fitness Initiative Committees regarding firefighter health and fitness. � c X Polk County RF'P 17-601 Firefighter Annual Physicals Packet Pg. 560 C.15.c CL-RRICULUM VITAE ANTHONY L. CAP SS@, WLD. Florida Medical License. ME69518 EDUCATION 1984-I987 Ohio State university, Columbus,Ohio, Bachelor of Science--Biology Cum Laude. 1984-1986 Cleveland State University, Cleveland,Ohio. N x POST GRADUATE TRAINING � 1988-1990 Ohio State College of Medicine, Columbus,Ohio 1991-1993 University of Alabama School of Medicine, Birmingham Alabama,M.D. 1993-1994 University of Florida Health Science Center,Jacksonville Florida; Internal Medicine Internship. 1994 University of Hawaii Integrated Medical Residency Honolulu, Hawaii;Internal Medicine Residency 7/l/94- 12/4/94 1995-1996 University of Florida Health Science Center, Jacksonville Florida, Internal.Medicine Residency. ca - Graduation July 1996 CD HONORS AND AWARDS cv 1 84-1987 Dean"s List 2 1985 Sumrna Award,University College, Ohio State University. 0. 1987 Graduate Cum Laude, College of Arts and Sciences,Ohio State University. 1989 Honorary Letter from the Department of Anatomy for outstanding performance, � Ohio State College of Medicine. CD 2 CERTIFICATION Diplomat of the National Board of Medical Examiners,June 1993 Diplomat ABIM, August 199$ LICENSURE _ State of Florida ME 0069518 x LU Packet Pg. 561 C.15.c MEMBERSELIPS 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 1993-1997 American Medical Association 1994-1997 ACP'Member 1.999-present Duval County Medical Society EMPLOYMENT 2007-present Life Scan Wellness Centers-Medical Director 2003-present Hospice of Jacksonville—Associate Medical Director 1997-present Smart for Life Jacksonville-Medical director 2 2002-present Anthony L. Capasso M.D. P.A.-private practice 2001-2003 University of Florida—Clinical Assistant Professor 1999-2000 Premier Family Care- Internal ?Medicine 1998-1999 Jacksonville Emergency Consultants -Emergency Medicine 1997-1998 Premier Family Care-Local Tenum 199 -1997 South Beaches Medical - Internal Medicine 1996-1998 Barnen Venus M.D.P.A. CCU intensivist CD CD ca N Packet Pg. 562 C.15.c po DEpkij,Ml 4T'CIF`HEALTH . .` DIVISION OF MbfcAL QOALrry Assum I E ?ATE OCENSE NO., CONML NO. LO — � v t11D31Z815 ME 69518 SA8182 . he NI1xDICAL DOCTOR ierntid bekAv has met all requlrerii ft of ® js � � he Ims and rum offt state of Floi^Ida. �I iplr€l# Date. JANE.EA,R' , 2010 I<+ITI•lihe'Y L CAPASSO 1351 13TH AVE SOUTH SUITE 110 � �" ' ' " , 1ACi'C9OMLLE BEACH FL 32250 0 .-. ,� 4* U) Rick Scoff V Johns H.Armstrong,MD, FA GOVERNOR STATE SURGEON GENERAL. 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A.ifyw do nw.know yowr„ter ID and l+��dr Leaft Help?'yr roll*w Cua r ContectCenter at(BStll iiEi-tlru9S reraaaiatatNee, MAIL TO;DERARR I'MENT OF itEAl.'1 H 1a RIM OF MEDICAL QUAL17"ASSURANCE IMPORTANTANNOUNCEMENT LICENSU1E SUPPORT SERVICES UNIT THE DEPARTWIENT OF HEAL WILL NOW REVIEW P.O.Box YOUR CONTINUING EDUCAT RECORDS AT TALLAHASSEE.FLORIDA 32314■i= THE TIME OF LICENSE REN AL. NAME CHAT OR(ATTACH LEGAL DOCUMENTATION) TO LEARN MORE.PLEASE>AS FROM: - --- TO ,1ST I iST IINDCLE Packet Pg. 563 C.15.c Pamela L. Desmarais, MS, ARNP-BC Certifications Registered Nurse Practitioner In the State of Florida,license number 25512ARNP Certified Adult Nurse Practitioner from the American Nurses Credentialing Center Registered Nurse in the ate of Florida and Massachusetts Basic tlfe Support(BLS)Certification ) Basic Life Support Instructor Advanced Cardiac Life Support Highlights • American Nurses Association (ANA) • Completed AAAASF accredltations • Florida Nurses Association (FNA) * Completed two JCAHO accreditations Professional Experience Life Scan Wellness Centers c 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, medication, smoking cessation, physical activity, and disease management Promote health screenings and healthy living. ca Clinique of Plastic Surgery 2008 to 2012 CD W N 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. Unlverslly of South Florida 2003 to 2012 Adjunct Faculty Instructor for College of Nursing CD 2 ManGadls Plasdc S'urpry 2005 to 2006 ARNPJPractice Manager Expertly managed all surgery services, including planning, scheduling and coordination,determination of procedures and procurement of supplies and equipment.Assessed need for,ordered,obtained and Interpreted appropriate lab tests. Provided pre intra-PACU care to surgical patients. Managed clinical and 0 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 University of South Florida Master of Science,Nursing University of South Florida Bachelor of Science, Nursing Packet Pg. 564 C.15.c c 0 0 c STATT OF FLOWA , �►�Er H _ x 0 c �rrd R�4�1ttie�d FbnAe, � ,me IMMANCCca cD � w2DO4004M t#RTIPMATI ON tV 1W y 4M V2015 tb 411 W2= � Mama of LU Adult Nunm Practitioner Ammfdod to: CD POR)WR L.Dn=mb,ANP43C 2 x Packet Pg. 565 C.15.c DEANNA M. SILVA$ RIMS, RVT CLLKICAL EXPEILWNCE0. o Life Scan Wellness Centers Tampa,Florida Registered Efitrasound Technologist October 2014-present Experience performing wellness screening exams for lain'enforcement aff1CCrS and firefighters throughout the state of Florida 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 company protocols and general ultrasound training • Responsible for creating training manual,presentations,and training of new technologist Edward White Hospital St.Petersburg,Florida Registered i]Itrasound Technologist April 20124X-tober 2014 • Crossed-trained in cardiac sonography with experience m echocardiograms and TEE +� Experience scanning general,vascular,and cardiac ultrasound in a busy Hospital ) setting including in-patient,out-patient,emergency room,and operating room services Proficient in assisting in radiology procedures including PICC lines,central lines, biopsies,paracentesis and thoracentesis co cv CD cv EDUCATION cv r9 Associates of Science Central Florida institute Major:Diagnostic Medical Sonography Graduated: October 2pQ8 . • Member of the National Technical Donor Society LU (Chi.Phi Iota Chapter) Bachelor of Science University of Tampa 0) Major:Biology Graduated: May 2005 2 • Member of the National Science Honor Society _ X Packet Pg. 566 C.15.c c r 0 c AlEaA�F1A� �► , DEANNAL M SUA uj ems)FNTM mm"tfN 13E478 2A10 12i12017 4�als Ar�pf��at� U 0 ca CD J N CD N M X LU 0) 2 U X LU U Packet Pg. 567 C.15.c Reem Regno, ARMS Qualifications c • ARDMS registered in specialties Abdomen and OB/GYN. • BLS certified with the American Heart Association. 0 • Eight years' experience with patient care. • Two years clinical experience in various local hospitals and clinics. 0 • Registry eligible for specialties Echocardiography,Vascular,and Neurosonology. Clinical Experience X Lu • AB, OB/GYN,Small Parts • High Risk Perinatal Protocol • Paracentesis/Thoracentesis c • Echocardiography,TEE • Vascular, PVR ) Professional Experience Life Scan Wellness Centers Tampa,Florida ca Registered Ultrasound Technologist October 2014-Present +' Experience performing wellness screening exams for law enforcement officers and firefighters throughout the state of Florida 0. X • Ultrasound screening studies include echocardiogram, carotid arteries,thyroid, abdominal organs, pelvic,prostate, and testicular • Responsible for training and coaching all new hires as well as students in company protocols and general ultrasound training Responsible for creating training manual, presentations,and training of new tech nologist Education • Associates of Science In Diagnostic Medial Sonography N Broward College, Coconut Creek FL. May 2012 X Lu • Bachelor of Arts and Sciences In Psychology University of South Florida,Tampa FL Dec 2005 Packet Pg. 568 C.15.c c � t �1. 0 U) OW 0 COMF7C+4't oms ROM%M owim)RvT(vn ) 157�$ f R1FREDSH F ON N 2011 twi m17 °�wr m�6g1+a rtffiue�{. � _.__...._ ......... U 0 E`3 Providier, �Fla U) 1io aeon.r am�r rn. wm ma cowftvs aw am WAWAFiWm in awm&rma wth ffs msrbAm of VaAn&im N CD CD M X LU tJ X J U Packet Pg. 569 C.15.c c) DETAILED STAFFING PLAN The Life Scan program is designed specifically for public safety and the entire medical staff has extensive knowledge and experience in providing firefighter physicals. The medical staff works in teams and each of them is experienced in all aspects of the scope of 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. a 2 0 Staffing: • The Life Scam Staffing will include three (3) Life Scan employees that are fully trained and experienced in public safety Life Scan physicals using an integrated, r_ team.approach. • Each team member is a direct employee of Life Scary and has undergone extensive training with Life Scan to fully understand the technical, clinical, Life Scan procedures, and individual protocols of the assessments and medicall clearances. e • 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. ca N N N 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 _ the profession of firefighter and corrections personnel.. ACLS Certified Ultrasound Technician The Life Scan registered ultrasound technicians are fully cross-trained in all modalities of medical ultrasound and interpretation including vascular,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 education of our patients. x Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 570 C.15.c Clinical Exercise Physiologist The Life Scan clinical exercise physiologists are experienced in clinical cardiac testing and interpretation., lung capacity(pulmonary function) testing and interpretation,firefighter and correctional officer fitness evaluations, diet and nutritiort,body eomposition, and all aspects of NTPA 1582,L FPA 1583,and the W FT. All Life Scan physiologists are trained and experienced w in OSHA Respirator Medical Testing and OSHA Mask Fit Testing protocol, ACLS Certified 0 X 0 CD ca CD N X CD U Polk County RFP 17-60 1 Firefighter Annual Physicals Packet Pg. 571 C.15.c d) Six I References from other Governmental Agencies that have utilized Life Scan for e~ Similar Services: c 1. Brevard County Fire Rescue Contact:Marvena Petty 0 Phone: (321) 633-2056 x 56414 Email:marvena.petty@brevardfl.gov Performance Period: 2012 to present Number of ANNUAL physicals; 550 Service Provided: LIFE SCAN Firefighter Annual and Candidate Physicals • 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 a Hazmat and Specialty Team Physicals • On-site program for all medical testing,blood draws,and X-rays Infectious Disease testing and vaccines OSHA Respirator Physicals for Public Safety • CSHA.Respirator Mask,Fit Testing for Public Safety N 2. St.Petersburg Fire Rescue and.St.Petersburg Police Department `V Contact: Fire Chief James Lark Phone: (727) 893-7058 Email: James.Large@stpete.org Number of ANNUAL physicals: 330 Performance Period 2008 to present Service Provided: LIFE SCAN Annual and Candidate Police and Firefighters: E • NFPA 1582 and FILE Annual Physicals • Candidate Physicals for Police and Firefighters • NFPA 1583 Fitness Evaluation for Police and Firefighters • IAFFAAFC Health and Wellness Initiative - • Life Scan ultrasound and advanced medical assessments for disease detection 0 and.prevention ' • Hazmat, 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. 572 C.15.c 2. Largo Fire Rescue � Contact: Fire Chief Shelby Willis 01 Phone: (727) 587-6740-2005 Email: marvenapetty@brevardfl.gov 0. Performance Period: 2012 to Present Number of ANNUAL physicals: 125 Service Provided: LIFE SCAN Annual and Candidate Physicals: � • NFPA 1582 Annual and Candidate Physicals for Firefighters 2 • NFPA 1583 Fitness Evaluation Firefightersc • IAFF/IAFC Health and WcUncss Initiative • Life Scan ultrasound and advanced medical assessments for disease detection and prevention • Hazmat and Specialty Team Physicals • On-site program for all medical testing,blood draws,and -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 ca Contact: Assistant Chief Todd Leduc ca Phone: (954) 831-8291 or(954)321-4109 CD 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 0. • NFPA 1583 Fitness Evaluation Firefighters • IAFFIIAFC Health and Wellness Initiative • Life Scan ultrasound and advanced medical assessments for disease detection 0) and prevention • Hazmat and Specialty Teats 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 x Polk County RFP 17-601 Fitofighter Annual Physicals Packet Pg. 573 C.15.c 4. Panama City Fire Department 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 • 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 ) 5. Fort Lauderdale Fire-Rescue M 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,. x Service Provided: LIFE SCAN Annual Firefighter Physicals: • NFPA 152 Annual Physicals for Firefighters • NFPA 1583 Fitness Evaluation Firefighters E • IAFF/AFC Health and Wellness Initiative 2 CD • Life Scan ultrasound and advanced medical assessments for discase detection and prevention • Hazmat and Specialty Team Physicals • On-site program for all medical testing, blood draws,,and X-rays , • Infectious Disease testing and vaccines • OSHA respirator Physicals for Public Safety • OSHA Respirator Mask Fit Testing for Public Safety x Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 574 C.15.c Survey Questionnaire—Polk County RFP 17-MI,Fireflghter Annual Physicals To. W � � c (Nam of PGMM ragl+eft (Nan fant Company/Firm) phone Numba.. yeEmail. rip-mol t Subject an P Survoy of _ ` ' " f N c fi � y (Pry Nww) ems: to Coo of ��, �� date Cnmpitte� '* �# ��, Rate wets®f the Brit aID a ram of 1 tag 10 l t You weans TM UddW(and would mire the 8r mftil vidual*pin)and 7 that You War*very unuMed(ad woW c never hire the f nRfiW nriduai a rr). PkM raesbe each offt criteria ter the bed of year keowierige. If you da Bet have sefiidcmt kROW1040 of Pad pie foresee In a pardealar areas,iaevre it bianL Similar Work Pna ea Nam _� .� :.. ,.�...�� Fi�xi. F'��. NO CRITERIA UNIT SCORE 1 Ability to manage cost (1 } 1 Ability to maintain pro)ect schedule(complete on- time/earlyl N Quality of workmanship (1- } CD Professionalism and ability to complete exams far all Fire and EMS positions (1-ifl 5 Ability to communicate with Client's staff timely 6 Ability to resolve issues promptly (1_10 Ability to follow requirements based on National Fire � 7 Protection A;tsociatlon standards (1-10) Ability to maintain paper documentation and complete � 8timely r• � � Appropriate application of technology used for the rrblie { testt ., 10 gall Client satis ctlori and comfort level in hiring (1-20) 11 Ability to offer solid recommendations bess:d on warn result 1-10 �A Ability to militate consensus and commitment to the plan L12 of action arnnn Staff `1 ..}' { Pt'irtted.Name of Evaluator g goatum o Evalw for 4p{ Picric fIM Or Mmaii thV WMplMd SUrVey to: ' 27 aeariiar 6 Packet Pg. 575 C.15.c Survey Questionnaire--Polk County RFP 17-01,Fire titer Annual Physicals , LAB arm Maw of Kam � �. `ad� � (Name ttf .t �t mpaay�rtn) Af Subject Email: U_ Of n e, � ��...m._ .. . _�..� 0 eerk of tha ed%v'*on aKsk of 1 tO 16,WM 10 nIRM"Oft that You sere Very setbftd(sad U would hire the ftrMftdWWk4I main)and 1 rep that yem rareVM gmmtkW(sod rrMM Off"biro the 5MfindIviftal spin. Men raft neb of the CritGeria to fife best of yfrr knowledge. if � YOU da nut have=41dent knowledge of perftraasoee in a past awls tsars it bkok. ) Slmilar work P NO UNIT SCORE 0 w, 1 Ability to manage east ��-�Q? � ca Ability maitttalrt project schedulecamplets on- _ _ (1-1 ? 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U) Peet - y Cost of lso vi +�� J,Grp � � Date CMwft—Laq&L Rafe each d the cowk M sMab of 1 to 111,witlri]@ woad 6i>I+e Rr�As met YM'care very=ds�(w 1�d l atJ�yrert wee very» ( weaW e 'Mw hire the th1w Ngft� Plims raft each af'tbe to the beet Qr7arrr lunwileftc U i"do wt ba" JaeMier of Pat J In a Pwftlar M14 lee"it b humL S4itniler`W'otk Phdm Nwme: i3�e NQ C.tTEgJq - tFi f SMIE tJ 1 Ability to manage cost U Ab11lty to maintain project :hedule ttinplete on - } } ca tirn earl ?1D} CD W N Qualityr cif worlttnanship CD n, (3-liJ} 4 Professionalism and ability to complete exams for all Firee and EMS podtkft 10 v, 5 Ability to communicate with iriient`s staff timely � 6 Ability to resolve Issues.prom r - (�-1.()} LU 7 Ability to follow requirements based on National Firer -PrOftWon Association standards - �) $ AbtilCy to matntatn paper rrrtacurnerttetJt+nand complete °' timely [1ti} Appropriate application of WON wcnWHW used for the mobile 1-113} Overall Client satW ctlon and comfblt level in hfring Al�any to comer solid recornritindadons based On-exam v, result (110} Ability to facilitate consaws and corn nment to the;p*Ian Vf acWn arnongs ff ' a P&Wd Nme of'Evaluaor Si of a�ltactor Plcasc hz o<�l the cOMPIEW survey to.- � w 7 o Packet Pg. 578 C.15.c Surrey Question alm Polk County RFP 17-0 ,Firefigliter Anumd Physic TO, �.+� Rmama �- of Persatx as a y) (N ofClian paay/Firm) 0 Ph"a Number: � r"V A U- Subjwt Past Pesrto:mannri buruey of " '� °', 7'�Cf'�s"� cllnte4, 'cn X Croat of Sa vice& ( toe Coaplait- � Rate eaA of dw aftak an a stak of l tol 10,with 10 c re�aeattfog that you rvetse waxy satiffied(sad would hire the firmfindkWal main)sad I rOPMendug that you Men Vary unsatialled OM would never biro tie firmfiDd l&ai again). PIMO rate oath of tlw erkerk to the but of your knowledge. It � you do not haw+wafffdeat knwbdge of peat Verformuce is a particular arts,leave ft spit. Similar Work Pnde ct Name: f � Gmspiak: U NO CRrf EM umrr scow U i Ability to manage cost 0 Ability to maintain project schedule(complete on- tirz ,lea1-gyp) 3 1 Quality of workmanship -1-10) CD Professionalism and ability to complete exams for all Fire and EMS posMans (1-10) 0 74 5 Ability to communicate with Client's staff'timely 6 Ability to resolve issues promptly -� j Ability to follow requirements based on National Fire � Protection Association standards { - ) CD S Ability to maintain proper documentation and complete timely (1-20) 9 Appropriate application of technology used for the mobile te$tinili _1pj - 10 OvOrall Client satlsfactlon and comfort level In hiring (1-�) -- D 11 Ability to offer solid recommendations based on exam � result (1-10) /r . 12 Ability to facilitate consensus and commitmnt to t ehe plan ca of action anion C1-iQ� tl c . - v, Printed Name of Evaluator ` " —.u`' --x Sigma off EvaluatorLU It _ Ple an fex or mTWI the completed survey To! T�^ �' -�+� �t keO 2'7 s � X Packet Pg. 579 C.15.c Survey Questionnntre Folk County r ` RFP 17.601,Fhvfthter Annual Phyaic is Lau d4dae W 04arne of Pmon completing suWey) (Name of Client Company/Firm) Phone Number-, 6-q- i`m- k� L. subjects Past Performance Suray of. _ cost of Services: D"31 J, crb (Pir',lact Complete,mplete: 1-t late e#ciw of the n teria O a Nab of l to ill,wilt 10 reprumdug dMt you warm very eatbiled(aad would hire tbifirmAndiviftal again)gad 1"PrOscuft that You were very tamtlsEled(and would now bire the fl Mual again Please rate each of the txlterle to the beet of your knowle ftc if � You do not bane auflldent knowledge of past performance In a particular area,leave It blank. Similar Work Project Name: Date Completed., NO CRITERIA - UNIT SC—OR—El 0 1 Ability to manage coast (1.10) 10 - ca W Ability to maintain project schedule(complete on- CD N tirrteJearl (1-10, 1CyCD 3 Quality of workmanship Professionalism and ability to complete exams for all Fire y and EMS positions C) 0. 5 Ability to communicate with ClIenVs staff timely ( . ) lb LU 6 Ability to resolve issues promptly 7Ability to follow requirements based on National Fire Protection Association standards 10 Ability to maintain proper documentation and complete timely (110� ) _ 9 Appropriate application of technology used for the mobile -- testing (1-10) iv --- 10 Overall client satisfaction and comfort level In hiring (1-101 I� � 11 Ability to offer stand recommendations based on exam result (1-10) t 1 Ability to facilitate consensus and commitment to the plan of action among staff .N Printed Name of Evaluator Si Evaluator Pl=c fax or email the completed Survey to: 7 Re*w t dwm Packet Pg. 580 C.15.c c 0 0 c 0 ca CD cv CD cv cv r9 x LU LU Packet Pg. 581 C.15.c TAB 3: REPORTING CAPABILITIES .,All Life Scan reports are customizable based on the individual needs and requirements of each department. Employees: 0 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,EIS. , exercise data, e ultrasound reports and images of abnormal studies,patient educational handouts, and personal. wellness plan.. X Polls County Fire Rescue: • PCFR will receive a FIT FAIR DUTY exam report and results of Hepatitis Titers/Screenings within 14 days of the exams. • Final Evaluations will be reviewed and signed by a licensed Physician,NP, MSN,or PA. • PCFR will be notified by phone within 24 hours for any employee that:is found to be NOT FIT FOR DUTY, to Reporting Samples include: CD W N CD • FIT FOR DUTY/OSHA RESPIRATOR MEDICAL CLEARANCE • OSHA MASK FIT TESTING REPORT X Lu Life Scan will provide samples of patient chart forms and patient results upon request. X Lu Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 582 - - C.15.c FLIFE CAN FIRE DEPARTMENT CLEARANCE FORM AND OSHA RESPIRATOR CLEARANCE Wellness Centers Employer:- OL.K Ct) 'TY'FIRE RESCUE Patient Last Name-._ First Name: - - D Patient.IIIISS : - _ Exam Date: D EMPLOYEE MEDICAL QUALIFICATION. The examination of this employee must include a complete � f physical examination at a level of specificity in accordance to 2013 N.F.P.A. 1582 guidelines with the purpose of determining whether there is any medical or physiological reason that may impair the employee's ability to perform the essential functions of his or her job. Disabilities,impairment,or limitations identified by the examination,which would prevent the employee from performing,the essential functions of the position,will be reported to their . employer.The reviewing medical personnel should note all abnormalities which might predispose the employee to 5 injury or aggravation of the condition due to the nature of the duties and tasks retluired 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. c ❑ MEDICALLY QUALIFIED WITH THE FOLLOWING RECOMMENDATIONS: - ) medical examination,l find this ❑ NOT AMICALLY QUALIFIED. Based on the results of the annual O ca individual is NOT CLEARED under O.S,H.A. 1910.156,O.S.H.A. 1910.134,O.S.H.A. 1910.120 W regulations and the guidelines set forth by 2013 edition of N.F.P.A. 1582. ca This patient must be examined by a medical specialist for follow up evaluation and final clearance. CD The evaluation should include confirmation,diagnosis,and/or treatment of the following: CD cv c44 OSHA RESPIRATOR CLEARANCE.- This medical evaluation determines any limitations as described in LU ®.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 m 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. NOT MEDICALLY QUALIFIED TO WEAR A RESPMATOIL 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. x LU Medical Practitioner information: Print Ivan= "Signature: Anthony L.Capasso.MR.P.A. � Medical Der Uonse Number:ME 69518 Packet Pg. 583 C.15.c LIFIE SCAN RESPIRATOR MASK FIT CLEARANCE FORM Wellness Centers Employer:. POLK COUNTY FIDE RESCUE Date: c Employee Information. - List Name. First Name: 0 ID/SS#. DOB: Occupation: 0 Mask Fit Test (For Clinical Use Only Respirator Medical Clearance: ❑ Pass ❑ Fail Date of Medical Clearance: Vision Correction,Required. ❑ Yes ❑ No LU If yes,what type correction used when wearing a respirator: ❑ Contact Lenses ❑ Masses ❑ None 0 Fit Testing_Results (For Clinical Use Oulv) -- Test Date: Test Completed: ❑ Yes ❑ No ) If No, give reason: Respirator Type. ❑ N95 Paper ❑ Full Face Negative Pressure ❑ Half Face Negative Pressure ca CD Make: Model: N Style: Size: Mask:Fit Test Date: _- - Fit Test Protocol Used: QMARtitative ❑ PortaCount Model Number: Serial Number: ❑ Dynamics Occupational Fit Tester Model Number: -__ Serial Number; E Overall Fit Factor: ❑ Pass ❑ Fail Notes: (For Clinical Use Only) Comments: Signatures x Print Patient Name Patient Signature Print Clinician Name Clinician Signature Packet Pg. 584 C.15.c TAB 4 MOBILE TESTI G a) Mobile Testing Location: Strategies: c + Life Scan has the capability, experience,direct full-time medical staffing,and equipment to provide can-site physical exams at on-site location(s)provided by Palk County Fire Rescue. All set-up,equipment,and associated costs will be the responsibility of Life Scan.. + All equipment maintenance will be performer)by Life Scan and will be kept clean and sanitized. All equipment will be kept in optimal working order or repaired/replaced within a reasonable time frame. Life Scan maintains backup of all equipment as well as service contracts to ensure timely replacement as needed. .Life Scan has the proven capability of providing all services on-site within time 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. Co owned by Life Scan. The equipment is portable and easily set up by the Life Scan CD staff04 04 Life Scan will bring portable exam tables as well as all the equipment necessary to completely provide the comprehensive medical and fitness exams. • Ultrasound Units: Terason o EKG Stress Units; Welch Alyn,Laptop computer based • Treadmill: will be a stationary unit at the Palk..County Fire Rescue locations E c Fitness Testing equipment:provided by Life Scan • .Audiometry Equipment: Welch Alyn audiometer a Vision: Titmus Vision Screener o X-ray: On-site mobile services (ML ob lex) • Blood draws at any LabCorp Patient Service Center in Florida or on-site at location(s)provided by FCFR X Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 585 C.15.c b), Scheduling Timeline: 1. Scheduling: Patient scheduling will be coordinated by PCFR to meet the needs of the department. The hours of operation, number of days and program dates will be determined by PCFR according to shifts/work hours of the employees and the number of annual firefighter physicals required, 2. Life Scan will be able to proceed AAb the scheduling of physicals can October 1, 2017. A. Life Scan will schedule 9 patients per day, 5 days per week (45 patients) in consecutive weeks to accommodate the successful completion of annual firefighter physicals. B. Example: 0 1. 450-500 physicals f 9 per day= approximately 11 weeks to complete the program- � a. Additional days will be provided as necessary to accommodate ) completion of all firefighter physicals at no additional cost to the County. ca 2. Implementation Strategy CD CD A. Phase 1: Site visit with PCFR by Life Scan management team 1. Discuss program components and requirements 2. Determine space requirements and coordinate on-site program a. Minimum 4 rooms with waiting area 0. • Physical exam • Cardiopulmonary/fitness evaluations ■ Ultrasound exams 0) • Hearing and Vision area. 2 3. Plan time line 4. Review and approve Patient Packet 5. Review and approve blood draw program and.LabCorp requisitions 6. Review Fit for Duty and.Respirator Medical Clearance Reports 7.. Review and approve reporting system . B. Phase 2: Schedule dates for blood draws and physicals U 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 LU U Palk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 586 C.15.c c. Each physical exam will require 3 hours (3 patients will rotate between 3 portions of the program including ultrasound, physical, and cardiopulmonary/fitness. c C. Phase 3.Blood draws (2-5 weeps prior to physicals) 1. On-site at any location(s)provided by PCFR. 2 0 2. LabCorp Patient Service Centers a. Phlebotomists are certified technicians b. Facility meets all requirements established by DOT and is Properly licensed. LU 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 E. Phase 5: Reporting per PCFR Requirements In c) Scheduling Timeline for second fiscal year: Same formula as above within 12 months W after the initial physicals. N X LU CD 2 X LU Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg. 587 C.15.c LIFE SCAN CCMMPREHENSPVE SAFETY AND SECURITY POLICY The Life Scan Comprehensive Safety and Security Policy is a safety management plan _ designed to maintain a safe environment free of hazards and reduce risk of injuries for patients and employees. a. Processes:for employee safety and.security; 0 1. New employee orientation and education program and annual recurrent tr ,in%ng that addresses Safety Procedures: i. Blood borne pathogen policy(Exhibit A) I Biohazard waste policy(Exhibit B) - iii. Fire Safety X b.. Processes and procedures for facilities and equipment security 1. Life Scan will coordinate with the on-site facility manager to determine what County procedures and processes are for specific site as well as best manner to secure equipment during program. c. Emergency Preparedness Pfau. � 1. Life Scan will coordinate with the ran.-site facility manager to determine what U, County procedures and processes are for specific site. d. Safety Equipment E ui ment 1. Life Scan routinely maintains and tests all equipment. Any equipment utilized `a will be tested prior to program start on-site. CD CD e.. Reporting to County Risk Management regarding accidents and/or damages 1. Life Scan management will receive any accident or damage reports and report y 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. a, 2. Life Scan stares all patient records in a secure facility in their corporate office with access limited to authorized Life Scan employees. 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. c X c Polk County RIFP 17-601 Firefighter Annual Physicals Packet Pg. 588 C.15.c EXHIBIT A LIFE SCAN WELLNESS; CENTERS SAFETY DEPARTMENT SUBJECT: LOODBORNE PROVED BY: EFFECTIVE REFERENCE: PATHOGEN EXPOSURE Patricia Johnson, � DATE: � CONTROL PROCEDURES SOP l Presided Sc t.22,2t1t93 ! � #00S - i a X INTRODUCTION The Occupational Safety and Health Administration (OSHA) reports that 5..6 million employees in the United States are at-risk of exposure to blood Marne pathogens where they work. This Bloodbome Pathogen (BBP) Exposure Control Procedure is designed to ) protect all Life Scan Wellness Centers' employees. The authority having jurisdiction for this procedure is derived from the Cade of Federal Regulations ca 1910.1030 and Florida De artxnent of Health Code cites Cha ter 64E-16 of the Florida Administrative Codes. ca CD This procedure includes the following key elements: CD 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, E -Engineering and work practice controls, -Personal protective equipment, -Housekeeping C. Training of Employees. D. Hepatitis B Prevention. 2 E. Post-Exposure Evaluation. F. Procedures for evaluation of circumstances of an exposure incident. G. It will be the responsibility of the Life Scan Wellness Centers' Safet Department to maintain this procedure. Life Scan Wellness Centers' Bloodborne Pathogen Exposure Control Procedure will be accessible to all 1 Packet Pg. 589 C.15.c -The recognition of tasks, which may involve exposure. -An explanation of their use and limitations of methods to reduce exposure. These include engineering controls, work practices, and personal protective equipment (PPE) offered at no cost to all full time and part time employees. 0 -Information on the types, use, location, handling, decontamination and disposal of PPE. An explanation of the basis of selection of PPE. X -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. ) The Record Information - Employee training records shall be maintained in Human CO Resources at a minimum for the duration of employment, These records shall includeCD the following, CD N -The dates of the BBP training sessions, -An outline describing the materials presented. -The names and qualifications of persons conducting the sessions. CD -The names and job titles of all persons attending the training sessions and signature of each employee. Life Scan Wellness Centers will be responsible for maintaining training records. The new at-risk full or part time employee will be notified that training is required at the time of employee orientation. Life Scan Wellness Centers will be responsible for completing an annual review of the Blood bome Pathogen training procedure and program, updating it as necessary. X 3 Packet Pg. 590 C.15.c Disposable gloves used shall not be washed or re-used after contamination. Disposable gloves shall be replaced as soon as their protective ability is compromised, such as being tom or punctured. Gloves shall be used for handling contaminated waste and for clean-up procedures. 0 For any at-risk employee who has allergic sensitivity, Wellness Centers ) will provide hypoallergenic gloves, or powderless gloves, at not cost to the employee. Housekeeping, Engineering and Workplace Controls X Hand washing facilities with antiseptic soap or single use antiseptic towelettes will be provided for immediate use after contamination. 0 At-Risk employees will wash hands immediately after removing gloves. Eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses is prohibited in work areas where exposure to BBP is possible. Labels and other warnings, as specified in Code of Federal Regulations M 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: X LU A. All contaminated waste will be placed into appropriately marked medical waste storage containers. The Jacksonville Sheriffs Office 0) will contract with a certified biomedical waste disposal company to CD dispose of waste for Life Scan Wellness Centers. B. In areas where there is to be a clean up of infectious waste material the following procedure should be followed: I. Put on gloves and ether PPE protective equipment as necessary, Post wet floor signs if available. Apply a tuberculocidal disinfectant over the potentially infectious material in accordance with label directed use. 2. Clean up the contaminated material with disposable paper towels and place and seal in a plastic bag to be disposed of LU as biomedical waste. Packet Pg. 591 C.15.c If the employee declines the vaccine (Exception 4), the employee must sign the Hepatitis B declination form attached hereto_ Once completed, this form must be included in the employee's human resource medical file. The term "no cost to the employee" means there will be no out of pocket expense to the employee. 0 If a routine booster dose(s) of Hepatitis B vaccine is recommended by the U.B. Public Heats Service at a future date, a boaster will be made available to all employees in the same manner as described above for Hepatitis B vaccination. POST EXPOSURE EVALUATION AND FOLLOW UP � X If employees follow the prevention guidelines as presented in this policy, an exposure incident to a BBP should be a rare event. However, if the employee does have an exposure incident it shall be reported, investigated and documented. Employees who have been exposed to BBP shall report the incident through normal Worker's Compensation (WC) procedures; by first notifying their supervisor, completing incident report and WC First Report of Injury report. After exposure, all costs of care will be ) treated as a workman's compensation incident. Titers (or retesting of immunization) will be offered after completion of the series if foe years has elapsed since completing the series. ca CD CD N PROCEDURE FOR EVALUATION OF AN EXPOSURE INCIDENT X 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 0) President of Life Scan Wellness Centers 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 Packet Pg. 592 C.15.c EXHIBIT B Life'Scan Wellness Centers Biohazard Waste Plan-Employee Education (Florida Administrative Cade 64E-16) a 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. 0 Objectives: � 2 0 The employee will be able to: identify `sharps' and `non-sharps' which is designated as a`biohazard' - identify the `faint of Origin' at the clinic and onsite properly prepare and stare completed`sharps' container(s)and/or`bio-hazard' red bag(s)for scheduled disposal 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 I. Bio-hazard Sharp and Non-sharps U a. Sharps are considered any needle that has been contaminated with blood whether W is be from a blood draw, vaccine injection or a PPD test. b. Non-sharps(absorbent or non.-absorbent)item(s)that are considered"soaked"in blood or ether bodily fluids considered potentially a `biohazard'. They may be disposable rubber gloves, extension tubes used for blood draws, gauze and/or band-aids. Scant amount of blood is not considered a`biohazard'. 11. Universal Precautions All personnel will need to use proper hand washing before and after the blood draw. Cloves must be worn during a blood dray and when corning in contact with a contaminated surface(s)with bodily fluids. III. Point of Origin and Sharps Disposal 0 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. 593 C.15.c EXHIBIT C: LIFE SCAN EQUIP.M%NT MAINTAINANCE PROGRAM: Life Scan has routine maintenance and calibration of all medical equipment on an annual basis according to the recommendations of the manufacturers. All equipment nudntenance 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 a time frame. Fife Scan maintains backup of all equipment as well as service contracts to ensure timely replacement as needed. Poly County will have the ability to inspect all equipment. x U) Y45=iq „z d N CD CV c s�F i1tA3 i�r ) - - �1 ,x E CD r 4)$ cuti - Terason Ultrasound Unit with Sony Printer Welch Alyn Easy One Spirometry Unit Welch Alyn EKG/Stress Unit Welch Alyn Audiometry Unit x Titmus Vision Tester Polk County RFP 17-601 Firefightcr Annual Physicals Packet Pg. 594 C.15.c c 0 0 c 0 ca CD cv CD cv cv r9 x LU LU Packet Pg. 595 C.15.c Attachment "A" COST PAGE G (STJ-BN TrAL PAGE) Cost per employee for all " requirements and items to be performed annually as defined 1 in the RIP Document. Cost i 0 shall be inclusive of all costs 657.00 Per Employee ) associated with the annual ' physical exam including overhead,indirect costs,etc. i O fter 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. 0 Chest X-Ray: Optional.annually,required.a ) minimum every five(5)yews $ 65..4d Respirator Fit Testing(SCB.A Face piece Fit ca TestfN-95 Respirators) $ 40.00 CD CD Hepatitis B Test(antigen) $ 55.00 CD N Hepatitis B Titer(antibody) $ 30.00 x Hepatitis B Vaccine(3 per series) $ 65.00 each � Hepatitis A Test(antigen.) $ 55.00 � Hepatitis A,Titter(antibody) $ 30.0 Hepatitis A Vaccine(2 per series) $ 65.00 each IPPD Test- $ 5.00 Attachment "B" SUBCONTRACTOR Packet Pg. 596 C.15.c AFFIDAVIT CERTIFICATION IMMIGRATION LAWS SOLICITATION NO.: RFP 17-601 PROJECT NAME: Firefighter Annual Physical POLK COUNTY WILL NOT INTENTIONALLY AWARD COUNTY CONTRACTS TO ANY CONTRACTOR WHO KNOWINGLY EMPLOYS UNAUTHORIZED ALIEN WORKERS, c 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). POLK COUNTY MAY CONSIDER THE EMPLOYMENT BY ANY CONTRACTOR OF UNAUTHORIZED ALIENS A VIOLATION OF SECTION 274A(e) OF THE INA. SUCH VIOLATION BY THE RECIPIENT OF THE EMPLOYMENT PROVISIONS CONTAINED IN SECTION 274A(e) OF THE INA SHALL BE GROUNDS FOR, UNILATERAL � CANCELLATION OF THE CONTRACT BY POLK COUNTY. BIDDER ATTESTS THAT THEY ARE FULLY COMPLIANT WITH ALL APPLICABLE IMMIGRATION LAWS (SPECIFICALLY TO THE 1986 IMMIGRATION ACT AND SUBSEQUENT AMENDMENTS), ) Sigfure Title Date W STATE OF: te� N COUNTY OF: CD Th 2a foregoing instrumental signed and ecknovvledged before me this day of y 4 , by �"�'"� L ;' who (Print or Type Name) x has produced as identification. ype of Ide nation and hlurnber) E , Notary Public Signature Prin ed Name of Notary Public DAVID A.CAS EW MNoTARyPUBLIC 2 S'A F.of FLORIDA . ca Nota iration x Packet Pg. 597 C.15.c Attachment "B" SUBCONTRACTOR (SLBNUTTAL PAGE) Please list below the name and address of subcontractors to be used in conjunction with this RPP (If applicable). I, 0 x 2. 0 3. N N N 4. x 5. 6. 2 x Packet Pg. 598 C.15.c TAB 8 MEDICAL LABORATORY LabCorp c Regional Office: Laboratory Corporation of America 5610 W.LaSalle Street Tampa,FL 33607 Life Scan will provide an on-site Mood draw program. Lire Scan patients are also able to have blood draws done at any LabCorp Patient Service Center within the Tinted States. LabCorp Patient Service Centers within 25 miles of Bartow: � x 1. LabCorp 2142 E EDGEWO7D DR LAKELAND,FL 33803 � 2. LabCorp 1120 HA.VENDALE BLVD NW WINTER HAVEN,FL 33881 3. LabCorp 3131 L.AKEI AND HILLS BLVD STE 1 LAKELAND,FL 33805 4. LabCorp 607 S ALEXANIDER ST STE 107 110 PLANT CITY,FL 33563 ca CD cv CD 5. LabCorp cv 2209 NORTH BLVD W STE B DAVENPORT,FL 33837CD N Polk County RFP 17-601 Firefighter Annual Physicals � Packet Pg. 599 dug. 1 2017 3;23Pfi 11n. 808—-p. 2'- —,. C.15.c , • c `t UlY' ?E3AF IEFl1CA' ja' aE., 1 p 27' LO ST , - F�12 oaf 4 04*41� 011 L` rrE,; •".°i� yOd v� • '� +: ; • '� ilh +a � .r, ,roc 410CD y�• W cv CD gar CmYi o }�d1ow► ar llt a 'ixe C4,4 °; PARASMMOGY t$ Y(tl Sii� i 81t8�$ 1Ff it1i ha f'1�i+ICC�Ft1�Lti134C '�8 t� ¢, (yn 1 6; HtSTOPRTHPUWji Iqj i �a)�t E l+I f iP ) € "p ;tl -v,YPHIL$ €OLQtl'rrtr{fignrs ht� :thAM .�G� �iild'1!lPitS' LIMNALtBPow l' ) x ✓+ia1/91[I'SiI� W�'��J1i,�' •., Air �1iL �• •` ®' ' ay f`[f C p W Packet Pg.600 C.15.c c 0 0 c 0 ca CD cv CD cv cv r9 x LU LU Packet Pg.601 C.15.c CERTIFICATE OF LIABILITY INSURANCE L�ILTIII�IIDI aara3r2a17 �. 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 �- JELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(8), AUTHORIZED REPRESENTATIVE OR,PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endonllsd. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an ondomement A statement on this certificate does not confer rights to the Certificate holder In lieu of such endorlse a, PRODUCER _ O.E.Wilson Insurance,Inc. 727 5 EAx T 536-9828 1475 Belcher Rd S cind Istsn.com - Largo FL 33771 _ Auto-Owners Insurance Corn -__ 18968 LNSURED - Admlral Insurance Com '' 248II6 Life Extensions Clinlc,lnc. 1011 N.Macdlll Ave _ - O Tampa FL 33607 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS � CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DR 0 TYPE OF INSURAh CY EPP X COMMERCIAL GE IMAI UABILrrY u 'I 000,000 INS A MM8 DE I X I'00CUR ETO AL 1aa aaa O 20690745 1IMO11'6 /1110117 410,000 _- ) 1 000 000 GATEL]MITAPFLL' PER 000 U X P4kJGYy ]JPERCd LLB 000 000 - Ca ALTO LE LIABILM - COM�NEo SI LIMIT $1 000 000 W _s_. A I ANY AUTO. BODILY INJURY Peraan) $ ALL OWNED AUTOS S8 IfOULED 4159162800 09MSM6 09118M7 BODILY INJURY(Per cent)5 HIREI?At1TC:5 NnuT N-OWNED PRDPERTYDaMAa€ tV 3 UMBRELLA LIAa ®OCCUR N __ G3 EXCESS LIAR HCLAJMS--M6L)E 3 NfOMM"COMPEMKTION RhME 7 - TM AND 9MPLOYEW LvMLrEYAW POFFIC EM _L NIA h' I T E (Manddery In NM - LL UASE-EA EMPLOYE 6 � fs e1 undlar E L -POUCY UMIT IS Medical Professional Liability E0000037591-01 0WIM7 18=1116 12,000,000 Aggregate B Retroactive Data:513112001 2,000,000 Each Claim DESCRIPTION Of 4W EItATIONs I LOCATION81vEn 8(ACORD 10a,Additional Rrrrwrlw Schedule,may be aaaeMd R meee apace n .0 contractorlk nsingop Ak-county.not Sexuol Abuse $1,000,000 Each Clslmld1,000,000 Aggregaft Network Security 8 Data Privacy Liability S1,00,000 Each Claim/S1,000,000 Aggregate U U - - O CERTIFICATE HOLDER CANCELLATION ur Polk County SHOULD ANYOFTHEABOVEDESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 330'West Church Street ACCORDANCE WITH THE POLICY PROVISIONS. :q Bartow,FL 33830 Aun1cD rLEPIIwxTArnre Phone:(863)604-608a fWi - - -- - 01988.2014 ACORD CORPORATION. All rights reserved. � ACORD 26(2014/01) The AGORD name and logo are registered marks of ACORD Packet Pg.602 C.15.c CERTIFICATEACOW CERTIFICATE OF THIS IS ISSUED AS A MATTER OFF MFORMA11ON ONLY Y�ANDCOWERSTY N INSURANCE UPON THE CERTiFICATE1HOLDEF THIS 1E CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTMFM A CONTRACT BETWEEN THE ISSUING INKS), AUTHORIZED REPRESENTATIVE OR PRODUCE&AND THE CERTIFICATE HOLDER, IMPORTANT: R the CorNfloete holder Is an ADDITIONAL INSURED,the Pollo ka)moot be endorsed. IF 4U®ROGATION!S WAIVED,gubjM to IIaI Wm and condlgons of the policy,rartain pollclas my mqufm an andonlema W. A sbftnwnt on this corditeft do"not Conflir noble to the eardticato holder In Neu of such ends mngo-h0. Valerie 79c+rt>yan-' hoolor PrimoGzvV Insurance Services, .Inc. (813)288-8270 it c N.> IsialRes-Mi 5402 W. Laurel St:. ft.y umlereprimegroop ns.coml w Suits 220 4 A IW AaE NaIGr � Tampa. FL 33607 _ m�5 1 Preferred Lnst suers Ca 1Q346 C • INSURER e Xd Xxtension Clinics, Inc IfSUFC C 1011 IN I!datcDiil Ave INIIUIIN�D a N ICI Ei Tampa FL 33607 Ito COVERAGES CERTIFICATE NUMBER;IIa610 311 64 05 - REW'ISIONNIJ1ilBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD M INDICATED. NOTINITHSTANDI,NG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS, O EXCLUSIONS AND CONOM15148 OF SUCH POLICIES,LIMITS EIHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. LTR TYPE OF NNSURAPOK yam MiEYNLMMM _ J.WTS Cpa1rIER+C I. LIAa�lr1' EACH OCCURRENCE CLAIMS-MADE Ll CCC M Pam U) I W W OfWam¢era PERSONAL A ACV IN.IURY eENL ACGRECIATE L NT APPLIES PER; C-3ENIERAL AGGREGATE ! (, POLICY tECT L�l LOC PRODUCTS_COIAPA7P AGO S OTHER: — AUTOMOBILE LUUiILflY ETUFf - iCD N ANY AUTO K OILY INJURY(Prr P.,w) iCD A d OG OWNEO NJr BpOELY IN JWiY III an11 S CD HIRER AUTOS p TY � ; CV UAWRILIA LIAR OCCUR EACH OCCURRENCE WUZSS LIAb CLAM"ADE AGGRIUM72logni # C2 R S S WORIGM TSCN - ANDIMPLOYNNIrLujam YIN SETA AW PROPRIEWWRARTNERMXECUTrANIA. L EACH AOGIGENT i 11000,08$ InN axruaoslsaa os �1112e/2old il/I!$/2017 F- DKWASr;-EAEMPLOY . S_ Y.t1Q0 000 0) c)F A7wFN9 r>ia�w E.L iNSEASr PoLRy U Mrr t 1,000 Coco CD PRS gP1rQN CN'G iRAT1010 l 10CATIONIS I Vl p...I&COM W,AdddQW MWMU o er<MNW Ws,my be xwootod Ir mm apses N n9'd" .21 CJ CERTIFICATE HOLDER CANCELLATION N $NLIULD/LIMY OF THE ABOVE"0=1111EIESI POLICIES ne CANCF4 i W BM;OFJE: ¢ FOR TMRHATIONAL P>;l,Eti?OSE8 THE EXPIRATION DATE TKEREOF, NOTICE sAtL BE OEUvrRSb IN ONLY ACCORDANCE WITH THE POLICY PROVISION& � AUTHOREW NIPR95ENTAI}I//E __---- - E Elisasser #AO77187/ • - �_-� 01988-2014 ACORD CORPORATION. All rights resQrvsd. ACORD 26(20'14101) The ACORD name and logo are reglstanod marks of ACORD IIiNNIe"18IPpi+Mi1 ¢, Packet Pg.603 C.15.c ns t3Wre Form to the >- For. aram rewe sur.Do not Re�qu"t for Taxpayer (Rev.De nbet 201) identification Number and Certificationvand Ito the IRS. i5epatitiW of ft Treeetxy r,t Flever�Ssrvieu _ Mauna( Ahshown on your ROM tax,iihi i Life Extension Cl#mime,trtc &,WrW5;;nW&n9w4ed snti±`y ni If from guava g� Lft art Wellness centers Check app"riats box for federal teas tkrrt; ❑m a c ❑ c c �+, V]s tkam 0 lea p Truwastate rablNt cart Eaate ttut tgst c iktn t r ar get cn.t3- rArpcxatiur.P 13 F=-V p� L. c traeret,rP)► __._w__.._.____�..__�..._ © other OW kwhai► - e name and;R t� N Ai member,stri and aPL Oraaall"11110a 1i)11 North Maedill Avenue etas-OF*we a� ,ww 33Iii17 a� !Iat account rwmbWW We PPmww VAU 'r ldertlificatlorr Ntllfnbf3r(Tl 1 ,,,,0 EnAar your TIN In the appropriate box.The TIN provided mutt match the mar"givers on the•Name•Ikrs to avoid backup wlt tfokfin9•Forincilvilduals,this to your scow sK utw number(am,However,for a _ � resident sun,mole proprietor,or disr�srd W entity,see the Part I instructiona on f _&Far d>ih�r ) wow.it is Your erne Identiocation number(M).If you do not have a number,see NOW to a 77N an Pap 3. "" number Note.b the socot nt Is lint more then one name,see the chart art page 4 for 9 k on whose �. numbef to enter. 6 - 3 5 3 D 2 8 C W • cm Under pewjdo of pajury,I certify that 1. The number shown on this farm is my correct taxpayer kientittostfon number(or I am waiting for a number to be tasued to► b),and cN 2. I arm not subject to backup wHhhdtlrJlrn@ because.(a)I win exempt tram backup wkhhr tg.or(b)I have not been notified by the internal Revenue Service(IRS)that 1 am Subject to backup withholdii as a result of a failure to report all Y7tereat or or(c)the IRS has gratified me that I am no longer subject to backup Withholding.end m 3. k am a U.S.eft or outer U.S.person(deflned below). Grr arSoa you must am out Item 2 above if YOU have been rtotiftad by the IRS that you we currdow subject to For mp wRht mil because you have failed to report&II interest and divldands on your tax return.For real saw*transactions,Item 2 dose not apply.RrmFor nnartgage Intets�st paid eoguisition or nc ellation of debt,rOntfi to an Individual retiramard atrrarrgrartdrmtt pfi ,and tam,payments other not required to so irrtersat . era the but you must provide your correct TIN.Sae the � irrstnitotlona on page 4. Sign Hem Itfa metre.► General Instructions NOW.fr a, 9i' a or theft Form W-9 to request your TIN,You must use the requeollers form If It Is Substantially slmll r Section references are to the Internal Revenue Code unless othetwlse to this Farm W-9. rioted. Do"niden of a U.S.parson.For federal true PWPO m,You am � Purpose of Form d:o' a U.S.Person If You arc: •An Individual who is a U.S.cutter or U.S.resident alien, A person who la required io file an Information return with the IRS must • oarraf�Y or association created car m obtain your ctrot uisYe: murmber f I INj to report,f A ip, example,irncartne paid to You,reel estate transactions.mor't�aQe)Fitereet In United States or order the laws of the Untied States, you paid,acquisition or abandonment of secured property,cancalletion r An estate(Other then a foreign estate),or of debt,or oontributiorrs You made to an 11W .A dormardlc trust(as dOOmd In Regukdtkans section 301.7701�7. Use Form W=9 anlly If you age a U.S.POW"lnclud Ing It resident f nAm for pa"narehip s that conduct a trams Or . alien),to Provide your cam TIN to the person requesting It i business In the hiked States arc genvOy stoked to Pay'a wWxkling requester}and.when applicable,to: tax on any foreign partners,share of income from Such business. � 1.Certify that the TIN you are gWg is otrrdtGt(or you are waltkrg for F ,Ign certain cases where a Forst W-8 has trot been received,a X number to be issued), partnership is required to Presume that a pWtrW IS a foreign person„ 2.Car*that you are not subject to backup withholding.or and pay tits withholding tax.Therefore.If You are a U.S.person that b it partner in a caortdkolling a trade or busliness in the United 3.Claim exei from backup wlthhoWY9 If You are a U,S.eaterttPt States,provkle Farm W-9 to the partnership to establish your U.S. payee.if appacebis,You are also codifying twat as a U.S.person,your status and avoid withraordin9 on your share Of PaMWMVp Income. allocable share of any parblarship erne from a U.$,.bade or buelnesa is trot subject to the withholdkrg tax on foreign _ 'share of E etf connected Income. Cat.No.tli iX Fdtmgliflf-�IP�" 12-20+1) � Packet Pg.604 C.15.c TAD 10: CONFIL1ENTUL ADDITIONAL INFORMATION 0 Our standard testing on Page One and additional testing can Page Two. c Life Scan Firefighter Physical: $395.00 QuantiFeron Gold: $ 60.00 Hazmat Tests: $ 127.00 Testosterone: $ 20.00 Heml tis C: $ 55.00 CD Total: $ 657.00 N CD Ch N x LU Polk County RFP 17-601 Firefighter Annual Physicals Packet Pg.605 C.15.c EXHIBIT 461391 RATES Life Scan Wellness Centers 2018 Polk County Comprehensive Physical Exam 0 Physical Exam(NFPA 1582 Compliant) included o Vision (Titmus) included Hearing Exam included Skin cancer assessment included N Personal Consultation with review of testing results included Cardio Pulmonary Assessment o Echocardiogram (Heart Ultrasound) included Resting EKG included Treadmill Stress Test with EKG included 0 Carotid Arteries Ultrasound included Aortic Aneurysm Ultrasound included Pulmonary Function Test included Cancer and Disease Assessment ca Thyroid Ultrasound included Liver, Pancreas, Gall Bladder, Spleen, & Kidney cv Ultrasounds included cV Bladder Ultrasound included Pelvic Ultrasound for Women (external, Ovaries and � Uterus included Testicular Ultrasound for Men included Prostate Ultrasound for Men Included Blood and Laboratory Tests QuantiFeron Gold (TB Blood Test) included Hepatitis C Test included Hemoccult Test included Urinalysis - included Lipid Panel included Diabetes Tests(Hemoglobin A1C and Glucose) included Complete Blood Count included Comprehensive Metabolic Panel included Thyroid Panel included PSA(men) included CA-125(women) included 1� m 0 Packet Pg.606 C.15.c QuantiFeron Gold included Testosterone(Men) NEW for this RFP (added $20.00) included — Fitness Program (NFPA 1582 Guidelines) 0 Fitness and,Agility Evaluation - included Body Composition Analysis included 0 StretchingfFlexabilitylEndurance Analysis included Nutrition and Diet Recommendations included Personal Fitness Recommendations included Medical Clearances v, OSHA Respirator Medical Clearance included Firefighter Medical Clearance included TOTAL �s�0.00 0 Palk County 2018 Additional Tests c, HAZMAT Tests(Cholinestrese and Heavy Metals) $1 20 CO Chest X-Ray with Radiologist review - $65 CD c44 Hepatitis A Test $65CD Hepatitis B Test $ Hepatitis A Titer $30 Hepatitis B Titer $30 Hepatitis A Vaccines each shot(2 series) Each$60 Hepatitis B Vaccines each shot(3 per series) Each$60 E PPD $`i5 OSHA Respirator Mask Fit Testing (Pcrtacount) $36 .E Packet Pg.607 C.15.c Exhibit 2 Life Scan Wellness Centers MONROE COUNTY 2018 Comprehensive Physical Exam $ 395.00 Physical Exam NFPA 1582 compliant) included 76 Comprehensive Hands-on Physical with Vital Signs Vision (Titmus) included 2 Audiometry included Skin Cancer assessment included Mental and Behavioral Health Questionnaire included Sleep Disorder Questionnaire included ) Personal Consultation with review of testing results included c Cardio Pulmonary Assessment Echocardiogram Heart Ultrasound included — Resting EKG included Treadmill Stress Test with EKG included Carotid Arteries Ultrasound included Aortic Aneurysm Ultrasound included Pulmonary Function Test s iromet included Cancer and Disease Assessment Thyroid Ultrasound included Liver, Pancreas, Gall Bladder, Spleen, & Kidney Ultrasounds included ) Bladder Ultrasound included Pelvic Ultrasound for Women Ovaries and Uterus included Testicular Ultrasound for Men included Prostate Ultrasound for Men Included Co Blood and Laboratory Tests cV Hemoccult Test included Urinalysis included cv Lipid Panel included Diabetes Tests (Hemoglobin Al C and Glucose) included Complete Blood Count included Comprehensive Metabolic Panel included Thyroid Panel included PSA(men) included Testosterone (Men) included CA-125 women included Fitness Evaluation NFPA 1583 Guidelines Aerobic Capacity Evaluation included Body Composition Analysis included Muscular Strength Evaluation Muscular Endurance Evaluation Flexibility Test included Nutrition and Diet Recommendations included Personal Fitness Recommendations included Medical Clearances X OSHA Respirator Medical Clearance included Firefighter Medical Clearance included TOTAL $395.00 Packet Pg.608 C.15.c Exhibit 2 c Additional Tests Available Chest X-Raywith Radiologist review 65.00 Lumbar X-Raywith Radiologist review 65.00 c Hepatitis A Test(antigen) 55.00 Hepatitis B Test(antigen) 55.00 Hepatitis C Test(antigen) 55.00 Hepatitis A Titer(antibody) 30.00 Hepatitis B Titer(antibody) 30.00 Hepatitis A Vaccine 2 Series 60.00 Each Hepatitis B Vaccine 3 Series 60.00 Each HIV Test 40.00 ) ABO Blood Type 22.00 OSHA Respirator Mask Fit Testing (Portacount) 35.00 Cholinestrese and Heavy Metals (Hazmat) 120.00 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 cv on the operational cost for Life Scan to provide space or increased cost of on-site locations. x .E x Packet Pg.609 CERTIFICATE OF LIABILITY INSURANCE °ATE( C.15.d �. 02/25/2021 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), AUTHORIZE[ REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. E IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject tt 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). CONT PRODUCER NAMEACT Cinda Groves 0.E.Wilson Insurance,Inc. PHONENo, (727)535-0524 aC No):(727)536-9828 1475 Belcher Rd S E-MAIL ADDRESS: cinda@oewilson.com Largo FL 33771 INSURERS AFFORDING COVERAGE NAIC# Q INSURERA: Auto-Owners Insurance Company 18988 INSURED INSURER B: Admiral Insurance Company 24856 Life Extension Clinics,lnc.dba Life Scan Wellness Centers INSURER C: Transportation Insurance Company 12408 1011 N.Macdill Ave INSURER D: Q O Tampa FL 33607 INSURER E: INSURER F: L` Q 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 PERIO[ INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI; a CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS N EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBTYPE OF INSURANCE INSp WVp POLICY NUMBER /Y POLICYPOLICY EFF LTR MM/DDYYY /Y M /DDYYY LIMITS uJX COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS-MADE MAGE OCCUR DA TO RENTED $100,000 X X 062312-20690745 11/10/2020 11/10/2021 MED EXP(Any oneperson) $10,000 Q Approved Risk Manag m nt PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: /""� GENERAL AGGREGATE $2,000,000 X POLICY jRO- ECT LOC 3-2-2021 PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ L� ALL OWNED SCHEDULED X X 4159162800 09/18/2020 09/18/2021 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ w AUTOS _ $ P X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS LIAB CLAIMS-MADE X X 41-591-628-01 11/10/2020 11/10/2021 AGGREGATE $1,000,000 N DED RETENTION$ $ WORKERS COMPENSATION X � STATUTE PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 C OFFICER/MEMBER EXCLUDED? N/A X WC 6 56600287 11/29/2020 11/29/2021 CD (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under LO DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 CV B Medical Professional Liability E0000037691-04 05/31/2020 05/31/2021 2,000,000 Aggregate CD Retroactive Date:5/31/2001 2,000,000 Each Claim DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) U Certificate holder is additional insured on the general liability and auto liability W with respect to work performed by insured. ' CJ Medical Professional Liability Additional Coverages: Sexual Abuse $1,000,000 Each Claim/$1,000,000 Aggregate Network Security&Data Privacy Liability$1,000,000 Each Claim/$1,000,000 Aggregate ) CERTIFICATE HOLDER CANCELLATION Monroe County BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED II 0) ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton St Key West,FL 33040 AUTHORIZED REPRESENTATIVE � � r/� <SK> ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD packet Pg.610