CITY OF RICHMOND
STANDARD CONTRACT
Department: Project Manager:
Project Manager E-mail: Project Manager Phone No:
PR No: Vendor No: P.O./Contract No:
Description of Services:
The parties to this STANDARD CONTRACT do mutually agree and promise as follows:
1. Parties. The parties to this Contract are the City of Richmond (herein referred to as the “City”) and the following named Contractor:
Company Name:
Street Address:
City, State, Zip Code:
Contact Person:
Telephone: Email:
Business License No: / Expiration Date:
A California [ ] corporation, [ ] limited liability corporation [ ] general partnership, [ ] limited partnership, [ ] individual, [ ] non-profit corporation, [ ] individual dba as [specify:] , [ ] other [specify:]
2. Term. The effective date of this Contract is and it terminates unless terminated as provided herein.
3. Payment Limit. City’s total payments to Contractor under this Contract shall not exceed $ . City shall not pay for services that exceed the Contract Payment Limit unless a contract amendment has been approved by the City Council or City Manager.
4. Contractor’s Obligations. Contractor shall provide those services and carry out that work described in the Service Plan (Exhibit A) which is attached hereto and is incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein.
5. City's Obligations. City shall make to the Contractor those payments described in the Payment Provisions (Exhibit B) which are attached hereto and are incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein.
6. Authorized Representatives and Notices. This Contract is subject to the Authorized Representatives and Notices Provisions (Exhibit C) which are attached hereto and are incorporated herein by reference.
7. General Conditions. This Contract is subject to the General Conditions (Exhibit D) which are attached hereto and are incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein.
8. Special Conditions. This Contract is subject to the Special Conditions (Exhibit E) (if any) which are attached hereto and are incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein. (Note:
other than Public Works contracts, the City will agree to Special Conditions only in unusual circumstances.)
9. Insurance Provisions. This Contract is subject to the Insurance Provisions (Exhibit F) which are attached hereto and are incorporated herein by reference.
10. Signatures. These signatures attest the parties' Contract hereto:
CITY OF RICHMOND CONTRACTOR:
a municipal corporation
By:
(* The Corporation Chairperson of the Board,
President or Vice President should sign below)
Title: By:
I hereby certify that this Contract Title:
has been approved by City Council.
Date Signed:
B y :
City Clerk
(* The Corporation Chief Financial Officer,
Secretary or Assistant Secretary should sign below)
Approved as to form:
B y :
B y : T i t l e :
City Attorney
Date Signed:
(NOTE: Pursuant to California Corporations
Code Section 313, if Contractor is a corporation
or nonprofit organization, this Contract (1) must
be signed by (a) the Chairperson of the Board,
President or Vice-President
and (b) the
Secretary any Assistant Secretary, the Chief
Financial Officer or any Assistant Treasurer.
LIST OF ATTACHMENTS:
Service Plan Exhibit A
Payment Provisions Exhibit B
Authorized Representatives and Notices Exhibit C
General Conditions Exhibit D
Special Conditions Exhibit E
Insurance Provisions Exhibit F
Standard Contract/EJ/TE 9-26-07
For the Contract between the City of
Richmond and
EXHIBIT A
SERVICE PLAN
Contractor shall, to the satisfaction of the , perform the following services and be compensated as outlined below:
Police Department
For the Contract between the City of
Richmond and
EXHIBIT B
PAYMENT PROVISIONS
{PLEASE NOTE THAT THE CITY OF
RICHMOND SHALL NOT PAY FOR SERVICES
THAT EXCEED THE CONTRACT PA YMENT LIMIT UNLESS A CONTRACT
AMENDMENT HAS BEEN APPROVED BY THE CITY COUNCIL OR THE CITY MANAGER}
1. Provided Contractor is not in default under this Contract, Contractor shall be compensated as provided below.
2. Any and all payments made pursuant to this Contract shall be subject to the Contract Payment Limit. The Payment Limit includes expenses (phones, photo copying, meals and travel etc). Invoices, shall be adequately detailed, based on accurate records, and be in a form reasonably satisfactory to the City. Contractor may be required to provide back-up material upon request.
3. Contractor shall submit timely invoices to the following address:
Attention: City of Richmond, Finance Department - Accounts Payable Project Manager: Department:
PO Box 4046
Richmond, CA 94804-0046
4. All invoices that are submitted by Contra ctor shall be subject to the approval of the City’s Project Manager, before payments shall be authorized.
5. The City will pay invoice(s) within 45 days a fter completion of services to the City’s satisfaction. The City shall not pay late fees or interest.
6. A Richmond business license shall be obtained before any payment under this Contract shall be authorized and the business license must be kept current during the term of this Contract for payments to continue to be authorized.
7. All insurance coverage required by this Contract shall be provided by the Contractor before this Contract shall be executed by the City. The insurance coverage must be kept current during the term of this Contract for payments to continue to be authorized.
For the Contract between the City of
Richmond and
EXHIBIT C
AUTHORIZED REPRESENTATIVES AND NOTICES
1. Notices
. All notices, demands, statements, or communications provided for by this Contract shall be in writing and may be delivered by deposit in the United States mail, postage prepaid. Notices to the City shall be addressed to the Department Head and (as delineated below in section 1.1) to the project manager responsible for the administration of or the supervision of the scope of work under this Contract. Notices to the Contractor shall be addressed to the party designated by Contractor (as delineated below in section 1.2). Notice shall be deemed delivered (a) upon personal delivery; (b) as of the fifth business day after mailing by United States certified mail, postage prepaid, addressed to the proper party; or (c) as of 12:00 p.m. on the second business day immediately after the day it is deposited with and accepted by Federal Express, or a similar overnight courier service, addressed to the proper party and marked for next business day morning delivery. For the purposes of this Contract, a "business day" means any day Monday through Friday that is not a holiday recognized by the federal government or the State of California.
1. 1 CITY hereby designates as its Authorized Representative the Project Manager whose name and address are as follows:
City of Richmond
Richmond, CA 94804-0046
1. 2 CONTRACTOR hereby designates as its Authorized Representative the Project Manager whose name and address are as follows:
General Conditions/EJ/TE 01-19-11 1 of 13
EXHIBIT D
GENERAL CONDITIONS
1. Independent Contractor . Contractor acknowledges, represents and warrants that Contractor is not a regular or temporary employee, joint venturer or partner of the City, but rather an independent Contractor. This Contract shall not be construed to create an agency, servant, employee, partnership, or joint venture relationship. As an independent Contractor, Contractor shall have no authority to bind City to any obligation or to act as City's agent except as expressly provided herein. Due to the independent Contractor relationship created by this Contract, City shall not withhold state or federal income taxes, the reporting of which shall be Contractor's sole responsibility.
2. Brokers . Contractor acknowledges, represents and warrants that Contractor has not hired, retained or agreed to pay any entity or person any fee, commission, percentage, gift, or any other consideration, contingent upon or resulting from the award or making of this Contract.
3. City Property . The rights to applicable plans, drawings, reports, calculations, data, specifications, videos, graphics or other materials prepared for or obtained pursuant to this Contract, which, upon request, are to be delivered to City within a reasonable time, shall be deemed assigned to City. If applicable, Contractor shall prepare check prints upon request. Notwithstanding the foregoing, Contractor shall not be obligated to provide to City proprietary software or data which Contractor has developed or had developed for Contractor's own use; provided, however, that Contractor shall, pursuant to Section 15 below, indemnify, defend and hold harmless City from and against any discovery or Public Records Act request seeking the disclosure of such proprietary software or data.
4. Patents, Trademarks, C opyrights and Rights in Data
. Contractor shall not
publish or transfer any materials, discoveries, developments, concepts, designs, ideas, know how, improvements, inventions and/or original works of authorship resulting from activities supported by this Contract without the express prior written consent of the City Manager. If anything resulting from activities supported by this Contract is patentable, trademarkable, copyrightable or otherwise legally protectable, City reserves the exclusive right to seek such intellectual property rights. Notwithstanding the foregoing, Contractor may, after receiving City's prior written consent, seek patent, trademark, copyright or other intellectual property rights on anything resulting from activities supported by this Contract. However, City reserves, and Contractor irrevocably grants, a nonexclusive, fully paid-up, royalty-free, assumable, perpetual, worldwide license, with the right to transfer, sublicense, practice and exploit said license and the right to make, have made, copy, modify, make derivative works of, use, sell, General Conditions/EJ/TE 01-19-11 2 of 13
import, and otherwise distribute under all applicable intellectual properties without restriction of any kind said license.
Contractor further agrees to assist City, at City's expense, in every proper way to secure the City’s rights in any patents, trademarks, copyrights or other intellectual property rights relating thereto, including the disclosure to City of all pertinent information and data with respect thereto. Contractor shall also assist City in the execution of all applications, specifications, oaths, assignments, recordations, and all other instruments which City shall deem necessary in order to apply for, obtain, maintain and transfer such rights, or if not transferable, to waive such rights. Contractor shall further assist City in the execution of all applications, specifications, oaths, assignments, recordations and all other instruments which City shall deem necessary in order to assign and convey to City, and any assigns and nominees the sole and exclusive right, title and interest in and to any patents, trademarks, copyrights or other intellectual property rights relating thereto. Contractor further agrees that its obligation to execute or cause to be executed, when it is in Contractor's power to do so, any such instruments or papers shall continue during and at all times after the end of Contractor's services and until the expiration of the last such intellectual property right. Contractor hereby irrevocably designates and appoints City, and its duly authorized officers, agents and servants, as its agent and attorney-in-fact, to act for and in its behalf and stead to execute and file any such applications and to do all other lawfully permitted acts to further the application for, prosecution, issuance, maintenance or transfer of letters of patents, copyright and other registrations. This power of attorney is coupled with an interest and shall not be affected by Contractor's subsequent incapacity.
5. Inspection
. Contractor's performance, place of business and records pertaining to this Contract are subject to monitoring, inspection, review and audit by authorized representatives of the CITY, the State of California, and the United States Government.
If the project or services set forth in Exhibit A shall be performed on City or other public property, City shall have the right to inspect such work without notice. If such project or services shall not be performed on City or other public property, City shall have the right to inspect such work upon reasonable notice.
6. Services
. The project or services set forth in Exhibit A shall be performed to the full satisfaction and approval of City. In the event that the project or services set forth in Exhibit A are also itemized by price, City, in its sole discretion, may, upon notice to Contractor, delete certain items or services set forth in Exhibit A, in which case there shall be a corresponding reduction in the amount of compensation paid to Contractor.
General Conditions/EJ/TE 01-19-11 3 of 13
Contractor shall, at its own cost and expense, furnish all facilities and equipment necessary for Contractor to complete the project or perform the services required herein, unless otherwise provided in Exhibit A.
7. Records
. Contractor shall keep and make available for inspection and copying by authorized representatives of the City, the State of California, and the United States Government, the Contractor's regular business records and such additional records pertaining to this Contract as may be required by the City.
Contractor shall retain all documents pertaining to this Contract for a period of five (5) years after this C ontract's termination (or for any further period that is required by law) and until all Fede ral or State audits are complete and exceptions resolved for this contract's funding period. Upon request, CONTRACTOR shall make thes e records available to authorized representatives of the CITY, the State of California, and the United States Government.
Contractor shall keep full and detailed accounts, maintain records, and exercise such controls as may be necessary for proper financial management under this Contract. The Contractor’s accounting and control systems shall be satisfactory to City. Contractor's accounting systems shall conform to generally accepted accounting principles and all records shall provide a breakdown of total costs charged under this Contract, including properly executed payrolls, time records, utility bills, invoices and vouchers. The City shall be afforded prompt access to Contractor's records, books, and Contractor shall preserve such project records for a period of at least five (5 years after the termination of this Contract , or for such longer period as may be required by law.
Contractor shall permit City and its authorized representatives and accountants to inspect, examine and copy Contractor's books, records, accounts, correspondence, instructions, drawings, receipts, subcontracts, purchase orders, vouchers, memoranda and other data relating to the project or services set forth in Exhibit A, and any and all data relevant to this Contract at any reasonable time for the purpose of auditing and verifying statements, invoices, or bills submitted by Contractor pursuant to this Contract and shall provide such assistance as may be reasonably required in the course of such inspection. Contractor shall also allow City access to the record keeping and accounting personnel of Contractor.
City further reserves the right to examine and re-examine said books, records, accounts, and data during the five (5 year period following the termination of this Contract; and Contractor shall in no event dispose of, destroy, alter, or mutilate said books, records, accounts, and data in any manner whatever for five (5 years after the termination of this Contract.
General Conditions/EJ/TE 01-19-11 4 of 13
Pursuant to California Government Code § 10527, the parties to this Contract shall be subject to the examination and audit of representatives of the Auditor General of the State of California for a period of three (3) years after final payment under this Contract. The examination and audit shall be confined to those matters connected with the performance of this Contract including, but not limited to, the cost of administering this Contract.
8. Changes and Extra Work . All changes and/or extra work under this Contract shall be performed and paid for in accordance with the following:
Only the City Council or the City Manager may authorize extra and/or changed work. Contractor expressly recognizes that other City personnel are without authorization to either order extra and/or changed work or waive contract requirements. Failure of Contractor to secure the authorization for such extra and/or changed work shall constitute a waiver of any and all right to adjustment in contract price due to such unauthorized work and Contractor thereafter shall be entitled to no compensation whatsoever for performance of such extra and/or changed work.
If Contractor is of the opinion that any work which Contractor has been directed to perform is beyond the scope of this Contract and constitutes extra work, Contractor shall promptly notify City of the fact. The City shall make a determination as to whether or not such work is, in fact, beyond the scope of this Contract and constitutes extra work. In the event that City determines that such work does constitute extra work, City shall provide extra compensation to Contractor on a fair and equitable basis. A change order or Contract Amendment providing for such compensation for extra work shall be negotiated between City and Contractor and executed by Contractor and the appropriate City official.
In the event City determines that such work does not constitute extra work, Contractor shall not be paid extra compensation above that provided herein and if such determination is made by City staff, said determination may be appealed to the City Council; provided, however, a written appeal must be submitted to the City Manager within five (5) days after the staff's determination is sent to Contractor. Said written appeal shall include a description of each and every ground upon which Contractor challenges the staff's determination.
9. Additional Assistance
. If this Contract requires Contractor to prepare
plans and specifications, Contractor shall provide assistance as necessary to resolve any questions regarding such plans and specifications that may arise during the period of advertising for bids, and Contractor shall issue General Conditions/EJ/TE 01-19-11 5 of 13
any necessary addenda to the plans and specifications as requested. In the event Contractor is of the opinion that City's requests for addenda and assistance is outside the scope of normal services, the parties shall proceed in accordance with the changes and extra work provisions of Section 8 of these General Conditions.
10. Professional Ability. Contractor acknowledges, represents and warrants that Contractor and its employees are skilled and able to competently provide the services hereunder, and possess all professional licenses, certifications, and approvals necessary to engage in their occupations.
City has relied upon the professional ability and training of Contractor as a material inducement to enter into this Contract. Contractor shall perform in accordance with generally accepted professional practices and standards of Contractor's profession. In the event that City, in its sole discretion, desires the removal of any person employed or retained by Contractor to perform services hereunder, such person shall be removed immediately upon receiving notice from City.
11. Business License
. Contractor shall obtain a Richmond Business License
before performing any services required under this Contract. The failure to so obtain such license shall be a material breach of this Contract and grounds for immediate termination by City; provided, however, that City may waive the business license requirement in writing under unusual or extraordinary circumstances without necessitating any modification of this Contract to reflect such waiver.
12. Termination Without Default. Notwithstanding any provision herein to the contrary, City may, in its sole and absolute discretion and without cause, terminate this Contract at any time prior to completion by Contractor of the project or services hereunder, immediately upon written notice to Contractor. Contractor may terminate this Contract at any time in its sole and absolute discretion and without cause upon 30 days' written notice to City. In the event of termination by either party, Contractor shall be compensated for: (1) all authorized work satisfactorily performed prior to the effective date of termination; (2) necessary materials or services of others ordered by Contractor for this Contract, prior to receipt of notice of termination, irrespective of whether such materials or services of others have actually been delivered, provided that Contractor is not able to cancel such orders. Compensation for Contractor in such event shall be determined by City in accordance with the percentage of the project or services completed by Contractor; and all of Contractor's finished or unfinished work product through the time of the City's last payment shall be transferred and assigned to City. Additionally, in the event of such termination, the City may proceed with the work in any reasonable manner it chooses.
General Conditions/EJ/TE 01-19-11 6 of 13
13. Termination in the Event of Default. Should Contractor fail to perform any of its obligations hereunder, within the time and in the manner provided or otherwise violate any of the terms of this Contract, City may immediately terminate this Contract by giving written notice of such termination, stating the reasons for such termination. Contractor shall be compensated as provided in Section 12 of these General Conditions; provided, however, there shall be deducted from such amount the amount of damage, including attorney's fees, expert witness fees and costs, if any, sustained by City by virtue of Contractor's breach of this Contract. Additionally, in the event of such termination, the City may proceed with the work in any reasonable manner it chooses.
14. Conflict of Interest. Contractor acknowledges, represents and warrants that Contractor shall avoid all conflicts of interest (as defined under any federal, state or local statute, rule or regulation, or at common law) with respect to this Contract. Contractor further acknowledges, represents and warrants that no City official or employee has any economic interest, as defined in Title 2, California Code of Regulations §§ 18703.1 through 18703.5, with Contractor that would invalidate this Contract. Contractor acknowledges that in the event that Contractor shall be found by any judicial or administrative body to have any conflict of interest (as defined above) with respect to this Contract, all consideration received under this Contract shall be forfeited and returned to City forthwith. This provision shall survive the termination of this Contract for one (1) year.
15. Indemnification.
(a) If this Contract is a contract for design professional services subject to California Civil Code Section 2782.8(a) and Contractor is a design professional, as defined in California Civil Code Section 2782.8(b)(2), Contractor shall hold harmless, defend and indemnify the City, its officers, agents, employees, and volunteers from and against any and all claims, damages, losses, and expenses including attorneys’ fees arising out of, or pertaining to, or relating to the negligence, recklessness, or willful misconduct of the Contractor, except where caused by the active negligence, sole negligence, or willful misconduct of the City. To the fullest extent permitted by law, Contractor shall immediately defend and indemnify the City and its officers, agents, employees, and volunteers from and against any and all liabilities, regardless of nature or type, that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor, or its employees, agents, or subcontractors.
Liabilities subject to the duties to defend and indemnify include, without limitation, any and all claims, losses, damages, penalties, fines, and judgments; associated investigation and administrative expenses; defense costs, including but not limited to reasonable attorneys’ fees; court costs; and costs of alternative dispute resolution. Contractor’s obligation to General Conditions/EJ/TE 01-19-11 7 of 13
indemnify applies unless it is finally adjudicated that the liability was caused by the sole active negligence or sole willful misconduct of an indemnified party.
(b) If this Contract is not a contract for design professional services subject to California Civil Code Section 2782.8(a) or Contractor is not a design professional as defined in California Civil Code Section 2782.8(b)(2), Contractor shall indemnify, defend, and hold harmless the City, its officers, agents, employees and volunteers from any and all claims, suits, or actions of every name, kind and description, brought forth on account of injuries to or death of any person or damage to property arising from or connected with the willful misconduct, negligent acts, errors or omissions, ultra-hazardous activities, activities giving rise to strict liability, or defects in design by Contractor or any person directly or indirectly employed by, or acting as, the agent for Contractor in the performance of this Contract, including the concurrent or successive passive negligence of the City, its officers, agents, employees or volunteers.
(c) It is understood that the duty of Contractor to indemnify and hold harmless includes the duty to defend as set forth in Section 2778 of the California Civil Code. Contractor shall be obligated to defend, in all legal, equitable, administrative, or special proceedings, with counsel approved by the City, the City and its officers, agents, employees, and volunteers, immediately upon tender to Contractor of the claim in any form or at any stage of an action or proceeding, whether or not liability is established. An allegation or determination that persons other than Contractor are responsible for the claim does not relieve Contractor from its separate and distinct obligation to defend under this Section 15. The obligation to defend extends through final judgment, including exhaustion of any appeals. The defense obligation includes an obligation to provide independent counsel if Contractor asserts that liability is caused in whole, or in part, by the negligence or willful misconduct of an indemnified party. (d) The review, acceptance or approval of the Contractor’s work or work product by any indemnified party shall not affect, relieve or reduce the Contractor’s indemnification or defense obligations. This Section 15 survives completion of the services or the termination of this Contract.
The provisions of this Section 15 are not limited by, and do not affect, the provisions of this Contract relating to insurance.
(e) Acceptance of insurance certificates and endorsements required under this Contract does not relieve Contractor from liability under this Section
15. This Section 15 shall apply whether or not such insurance policies are determined to be applicable to any such damages or claims for damages.
16. Safety
. Contractor acknowledges that the City is committed to the highest standards of workplace safety. Contractor shall perform all work hereunder in full compliance with applicable local, state and federal safety requirements including but not limited to Occupational Safety and Health Administration requirements, and shall assume sole and complete General Conditions/EJ/TE 01-19-11 8 of 13
responsibility for the safety of Contractor's employees and any subContractor's employees. If a death, serious personal injury or substantial property damage occurs in connection with the performance of this Contract, Contractor shall immediately notify the City by telephone.
17. Insurance. Insurance requirements are set forth in Exhibit F to this Contract. Contractor shall abide by the insurance requirements set forth in said Exhibit F.
18. Non-Liability of Officials and Employees of the City. No official or employee of the City shall be personally liable for any default or liability under this Contract.
19. Compliance with Laws. Contractor shall comply with all federal, state and local laws, statutes, ordinances, rules and regulations, and the orders and decrees of any courts or administrative bodies or tribunals, with respect to this Contract, including without limitation environmental laws, employment discrimination laws and prevailing wage laws. Compliance under this provision includes compliance with all provisions of the Richmond Municipal Code ("Municipal Code"), including Chapters 2.50, 2.52, 2.56, and 2.60, if applicable.
Contractor acknowledges that under § 2.60.070 of the Municipal Code ("Living Wage Ordinance"), Contractor shall promptly provide to City documents and information verifying its compliance with the Living Wage Ordinance. Also as prescribed in § 2.60.070, Contractor shall notify each of its affected employees with regards to the wages that are required to be paid pursuant to the Living Wage Ordinance.
Contractor shall comply with § 2.28.030 of the Municipal Code, obligating every Contractor or subcontractor under a contract or subcontract with the City for public work or for goods or for services to refrain from discriminatory employment or subcontracting practices on the basis of race, color, sex, sexual orientation, religious creed, national origin or ancestry of any employee, any applicant for employment or any potential subcontractor.
Contractor acknowledges that the City’s Drug Free Workplace Policy, Violence in the Workplace Policy and the Policy Against Workplace Harassment, are available on the City’s website at
http://www.ci.richmond.ca.us/workplacepolicies
. Contractor agrees to
abide by the terms and conditions of said policies.
20. Limitations upon Subcontracting and Assignment. This Contract binds the heirs, successors, assigns and representatives of Contractor. The Contractor shall not enter into subcontracts for any work contemplated General Conditions/EJ/TE 01-19-11 9 of 13
under this Contract and shall not assign this Contract, nor any portion hereof or monies due or to become due, without the prior written consent of the City Council or its designee.
Contractor acknowledges that the services which Contractor shall provide under this Contract are unique, personal services which, except as otherwise provided herein, Contractor shall not assign or sublet to any other party without the prior written approval of City, which approval may be withheld in City's sole and absolute discretion. In the event that City, in writing, approves any assignment or subletting of this Contract or the retention of subcontractors by Contractor, Contractor shall provide to City upon request copies of each and every subcontract contract prior to the execution thereof by Contractor and subcontractor. Any assignment by Contractor of any or all of its rights under this Contract without first obtaining City's prior written consent shall be a default under this Contract.
The sale, assignment, transfer or other disposition of any of the issued and outstanding capital stock of Contractor (if applicable), or of the interest of any general partner or joint venturer or syndicate member if Contractor is a partnership or joint-venture or syndicate, which shall result in a change of control of Contractor, shall be deemed an assignment. For this purpose, control shall mean fifty percent or more of the voting power or twenty-five percent or more of the assets of the corporation, partnership or joint-venture.
21. Integration
. This Contract constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes any previous oral or written agreement; provided, however, that correspondence or documents exchanged between Contractor and City may be used to assist in the interpretation of the Exhibits to this Contract.
22. Modifications and Amendments. This Contract may be modified or amended only by a change order or Contract Amendment executed by both parties and approved as to form by the City Attorney.
23. Conflicting Provisions. In the event of a conflict between these General Conditions and those of any Exhibit or attachment hereto, these General Conditions shall prevail; provided, however, that any Special Conditions as set forth in Exhibit E shall prevail over these General Conditions. In the event of a conflict between the terms and conditions of any two or more Exhibits or attachments hereto, those prepared by City shall prevail over those prepared by the Contractor, and the terms and conditions preferred by the City shall prevail over those preferred by the Contractor.
24. Non-exclusivity. Notwithstanding any provision herein to the contrary, the services provided by Contractor hereunder shall be non-exclusive, and General Conditions/EJ/TE 01-19-11 10 of 13
City reserves the right to employ other Contractors in connection with the project.
25. Exhibits. All Exhibits hereto are made a part hereof and incorporated herein by reference; provided, however, that any language in Exhibit A which does not pertain to the project description, proposal, scope of services, or method of compensation (as applicable) , or any corresponding responsibilities of City, shall be deemed extraneous to, and not a part of, this Contract.
26. Force Majeure. Neither party hereto shall be considered in default in the performance of its obligations hereunder to the extent that the performance of such an obligation is prevented or delayed by reason of acts of God, strikes, boycotts, lock-outs, inability to procure materials not related to the price thereof, failure of power, restrictive governmental laws and regulations enacted after the date of this Contract, riots, civil unrest, acts of terrorism, insurrection, war, declaration of a state or national emergency or other reasons of a like nature not within the reasonable control of such party.
27. Time of the Essence. Time is of the essence of this Contract. Contractor and City agree that any time period set forth in Exhibit A represents their best estimates with respect to completion dates and both Contractor and City acknowledge that departures from the schedule may occur.
Therefore, both Contractor and City will use reasonable efforts to notify one another of changes to the schedule. Contractor shall not be responsible for performance delays caused by others, or delays beyond Contractor's control, and such delays shall extend the times for performance of Contractor's work.
28. Confidentiality. Contractor agrees to comply with, and to require its employees, agents and partners to comply with, all applicable State or Federal statutes or regulations respecting confidentially, including but not limited to, the identity of persons served under this Contract, their records, or services provided them, and assures that:
All applications and records concerning any individual made or kept by Contractor or any public officer or agency in connection with the administration of or relating to services provided under this Contract will be confidential, and will not be open to examination for any purposes not directly connected with the administration of such service.
No person will publish or disclose or permit or cause to be published or disclosed, any list of persons receiving services, except as may be required in the administration of such service.
General Conditions/EJ/TE 01-19-11 11 of 13
29. Third Parties. Nothing herein shall be interpreted as creating any rights or benefits in any third parties. For purposes hereof, transferees or assignees as permitted under this Contract shall not be considered "third parties."
30. Governing Law. This Contract shall be construed in accordance with the law of the State of California without regard to principles of conflicts of law.
This Contract is made in Contra Costa County, California, and any action relating to this Contract shall be instituted and prosecuted in the courts of Contra Costa County, California.
31. Nonrenewal. Contractor understands and agrees that there is no representation, implication, or understanding that the services provided by Contractor under this Contract will be purchased or renewed by the City under a new contract following expiration or termination of this Contract, and waives all rights or claims to notice or hearing respecting any failure by City to continue the purchase of all or any failure to continue purchase of all or any such services from Contractor.
32. Claims. Any claim by Contractor against City hereunder shall be subject to Government Code §§ 800 et seq. The claims presentation provisions of said Act are hereby modified such that the presentation of all claims hereunder to the City shall be waived if not made within six months after accrual of the cause of action.
33. Interpretation. This Contract shall be interpreted as if drafted by both parties.
34. Warranty. In the event that any product shall be provided to the City as part of this Contract, Contractor warrants as follows: Contractor possesses good title to the product and the right to transfer the product to City; the product shall be delivered to the City free from any security interest or other lien; the product meets any specifications contained herein; the product shall be free from material defects in materials and workmanship under normal use for a period of one (1) year from the date of delivery; and the product shall be fit for its intended purpose(s). Notwithstanding the foregoing, consumable and maintenance items (such as light bulbs and batteries) shall be warranted for a period of one hundred and eighty (180) days from the date of delivery. All repairs during the warranty period shall be promptly performed by Contractor, at Contractor's expense, including shipping.
35. Severability. In the event that any of the provisions or portions or applications thereof of this Contract are held to be unenforceable or invalid by any court of competent jurisdiction, City and Contractor shall negotiate an equitable adjustment in the provisions of the Contract with a view General Conditions/EJ/TE 01-19-11 12 of 13
toward effecting the purpose of this Contract, and the validity and enforceability of the remaining provisions or portions or applications thereof, shall not be affected thereby.
36. Authority. City warrants and represents that the signatory hereto (the Mayor of the City of Richmond or the City Manager) is duly authorized to enter into and execute this Contract on behalf of City. The party signing on behalf of Contractor warrants and represents that he or she is duly authorized to enter into and execute this Contract on behalf of Contractor, and shall be personally liable to City if he or she is not duly authorized to enter into and execute this Contract on behalf of Contractor.
37. Waiver. The waiver by City of any breach of any term or provision of this Contract shall not be construed as a waiver of any subsequent breach.
Inspections or approvals, or statements by any officer, agent or employee of the City relating to the Contractor’s performance, or payments therefore, or any combination of these acts, shall not relieve the Contractor’s obligation to fulfill this Contract as prescribed; nor shall the City be thereby stopped from bringing any action for damages or enforcement arising from any failure to comply with any of the terms and conditions of this Contract.
38. Possessory Interest. If this Contract results in the Contractor having possession of, claim to or right to the possession of land or improvements, but does not vest ownership of the land or improvements in the same person, or if this Contract results in the placement of taxable improvements on tax exempt land (Revenue and Taxation Code 107), such interest or improvements may represent a possessory interest subject to property tax, and Contractor may be subject to the payment of property taxes levied on such interest.
39. Performance and Final Acceptance.
Contractor represents that it is experienced, qualified, registered, licensed, equipped, organized and financed to perform the services under this Contract.
Contractor shall perform the services under this Contract with that degree of skill and judgment normally exercised by professional firms performing services of a similar nature in the State of California, and shall be responsible for the professional quality, technical accuracy and coordination of the services it performs under this Contract. In addition to the other rights and remedies which City may have, Contractor shall, at its own expense, correct any services which fail to meet the above standard.
General Conditions/EJ/TE 01-19-11 13 of 13
City shall provide Contractor an opportunity to cure errors and omission which may be disclosed during the review of submittals, with no increase in the authorized Contract Payment Limit. Should Contractor fail to make necessary corrections in a timely manner, such corrections shall be made by the City and the cost thereof shall be charged to Contractor.
If warranted, City shall determine, and Contractor may request such determination, that Contractor has satisfactorily completed performance of this Contract. Upon such determination, City shall issue to Contractor a written Notice of Final Acceptance, after which Contractor shall not incur further costs under this Contract. Contractor shall respond to such Notice of Final Acceptance by executing and submitting to City a Release and Certificate of Final Payment.
40. Survival
. The rights and obligations of the parties which by their nature survive termination or completion of the services covered by this Contract shall remain in full force and effect after termination or completion.
For the Contract between the City of
Richmond and
EXHIBIT E
SPECIAL CONDITIONS
The General Conditions are hereby amended to include the following modifications and/or provisions (if applicable):
For the Contract between the City of
Richmond and
EXHIBIT F
INSURANCE PROVISIONS
During the entire term of this Contract and any extension or modification thereof, the CONTRACTOR shall keep in effect insurance policies meeting the insurance requirements specified in the insurance provisions which are attached hereto and incorporated herein by this reference.
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 1 of 3
Revised: September 2011
In all instances where CONTRACTOR or its representatives will provide professional services (architects, engineers, construction management, counselors, medical professionals, hospitals, clinics, attorneys, consultants, accountants, etc.) to the City of Richmond (City), the City requires the following MINIMUM insurance requirements and limits.
CONTRACTOR shall procure and maintain for the duration of the contract, agreement, or other order for work, services or supplies, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder and the results of that work by the CONTRACTOR, its agents, representatives, employees or subcontractors. Maintenance of proper insurance coverage is a material element of the contract. Failure to maintain or renew coverage or to provide evidence of renewal may be treated by the City as a material breach of contract.
CONTRACTOR agrees that in the event of loss due to any of the perils for which it has agreed to provide Commercial General Liability insurance, CONTRACTOR shall look solely to its insurance for recovery.
CONTRACTOR hereby grants to CITY, on behalf of any insurer providing Commercial General Liability insurance to either CONTRACTOR or CITY with respect to the services of CONSULTANT herein, a waiver of any right to subrogation which any such insurer of said CONTRACTOR may acquire against the CITY by virtue of the payment of any loss under such insurance.
Original, signed certificates and original, separate policy endorsements, naming the City as an additional insured for general liability coverage, as well as a waiver of subrogation for Workers’ Compensation insurance, shall be received and approved by the City before any work may begin. However, failure to do so shall not operate as a waiver of these insurance requirements.
City reserves the right to modify or require additional coverages for specific risk exposures depending on scope of CONTRACTORS work.
Minimum coverage is detailed below. The policy limits of coverage shall be made available to the full limits of the policy. The minimum limits stated herein shall not serve to reduce the policy limits of coverage of CONTRACTOR.
Minimum Scope of Insurance – the following forms shall be provided and coverage shall be at least as broad as the following:
1. Insurance Services Office Commercial General Liability coverage (ISO Occurrence Form CG 0001), and including coverage for bodily and personal injury, property damage, and products and completed operations (if applicable).
2. Insurance Services Office Automobile Liability coverage (ISO Form CA 0001, Code 1, Any Auto).
3. Original and Separate Additional Insured Endorsement for General Liability (ISO Form CG 20 10 11/85 or its equivalent) with primary and non-contributory language.
4. Workers’ Compensation Insurance as required by the State of California including Employer’s Liability coverage.
5. Original and Separate Waiver of Subrogation for Workers’ Compensation insurance.
6. Professional Liability or Errors & Omissions Liability Insurance appropriate to the CONTRACTOR’s profession (if required.)
Required Coverage Minimum Limits
Workers’ Compensation and
Employers’ Liability
Statutory limits as required by the State of California including $1 million Employers’ Liability per accident, per employee for bodily injury or disease.
If CONTRACTOR is self-insured, provide a certificate of Permission to Self- Insure, signed by the California Department of Industrial Relations and Self- Insurance. If contractor is a sole proprietor (has no employees) than contractor must sign “Contractor Release of Liability” found at:
http://www.ci.richmond.ca.us/index.aspx?nid=61.
General Liability
(primary and excess limits
combined)
$2,000,000 per occurrence for bodily injury, personal injury and property damage. If the policy includes a general aggregate, either the general aggregate shall apply separately to this project, service or location or the minimum required aggregate limit shall be twice the per occurrence limit ($4 million aggregate limit).
Policy shall be endorsed to name the City of Richmond as an additional insured per the conditions detailed below.
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 2 of 3
Revised: September 2011
Automobile Liability $1,000,000 per occurrence for bodily injury and property damage.
PROJECT COST R EQUIRED LIMIT
$0 - $1 million $1 million p/o
$1 million - $5 million $2 million p/o
Over $5 million $5 million p/o
Professional Liability or Errors &
Omissions Liability –
Required for all professionals
including architects, engineers,
consultants, construction
management, counselors, medical
professionals, hospitals, clinics,
attorneys and accountants, & other
consultants as may be required by
the City.
Required Policy Conditions
Additional Insured Endorsement
Applicable to General Liability coverage.
The City of Richmond, its officers, officials, employees, agents and volunteers are to be named as additional insureds for all liability arising out of the operations by or on behalf of the named insured including bodily injury, deaths and property damage or destruction arising in any respect directly or indirectly in the performance of this contract.
ISO form CG 20 10 (11/85) or its equivalent is required. If the Contractor is supplying their product or providing a service then the endorsement must not
exclude products and completed operations
coverage. If it does, then CG 20 37 (10/01) is also required.
SAMPLE Endorsements can be found at
http://www.ci.richmond.ca.us/index.aspx?nid=61
.
Primary and Noncontributory The contractor’s insurance coverage must be primary coverage as it pertains to the City, its officers, officials, employees, agents and volunteers. Any insurance or self insurance maintained by the City is wholly separate from the insurance of the contractor and in no way relieves the contractor from its responsibility to provide insurance.
Waiver of Subrogation
Endorsement Form
Contractor’s insurer will provide a Waiver of Subrogation in favor of the City for Workers’ Compensation Insurance during the life of this contract.
SAMPLE Endorsements can be found at
http://www.ci.richmond.ca.us/index.aspx?nid=61.
Deductibles and Self-Insured
Retentions
Any deductible or self-insured retention must be declared to and approved by the City. At the option of the City either the insurer shall reduce or eliminate such deductibles or self-insured retention as respects the City or the CONTRACTOR shall procure a financial guarantee in an amount equal to the deductible or self-insured retention guaranteeing payment of losses and related investigations, claims administration and defense expenses.
Contractor is responsible for satisfaction of the deductible and/or self-insured retention for each loss.
A. M. Best Rating A:VII or Better. If the A.M. Best Rating falls below the required rating, CONTRACTOR must replace coverage immediately and provide notice to City.
Umbrella/Excess Liability Policies
If an Umbrella or Excess Liability Policy is used to meet the liability limits, coverage shall be as broad as specified for underlying coverage’s and cover those insured in the underlying policies.
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 3 of 3
Revised: September 2011
Claims-Made Policies
If any insurance policy is written on a claims-made form: 1) the retroactive date must be shown, and must be before the date of the contract or the beginning of contract work. 2) Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. 3) If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a retroactive date prior to the contract effective date, the Contractor must purchase an extended period coverage for a minimum of five (5) years after completion of contract work.
Subcontractors
CONTRACTOR
shall include all subcontractors as insured under its policies or shall furnish to the City for review and approval, separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall be subject to all of the requirements stated herein.
CONTRACTOR agrees to defend and indemnify the City of Richmond for any damage resulting to it from failure of either CONTRACTOR or any subcontractor to take out or maintain the required insurance policies.
The fact that
insurance is obtained by CONTRACTOR, and/or CONTRACTOR’s subcontractors, will not be deemed to release or diminish the liability of CONTRACTOR, including, without limitation, liability under the indemnity provisions of this contract. Damages recoverable by CITY from CONTRACTOR or any third party will not be limited by the amount of the required insurance coverage.
Verification of Coverage
All original certificates and endorsements shall be received and approved by the City before work may begin .
The City of Richmond reserves the right to require complete, certified copies of all required insurance policies including endorsements affecting the coverage at any time.
Original insurance certificates and required policy endorsements shall be mailed or delivered to the Designated Project Manager for the City of Richmond.
Insurance certificates and endorsements may be faxed to the Designated Project Manger. However, CONTRACTOR must mail the original certificates and endorsements to Designated Project Manager once faxed.
Continuous Coverage
CONTRACTOR shall maintain the required insurance for the life of the contract. Should the CONTRACTOR cease to have insurance as required during this time, all work by the CONTRACTOR pursuant to this agreement shall cease until insurance acceptable to the City is provided. In the event that CONTRACTOR fails to comply with the City’s insurance requirements, the City may take such action as it deems necessary to protect the City’s interests. Such action may include but is not limited to termination of the contract, withholding of payments, or other actions as the City deems appropriate.
If services or the scope of work extend beyond the expiration dates of the required insurance policies initially approved by the City, CONTRACTOR must provide updated certificates and endorsements indicating that the required coverage, terms and conditions are still in place. Renewal certificates and updated endorsements shall be mailed to the Designated Project Manager.
Cancellation
CONTRACTOR shall ensure that coverage shall not be cancelled, reduced or otherwise materially changed except after thirty (30) days’ prior written notice has been given to the City.
Reporting Requirements
Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City, its officers, officials, employees or volunteers.
Consistent with Public Policy
The insuring provisions, insofar as they may be judged to be against public policy shall be void and unenforceable only to the minimum extent necessary so that the remaining terms and provisions herein may be consistent with public policy and thus enforceable.
2121 West Bullard Avenue, Fresno, California 93711 ½ 559.435.2800 ½ Fax: 559.435.7200 ½ www.occu-med.com Febr
uary 24, 2023
Mr. Eric Tam
Technology Supervisor
City of Richmond
450 Civic Center Plaza
Richmond, CA 948004
RE: Response to Request for Proposal (RFP) for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing.
Cover Letter
De
ar Mr. Tam:
Occu-Med has reviewed the City of Richmond’s Request for Proposal (RFP) for DOT and Pre- Employment physical exams, drug testing immunizations and TB Testing and subsequent.
Q and A 1-4. In due course, we are pleased to submit our proposal demonstrating our ability to perform the services outlined therein.
Occu-Med, a federally registered small business, with regional offices throughout the United States and Headquartered in Fresno, CA, has been an industry leader in occupational health programs for more than 43 years. If awarded the City’s business, our Fresno office will manage this project and utilize medical clinics on our network located in Emeryville, Concord, and Lafayette. Our approach to responding to the City’s RFP is one that capitalizes on our expertise in order to provide the City with a comprehensive and cost-effective solution for obtaining a quality, ADAAA, FEHA, DOT & POST compliant Occupational Health Services Program.
Therefore, our proposal offers the City a range of high-quality professional services across multiple breadths of expertise including: medical, legal, OSHA and DOT. To this end, the goal of our response is to demonstrate how Occu-Med’s Program provides the solution to all of the scope of services requested in the City’s RFP.
For these reasons we are offering the City a medical evaluation solution that is currently utilized by the Cities of Fremont, Hayward, San Leandro, San Pablo, Pleasant Hill, Pittsburg, Walnut Creek and the Counties of Santa Clara & Sacramento as well as many others public agencies throughout the Bay Area.
Occu-Med is willing to enter into an agreement under the terms and conditions prescribed by the City’s RFP insurance requirements (attachment A) and sample service agreement (attachment B).
Please consider our price proposal valid for a period of 180 days from the date printed on this letter.
James A. Johnson
President & CEO
EXHIBIT G
Cover Letter February 24, 2023 Page 2 I will be the City’s single point of contact during the City’s RFP review process. I can be reached anytime at: 559.435.2800 x 207 or my mobile 559.999.7713. As we continue to perform our service for our clients nationwide, including hundreds of Public Agencies in California, we are pleased to present our proposal for your review. We would be honored to begin providing our service to the City of Richmond as well as its applicants and employees. We look forward to hearing from you. Sincerely, Chris St. George Business Development Director
The City of Richmond Response Request for Proposals for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. Proposal Submitted by: February 24, 2023 Corporate HQ - 2121 West Bullard Avenue, Fresno, CA, 93711 Federal Tax ID: #52-2333519 State of California Corporate ID: C2472806 559.435.7200 - Fax Contact: Chris St. George 559.435.2800 x207 – Telephone 559.999.7713 – Mobile [email protected] www.occu-med.com
The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
2 Occu-Med
Table of Contents Page Number A. Cover Letter N/A Title Page 1 Table of Contents 2 B. Scope of Services 3 1. Team 3 2. Experience 5 3. Approach 7 4. Proposed Scope of Services 9 a. Pre-Employment and DOT Physicals - QA2 Occupational Health Program 9 b. Immunizations - Occu-VAX 14 c. Infectious Disease Screening 15 d. Drug Screening 16 C. Cost Information 18 D. Contractor Assignment of Sub-Contract 20 E. Exceptions to this Request for Proposal 20 F. Statement of Impartiality and Disclosure 21 EXHIBITS CITY REQUIRED FORMS The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
3 Occu-Med
1. Team Occu-Med’s Team Bailey will be assigned to the City’s account as its dedicated team. Team Bailey is comprised of eight individuals who also receive support from dozens of other Occu-Med staff. As we commit to with all our clients, we will respond to a referral within two business hours of receipt. And, based on the completion of over 15,000 exams in 2022, and hundreds of thousands of exams in our 43 years, we are confident that we can be responsible for the City’s account and any anticipated applicant/employee population. Christopher St. George - Project Manager (Implementation) Mr. St. George began serving as Occu-Med’s Business Development Director following five (5) years of work as the Company’s Director of Global Business Services. In his current role Mr. St. George continues to lead Occu-Med in the global arena of employment medical services. This has included the management and delivery of medical exams and evaluations for various international assignments involving medium to long-term projects overseas and various operations in almost every Gulf Cooperation Council (GCC) Country. He has also served as an embedded consultant with Fortune 200 Companies in Kuwait and Dubai. His Programs are regularly graded by clients as “Industry-Best” “Exceptional” and “The Clear Choice” in past performance ratings in multiple areas of service. During his tenure with Occu-Med Mr. St. George has advised his clients on wide-ranging employment legal, medical compliance and personnel policy-making decisions drawing on both: a) the continuing study and education of the evolving regulations and compliance with the American with Disabilities Act (ADA) & its Amendments Act (ADAAA), California Fair Employment and Housing Act (FEHA), Family Medical Leave Act (FMLA), National Fire Protection Association (NFPA) 1582 & 1583 Standards, Peace Officer Standards and Training (POST) Guidelines, United States Central Command (USCENTCOM), Individual Protection and Individual Deployment Policy, Occupational Safety & Health Administration (OSHA) Regulations, Department of Transportation (DOT) Regulations and Health Insurance Portability and Accountability Act (HIPAA) as well as, b) an international network of expert business consultants across a wide breadth of industry and background. In 2022, Mr. St. George has continued to consult on employment medical compliance and safety that will help to craft employment medical programs for his clients during their ongoing expansion into emerging The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
4 Occu-Med
markets throughout Asia, Africa and Central/South America. Mr. St. George joined Occu-Med in 2005. He is a graduate of the Craig School of Business at CSU Fresno. Cristal Granse, Director of Team Bailey Mr. Granse will provide leadership and management of the day-to-day operations of the County’s account if Occu-Med is awarded the contract. Ms. Granse has been with Occu-Med for over 10 years. She initially began her journey with us as an EXAMQA Analyst, but has since progressed into a role as the Director for Team Bailey. Her focus is to be an advocate for our clients and their needs. Contact information for both Ms. Granse and Team Bailey can be found below:
Devonna M. Kaji M.D. - Director of Medical Research Dr. Kaji graduated Magna Cum Laude from the University of California, Berkeley and the University of Hawaii, John A. Burns School of Medicine. She received her surgery training at the University of Southern California (USC) and is a Board Certified Urologist. She has served as Professor of Urology and Assistant Chief of the Department of Urology at the Children’s Hospital of Los Angeles, the University of Southern California and the University of Colorado. Dr. Kaji has served on Occu-Med’s Board of Directors and managed its Medical Advisory Board for more than 30 years, and she has been the Company’s Medical Director for more than 20 years. She has participated in all of the Company’s medical research, having met with the medical specialists and sub-specialists representing 12 separate body systems who initially formulated Occu-Med’s Compendium of Medical Standards (now termed Medical Guidelines). She has continued to supervise and participate in every medical research meeting addressing the continued effectiveness and appropriateness of this Compendium. Dr. Kaji supervises all medical specialists to Occu-Med. Further, Dr. Kaji oversees all medical aspects of the Company’s EXAMQA program.
The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
5 Occu-Med
James A. Johnson J.D. - CEO Mr. Johnson founded Occu-Med in 1979 with an initial focus on research and consulting. As interest in the Company’s proprietary research grew, Mr. Johnson expanded operations to include occupational medicine clinic management (including Occu-Med’s own clinics), workers’ compensation cost containment, vocational rehabilitation counseling (with a department of 9 counselors), franchise operations, and an international network of medical providers committed to providing timely, professional and cost-effective medical examinations for our clients. Under Mr. Johnson’s guidance, Occu-Med has been the vanguard of medical standards / guidelines research and risk management programs designed around such research. He has also guided the Company’s national expansion for 40 years. Prior to founding Occu-Med, Mr. Johnson was a private consultant directing several major civil rights consulting projects. Mr. Johnson was a legal analyst and an Affirmative Action Advisor with the County Supervisors’ Association of California and a legislative analyst with the State of Hawaii’s Commission on the Handicapped. Mr. Johnson is a graduate of The Ohio State University and the University of the Pacific’s McGeorge School of Law. Geoffrey W. Black M.D.- Staff Physician Dr. Black overseas Occu-Med’s medical operation in the Fresno area and is the primary provider at our medical clinic at that location. In addition to his day-to-day clinical duties, Dr. Black provides medical policy and expert resources guidance to Occu-Med regarding OSHA and HAZMAT compliance. Dr. Black attended medical school at USC’s Keck School of Medicine. 2. Experience Since 1979 Occu-Med’s primary mission has been to reduce occupational injuries. Beginning in 1976, Occu-Med’s founder, James Johnson J.D., directed a two-million dollar United States Civil Service Commission grant “to develop and implement an improved system of physical and medical standards and procedures for employment.” The goals of this project were: a) to ensure workers were able to safely perform the essential function of their jobs, b) reduce the costs associated with worker injuries, and c) protecting the rights of the disabled by developing a medically appropriate and legally defensible methodology for determining what medical conditions, injuries or illnesses allowed for reasonable accommodation. The culmination of Occu-Med’s initial research project was the Occu-Med Program of medically evaluating applicants’ and employees’ job suitability.
The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
6 Occu-Med
During the thousands of hours spent analyzing various job classes amongst cities and counties throughout California (which were participating in the research grant), Occu-Med was able to discover and statistically document that - regardless of job class - approximately 41% of worker injuries occurred in the first year of employment. Further analysis of this figure, conducted with Sacramento County, Los Angeles County, and many other agencies (in coordination with Jean Felton, M.D., (“The Modern-Day Father of Occupational Medicine” and Occu-Med’s first Medical Director), as well as Lee Cady, M.D., Occu-Med’s cardiologist), resulted in what eventually became the basis of Occu-Med’s signature service QA2, the gold-standard in pre-placement and occupational health medical evaluations. Many of the organizations that participated in this project were eager to begin utilizing the Occu-Med Occupational Health Evaluation Program. Accordingly, the second phase of Occu-Med’s research began with the goal of discovering why such a disproportionate amount of injuries occurred almost immediately after an employee was placed. The results of Occu-Med’s second phase of research (conducted in coordination with the State of Hawai’i) yielded a revelation, applicants and employees with pre-existing medical conditions were being placed into jobs that, upon the performance of their essential functions, predisposed the individual to injury. Therefore, if these medical conditions could be identified prior to the applicants or employee being placed, entire injuries could be avoided, thus completely eliminating the associated cost of the resulting workers’ compensation claim. Today, we serve approximately one thousand clients, including more than 100 Cities and Counties, more than 300 water agencies, and more than 300 fire districts, dozens of police and sheriff’s departments and national private employers—frequently reviewing more than 200 medical examinations daily. In fact, in 2019, we assisted in the placement (or continued placement) of more than 15,000 employees. In Northern California a partial list of current clients for which we have performed the same or similar work/projects includes: Santa Clara County Fire and the Office of Education, City of Fremont, City of San Leandro, City of Sacramento, City of Sebastopol, City of St. Helena, City of Modesto, Central Marin Police Authority, Amador Fire Protection District, City of San Pablo, City of Walnut Creek, City of Pleasant Hill, City of Winters, City of West Sacramento, and many others. References for whom the City may contact (We would be happy to provide additional reference information upon request): City of Walnut Creek – Kathryn Tunney, HR Specialist, 925.943.5899x2413, E: [email protected] City of San Pablo – Alicia Southern, HR Manager, P: 510.215.3002, E: [email protected] City of Fremont – Kelly Wright, HR Manager, P: 510.494.4666, E: [email protected] The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
7 Occu-Med
3. Approach One of three key elements in our continued management of the City’s Occupational Health Program would be incorporating a process for updating, collecting and analyzing valid job information pertaining to the most physically demanding essential job function for any physical ability required for a job. In due course, Occu-Med developed Physical Abilities Analysis, its proprietary system of identifying the most physically demanding essential functions of a job. - But, how do you analyze so much information, jobs can be so complicated? Physical Abilities Analysis is a structured group process that involves interviewing job incumbents from the job being analyzed. During the job analysis sessions, incumbents are asked to identify the most physically demanding essential job tasks for 19 physical ability categories, and then they are instructed to rate those tasks on a 7-point, behaviorally-anchored scale. The incumbents are also asked to complete a questionnaire that addresses the environmental factors that they may be exposed to in their job. Overall, each session only requires about two (2) hours to complete. Data collected is then qualitatively and statistically analyzed to develop easy to understand 1-page Job Profiles. The job information collected during these sessions allows Occu-Med’s medical review personnel to know at what exact point a job task in question becomes too demanding for a medical condition or injury identified on a job applicant’s post offer pre-placement medical evaluation, or an employee’s periodic or compulsory medical evaluation. In light of the almost 5-years of research completed, Occu-Med began utilizing its Physical Abilities Analysis in collaboration with many of the agencies who participated in the research and, in 1984 we opened our own clinic. Utilizing our research-based Program designed specifically to understand what medical conditions to look for during a pre-placement medical evaluation Occu-Med began to dramatically reduce workers’ compensation costs at organizations which utilized our Program. Throughout the rest of the 1980’s and into 1990 Occu-Med continued to apply its findings to help reduce employee injuries and workers’ compensation costs at hundreds of public agencies throughout [primarily] the United States. Then, in 1990 with the legislation (and success) of the Americans with Disabilities Act, employers were required to comply with more stringent regulations regarding how an occupational health evaluation was both administered and reviewed. Out with Standards & In -dividualized Assessment (Guidelines): As it related to occupational health, one of the key aspects of the 1990 Americans with Disabilities Act (the “ADA”) was the requirement that pre- The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
8 Occu-Med
placement medical testing be job-related and consistent with business necessity. Previously, with varying degrees of ambiguity, employers could merely select a medical test (they believed was diagnostic of an individuals’ ability to perform a job function) and require all job applicants “pass” such a test, regardless of whether or not that test was actually a valid measure of safe job performance. The ADA, instead, now required a nexus be shown between the medical test and one or more of the essential functions of the job into which the applicant was to be placed. Fortunately, Occu-Med, and its clients, were very well prepared for this legislation, after all we had already been solely conducting job-related medical evaluations for over a decade utilizing the Physical Abilities Analysis process previously described on page 8. In due course, employers would now look to Occu-Med not only as medical experts but also for discerning legal and risk management guidance regarding how to appropriately comply with the ADA legislation which would now govern occupational health-related medical evaluations. For the remainder of the 1990’s Occu-Med would continue to establish itself as the premier authority related to occupational health evaluations. By the early 21st century, in addition to the 2008 ADAAA legislation, Occu-Med saw the expansion and updates to other regulations and guidelines related to occupational health including: Genetic Information Non-Discrimination Act (GINA), National Fire Protection Agency (NFPA) 1582, OSHA 1926, as well as updates to the Federal Motor Carrier Safety Administration (FMCSA) Medical Examiners Handbook. In light of these updates our team would work lockstep with our client employers to ensure continual compliance with each update.
The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
9 Occu-Med
4. Proposed Scope of Services Occu-Med is best able to respond to the City’s requested Scope of Services listed on page 3 and 4 of the City’s RFP items a-d. Scope of Services (Initial) The cornerstone of creating OSHA Compliance is Occu-Med’s QA2 Occupational Medicine Program, this begins with the review and approval of all medical testing performed through a statistically validated method – This Process is detailed in the Approach Section of the Proposal Section “D”. Job Profiles (Exhibit 1) are prepared for use in evaluating pre-placement, fitness-for-duty and return-to-work medical examinations by conducting on-site job analysis sessions. The procedure utilized during the job analysis sessions is the same one that we have used for more than 3,000 other agencies: Physical Abilities Analysis. The methodology used for completing this process, is explained on page 4 and 5 of our proposal. The Job Profile accurately and fully reflects the most physically demanding essential job tasks of the jobs studied, and the Medical Examination Component Profile (see Exhibit 2) details the specific medical tests that are job-related and consistent with business necessity and therefore recommended to find or diagnose the medical or physical conditions that would be of concern for that job. Every medical exam performed by Occu-Med is done so in order to comply with the legal requirements surrounding what is permissible for pre-placement and periodic medical evaluations under the ADAAA, FEHA, HIPAA, OSHA and GINA. Put simply, we do not just ask the applicant or employee if he or she is able to “do the job” or “return to work”, rather, our approach provides a quantifiable way to make such a determination for each applicant as part of an individualized assessment. With the completion of Job Analysis and approved Medical Exam Component Profile the City can be confident that all medical testing is job related and consistent with business necessity. After our initial job analysis is completed Occu-Med can on a regular basis refresh the City’s Job Profiles to reflect changes to the physical demands of the position. This will also be performed for the City’s Medical Exam Component Profiles in order to stay compliant with changes to applicable laws, like updates to OSHA Medical Surveillance Standards. NOTE: If the City elects not to purchase Job Analysis services, Occu-Med will immediately begin work from the City’s existing Job Information, DOT Standards, POST and the City’s existing Medical Examination Protocols. Our job analysis service The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
10 Occu-Med
can always be performed at a later date. We can also conduct a complimentary review the City’s existing Medical Profiles to determine if any testing can be added or removed in light of return on investment, or immediate hiring needs. Either using our Job Analysis Program or Occu-Med/the City’s existing guidelines, Occu-Med is uniquely positioned to assist the City with the human resources matters involving complex medical cases that require a prompt and discerning assessment of the medical factors that may constitute a contraindication to an employee's performing one or more of the essential functions of the his/her job. a. Pre-Employment & DOT Physicals - QA2 Occ. Health Program Scope of Services (Ongoing) QA2 is the name given to Occu-Med’s end-to-end solution for the scheduling, performance and on-going review of all medical evaluations for City applicants and employees. As the need arises the same process outlined in this section for scheduling, tracking and reporting the results of the medical exam will be applied when scheduling periodic exams, or standalone drug screens. This service includes Occu-Med’s review of exams, the further investigation of job-related medical conditions identified during these exams (through the “RDQA” service--see pages 13-14), the preparation of letters to applicants who are determined to be Medically Disqualified for the job for which they applied, an analysis of Reasonable Accommodation for each individual Medically Disqualified, and the preparation of periodic status reports. Scheduling: Scheduling pre-placement or periodic medical evaluations through Occu-Med could not be easier a representative contacts Occu-Med’s Exam Scheduling Hotline or submits an Occu-Med Exam Referral Form via e-mail (see Exhibit 3), and the necessary medical exam is scheduled by Occu-Med the same day as the referral. Occu-Med within two (2) business hours of receipt of your referral will contact your applicant/employee in order to arrange a medical appointment with him or her. Occu-Med is proposing the performance of most of the City’s evaluations at one of our preferred medical providers in Emeryville, Concord and Lafayette. This provider currently performs the same or similar evaluations for Occu-Med for the Cities of Hayward, Fremont, San Pablo, San Leandro, and Pleasant Hill. Of course, our timeline will remain flexible should the City’s needs change including our ability to increase daily throughput to up to 40 exams a day, if a mass hiring need arises, and Occu-Med will also have personnel onsite. We believe that this approach will afford the Department with a high-quality, flexible, timesaving and cost-effective solution. CCCMA offers onsite X-ray equipment, audiograms, vision testing, including the Hardy Rand Rittler for Peace Officer positions, laboratory, collections The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
11 Occu-Med
services (blood & urine), large off-street parking, and locked storage containers. Additionally, Occu-Med is able to arrange for onsite clinical testing for large “hiring events”, health fairs or other similar activities. Additionally, many other locations are available throughout the State that can be used for specific services requested in the City’s RFP. For instance, if the City is hiring someone who lives closer to Sacramento, or in Southern California. Upon completion of scheduling, the designated City representative[s] will immediately receive email confirmation of the appointment time and date, which will be scheduled to occur within 3 business days of the referral (or as directed by the City). Normally, the exam will be scheduled at a medical provider currently on the Occu-Med network closest to the candidate’s home of record (see above), however, with your permission, exams could be scheduled at an alternative nearby clinic if the preferred clinic is booked out beyond acceptable time periods or if the applicant or employee currently works closer to an alternative clinic. Upon scheduling the medical evaluation the individual and the clinic is provided in advance all the necessary paperwork in order to complete the process successfully. This includes an electronic copy of Occu-Med’s GINA & POST compliant medical history forms (see Exhibit 4) which are used in place of the local medical providers forms. We do this to ensure no inappropriate medical history questions are solicited as oftentimes, clinic specific forms lack compliance as they are used for various other types of medical evaluations. Additionally, when applicable, we will also always provide job specific forms and questionnaires to the applicant/employee ahead of time, for instance OSHA Respirator Questionnaire 1910.134, Appendix C. Copies of medical history and examination forms are also pre-positioned at the clinic for ease of access for the provider or should the individual forget his or her copy. And, our email includes helpful hints for completing the exam, like fasting before a blood glucose draw. As a yet another quality control measure, based on the pre-agreed upon medical testing components and laboratory services Occu-Med always provides each clinic with a separate pre-authorization form to reinforce the required components for that specific evaluation. This coupled with Occu-Med’s pre-positioned laboratory requisition forms virtually eliminate the ability for a clinic to attempt “winging-it” regarding which medical components it performs. Having scheduled the medical exam, and with knowledge of the length of time required to obtain results from the medical testing included in the exam (i.e., PPD test for tuberculosis takes 48 to 72 hours for results), Occu-Med contacts the medical provider to request, or “harvest,” the exam at the absolute earliest time that it should be ready for review. This service has cut exam turnaround time for our clients The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
12 Occu-Med
in half in almost every case. Thus, eliminating a clinic from “holding” an exam until they have staff that can fax or email the results. Occu-Med commits to submitting a Medical Exam Summary Report to the City on the same day the complete medical exam is received (provided it is received before 4:00PM PT). EXAMQA When reviewing an exam Occu-Med combines: a) a thorough knowledge of the essential physical and environmental components of the jobs in question; b) the medical expertise to gather all necessary and appropriate medical information upon which to base safe placement, return-to-work and fitness-for-duty recommendations; and, c) extensive knowledge of the medical requirements and the associated legal constraints within which such placement decisions must be made. This aspect of our services means that Occu-Med, and our medical review staff, review all completed medical evaluations and it is Occu-Med’s recommendation that is made to the City regarding an applicant/employees safe placement (not just the individual clinic’s medical staff). This process ensures that all pertinent aspects regarding a placement decision are considered and not just those in the examining physician’s purview and; at the same time, ensures a continuity in the way each exam is reviewed and, when necessary, additional information requested. This continuity is a fundamental difference from the usual model of allowing each individual doctor, nurse or other medical staff at each individual clinic to interpret the required employment considerations. For Conditional Qualifications (CQ), an Employment Agreement accompanies each such report. For Recommended Delayed for Qualification (RDQ), RDQA is initiated with the applicant/employee, and the City is simply notified that the process has begun. This eliminates the possibility of disclosure of protected personal medical information that may be undesirable for the City to have received. For each Disqualification (DQ), an appropriate medical-legal report is submitted documenting the specific justifications for the disqualification and informing the City of the requirement of a consideration of Reasonable Accommodation (a process in which we encourage the City to involve us). Periodic performance reports, addressing both clinic turnaround statistics and EXAMQA results, are available upon request. Details regarding Occu-Med’s qualification recommendations are as follows:
The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
13 Occu-Med
Medically Qualified - Applicant/employee is an immediate/continued safe placement. Conditionally Qualified - Applicant/employee may be (or remain) placed immediately but has work restrictions or accommodation as outlined on the medical restrictions and/or reasonable accommodations page of the report. The specific restrictions or accommodations are always included as part of the Conditionally Qualified Medical Exam Summary Report. Recommendation Delayed for Qualification - Applicant/employee will be required to submit further information regarding one or more medical conditions before being placed. This process is facilitated by Occu-Med via RDQA. The applicant/employee is contacted on the day that he/she becomes delayed and informed that he or she has 10 business days to complete the request for additional medical information (extensions of the timeframe can be granted at the City’s discretion). Medically Disqualified - Applicant/employee has been deemed medically unsuited for this job class (or specific activities within a job class and will not be (or remain) placed. Occu-Med’s report outlining relevant issues will be attached. The City must consider Reasonable Accommodation for this Medical Disqualification and must determine whether such an accommodation is feasible. Recommendation Delayed for Qualification – RDQA The RDQA process is one of the most advantageous services associated with the Occu-Med Program. When the Occu-Med recommendation is that a decision be delayed until certain medical information can be further explored (that is, when the applicant is classified as “Recommendation Delayed for Qualification”—or “RDQ”—under Occu-Med terminology), Occu-Med will submit that report as well as an additional report when the requested additional information is received and Occu-Med is able to offer a conclusive placement recommendation. Since the law permits making “further medical inquiry” into medical conditions that could pose a direct threat of injury from the performance of the job’s essential duties, it is necessary to notify the applicant or employee of the specific findings as well as the information that will be necessary to submit in order to make a final placement decision. Since City staff may not have the time or the medical expertise to contact each of these individuals to describe in detail the medical findings and to answer their questions about the medical information needed for clearance, Occu-Med staff communicates directly with these applicants/employees. Further, there is also a growing fear by employers that they may be receiving medical information about employees or potential employees from a medical evaluation in violation of state and federal laws relating to such information (specifically, when the medical condition being investigated more fully pursuant to an “RDQ” designation The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
14 Occu-Med
is found to be benign in relation to the job’s essential duties). For these reasons Occu-Med has developed—and will institute as part of this contract—a service designated as “RDQA.” Under RDQA Occu-Med corresponds directly with job applicants to discuss the medical findings, to answer any questions about the medical condition or the process being employed, and to describe any medical records or documentation required for clearance. Each individual will have five (5) days to respond to Occu-Med and ten (10) days to provide further information (unless the City dictates the application of different time requirements). The City’s staff will simply be notified that such a review has been initiated via a corresponding report, and the City will be informed on a periodic basis (as directed) on the status of each RDQ. Then, when the requested information is submitted, Occu-Med will prepare the appropriate (final) Medical Exam Summary Report. b. Immunizations - Occu-VAX Occu-VAX is the scheduling and coordination, immunization record management and the on-going management of all immunizations for applicants and employees for jobs. This service includes an individualized evaluation of each applicant / employee to assess the appropriateness and necessity for administering the immunization treatments outlined in the specific Occu-VAX Profile prior to and, when appropriate, during employment. Scheduling and Coordination: Upon completion of the medical evaluation or concurrently by requirement or request from a designated City employee, Occu-Med will promptly contact applicants / employees to: a) assess the appropriateness and necessity for receiving immunization treatments, and b) schedule and coordinate the administration of those immunizations deemed appropriate and necessary prior to and during employment. Immunization Record Management: Applicants and employees will be given an immunization record (documentation of immunization history) upon completion of: a) initial administration of immunizations; or b) an assessment of each individual’s vaccination history concluding that no immunizations are necessary. Immunization records for all applicants and employees evaluated will be maintained electronically by Occu-Med. In the event an applicant tor employee declines an immunization Occu-Med will obtain the appropriate declination from the individual. On-Going Immunization Management: All immunizations recommended will be managed by Occu-Med. This service includes tracking to assure compliance with the CDC and OSHA, in addition to other The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
15 Occu-Med
applicable guidelines; notification of employees and designated supervisory personnel of all periodic follow-ups associated with immunizations; and, upon request, preparation and provision of customized tracking reports documenting any aspect of the immunization treatment program and/or obtaining signed declination forms documenting the individual’s electing not to obtain the immunization[s]. Occu-VAX is a dynamic service that any employer can access, from including a Tetanus Shot as part of a pre-placement medical evaluation to providing on-site flu immunizations during the flu season. c. Infectious Disease Screening A blood draw can be performed for a Quantiferon Test so that the applicant need not return for a TB read. When Quanitiferon Lab testing is not ordered, a PPD (TB) skin test can be administered. This test will require the applicant return to the clinic 48-72 hours later for the test to be read. Applicants with positive results, as interpreted by the medical professional, consisting of induration of greater than or equal to 5 or 10mm (depending on job class) will receive the additional screening as recommended by the CDC. Occu-Med can also administer its custom TB signs and Symptoms Questionnaire (sample right). Upon our review of responses to this document Occu-Med can recommend what, if any, additional infectious disease testing is appropriate.
The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
16 Occu-Med
d. Drug Screening Substances of Abuse Testing: Drug screening at many clinics is “hit or miss” if not managed properly. Additionally, if a Medical Review Officer (MRO) is ever required, that service is subject to a separate fee. And, finally, many issues that arise are beyond the experience of the clinic to address (i.e., dilute negative tests and shy bladder). Occu-Med has developed a national program that manages all such drug screening issues for its clients, including assisting in the development of drug screening programs and procedures, pursuant to CFR Title 49 Part 40. Further, we are readily available to address any issues in this area that arise. This service will be substituted for the clinic’s typical program, ensuring compliance (or mirroring a DOT drug screen program. Urine Collections - Only Certified Specimen Collectors having received the CFR Title 49, PART 40.33 Training will be used for these collections. All urine results will be sent to Labcorp Laboratories for confirmation. Labcorp is SAMHSA certified (Federal Register/Vol. 88, No. 21/Wednesday, February 1, 2023/Notices), and is able to conduct confirmatory tests using the split-specimen regulations and MRO confirmation. These results are typically available within 48-72 hours, with up to 72 additional hours needed if MRO confirmation is required pursuant to a DOT requirements for a positive finding using GCMS confirmation. When MRO confirmation is required the County will be notified of the delay. Much of the workplan is discussed in the scope of services section, but by using Occu-Med’s web-based client portal, the Occu-Portal, clients are able to track in real-time the movement of a referral through the Occu-Med Program: Occu-Portal & Electronic Medical Record Maintenance: At the request of the City results will also be made available via an online web-based portal known as the Occu-Portal. Occu-Med will provide personnel, designated as authorized by the City with access to the Occu-Med Portal. This web-based tool will permit designated City personnel to access real-time statuses of
The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
17 Occu-Med
individuals referred to Occu-Med for evaluation. Additional tutorial information regarding utilizing Occu-Med's vendor portal will also be made available online should new users need training on the site. Occu-Med will also provide to the City, at its convenience, a telephonic or face-to-face walk-through of our portal features so that the City can customize which fields it wishes to have appear on the portal. Occu-Med will create vendor logins for six (6) City personnel, and more can be added at the City's convenience. Login access will be emailed by Occu-Med to the designated City representatives. It will be incumbent upon the City to notify Occu-Med should a representative change or no longer require access. Occu-Med's web-based portal utilizes individualized logins for each client contact and protects data transmission by utilizing a 128-bit SSL security certificate. As part of our QA2, Occu-Med serves as the custodian of records for all medical records for our clients. Occu-Med maintains this information in a HIPAA compliant softcopy that is available to the City with a one (1)-business day request. - Feedback Process Each Team Director prepares an audit checklist to provide feedback as to the quality and accuracy of the respective processes. This feedback is provided to the Director of Quality to serve the preparation of dynamic guidelines for process improvement. These checklists are compiled and categorized and distributed to each Team to serve as a knowledge base to improve the quality of the processes involved in fulfilling the Statement of Services as issued by the City. - Process Improvement Occu-Med’s Information Technology (I.T.) Department is proactively involved in ensuring adherence to designated quality norms. Any required process improvements are conducted under the auspices of the I.T. Department, with inputs from the Director of Quality and Team Directors, on the basis of the results of previous audits conducted.”
The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
18 Occu-Med
Activity to be audited Benchmarks Audited by Examination Scheduling Job Profile and Medical Exam Component Profile as provided by the City/Occu-Med Director of Quality + Director of Scheduling Medical Provider Relations Job Profile and Medical Exam Component Profile as provided by the City & Occu-Med; Director of Quality + Director of Medical Provider Relations QA2 Job Profile and Medical Exam Component Profile as provided by the City & Occu-Med; FMCSA and/or POST Guidelines Director of Quality + Director of Team Bailey Medical Examination Review Job Profile and Medical Exam Component Profile as provided by the City & Occu-Med; FMCSA and/or POST Guidelines Director of Quality + Director of Medical Examination Review C. Cost Information Please refer to the enclosed Exhibit 5. That section will contain Occu-Med’s specific cost of each medical service offered in responses to the services listed on page 3-4 of the City’s RFP. As documented in response to the Q and A portion of the City’s RFP, Occu-Med is not submitting a fee for Back X-Rays and Strength Testing. We often find there is little to no value in such tests, and, if eliminated by the City, we hope those saving would be considered as part of the City’s award Criteria specified in the Cost Proposal Section of its RFP. Occu-Med would be happy to offer additional information on this topic during the negotiations portion of the City’s Solicitation. Should the City elect to include Occu-Med’s - optional - Job Analysis service, such analysis can be conducted for approximately $1,000.00 per day and can be accomplished in 1-2 days onsite (with 1-2 days of back-office support to roll out the data collected). Nominal out-of-pocket expenses will be billed as incurred.
The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
19 Occu-Med
Our QA2 service fee includes: • Scheduling of each medical exam • Tracking each medical exam for applicant/employee attendance • Harvesting all medical exam results from the clinic • Occu-Med Medical Network - Allowing for evaluations throughout California and the United States • Review and evaluation of completed medical examinations with results sent to you on the same day that the exam is received • Written reports for each review undertaken for each applicant/employee, including medical monitoring of exposure levels. • Employment Agreements for any employees placed with accommodations • Additional reviews for applicants with medical or physical conditions requiring further and/or more frequent testing or submission of additional information • RDQA services - Explanation (by telephone and by letter) to prospective employees of additional medical information necessary for job clearance • Submission of legally defensible placement recommendations within 8 hours of receipt of an exam • Assistance with reasonable accommodation recommendations • Policy Assistance to better align with OSHA requirements • Consultation relative to pre-placement, return-to-work, and fitness-for-duty issues • Assurance of excellent clinic performance issues, including onsite visits, as needed • Periodic reports documenting the results of Occu-Med’s work • Occu-Portal – online real time access to results • Clinic Invoice Accuracy Review (described page 20).
The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
20 Occu-Med
Clinic Invoice Accuracy Review Occu-Med began its Clinic Invoice Accuracy Review service in 2006 as part of its service to ITT, a company working on various major federal projects. We have evaluated more than 100,000 clinic invoices for pre-placement exams over this span of time and have been absolutely appalled at our findings: a) more than 92% of these clinic invoices were initially submitted with inaccuracies (wrong charges for tests not performed, charges for unnecessary testing performed, duplicate billings); and b) much worse is the fact that nearly all of the incorrect invoices were inaccurate in favor of the clinic. Occu-Med is able to bill the City with either line-item prices or pursuant to one flat pre-agreed upon rate per exam. Occu-Med’s invoices demonstrate a clear departure from the amorphous invoices customarily generated by a clinic or medical facility. Occu-Med requires the submission of an accurate invoice for payment—at which point we immediately submit payment to the clinic. Clients have informed us that this “bill review” service alone has literally saved days of staff time. Another client, upon learning of this billing trend, audited the previous year’s invoices and was able to obtain a refund of more than $3,000 for exams performed. Each of Occu-Med’s invoices will include the applicant’s name, contract number and Occu-Med’s Federal Tax ID. D. Contractor Assignment of Sub-Contract Occu-Med utilizes a clinic Network to perform the hands-on physical exam portion of the medical evaluation. For the City’s work Occu-Med proposes using the following medical clinics. These clinics currently perform Occu-Med medical evaluations for other Bay Area City’s throughout the East Bay. Agile Occupational Health Stat Med Stat Med 6001 Shellmound Street Suite 115 901 Sunvalley Blvd. Suite 100 3799 Mt. Diablo Blvd. Emeryville, CA 94608 Concord, CA 94520 Lafayette, CA 94549 M-F: 8:30am-5pm M-F: 8am-6pm M-F: 9am-5pm *All laboratory testing and drug screens will be processed at Occu-Med’s CAP accredited Lab, Labcorp (licenses included as Exhibit 6). E. Exceptions to this Request for Proposal Occu-Med has reviewed the City’s Standard Services Agreement. – Attachment 1. Occu-Med takes no exceptions to this Agreement.
The City of Richmond - Response to Request for DOT and Pre-Employment Physical Exams, Drug Testing, Immunizations and TB Testing. 2/24/2023
21 Occu-Med
F. Statement of Impartiality and Disclosure Occu-Med and sub-consultants are not currently, and will not, during the performance of these services, participate in any other similar work involving a third-party with interests currently in conflict or likely to conflict with City of Richmond’s interests. Occu-Med has no pending litigation or investigations that may affect our ability to carry out this project. Thank you for this opportunity, we appreciate your time in reviewing our proposal and we hope to continue to serve the City of Richmond Proposal Respectfully Submitted By:
Christopher St. George Business Development Director
OCCU-MED JOB PROFILE
July 2018
EMPLOYER:
JOB CLASS:
CITY OF
BACKFLOW/CROSS CONNECTION TESTER
Physical Ability Rating Most Demanding Essential Tasks Environmental Factors
1. Stamina
2. Extent Flexibility
3. Dynamic Flexibility
4. Static Strength
5. Explosive Strength
6. Dynamic Strength
7. Trunk Strength
8. Speed of Limb Movement
9. Gross Body Coordination
10. Gross Body Equilibrium
11. Arm-Hand Steadiness
12. Manual Dexterity
13. Finger Dexterity
14. Near Vision
15. Far Vision
16. Visual Color Discrimination
17. Hearing
18. Mobility
19. Effort
5.0 4.5
5.0 5.5
5.5 5.0
5.5 4.5
4.5 4.5
4.5 5.0
4.5 4.0
4.0 4.0
4.5 5.0
5.0 Climb up/down hills to test/repair backflow device
Bend/reach to access backflow device
Open/close meter lids repeatedly
Carry backflow devices/valves/meters to worksite
Loosen stuck valves/nuts/bolts on flow equipment
Climb ladder into/out of cross connection vault
Lift backflow devices/valves/meters from ground
Drive to/from worksite
Climb ladder into/out of vault with tools
Step on/over pipes on uneven/slippery surface
Operate computer mouse
Repair/replace backflow device/meter with hand tools
Attach adapter to test backflow device
Read reports and computer monitor
Drive to/from worksite
Distinguish colors of water during test
Take notes at lecture
Walk throughout sites during flow test
Carry backflow devices/valves/meters to worksite
1. EXPOSURE TO SUN: 50%
to 100% of work time spent
outside a building and
exposed to the sun.
2. WO
RK ABOVE FLOOR
LEVEL: Some work done on
ladders or other surfaces from
4 to 12 feet above the ground.
3. HIGH TEMPERATURE:
Considerable work time spent
in
light and moderate work in
temperatures above 80
degrees.
4. CONFINED OR CRAMPED
BODY POSITIONS:
Occasional work in confined
or cramped positions less than
1/3 of the time.
5. WE
TNESS: More than 10%
of the work time involves
getting part or all of the body
and/or clothing wet.
6. NOI
SE: Occasionally there
are unusually loud sounds.
7. SLIPPERY SURFACES:
Frequent work on slippery
surfaces.
8. OI
L: Some part of the body
come in contact with oil or
grease occasionally.
9. INJURY POTENTIAL:
Frequent possibility of bodily
injury.
10. DUST: Works in or around
areas with major amounts of
dust present.
11. HAZARDOUS
MATERIALS: Rarely any
opportunity for exposure.
12. COMMON ALLERGEN
EXPOSURES: Frequent
exposure to common allergy-
causing agents.
RESPIRATOR USE
Required? No
EXHIBIT 1
MEDICAL EXAM COMPONENT PROFILE
CREATE
D AUGUST 2018
EMPLOYER: CITY OF
JOB CLASS: BACKFLOW / CROSS CONNECTION TESTER
THE FOLLOWING ARE THE RECOMMENDED ACTIVITI ES AND TESTS, WHICH SHOULD BE COMP LETED FOR THIS JOB CLASS. THESE MEDICAL EVALUATION COMPONENT S ARE BASED ON MINIMUM REQUIREMENTS FOR A JOB -RELATED MEDICAL EVALUATION.
X Review Job Profile (physical abilities & environmental factors) as necessary, determine work location and areas of work specialization.
X Occu-Med Medical History Questionnaire.
X Problem-oriented written history of personal and occupational health based on a brief interview to verify the Medical History Questionnaire (usually conducted by a nurse or paramedical staff and supplemented by physician comments).
X Authorization For Release of Information From Medical Record Form .
X General Physical Examination:
a. Vital Signs: temperature, pulse, respiration, blood pressure, height, weight. b. Physician’s Examination: head, eyes, ears, nose and throat, neck, chest, heart, abdomen, extremities, back, neurological, vascular, lymphatic, and skin. c. Ran
ge of Motion: back exam .
d. Dipstick Urinalysis – blood, glucose, protein.
e. Sight screening - near, far, depth, color, and peripheral. f. Physician’s summary, including comments related to job requirements.
X Audiogram – with headset.
X PPD (TB) Skin Test.
X Pulmonary Function Test with Interpretation.
X Venipuncture (Use MEDTOX collection supplies provided by Occu- Med) includes the following:
Test Name Test Code
a. Occu-Panel A 11735
X Urine Collection (Use MEDTOX collection supplies provided by Occu -Med) includes the following:
Test Name Test Code
a. 5-Panel Non-DOT Urine Drug Screen 88544
NOTE: PLEASE SUBMIT ALL COMPONENTS TO OCCU-MED IMMEDIATELY BY FAX TO 559-435-7200 UPON COMPLETION OF EXAM. EXAM RESULTS SHOULD THEN BE MAILED TO: OCCU-MED, 2121 W. BULLARD AVE., FRESNO, CA 93711.
EXHIBIT 2
4/24/2014 KMZ
Pre-Placement Medical Exam Requisition Form
Submit completed form to Occu-Med via email at [email protected] If you are unable to Email, please Fax to (800) 262-2863.
Occu-Med to Schedule Applicant
@ Clinic:
Date/Time Preference____________________ Morning Afternoon
EMPLOYER INFO
EMPLOYER:
EMPLOYER REPRESENTATIVE:
PHONE:
EMAIL ADDRESS:
DEADLINE FOR RETURNING RESULTS:
APPLICANT INFO
APPLICANT:
JOB CLASS:
PRIMARY PHONE #:
ALTERNATE PHONE #:
EMAIL ADDRESS:
LOCATION (City, State):
DATE OF REQUEST:
Any questions regarding Exam Scheduling should be directed to Occu-Med's Exam Scheduling Department @ (559) 435-2800 x105.
EXHIBIT 3
Copyright
2014
Occu-‐Med.
All
rights
reserved.
Page
1 OCCU-MED MEDICAL HISTORY Q UESTIONNAIRE
APPLICANT INFORMATION
APPLICANT’S NAME (Last, First, Middle) SOCIAL SECURITY NUMBER BIRTHDATE (MM/DD/YYYY) __ __ / /
MAILING ADDRESS CITY STATE / ZIP
/
PHONE NUMBERS WHERE YOU CAN BE REACHED EMAIL
HOME: ( ) - CELL: ( ) -
DISCLAIMER
A thorough evaluation of the information provided will p ermit an accurate assessment of an applicant’s ability to safely perform the essential duties of the job. This statement is confidential. The information you provide will be maintained in a manner that appropriately protects its confidentiality.
I, THE UNDER SIGNED, DO HEREBY CONSENT TO UNDERGO A MEDICAL EXAMINATION, INCLUDING BLOOD SPECIMEN,
X-RAYS, SKIN TESTS, AND OTHER EXAMINATIONS WHICH ARE NECESSARY TO DOCUMENT MY ABILITY TO SAFELY
PERFORM THE ESSENTIAL DUTIES OF THE JOB THAT I AM CURRENTLY PERFORMING (PERIODIC EXAM) OR HAVE BEEN OFFERED CONTINGENT UPON PASSING THIS MEDICAL EXAMINATION (PRE -PLACEMENT EXAM). I CERTIFY THAT ALL
INFORMATION PROVIDED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, AND I AGREE AND UNDERSTAND THAT ANY MISSTATEMENT OF MATERIAL FACT HEREIN MAY CAUSE FORFEITURE OF ALL RIGHTS TO ANY EMPLOYMENT.
SIGNATURE IN FULL DATE COMPLETED
MEDICAL HISTORY
1. Have you ever been medically examined for employment before ? Yes ☐
No ☐
1.1 If YES, complete the following:
EMPLOYER JOB CLASS DATE OF EXAM
2. Please list all prescription and non -prescription medication you regularly use (vitamins, birth control pills, laxatives, aspirins, antihistamines, tranquilizers and weight reducing aids):
3. Please list any prescription or non -prescription medications, not taken regularly, which you have taken in the last 2 months:
4. Please list any drugs or other substances (including: food, insect stings, etc.) that you are allergic to:
5. Have you had the following immunizations?
Y N ? Y N ?
☐
☐ ☐ Hepatitis A ☐ ☐ ☐ Measles
☐ ☐ ☐ Hepatitis B ☐ ☐ ☐ Mumps
☐ ☐ ☐ Varicella (Chicken Pox) ☐ ☐ ☐ Rubella
☐
☐ ☐ Tetanus ☐ ☐ ☐ Bacillus Calmette-Guernin
6. Have you ever had a positive reaction to a PPD (Tuberculosis) Skin Test? Yes ☐
No ☐
7. Please list your last three (3) hospitalizations, beginning with the most recent (excluding routine child birth):
REASON HOSPITAL / CITY DATE (MM/DD/YYYY)
/ /
REASON HOSPITAL / CITY DATE (MM/DD/YYYY)
/ /
REASON HOSPITAL / CITY DATE (MM/DD/YYYY)
/ /
EXHIBIT 4
Copyright
2014
Occu-‐Med.
All
rights
reserved.
Page
2 OCCU-MED MEDICAL HISTORY QUESTIONNAIRE MED Have you ever been exposed to any of the following (at home, work, or in any other setting) or do you have a problem with: Y N Y N 8. ☐ ☐ Prolonged loud noises 11. ☐
☐ Sprays or powders for insects or plants 9. ☐ ☐ Substances which irritated your skin or eyes 12. ☐ ☐ Prolonged X-Rays or other radiation 10. ☐ ☐ Substances which caused breathing difficulties 13. ☐ ☐ Dusty conditions (sandblasting, drilling, etc.) Y N 14. ☐ ☐ Have you ever had a bad reaction to high environmental temperatures?
15. ☐ ☐ Have you ever had a bad reaction to low environmental temperatures?
16. ☐ ☐ Have you been rejected by the military for health reasons?
17. ☐
☐ Were you ever in the Armed Services?
18. ☐ ☐ If you were in the Armed Services, did you ever receive a Medical Discharge? Have you ever had the following? Y N 19. ☐ ☐ Injury of any kind (list any restrictions / limitations on page 4) 20. ☐ ☐ Limiting injury of any kind (list all restrictions / limitations on page 4) 21. ☐ ☐ Any claims submitted, pending or awarded for the above 22. ☐ ☐ Are you now receiving, or have you applied for, any VA, Federal, State or Medical Disability payments? * NOTE: Information relative to Workers’ Compensation claims may not be used by an employer in making an employment decision. Your responses to questions 19 – 22 will be used by the medical evaluator in determining your current health status only. Have you ever had, now have or believe you may have any of the following? Y N Y N 23. ☐ ☐ Tuberculosis 54. ☐ ☐ Histoplasmosis 24. ☐ ☐ Pneumonia 55. ☐ ☐ Cancer 25. ☐ ☐ Bronchitis 56. ☐ ☐ Disease of the Immune System 26. ☐ ☐ Emphysema 57. ☐ ☐ Hyperthyroidism 27. ☐ ☐ Asthma 58. ☐ ☐ Hypothyroidism 28. ☐ ☐ Pneumothorax 59. ☐ ☐ Allergic Rhinitis 29. ☐ ☐ High Blood Pressure 60. ☐ ☐ Psychological Problems (e.g. PTSD, ADHD) 30. ☐ ☐ Heart Murmur, Heart Disease 61. ☐ ☐ Scarlet Fever 31. ☐ ☐ Stroke 62. ☐ ☐ Decompression Sickness or Air Embolism 32. ☐ ☐ Hiatal or Diaphragmatic Hernia 63. ☐ ☐ Trouble with your Thyroid Gland 33. ☐ ☐ Esophageal Reflux 64. ☐ ☐ Skin Rash, Burning, Itching or Infection 34. ☐ ☐ Rheumatic Fever 65. ☐ ☐ Skin Cancer(s) 35. ☐ ☐ Encephalitis, Meningitis 66. ☐ ☐ Bleeding Gums or Nose in the Past Year 36. ☐ ☐ Epilepsy, Convulsions 67. ☐ ☐ Sinus Trouble 37. ☐ ☐ Glaucoma 68. ☐ ☐ Perforated Ear Drum 38. ☐ ☐ Duodenal or Stomach Ulcer 69. ☐ ☐ Colds more than twice a year 39. ☐ ☐ Gall Bladder Trouble 70. ☐ ☐ Loss of Consciousness 40. ☐ ☐ Liver Trouble or Hepatitis 71. ☐ ☐ Shortness of Breath 41. ☐ ☐ Sleep Apnea 72. ☐ ☐ Chest Pains 42. ☐ ☐ Anemia 73. ☐ ☐ Frequent Headaches 43. ☐ ☐ Diabetes 74. ☐ ☐ Dizziness, Vertigo or Motion Sickness 44. ☐ ☐ Kidney Disease 75. ☐ ☐ Problems with Eyes / Vision 45. ☐ ☐ Kidney Stones 76. ☐ ☐ Back or Joint Surgery 46. ☐ ☐ Rheumatism, Arthritis, Gout 77. ☐ ☐ Back or Joint Pain (o Frequent o Occasional) 47. ☐ ☐ Varicose Veins 78. ☐ ☐ Back Injury 48. ☐ ☐ Phlebitis 79. ☐ ☐ Cervical Neck Injury or Problem 49. ☐ ☐ Hay Fever 80. ☐ ☐ Knee Surgery 50. ☐ ☐ Typhoid Fever 81. ☐ ☐ Upper Extremity Injury or Problem 51. ☐ ☐ Sore Throats Chronically 82. ☐ ☐ Lower Extremity Injury or Problem 52. ☐ ☐ Hernia 83. ☐ ☐ Other (explain): 53. ☐ ☐ Valley Fever (Coccidioidomycosis) Y N 84. ☐ ☐ Have you gained or lost more than 10 pounds in the past 2 years without trying to do so?
85. ☐ ☐ Have you had any changes in your appetite in the past 6 months?
86. ☐ ☐ Have you noticed unusual fatigue or weakness recently?
87. ☐
☐ Have you had a change in the size or color of a mole (dark growth) or wart in the past year?
88. ☐
☐
Do you have a skin rash, burning, itching or other skin sensitivity?
89. ☐
☐
Have you ever coughed up blood or have / had a chronic cough? Name: ___________________________________________
Copyright
2014
Occu-‐Med.
All
rights
reserved.
Page
3 Name: ___________________________________________
OCCU-MED MEDICAL HISTORY QUESTIONNAIRE
Have you ever had the following? Y N 90. ☐ ☐ Do you smoke or use other forms of tobacco? If YES: __________ packs per day; __________ per day 91. ☐ ☐ Do you drink alcohol? If YES: __________ drinks per day 92. ☐ ☐ Have you, or are you currently, being treated for alcoholism? If YES, date of treatment: __________ 93. ☐ ☐ Do you engage in potentially hazardous recreational activities (e.g. Weightlifting, Sky Diving, Scuba Diving, etc.)? Y N 94. ☐ ☐ Have you had, or do you currently have, any FEMALE disorders? 95. ☐ ☐ Do you have any reason to believe you are pregnant? Date of last menstrual period: __________ 96. ☐ ☐ Have you had, or do you currently have, any MALE disorders? Y N 97. ☐ ☐ Have you ever had, or do you currently have, repeated feelings of numbness, tingling, “pins and needles” sensations or loss of sensation in one or both hands? If YES, date: __________ 98. ☐ ☐ Have you ever had, or do you currently have, repeated feelings of soreness or pain in either forearm or elbow? 99. ☐ ☐ Have you ever had, or do you currently have, repeated feelings of pain, discomfort, burning or tingling in your shoulders? If YES, o Left o
Right Date: 100. ☐
☐ Have you ever had, or do you currently have, knee pain, popping or locking? If YES, o Left o
Right Date: What time does your discomfort regularly occur? o Mornings o Afternoons o Evenings o Night 101. ☐ ☐ Have you ever had, or do you currently have, foot pain? If YES, o Left o
Right Date: 102. ☐ ☐ Have any of the above symptoms (numbness, tingling, soreness or pain) ever caused you to be awakened while sleeping? 103. ☐ ☐ Does/did discomfort in your wrists, arm, or shoulder interfere with your daily activities (eating, writing, sports, etc.)? 104. ☐ ☐
Have you ever received, or do you currently receive, medical treatment for this pain and/or discomfort? 105. ☐ ☐
Have you ever received, or do you currently receive, medical help for any of the following: Condition Date of Surgery, if performed o Carpal tunnel syndrome o Ganglionic cyst o Tendonitis o Bursitis o Arthritis 106. ☐ ☐
If you are presently employed, does your job require arm, hand or finger actions to be repeated many times each hour and work shift? 107. ☐ ☐
Have you ever had an auto accident?
If YES, Date: 108. ☐
☐
Do you currently wear corrective lenses? If YES, o Glasses o
Soft Contacts
o
Reading Glasses Only o Hard Contacts 109. ☐
☐
Are you presently experiencing any pain or discomfort? If YES, please mark the affected areas on the body diagram:
Peace Officer and P.O.S.T. compliant job classes: Y N 110. ☐ ☐ Have you ever failed a pre-placement medical or psychological examination? 111. ☐ ☐ Have you ever been terminated or resigned from employment, or had to change positions, due to a physical, psychological or medically related reason? 112. ☐ ☐ Has your driver’s license ever been suspended or revoked due to medical reasons? 113. ☐ ☐ Have you ever taken medication to prevent wheezing or shortness of breath during exercise? 114. ☐ ☐
Are you currently under a health care provider’s care for any medical condition? Copyright
2014
Occu-‐Med.
All
rights
reserved.
Page
4 Name: ___________________________________________
OCCU-MED MEDICAL HISTORY QUES TIONNAIRE
ACKNOWLEDEGMENT
I understand that any incomplete, misleading or missing information (provided or omitted from this page) relevant to my safe performance of the essential duties of the job that I have been offered could result in a rescission of the conditional offer of em ployment or, if discovered after placement, could result in a reconsideration of my placement into this job class.
SIGNATURE IN FULL DATE COMPLETED
A. Reason for Medications Taken
MEDICATION
MEDICAL CONDITION
TREATED
SIDE EFFECTS
EXPERIENCED
DATE
STARTED
DATE
ENDED
FREQUENCY
TAKEN
B. Reason for Hospitalizations
MEDICAL CONDITION TREATMENT
RECOVERY OR
PROGNOSIS DATE
C. Explain All YES Responses (Questions 8 – 114)
QUESTION
NUMBER RESPONSE
End Exhibit 4
Occu-Med Fee Schedule
City of Richmond
February 22, 2023
Agile - Emeryville Stat Med Urgent
Care Safeway
Physical with Musculoskeletal Exam 94.50$ 128.25$ N/A DOT Exam 101.25$ 195.75$ N/A
PPD 27.00$ 47.25$ N/A
QuantiFERON 106.00$ 106.00$ N/A
Audiogram w/ Headset 40.50$ 29.70$ N/A
Audiogram w/ OSHA Approved Sound Booth 40.50$ N/A N/A Infectious diseases screening 20.00$ 20.00$ N/A
Drug screen 36.00$ 36.00$ N/A
Urine collection (Drug Screen) 33.75$ 27.00$ N/A
Hepatitis A N/A N/A 122.16$
Hepatitis B N/A N/A 120.81$
Typhoid N/A N/A 177.39$
MMR N/A N/A 135.01$
Occu-VAX Mgt Fee (charged annually only when vaccination services are used) N/A N/A 45.00$ Medical Exam Scheduling Fee (charged once per exam) 60.00$ 60.00$ N/A Medical Exam Review Fee (charged once per exam) 40.00$ 40.00$ N/A Exhibit 5
Business Type
Business Name
Business Location
Owner Name
License Number
Expiration Date
CITY OF EMERYVILLE
BUSINESS LICENSE TAX CERTIFICATE
6001 SHELLMOUND ST STE
115
AGILE OCCUPATIONAL MEDICINE, PC
3200 BRISTOL ST STE 600
COSTA MESA, CA 92626-1810
For all inquiries regarding this license, contact HdL Business Support Center at (510) 725-4161.
MINH NGUYEN
AGILE OCCUPATIONAL
MEDICINE, PC
PHYSICIANS OFFICE
December 31, 2023
18816043
AGILE OCCUPATIONAL MEDICINE, PC :
Thank you for your payment on your City of Emeryville Business License. ALL LICENSES MUST BE AVAILABLE FOR INSPECTION UPON REQUEST. If you have questions concerning your business license, contact the Business Support Center via email at: [email protected] or by telephone at: (510) 725-4161.
Keep this portion for your license separate in case you need a replacement for any lost, stolen, or destroyed certificate.
Starting January 1, 2021, Assembly Bill 1607 requires the prevention of gender-based discrimination of business establishments. A full notice is available in English or other languages by going to: https://www.dca.ca.gov/publications/ NOTE: All businesses are responsible for renewing or closing their business license account with the City. The HdL Business Support Center will mail out courtesy renewal notices every year/quarter but penalties and interest will begin to accrue after the due date regardless of whether or not the taxpayer receives/responds to future courtesy notices.
City of Emeryville
BUSINESS LICENSE
CITY OF EMERYVILLE
BUSINESS SUPPORT CENTER
8839 N CEDAR AVE #212
FRESNO, CA 93720-1832
Date of Issue: 01/01/2023
18816043License Number: AGILE OCCUPATIONAL MEDICINE, PC 3200 BRISTOL ST STE 600
COSTA MESA, CA 92626-1810
TO BE POSTED IN A CONSPICUOUS PLACE AND IS
NOT TRANSFERABLE OR ASSIGNABLE.
The issuing of a Business Tax Certificate is for revenue purposes only. It does not relieve the taxpayer from the responsibility of complying with the requirements of any other department of the City of Emeryville or any other ordinance, law, or regulation of the City of Emeryville, State of California or any other governmental agency. 12/31/2023
Interim Finance Director
EXHIBIT 6
CITY OF RICHMOND Sanctuary City Compliance Statement The undersigned, an authorized agent of Occu-Med (hereafter "Contractor"), has had an opportunity to review the requirements of City of Richmond Ordinance 12-18 (hereafter "Sanctuary City Contracting Ordinance" or “SCCO”). Contractor understands and agrees that the City may choose with whom it will maintain business relations and may refrain from contracting with any person or entity that provides Data Broker or Extreme Vetting services to the U.S. Immigration and Customs Enforcement Division of the United States Department of Homeland Security (“ICE”). Contractor understands the meaning of the following terms used in the SCCO: a. "Data Broker” means either of the following: i. The collection of information, including personal information about consumers, from a wide variety of sources for the purposes of reselling such information to their customers, which include both private-sector business and government agencies; ii. The aggregation of data that was collected for another purpose from that for which it is ultimately used. b. “Extreme Vetting” means data mining, threat modeling, predictive risk analysis, or other similar services." Contractor understands that it is not eligible to receive or retain a City contract if at the time the Contract is executed, or at any time during the term of the Contract, it provides Data Broker or Extreme Vetting services to ICE. Contractor further understands and agrees that Contractor's failure to comply with the SCCO shall constitute a material default of the Contract and the City Manager may terminate the Contract and bar Contractor from bidding on future contracts with the City for five (5) years from the effective date of the contract termination. By executing this Statement, Contractor certifies that it complies with the requirements of the SCCO and that if at any time during the term of the Contract it ceases to comply, Contractor will promptly notify the City Manager in writing. Any person or entity who knowingly or willingly supplies false information in violation of the SCCO shall be guilty of a misdemeanor and subject to a $1,000 fine. Based on the foregoing, the undersigned declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed this 21 day of February , 20 23 , at Fresno , California. Printed Name: Chris St. George Title: Business Development Director Signed: Date: February 21, 2023 Business Entity: Occu-Med Ltd. Vendor SCCO Compliance Statement (Augt2020)
Disclosure Statement for Limited Liability Companies This Statement Shall be included with all Bid and Proposal Submissions Is your Business a Limited Liability Company (LLC)? pYES xNO If you answered YES, please provide the City with the names and business addresses of any and all shareholders, directors, officers, members, managers, other authorized persons, partners, and “Beneficial Owners” of the applying LLC. A Beneficial Owner is any person or entity who: (1) exercises substantial control over the applying LLC; (2) owns 25% or more of the interest in the applying LLC; or (3) receives substantial economic benefits from the assets of the applying LLC. If any LLC shareholder, director, officer, member, manager, other authorized person, partner, or Beneficial Owner is itself an LLC or other business entity, the names and business addresses must also be provided for any and all shareholders, directors, officers, members, managers, other authorized persons, partners, and Beneficial Owners of that LLC or other business entity all the way up through each entity in the organizational chart until ultimate ownership by individual people is disclosed. Name: _____________________ Title: _____________________ Address:__________________________________________ Name: _____________________ Title: _____________________ Address:__________________________________________ Name: _____________________ Title: _____________________ Address:__________________________________________ ☐ Check this box if additional ownership information is attached to this Disclosure Statement. In signing this Disclosure Statement, I represent that the information submitted in this Disclosure Statement, and any attachments, is true and correct. Signature: _____________________ Printed Name: ___Chris St. George __________________ Title: __Business Development Director ___________________ Date: ___February 21, 2023__________________
a. "Data
Brok er” means either of the following:
i. The collection of information, including personal information about consumers, from a wid
e variety of sources for the purposes of reselling such information to their customers, which include both private-sector business and government agencies; ii. The aggregation of data that was collected for another purpose from that for which it is ultima
tely used.
b. “Extreme Vetting” means data mining, threat modeling, predictive risk analysis, or other similar serv
ices."
Contractor understands that it is not eligible to receive or retain a City contract if at the time the Contract is executed, or at any time
during the term of the Contract, it provides Data Broker or Extreme Vetting services to ICE.
Contractor further understands and agrees that Contractor's fa ilure to comply with the SCCO shall constitute a material default of the Contract and the City Manager may terminate the Contract and bar Contractor from bidding on future contracts with the City for five (5) years from the effective date of the contract termination.
By executing this Statement, Contractor certifies that it complies with the requirements of the SCCO and that if at any time during the term of the Contract it ceases to comply, Contractor will promptly notify the City Manager in writing. Any person or entity who knowingly or willingly supplies false information in violation of the SCCO shall be guilty of a misdemeanor and subject to a $1,000 fine.
Based on the foregoing, the undersigned declares under penalty of perjury under the laws of the State of California that the foreg oing is true and correct. Executed this day of , 20 , at , California.
Printed Name: Title:
Signed: Date:
Business Entity:
Vendor SCCO Compliance Statement (Augt2020)
EXHIBIT H
CITY OF RICHMOND
Sanctuary City Compliance Statement
The undersigned, an authorized agent of (hereafter
"Contractor"), has had an opportunity to review the requirements of City of Richmond Ordinance 12-18 (hereafter "Sanctuary City Contracting Ordinance" or “SCCO”). Contractor understand s and agrees that the City may choose with whom it will maintain business relations and may refrain from contracting with any person or entity that provides Data Broker or Extreme Vetting services to the U.S. Immigration and Customs Enforcement Division of the United States Department of Homeland Security (“ICE”). Contractor understands the meaning of the following terms used in the SCCO: