Proposal
Response to:
City of Richmond
Police Department
For:
DOT and pre-employment physical exams, drug testing,
immunizations and TB testing.
February 2023
Submitted By:
Kaiser Permanente
Joan Carson
1851 E. First Street, Ste. 1100
Santa Ana, CA 92705
Cell: 714-296-7333
[email protected]
A. Vendor Cover Letter
A cover letter should summarize key elements of the proposal and shall:
• Confirm that all elements of this RFP have been reviewed and understood; • Include a statement of intent to perform the services as outlined; • Express company’s willingness to enter into an agreement under the terms and conditions prescribed by this RFP, insurance requirements
• (Attachment A) and in the sample Service Agreement (Attachment B); • Indicate the address and telephone number of the vendor’s office located nearest to Richmond, California and the office from which the project will be managed. • Stipulate that the proposal price will be valid for a period of at least 180 days. • Identify a single person for contact during the RFP review process; and • Cover letter shall be signed by an authorized official of the company. • Proposer must have the qualifications and skills necessary to perform the services described in this RFP in a competent and professional manner without the advice or direction from the Police Department. The facility must be authorized to conduct DOT (Department of Transportation) Physical Examinations and Drug Testing. The Proposer warrants that all examinations and testing are performed by a qualified, licensed Physician, Nurse Practitioner, or certified Physician’s Assistant. Results of all testing will be sent to the Police Department’s designee, and said results are required to be disseminated in accordance with the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule.
February 24, 2023
City of Richmond Police Department
1701 Regatta Blvd.
Richmond, CA 94804
Proposal Submitted via: http://www.ci.richmond.ca.us/bids Dear City of Richmond Police Department,
Thank you for allowing Kaiser Permanente the opportunity to present a response to the City of Richmond Police Department for Occupational Health Services. Kaiser Permanente has been honored to provide health care to City of Richmond employees for several years; currently, approximately 54% of your population are Kaiser Permanente members. Kaiser Permanente-on-the-Job ® (KPOJ) currently provides injury care for many of your employees who seek care at our facilities for workplace injuries as well as Occupational Health Services for your Fire Department. Kaiser Permanente is committed to continuing our working relationship with the City of Richmond to assure the highest quality of health and safety for its candidates and employees.
Based on your request for proposal, we understand that you are seeking services for pre- employment and DOT (Department of Transportation) physical examinations, random drug testing, immunizations and infectious disease testing for City of Richmond Police Department candidates and personnel.
Please note, we are unable to provide the following services:
• 3-View Back X-ray
• Computerized Strength Testing
We are willing to enter into an agreement under the terms and conditions prescribed by this RFP, insurance requirements (Attachment A) and in the sample Service Agreement (Attachment B).
Our proposed pricing as provided in Attachment is A is valid for 180 days from our submission.
We are very pleased to have responded and we trust you will find our reply informative and thorough. We are enthusiastic about the opportunity to work with the City of Richmond Police Department to provide services for your Occupational Health and Safety program.
Based upon your location, the primary office to provide these services is located here:
Kaiser Permanente Richmond
901 Nevin Ave
Richmond, CA 94801
Please see attachment, “KPOJ Facilities Map NCAL” for a complete list of facilities available to City of Richmond.
The following proposal will be valid for 180 days.
Qualifications
We have trained and certified physicians and other health care professionals at each of our occupational health centers who are qualified and dedicated to providing high quality services to your employees.
The majority of our physicians are employees or partners of the Permanente Medical Groups. We recredential all physicians at least every 24 months.
We offer our health care professionals a broad training program, including specialized training in preplacement exams, both general and comprehensive, as well as the numerous types of examinations required by medical surveillance programs and regulatory requirements such as Department of Transportation/Department of Motor Vehicles (DOT/DMV).
All personnel performing audio screening are certified by the Council on Accreditation of Occupational Hearing Conservation (CAOCH); personnel performing spirometry screening (pulmonary function testing) are certified through a National Institute for Occupational Health and Safety (NIOSH) -approved spirometry course; and personnel performing breath alcohol testing are certified Breath Alcohol Technicians. In addition, all personnel who perform Department of Transportation (DOT) and non- DOT urine collections have completed a training course in compliance with 49CFR, Part 40 and the Department of Transportation regulations.
We require all physicians to fulfill Continuing Medical Education (CME) requirements. We also provide specialized programs for advanced practice nursing, medical technologists, and physical/occupationa l therapists that help fulfill their license requirements for CME.
Occupational Health Center Level
• Chief Physicians oversee the operations and services for occupational health centers. • Lead Physicians manage the occupational health center under the direction of the Chief Physician.
• Clinic Managers provide the day-to-day management of the occupational health centers. • Case Managers provide utilization management and review for work-related injuries and illnesses.
They help coordinate activity between the treating physician, the employer and the payer for the injured or ill worker. They may also help to facilitate return to work. • Medical Assistant/ Certified Occupational Health Technician (MA/COHT) a healthcare assistant who performs non-invasive routine technical support services under the specific authorization, supervision, and direction of and for a licensed physician. Kaiser Permanente On- the-Job has a specialized program to certify Medical Assistants for Occupational Health. The purpose is to credential Medical Assistants for knowledge and specialization in Occupational Health know as Certified Occupational Health Technicians (COHT).
Our physicians and staff are trained to recognize trends, perform site visits and make presentations to employer groups and follow -up with Occupational Health preventative recommendations. The advanced information and communication systems available at the clinic allow the staff effectively to interact with management and employees ensuring well-coordinated service with a high level of communication.
HIPAA
Kaiser Permanente has rigorous guidelines for protecting confidentiality. We adhere to state and federal patient confidentiality guidelines and are compliant with HIPAA Privacy Regulations. We regard all paper and electronic medical records as confidential. Unless required or allowed by law, records are released only with prior authorization from the patient or patient's guardian. Physicians and staff store, handle, and review medical records in a manner that controls access and protects confidentiality .
Electronic storage of health information makes it possible for the care provider in the medical office to have access to the same information as the specialist in the medical center across town, without the time consuming delays of transporting paper records from one location to another.
We have built into our electronic records system several confidentiality safeguards, including:
• Thorough confidentiality training for all users
• Monitoring for compliance with confidentiality and security guidelines Automatic shut-down of electronic records when not in use
• User access restricted to minimum needed information
• Care is also provided through health practitioners and hospitals that contract with us. Our contracts allow us to share pertinent patient information in order to coordinate care and also require strict patient confidentiality.
During the RFP process you may contact your account manager Joan Carson:
Sincerely,
Joan Carson
Joan Carson
Account Manager IV
[email protected]
714.296.7333
B. Scope of Services
Proposer must have the ability to provide the following services (although not all listed will be performed):
a. Pre-employment and DOT (Department of Transportation) Physicals • Medical History Questionnaire
• Hands-on Physical
• 3-View Back X-ray
• Musculoskeletal Exam
• Computerized Strength Testing
• Hearing Examination (Hearing Examination is required for specified classifications only.)
b. Immunizations
c. Infectious Disease Screening
d. Random Drug Testing
Proposer must warrant that its providers will perform services in accordance with the generally accepted principles and practices applicable to the medical profession, and that said providers are properly licensed, registered and/or certified employees as may be required under any applicable federal, state and local laws, statutes, ordinances, rules and regulations.
Proposer must be authorized to perform DOT (Department of Transportation) Physicals and Drug Testing.
Proposer ensures that all examinations and the results are disseminated in accordance with the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule.
KPOJ Response:
We will perform services in accordance with the generally accepted principles and practices applicable to the medical profession. Our providers are properly licensed, registered and/or certified employees as may be required under any applicable federal, state and local laws, statutes, ordinances, rules and regulations.
Pre-employment and DOT (Department of Transportation) Physicals To help determine a job applicant's current limitations in relation to the essential job tasks identified by the employer we offer comprehensive pre-placement medical evaluations. Our pre-placement examinations provide valuable information to the employer to assist them in either determining an applicant’s fitness to perform essential job tasks, making reasonable accommodations for safety, and in complying with the Fair Employment and Housing Act (FEHA) and the Americans with Disabilities Act (ADA). Pre- placement evaluations are also required for Occupational Safety and Health Administration (OSHA) -regulated medical surveillance. KPOJ DMV/DOT medical evaluations assess the driver’s medical condition, risk factors and objective findings that would render the driver unsafe considering the driver’s job responsibilities according the requirements of 49 CFR 391.41-49.
POST Exams
Our Police Officer exams meet the extensive medical guidelines of Peace Officer Standard and Training (POST) and Occupational Safety & Health Administration (OSHA) standard regulations. Our comprehensive POST medical evaluation includes:
• Occupational and medical history assessment, including review of past injuries and illnesses and disabling claims related to cardiovascular and musculoskeletal conditions, back injuries, and other conditions per the POST guidelines for law enforcement • Review of local agency job requirements, including essential tasks, environmental factors, and staffing
• POST physical examination, including musculoskeletal evaluation based on past problems and current job tasks, focused back evaluation, neck and upper extremity screening, and low extremity functional assessment
• Vision testing
• Other POST-recommended exam components, including audiometry, spirometry, electrocardiogram (EKG), treadmill, urinalysis, drug testing, purified protein derivative test (PPD) for tuberculosis (TB), complete blood count test (CBC) for anemia or infection, comprehensive chemistry panel, and antibody measurements to test for hepatitis B and C • Physician assessment and medical recommendations for placement, restrictions, or further evaluation prior to final employer decision
• Voluntary discussion of wellness issues
Additional tests and services can be added based on employer’s specific needs or the recommendation of our evaluating physician.
Preplacement Exam
Our typical pre-placement (post offer) exam includes:
• Occupational and medical history, including review of past injuries, illnesses, and disabling claims, especially related to musculoskeletal conditions, back and repetitive motion injury (RMI) that are directly related to essential tasks and environmental factors in the employer’s job description
• Vital signs, height and weight
• Physical examination focused on job tasks, for example:
o Musculoskeletal evaluation directed toward past problems and current job tasks
• Focused back evaluation
• Neck and upper extremity screening (over 10 separate assessments and maneuvers) • Lower extremity functional assessment
o Vision testing (far, near, color, peripheral)
o Hearing screen (Whisper test)
• Physician assessment and medical recommendation for applicant placement including:
o Recommendations for accommodation
o Recommendations for placement restrictions
o Recommendations for further evaluation prior to final employer decision o Discussion of wellness issues with applicants
DOT (Department of Transportation) Physicals
Our Department of Transportation/Department of Motor Vehicles (DOT/DMV) medical evaluations are compliant with regulatory agencies (federal, state, and local). Only providers who are registered as Certified Medical Examiners in the National Registry of Certified Medical Examiners (NRCME) perform physical examinations for commercial motor vehicle (CMV) drivers. They review the health history in detail and perform a thorough physical examination according to the requirements of 49 CFR 391.41-
49. Components of our exam include the following:
• Occupational and medical history, including review of past injuries, illnesses, and prior disabling claims; especially related to musculoskeletal conditions, back and motor vehicle operation tasks
• Vital signs along with height and weight
• Physical examination including skin, eyes, ears/nose/throat, heart, lungs, abdomen, nervous system
• Musculoskeletal evaluation directed toward past problems and motor vehicle operation tasks:
o focused back evaluation
o neck and upper extremity functional assessment
o lower extremity functional assessment
o individual interpretation of regulations
o identification of renewal interval (two years or less depending on medical conditions)
o completion of forms and certificate
• Vision testing (far, near, color, peripheral)
• Hearing screen (Whisper Test/Audiogram)
• Dipstick urinalysis
• Physician assessment and decision based on DOT regulations
Immunizations
To help you meet regulatory requirements and keep your employees healthy and on the job, we offer the following immunizations at our occupational health centers:
• Mumps
• Rubella
• Rubeola
• Varicella (Chickenpox)
• Influenza
• Tdap
• Hepatitis A
• Hepatitis B
• Twinrix (Hep B and Hep A combo)
Infectious Disease Screening
Infection and immunity screenings include:
Hepatitis A, B, and C - Blood tests to detect active or prior hepatitis A, B, or C infection, as well as immune status for hepatitis A and B
Tuberculosis (TB)/PPD skin test - We provide both PPD and QuantiFERON TB Screening Random Drug Testing
To ensure the accuracy of drug and alcohol screening of employees or potential employees, our substance abuse program is administered by a third party specializing in private and public sector substance abuse testing programs. We provide urine specimen collection services and breath alcohol testing, while Preferred Alliance provides specialty laboratory services, medical review officer (MRO) services, reporting, training, and assistance with employer policy development and record keeping requirements.
We can also act as a collection site for any laboratory you may select. We require a supply of collection kits, chain of custody forms, and information about the courier service. The turnaround time is 24 to 48 hours for an average negative result. A positive result typically takes longer because a MRO must interview the donor to determine final results.
Preferred Alliance routinely trains all staff in Chain of Custody procedures, including specimen collection and National Institute for Drug Abuse (NIDA) and non-NIDA collection requirements. In compliance with 49 CFR Part 40 and the Department of Transportation (DOT) regulations, we require all staff to complete the Preferred Alliance training course for urine drug screen collections prior to any drug screen collection.
In addition, our staff is current with breath alcohol technician training and demonstrates proficiency in accordance with 49 CFR Part 40.
Breath alcohol testing is provided in all our occupational health centers. Our equipment meets DOT/DMV standards, and is on the National Highway Traffic Safety Administration’s Conforming Products List for instruments that conform to the model specifications for Evidential Breath Testing Devices. The occupational health technicians who perform breath alcohol testing have all successfully completed a DOT certification course.
C. Cost Information
Provide a comprehensive fee schedule for all of the services the Proposer will provide to the Police Department. All cost and pricing data, including documents showing indirect costs and direct labor rates, must be placed in a separate sealed envelope. Proposers must not include any information regarding their detailed cost estimates in the envelope containing their written proposal.
Proposers will be paid at the same rates set forth in their cost proposal unless further negotiated in writing and agreed to by the Police Department.
KPOJ Response:
This has been provided with the attachments. Please see “City of Richmond Police RFP 2023 - Sample Fee Schedule”.
D. Contractor Assignment of Sub-Contract
The resulting contract shall not be assigned, transferred, or sublet, in whole or in part, without the prior written approval of the Police Department. If Offerors intend to subcontract any portion of the resulting contract, they must describe their process for selecting such subcontractor(s) and the quality control measures that the Offeror will employ to ensure that any subcontractor complies with the provisions of Offeror’s contract with the Department.
KPOJ Response:
Kaiser Permanente On-the-Job
® will not utilize subcontractors for these services.
E. Exceptions to this Request for Proposals
The proposer shall state whether or not it takes exception(s) to this RFP, including but not limited to the City of Richmond’s Standard Services Agreement RFP (Attachment 1). If the proposer does take exception(s) to any portion of the RFP or contract, the specific portion to which exception(s) is taken must be identified by section number and explained. Requests for changes or additions to sections of City of Richmond’s Standard Services Agreement must be shown by requesting deletion of specific words and/or by providing new requested contract language. Requests for complete replacement of the City of Richmond’s Standard Services Agreement for another contract will not be granted. Failure to make exceptions to the RFP or Standard Services Agreement within the proposal will be deemed a waiver of any objection. Exceptions will be considered during the proposal evaluation process.
Exceptions to the RFP
Section Exception
Section B
(Scope of
Services),
Item (a)
3-View Back X-ray
Kaiser Permanente On- the-Job does not recommend back x -rays for pre -placement examinations and will not bid on this service. We believe back x -rays provide minimal medical value in a preplacement examination and the exposure to unnecessary radiation outweighs any value x -rays will have to the City. Our experience has found the medical history and examination provide the necessary information for the physician.
Please see additional citations regarding these services for your reference:
Strength Testing
Kaiser Permanente On-the-Job does not offer Computerized Strength Testing and will not bid on this service. Our experience, which includes the care of our own 85,000+ employees, is that this type of test is not useful in predicting future work capability. We recommend a medical examination that includes a thorough musculoskeletal evaluation. This evaluation is directed toward past problems and current job demands including:
• Focused back evaluation
• Neck and upper extremity screening for cumulative trauma disorders (over 10 separate assessments and maneuvers)
• Lower extremity functional assessment
1. From Occupational and Environmental Review - by Robert McCunney, et al, Second Edition,
2. ACOEM policy/position reference material:
https://www.acoem.org/uploadedFiles/Public_Affairs/Policies_And_Position_Statements/Guide lines/Library_and _Reference_Material/Choosing%20Wisely.pdf
3. From POST manual emphasizing individual assessment:
The Richmond Occupational Health Center Chief is available to consult with you further on what will best meet your needs.
Exceptions to the Standard Contract
KPOJ Response:
Pages 1 and 2 of Standard Contract
Clause Request for new contract language
3 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.
City shall monitor the total amount of payments owed to Contractor and shall immediately notify Contractor when the Contract Payment Limit permitted under this Contract is reached. Notwithstanding anything to the contrary in this Contract, City shall be liable for and pay Contractor for any services provided by Contractor before City notified Contractor of the reaching of the Contract Payment Limit.
9 9. Insurance Provisions. This Contract is subject to the Insurance Provisions (Exhibit F) which are attached hereto and are incorporated herein by reference. Notwithstanding any other provision of this Contract, including but not limited to those contained in Exhibit F, Contractor, in lieu of any insurance requirements contained herein, may fulfill such insurance obligations through its alternative risk management programs, including self - insurance, and City consents to such self-insurance and agrees that, in such case, Contractor cannot provide endorsements or report deductibles, or self-insured retentions, or other requirements that are inconsistent with a program of self-insurance. City also agrees that Contractor’s fulfillment of the insurance requirements through alternate risk management programs shall not constitute a breach of this Contract.
Exhibit B- Payment Provisions
Clause Request for new contract language
2 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. City shall monitor the total amount of payments owed to Contractor and shall immediately notify Contractor when the accumulated compensation paid under this Contract reaches the Contract Payment Limit. Notwithstanding anything to the contrary in this Contract, City shall be liable for and pay Contractor for any services provided by Contractor before City notified Contractor of the reaching of the Contract Payment Limit.
Exhibit D- General Conditions
Clause Request for new contract language
3 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 d ata.
Notwithstanding the foregoing, this Section 3 shall not apply to medical records and any medical record created or modified by Contractor in connection with its provision of services hereunder shall not be considered work product prepared for or obtained by Contractor in the performance of this Contract. Contractor shall retain all rights and title to such medical records.
4 4. Patents, Trademarks, Copyrights 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, 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.
Notwithstanding the foregoing, this Section 4 shall not apply to medical records.
5 5.
Inspection. Contractor's performance, place of business and records pertaining to this Contract are subject, upon reasonable prior written notice, 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 6. Services. The project or services set forth in Exhibit A shall be performed to the reasonable 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.
13 13. Termination in the Event of Default. Should either party fail contractor 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, the other party 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.
15 15. Indemnification. To the fullest extent permitted by law, Contractor shall indemnify, defend and hold harmless City and its officers, employees, elected and appointed officials, and volunteers (the "Indemnified Parties") from and against any and all claims, demands, causes of action, lawsuits (whether at law, equity or both), proceedings, liabilities, losses, damages, expenses, costs (including without limitation reasonable attorney's fees and costs and expert witness fees), judgments, penalties, and liens of every nature resulting from injury to or death sustained by any person (including Contractor's employees), or damage to property of any kind, or any other injury or damage whatsoever, which injury, death or damage arises out of or is in any way connected with Contractor's negligent performance of work hereunder, willful misconduct, or its failure to comply with any of its obligations contained in this Contract, or its failure to comply with any applicable current law or prospective, regardless of Contractor's fault or negligence, including any of the same resulting from the alleged or actual negligent act or omission of an Indemnified Party, except that said indemnity shall not be applicable to (i) injury, death or damage to property arising from the sole or active negligence or willful misconduct of City, their officers, agents, or servants or (ii) any liability arising as a result of an employment-related dispute (including but not limited to a lawsuit by an employee of City for employment discrimination based on results of Contractor’s services, a lawsuit by an employee of City alleging breach of an employment statute or regulation, etc.).
Insurance Requirements
Clause
Paragraph 1 In all instances where CONTRACTOR or its representatives will provide professional services (architects, engineers, construction management, counselors, medical professionals, hospitals, clinics, attorneys, accountants, etc.) to the City of Richmond (City), the City requires the following MINIMUM insurance requirements and limits.
Such insurance may include alternative risk management programs, including self - insurance or a combination of self -insurance and insurance, provided that such alternative risk management programs provide protection equivalent to that specified under this Agreement.
Paragraph 4 Original, signed certificates and original, separate policy endorsements, naming the City as an additional insured for general liability and auto 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.
Minimum
Scope of
Insurance
1. Insurance Services Office Commercial General Liability coverage (ISO Occurrence Form CG 0001), and including coverage for operations, 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 Endorsements for General Liability (ISO Form CG 20 10 11/85 or its equivalent) and Auto Liability with primary and non- contributory language or equivalent.
4. Workers’ Compensation Insurance as required by the State of California including Employer’s Liability coverage or equivalent.
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.)
Paragraph 7 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.
Required
Coverage
General Liability
2,000,000 per occurrence for bodily injury, personal injury and property 17 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.
Notwithstanding any other provision of this Contract, including but not limited to those contained in Exhibit F, Contractor, in lieu of any insurance requirements contained herein, may fulfill such insurance obligations through its alternative risk management programs, including self-insurance, and City consents to such self-insurance and agrees that, in such case, Contractor cannot provide endorsements or report deductibles, or self-insured retentions, or other requirements that are inconsistent with a program of self-insurance. City also agrees that Contractor’s fulfillment of the insurance requirements through alternate risk management programs shall not constitute a breach of this Contract.
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.
Policy shall be endorsed to name the City of Richmond as an additional insured per the conditions detailed below.
Required
Coverage
Automobile Liability
$1,000,000 per occurrence for bodily injury and property damage.
Policy shall be endorsed to name the City of Richmond as an additional insured per the language detailed below.
Required
Policy
Conditions
Deductibles and Self-Insured Retentions
City recognizes that Contractor’s insurance may include alternative risk management programs, including self-insurance or a combination of self-insurance and insurance, provided that such alternative risk management programs provide protection equivalent to that specified under this Agreement. City hereby gives its approval for Contractor’s alternative risk management programs. 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.
Required
Policy
Conditions
A. M. Best Rating
:VII or Better, or equivalent. If the A.M. Best Rating falls below the required rating, CONTRACTOR must replace coverage immediately and provide notice to City.
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
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 Manager. However, CONTRACTOR must mail the original certificates and endorsements to Designated Project Manager once faxed and endorsements to Designated Project Manager once faxed.
G. Impartiality and Disclosure
The nature of this Project requires an impartial unbiased approach on the part of the proposer’s team. This proposal shall include a statement declaring that the proposer’s 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 be in conflict with City of Richmond’s interests. Additionally, proposer is required to disclose any pending or active investigations or litigation that may affect the reputation or ability of the proposer to carry out the Project.
KPOJ Response:
We are not participating with any third party that would represent a conflict of interest.
We are also unaware of any litigation, pending or otherwise, that would affect our ability to provide the services outlined in this proposal.
Insurance Requirements The City of Richmond requires consultants doing business with it to obtain insurance, as shown in RFP Attachment 2. The required insurance certificates must comply with all requirements of the standards as shown and must be provided within fifteen (15) days of issuance of the Notice of Intent to Award and prior to the commencement of any work on the Project.
KPOJ Response:
Confirmed. Please note, changes to the Insurance Language (RFP Attachment 2) have been provided in the section, “D. Exceptions to this Request for Proposals.” Business Licenses The successful Contractor and all subcontractors used in the work will be required to hold or to obtain a City of Richmond business license for which the fee will not be waived.
KPOJ Response:
This has been provided with the attachments. Please see “Business License”.
Please note, The City will send renewal notices in March 2023. We are in compliance through June 2023.
2121 West Bullard Avenue, Fresno, California 93711 ½ 559.435.2800 ½ Fax: 559.435.7200 ½ www.occu-med.com
February 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
Dear 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
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
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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
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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
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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.
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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.
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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
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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
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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.
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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
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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
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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
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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:
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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
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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
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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.
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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__________________