Mayor and City Council
June 17, 2026

Proposal to The City of San Bernardino RFP# F-26-1054 Proposal Submitted by:

May 21, 2026 Corporate HQ - 2121 West Bullard Avenue, Fresno, CA, 93711 Denver Office - 1928 East 18th Avenue, Denver, CO, 80206 TAX ID: 52-2333519 State of California Corporate ID: C2472806 559.435.7200 - Fax Contact: Christopher St. George 559.435.2800 x207 - Telephone [email protected] - Email www.occu-med.com

The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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I. Executive Summary Occu-Med has a 46-year history of providing our quality driven, customer service oriented Occupational Health Evaluation Program to more than a thousand Cities, Counties, and Private Sector organizations throughout the United States including hundreds of municipal agencies in Southern California, forming close working relationships with human resources, risk management, police and fire personnel staff members - at each agency - in order to ensure continuity in accessing Occu-Med’s turnkey system for completing medically appropriate and legally defensible occupational health evaluations. Occu-Med’s technical approach to the services described in our proposal is designed to squarely respond to City’s needs - in order to deliver a program that reduces the number of employee accidents and injuries in a medically appropriate and legally defensible manner. Our goal in the delivery of our service will be to enhance the delivery of our Program to assure applicants/employees are able to safely perform the essential functions of the jobs in which they are being placed. Because we have licensed physicians and legal experts on staff, no matter how simple or dynamic an evaluation might be, Occu-Med will always furnish the City a clear and legally defensible medical recommendation in consideration of all applicable laws and guidelines (ADAAA, FEHA, cal-OSHA, FMCSA, POST, NFPA 1582 & GINA) as to whether or not an employee is able to safely perform the essential functions of the job with or without reasonable accommodation. In addition to providing all the current services offered to the City of San Bernardino (hereafter, “the City”), Occu-Med is proposing the expansion of our service to include management of a medical Network throughout California that will now be available to the City in order to enhance the convenience for the City’s applicants of attending the pre-placement medical evaluation. Our proposed Primary Network includes: hundreds of medical facilities throughout California. (see our fee schedule for occupational health services valid at any network location in California.

The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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Additional providers can be added at the City’s direction or by requesting an out-of-area-exam on the medical exam requisition form. For instance, if an applicant lives in Las Vegas the City can simply request the exam occur at a clinic closer to that location.

The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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2. Table of Contents Page COVER PAGE N/A Section 1 - Executive Summary 3 Section 2 - Table of Contents 4 Section 3 - Identification of Proposer 5 Section 4 - Staffing Resources 3 Section 5 - Fiscal Stability 11 Section 6 - Experience & Technical Competence 11 6a. Experience 11 6b. Project Specific Experience 16 6c. Technical Competence 17 Section 7 - Proposed Method to Accomplish the Work 17 Section 8 - Fee Proposal 28 Section 9 - Insurance 29 Section 10 - Litigation 29 Section 11- Other Information 30 Section 12 - Certification of Proposal 32 Section 13 - Appendices 32 EXHIBITS 1-7 The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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3. Identification of Proposer a. Occu-Med Ltd. dba Occu-Med b/c. Occu-Med is a Corporation wholly owned by its Founder and CEO James Johnson Esq. d. The City’s single point of contact for this RFP is Chris St. George, Business Development Director, Mr. St. George works at both Occu-Med’s Fresno & Denver Offices, correspondence may be sent to his attention at: 2121 West Bullard Ave, Fresno, CA 93711. e. State of California Corporate ID: C2472806. 4. Staffing and Resources The following staff work at Occu-Med’s Fresno Office, however with dozens of Southern California clients we are in the San Bernardino/ Riverside area on a monthly basis. Cristal Granse – Main Account Manager and Director of Team Bailey – Principle 1/3 Ms. Granse has been with Occu-Med for over 10 years. If awarded the City’s new solicitation, Mr. Granse will continue to be the main Account Manager for the City. 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, large or small. She has been the City’s main account manager for the majority of Occu-Med’s current contract with the City. Organize and manage the team’s daily workflow: • Prioritize work to be done and individual team member assignments • Proofread Medical Examination Summary Reports • Approve/deny PTO requests of team members and ensure availability of Utility Staff coverage prior to approving (and/or taking) PTO. Perform evaluations of team members in accordance with the Occu-Med Training and Management Strategy: • Work with Quality Department to ensure team members receive regular training until fully trained. Ensure work performed is in accordance with client expectations and commitments made by Occu-Med: • Manage Client Protocols for clients assigned to his or her team by creating new protocols and updating existing ones as needed • Ensure that Occu-Med services for clients assigned to his or her team meet or exceed client expectations The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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• Investigate cases identified by the Quality Department as failing to meet client and/or Occu-Med expectations. Christopher St. George, Director of Business Development & Contract Manager - Principle 2/3 Christopher St. George. Mr. St. George has more than 20 years-experience managing compulsory occupational health evaluations and conducting job analysis. He has also been the contracts manager for the City’s work since 2014. If awarded, he will continue to be the contract manager for the City. Among his many accomplishments from 2019-2024, Mr. St. George has been the Project Manager for CDOT on a continuous basis since Occu-Med’s initial award in 2014. Prior to this Mr. St. George was the Project Manager responsible for Occu-Med’s portion of the United States Army Kuwait Base Operations Support Services contract for which over 2,000 Department of Defense medical evaluations were performed in a three (3) month period. (The largest turnkey government contract transition in US DoD history). Additionally, from 2015-2018 on an as needed basis Mr. St. George worked as a full time onsite consultant for one of Occu-Med’s Fortune 500 clients in Colorado Springs. Chris St. George is responsible for the provision of Occu-Med’s services on a global scale – creating relationships with United States-based and overseas clients and strategic partners – allowing these services to be delivered wherever our client-employers need us. And, despite the typical hardships that arise from maintaining a global footprint, Occu-Med’s international projects, overseen by Mr. St. George, consistently receive ranks of “Industry-best,” “Exceptional,” and “the Clear Choice” from our clients for all of our service offerings. Mr. St. George values diligence and trust as the keys to sustaining productive relationships with Occu-Med’s clients; and, when necessary, by positioning himself or his staff inside clients’ operations, Mr. St. George is able to ensure each project is uniquely prepared to utilize our services in the most effective manner possible. Consistent collaboration with our clients by Mr. St. George allows Occu-Med to deliver “turnkey” and customized occupational health programs regardless of project scale, from basic services such as substance abuse screening programs to multi-country pre-placement/pre-deployment and compliance-based periodic medical evaluations. Mr. St. George joined Occu-Med in 2004. He is a graduate of the Craig School of Business at Fresno State University earning a Bachelor of Science Degree in Business Administration. He also holds multiple certifications in compliance and management. Chase Coyle, Director of Operations Principle 3/3 My professional qualifications began with obtaining my BS in Business Management with a focus on Organizational Leadership at Fresno State University in 2012. Since my graduation, I have built upon the foundation of my education with 6+ years of experience in executive management and customer service. I have always had a natural passion for finding ways to better myself and others and continue to study management theories by attending various leadership seminars and reading leadership publications.

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James A Johnson, J.D., CEO/Owner/Chief Legal Advisor Mr. Johnson is a graduate of the Ohio State University and received his law degree from the McGeorge School of Law at the University of the Pacific. Prior to founding Occu-Med in 1979, Jim Johnson was a private consultant directing several major civil rights projects in California, Hawaii, Washington and Oregon. Mr. Johnson served as a Legal Intern and subsequently Affirmative Action Advisor with the County Supervisors Association of California and as a Legislative Analyst with the State of Hawaii’s Commission on the Handicapped. Mr. Johnson has supervised more than four hundred medical standards research projects and is responsible for the development of Occu-Med’s state-of-the-art quality assurance program, EXAMQA. Occu-Med itself is the result a multi-million dollar grant issued in 1976 to study the dramatic rise in workers’ compensation claims costs. The study included input from groups of experts in numerous medical specialties to develop a methodology to correlate pre-existing medical conditions and their effect on workers in various demanding job classes. Mr. Johnson was the director of this multi-agency project for the four years of its research and field-testing. Additional expertise in the technical and daily functions in this field was gained through the operation of a network of independent occupational health clinics. He continues to oversee the day-to-day operations of Occu-Med as well as the on-going advanced research conducted by the company. Mr. Johnson’s work includes consultation with national and international corporations and public sector agencies in developing innovative placement programs dealing with hiring, return-to-work, immunizations and wellness Mr. Johnson remains personally involved in the oversight of implementation and operation of Occu-Med’s Employment Medical Examination Management Service. All final decisions and approvals impacting the welfare of the business relationship between Occu-Med and the County will be assessed and authorized by Mr. Johnson. Devonna M. Kaji, M.D., Medical Director 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 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. 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. She has continued to supervise and participate in every medical research meeting addressing the continued effectiveness and appropriateness of this The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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Compendium of what is now termed Medical Guidelines. Dr. Kaji supervises all medical specialists currently on retainer to Occu-Med. Further, as Medical Director, Dr. Kaji oversees all medical aspects of the Company’s EXAMQA program. Dr. Kaji is actively involved with Occu-Med’s advanced projects and the periodic review and revision of all Occu-Med Medical Exam Forms, Medical History Forms, Medical Exam Results Summary Forms and all related internal operations. Dr Kaji examines and evaluates the accuracy and validity of all data and recommended medical exam components to assure that they are comprehensive and medically appropriate. The administration of EXAMQA reviews and recommendations are managed under the direction Dr. Kaji. Tracy Lee M.D. Consulting physician OSHA compliance (CV’s Enclosed Exhibit 1). LT. Colonel.(Ret) Joe Kelley N.P. LTC Kelley has 31 years of nursing experience in all aspects of the continuum of Mental Health care. This experience ranges from civilian inpatient psychiatry, serving in combat zones and currently working as Senior Nurse Practitioner consultant at Occu-Med and working in a maximum-security prison inpatient program. LTC Kelley is a former CENTCOM Waiver Action Officer. LTC Kelley provides extensive technical consulting advice at Occu-Med. This includes expertise in potential waiver related medical conditions, mental health results and DoD Deployment medicine. Jared Kaji, Vice President, Business Development Jared H. Kaji is Occu-Med’s Vice President and is chiefly responsible for the Company’s development and operations. Mr. Kaji began his career at Occu-Med in 2003, while studying at California State University, Fresno, as an intern working in the Company’s EXAMQA Department. In this role, Mr. Kaji’s attention to detail, need for efficiency, and passion for nuance furthered the Company’s commitment to Quality and perpetuated a word-of-mouth marketing campaign. As a result, Mr. Kaji was promoted to the Company’s Director of Business Development in 2006. Over the next ten years, as Director of Business Development, Mr. Kaji championed Occu-Med’s venture into the global marketplace – developing Occu-Med’s International Network of Medical Providers and the Company’s Scheduling and Harvesting Departments, while simultaneously promoting the service and building a client base comprised of more than a thousand public agencies, fortune 500 companies, and more than 60% of the Company’s target market within the government contracting arena. Mr. Kaji, currently spends his time developing and implementing solutions with Occu-Med’s client employers; enhancing relationships with strategic partners and vendors; and leading the operations team to achieve each client’s unique goals. In his words, “Each evaluation we perform is an opportunity to The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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make a difference – we can save a life, prevent an injury, tear down arbitrary barriers to job placement for the disabled and more – we help a lot of people and we do it one evaluation at a time.” Sean Edin APT, Director of Quality Sean Edin is a graduate of California State University, Fresno with a degree in Physical Education with Athletic Training Option. He is also a licensed Physical Therapist Assistant with the State of California. Mr. Edin has over 15 years experience working in the Workers’ Compensation arena performing Functional Capacity Evaluations and physical therapy treatments for employees of large corporations, local hospitals and private clinics. His background also includes working with Orthopedic Surgeons providing treatments and medical services and he is a Certified Professional Drug Screen Collector. Mr. Edin has been with Occu-Med since 2006 and currently serves as the Director of Quality that has included the implementation of on-site medical services at a government contractor in Houston, Texas, performing on-site Job Analysis and managing large client contracts including the Association of California Water Agencies-Joint Powers Insurance Authority (ACWA-JPIA) and Morton Buildings, which operates in 36 states. In addition, Sean is involved with the day-to-day operations of the Network Management and EXAMQA Departments as well as our client implementation and management services. His wealth of medical knowledge has been a tremendous asset to the growth and experience of Occu-Med services. Angela Coleman, Manager of Exam Quality Assurance • Career with Occu-Med began in August 2019 • Versed in industry-specific guidelines and knowledge standards (HIPAA, OSHA, FMCSA, POST, NFPA) • Focused in quality monitoring, workflow optimization and process improvement • Experience applying risk-based thinking to continually improve training initiatives • Maintains feedback loops with internal and external stakeholders to enhance and streamline existing protocols • Responsible for tracking and auditing quality metrics and utilizing root cause analysis for identifying and improving error trends Dana Tamayo; EXAMQA Director • Years of Experience: o Over 7 years with Occu-Med, Inc. (since 2017) • Career Progression: o Began as an EXAMQA Analyst o Promoted to EXAMQA Manager o Currently serving as Director of EXAMQA • Core Responsibilities: o Lead through Occu-Med’s Core Values to foster a positive, mission-driven culture The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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o Oversee delivery of EXAMQA services with a focus on quality, customer service, and turnaround time (TAT) o Set clear expectations and performance goals aligned with company objectives o Provide strategic oversight and hands-on coaching for EXAMQA Managers and Analysts o Ensure compliance with contract requirements and individualized assessment standards • Key Expertise: o Deep technical knowledge of medical/legal issues related to disability evaluation and individualized assessment o Experience managing complex cases involving ADA compliance, fitness for duty, and reasonable accommodation o Liaison between Operations, Quality, and Account Management to ensure seamless service delivery • Leadership Focus: o Promote a culture of continuous improvement and accountability o Mentor and develop high-performing teams through clear communication and strategic coaching o Drive process enhancements and quality assurance in support of Occu-Med’s mission to prevent injuries and protect the rights of the disabled. The rest of team bailey also includes: Team Bailey 559.435.2800 x 341 Name Extension Email Title Cristal Granse (Meza) 165 [email protected] Director of Client Services Dana Tamayo 159 [email protected] EXAMQA Director Selena Edin 107 [email protected] Scheduling Director Jasmine Hines 128 [email protected] EXAMQA – Analyst Angela Coleman 195 [email protected] EXAMQA – Analyst Brenna Moore 192 [email protected] EXAMQA – Analyst Doug Jew 188 [email protected] EXAMQA – Analyst Bianca Watkins 155 [email protected] Scheduling- Analyst Jack Coyle 139 [email protected] Scheduling- Analyst Pierre Rai 191 [email protected] Scheduling- Analyst Larissa Romero 146 [email protected] Scheduling - Analyst The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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b. Subcontractors Occu-Med manages a network of medical clinics throughout the Country. If awarded this work Occu-Med will subcontract the actual performance of the medical exam to our medical clinics in the San Bernardino area including: Agile Medical COMP – Central Occ Medical Partners Riverside Cardiology Riverside, CA San Bernardino, CA Riverside, CA Additionally, because of our large client base in Southern California, we are making our entire Network available to the City (see enclosed fee scheduled and licenses Exhibit 1). V. Fiscal Stability. Please find a recent D& B report for Occu-Med. A letter from our financial institution and 2025 financial reports enclosed – (Exhibit 2). VI. Experience and Technical Competence VIa. Experience Our experience, gained over almost four decades, has shown that Occu-Med’s service is uniquely capable of achieving a significant reduction in the number of employees injured on the jobs of our clients. Our commitment is the provision of our service in as conscientious, diligent, professional, non-discriminatory, timely, consistent and cost-effective a manner as possible to achieve the greatest possible value for our clients. Founded in 1979, Occu-Med specializes in Job Analysis, Pre-Placement/Periodic Occupational Health Evaluations, including a full battery of associated testing. Return-To-Work Evaluations, Fitness-For-Duty Evaluations, Independent Medical Evaluations, HAZMAT Exams, OSHA Respirator Evaluations and Exams, OSHA Hearing Conservation Medical Exams, Robust Drug Screen Services, including Pre-Placement, Random, DOT compliant with 49 CFR Part 40 and non-DOT. Pre and Post Deployment Medical Exams (civilian contractors), Family Medical Leave Act (FMLA) and National Fire Protection Association Medical (NFPA 1582) and POST medical exams.

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Since being founded 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 would be the Occu-Med System of medically evaluating applicants’ and employees’ job suitability. During this exhaustive research and while analyzing various job classes amongst cities and counties throughout California (in coordination with CSAC which was participating in the research grant), Occu-Med was able to discover and statistically document that - regardless of job class - approximately 41% of workers’ compensation injuries occurred in the first year of employment. Further analysis of this figure, conducted with Sacramento County, Los Angeles County, Orange 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 [retired 2014]), 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 number 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 The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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medical conditions could be identified prior to the applicant or employee being placed, entire injuries could be avoided, thus eliminating the associated cost of the resulting workers’ compensation claim. One of three key elements in this process would be 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. 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 any agency which utilized our Program. Brief Case Study of Workers’ Compensation Savings Throughout the rest of the 1980’s and into the 1990’s 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 would be required to comply with more stringent regulations regarding how an occupational health evaluation was both administered and reviewed.

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Out with, Standards & Individualized 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 post-offer/pre-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 that test was 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 conducting only job-related medical evaluations for over a decade utilizing the Physical Abilities Analysis process (previously described).

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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 1990s Occu-Med would continue to establish itself as one of the premier authorities 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 additional regulations and guidelines related to occupational health including: California Peace Officer Standards and Training (POST), National Fire Protection Agency (NFPA) 1582 as well as updates to the Federal Motor Carrier Safety Administration (FMCSA) Medical Examiners Handbook. Considering these updates our team would work lockstep with our client employers to ensure continual compliance with each update. Today, we serve clients around the globe, including more than 100 Cities, Counties and municipal agencies, more than 300 water agencies, and more than 200 fire districts, and hundreds of national private employers—frequently reviewing more than 200 medical examinations daily. In fact, in 20234, we assisted in the placement (or continued placement) of more than 10,000 employees in Iraq, Kuwait, Qatar, Dubai, Uganda, Ecuador, Germany, Bosnia, Kosovo, Romania and many other countries for clients such as: Lockheed Martin, V2X, L-3 Communications, ManTech, Valiant Integrated Services, Arch Insurance, Trace Systems and TCOM. In addition to the references listed in Exhibit 3, Occu-Med also manages and performs pre-placement, periodic, and compulsory occupational health evaluations for dozens of other satisfied clients in Southern California including: Orange County Water District, City of Costa Mesa, City of Fullerton, The City of Ontario, The City of Riverside, The City of Redondo Beach, The City of Whittier, Antelope Valley-East Kern Water Agency, Eastern Municipal Water District, Palmdale Water District, The City of Monrovia, The City of Huntington Park, Santa Clarita Water District and many others. Should further referral information be helpful Occu-Med can happily provide it upon request.

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Please find a list of 5 references the City may contact. (EXHIBIT 3). As an organization founded, in part, to reduce workers’ compensation costs and assist in applicant placement; we believe we are uniquely positioned to assist the City of San Bernardino in assuring safe and speedy placement of all medically qualified candidates. And, we know, in today’s hiring landscape the more efficiently a city can navigate the onboarding process the more likely it is that entity will be able to place a qualified applicant during a competitive hiring process. 6b. Project Specific Experience City of Riverside (a) Role of Firm - Occupational Health Consultant for Pre-Placement Medical Evaluations (b) Dollar value of the Services - Approx. $150,000 annually (c) Dollar value of the Fee - Approx. $150,000 annually (d) Description of Services - From 2017-Present Occu-Med has provided many of the services described herein to the City of Riverside (e) Staffing - Occu-Med has staffed this contract using Team Bailey and other Key staff members described herein (f) Duration - 2017-Present (g) Relationship to Client - Consultant (h) Contact information Maggie Tanner, HR Division, Email: [email protected] (i) P: 951.826.5459 City of Covina (a) Role of Firm - Occupational Health Consultant for Pre-Placement Medical Evaluations (b) Dollar value of the Services - Approx. $75,000 annually (c) Dollar value of the Fee - Approx. $75,000 annually (d) Description of Services - From 2018-Present Occu-Med has provided many of the services described herein to the City of Covina The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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(e) Staffing - Occu-Med has staffed this contract using Team Bailey and other Key staff members described herein (f) Duration - 2018-Present (g) Relationship to Client - Consultant (h) Contact information – Joanna Espinosa, Email – [email protected] , P: 626.384.5554, Address: 125 E College St, Covina, CA, 91723 City of Ontario (a) Role of Firm - Occupational Health Consultant for Pre-Placement Medical Evaluations (b) Dollar value of the Services - Approx. $50,000 annually (c) Dollar value of the Fee - Approx. $50,000 annually (d) Description of Services - From 2024-Present Occu-Med has provided many of the services described herein to the City of Ontario (e) Staffing - Occu-Med has staffed this contract using Team Bailey and other Key staff members described herein (f) Duration - 2024-Present (g) Relationship to Client - Consultant (h) Contact information – Marquie Lugo, Email: [email protected], P:909.395.2191. Address: 200 N. Cherry Ave, Ontario, CA 91764 6c. Technical Competence The City will also be given access to our Customer Interface Portal “The Occu-Portal” this will allow appropriate staff to submit referrals, make updates to requests and check on the status of the Project for instance, number of completed evaluations, or number of “no shows”. Note: No Private Medical Information (PHI) will be shared on our customer portal. As a result of the Occu-Portal Occu-Med is able to report a flawless record in any breach of PPI or PHI for any of our medical referrals.

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The Occu-Portal is able to track all aspects of each occupational health evaluation referred to Occu-Med. This allows for real-time updates of appointment scheduling, exam results and turnaround tim. 7. Proposed Method to Accomplish the Statement of Work (EXHIBIT A of the City’s RFP) We believe that following the City’s review of our Proposal Occu-Med will remain the obvious choice for the quality provision of the City’s Occupational Health Program. Occu-Med has over 46 years of experience specializing in exactly the type of services being solicited in the City’s RFP this includes ADAAA and FEHA compliant pre-placement and periodic medical evaluations, including POST medical requirements, cal/OSHA surveillance evaluations and our DOT compliant FMCSA Medical Program. Moreover, we have been providing these service to the City since 2014 during which time we have worked to build lasting business relationships with the City’s Human Resources Personnel and hopefully we have become the City’s trusted medical advisor for any occupational health related case no matter how dynamic. In light of Occu-Med’s review of the City’s RFP it appears the City seeks to contract with a medical vendor[s] that is able to manage and perform Pre-Employment Physicals in a manner that combines: a) a thorough knowledge of the essential physical and environmental components of the City’s job classifications especially safety-sensitive jobs in question; b) the medical expertise to gather all appropriate medical information upon which to base safe placement, continued placement, return-to-work and fitness-for-duty recommendations; and,

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c) extensive knowledge of the legal constraints within which such placement decisions are made. Approach - Implementation The implementation of our service typically begins with a Client Orientation to the laws and regulations governing employment medical testing, the manner in which the Occu-Med Program fulfills these legal requirements, the goals of our service and the provision of assistance to you in the establishment of appropriate policies and procedures within the City to authorize the appropriate medical review of employment examinations and the training of selected staff in the manner in which this process will be performed. This process will include the completion of a New Client Interface. During this implementation phase, if requested, we also perform Job Analysis for all job classes requiring medical examinations in order to determine and document the specific physical abilities and environmental factors involved in the performance of each of these job classes. The result of this Job Analysis is the production of Job Profiles and Medical Examination Component Profiles for the job classes included in our Program. [NOTE: Job Analysis is a component of the Occu-Med Program which will typically accompanies our occupational health program, particularly pre-placement. The City has not requested the Job Analysis component at this time; nonetheless, the value is highlighted below as a Technical Enhancement to the Occu-Med Program. While client orientation is included with our proposed program, Job Analysis is more extensive and contains associated costs. If Job Analysis is not performed or deemed necessary by the City Occu-Med presumes that the City has validated batteries of medical testing associated with each job class, or government mandated testing requirements, for instance those recommended by POST. Of course, Occu-Med serves as a “ready resource” to consult on appropriate medical testing as promulgated by any government entities, statutes, acts and amendments (ADAAA, FEHA, OSHA, EEOC etc…) if selected, this “ready resource” services is provided free of charge to the City.] The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

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- Job Analysis The foundation of Occu-Med’s pre-placement and periodic medical evaluation programs is a thorough understanding of the job into which an applicant is to be placed or an employee is to be returned, or retained in. Therefore, typically the first step to implement our program is the development of a comprehensive Job Profile (Sample Exhibit 4) that documents the physical and environmental demands of each of the job classes to be included in the medical evaluation program. Using a statistically valid sample of workers in the selected job classes, we conduct on-site structured group interviews to determine the essential tasks of the jobs being analyzed. The Job Profile also describes working conditions and environmental exposures encountered on the job, in which the jobs are rated on 19 physical abilities and 25 environmental factors. The physical abilities and environmental factors provide the foundation for the next two steps of our service: the medical examination and the employee / job compatibility determination. The Job Profile provides the foundation: a) to determine which medical conditions would be inappropriate to place into the job, and to permit the establishment of job-related and cost-effective medical examinations; and b) to use in the worker / job compatibility recommendation that Occu-Med performs following each medical examination. With this knowledge a recommended Medical Exam Component Profile (MECP) is developed (Exhibit 5) by Occu-Med to document what testing will be required for a specific job class. This Profile, or one we create from an existing job description, serves as a blueprint for the medical exam provider for conducting the specific medical exam for each job class. Once the recommended Medical Exam Component Profiles have been approved by the City these Medical Exam Profiles are ready for immediate use in conducting medical evaluations. Finally, as part of the review/implementation process, Occu-Med’s key staff is available for interviews, and/or a client orientation/reorientation onsite at any time as requested by the City.

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21 Occu-Med
- QA2 QA2 is the scheduling and on-going medical management service of all medical examinations for applicants and employees for jobs with the City. This Quality Assurance includes exam reviews for medical exams, the further investigation of medical conditions identified during these exams (through the “RDQA” service—see EXAMQA), the preparation of letters to applicants or employees who are determined to require the submission of additional information for the job for which they applied, an analysis of Reasonable Accommodation for each individual Medically Disqualified, and the preparation of periodic (daily, when useful) production / performance / status reports. Our QA2 Program is how Occu-Med will accomplish most of the items requested in the City’s RFP EXHIBIT A Proposed Scope of Services. The City will also be given access to our Customer Interface Portal “The Occu-Portal” this will allow appropriate staff to submit referrals, make updates to requests and check on the status of the Project for instance, number of completed evaluations, or number of “no shows”. Note: No Private Medical Information (PHI) will be shared on our customer portal. As a result of the Occu-Portal Occu-Med is able to report a flawless record in any breach of PPI or PHI for any of our medical referrals. Schedule Medical Exams: Scheduling pre-placement, or periodic medical evaluations (such as those requested in the Scope of Services) through Occu-Med could not be easier. And the continuity of the entire process is enhanced via our internal management software OMIS. Applicants or employees

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22 Occu-Med
requiring medical exams who have been offered positions (conditionally upon passing a medical examination demonstrating the ability to perform the essential duties of the job safely) or who require periodic evaluation can be referred to Occu-Med by submitting a completed Exam Requisition Form or via the Occu-Portal, and/or email to [email protected], or by contacting the City’s dedicated Team Bailey phone number (1.877. OCCUMED x148). Occu-Med will immediately (within two (2) business hours from the time of request receipt) attempt to schedule the medical examinations for each of these applicants or employees at medical clinics in the general geographic areas of the applicant or employee. Occu-Med’s first option will always be to schedule the exams at the clinic most convenient for the employee and each of these clinics will have been previously evaluated and is prepared to perform timely and medically appropriate examinations (see page 11 for clinic information). Additionally, since Occu-Med maintains a robust medical provider network throughout Riverside, San Bernardino, Orange and Los Angeles Counties we can typically offer an applicant or employee an exam at a clinic very close to their home or current job. And we understand that “last minute” or rush requests do arise and whenever possible we can typically accommodate such requests even on the same day of the appointment. For all Occu-Med exams, the goal will be to have scheduled the exam by the next business day (or as directed by the City on the Exam Requisition Form), and submission of completed medical exams within 3-4 additional business days following the exam (or 1-2 business days for exams not requiring labs or a TB skin test). Occu-Med will immediately contact any clinic that fails to meet these performance goals to assure that the processing and placement of City applicants is achieved as efficiently as is possible. Upon scheduling the medical evaluation the individual is provided in advance all the necessary paperwork in order to complete the process successfully. This includes a copy of Occu-Med’s POST & GINA compliant medical history forms (Exhibit 6) 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 The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

23 Occu-Med
evaluations. Additionally, when applicable, we always include job specific forms and questionnaires ahead of time, for instance OSHA Respirator Questionnaire 1910.134, Appendix C. Copies of medical history and examination forms are pre-positioned at the clinic for ease of access for the provider and should the individual forget his or her copy. As a yet another quality control measure, based on the pre-agreed upon medical testing components and laboratory services Occu-Med provides each clinic with a pre-authorization form to reinforce the required components for that specific evaluation (see Exhibit 6). This coupled with Occu-Med’s pre-positioned laboratory requisition forms virtually eliminate the ability for a clinic to “wing-it” regarding which medical components will be performed. Occu-Med utilizes its custom tracking software in order to assure that all required client “turnaround time” deliverable metrics are being met. This process allows us to customize the scheduling, appointment date and results date pursuant to client specific requirements. While every client is different, a topline sample view of these tracking tools is provided below (DOR=Date of Referral, DS=Date Scheduled, DOE= Date of Exam):

Additional Sample Reports are included as Exhibit 7. EXAMQA: Occu-Med will review each examination performed for timeliness, accuracy of medical components performed, thoroughness of medical information provided, correctness in the

SCHEDULING TURN AROUND TIME AVERAGE
2 4
6 8
Bailey Juno Rambis Tatum

0.48 0.5

0.82 0.45 1.88

4.625.32*3.47
DOR to DOEDOR to DS

NUMBER OF EXAMS SCHEDULED
55 110
165
220
275
Bailey Juno Rambis Tatum
242175150169
184Average
SCHEDULING DOR TO DOE TAT4-WEEK TREND
0 2
4 6
8 8/22/168/29/169/5/169/12/16

1.88 2.682.84

4.4 4.624.58

6.14 4.38

5.32 3.67

7.037.19

3.474.02

5.11 6.54
BaileyJunoRambisTatum
EXAMS SCHEDULED 4-WEEK TREND
70 140
210
280
8/22/168/29/169/5/169/12/16
242
213
265
175 175
88 146166 150133133146 169
120131130
BaileyJunoRambisTatum
*Expressed in days
Medical Exam Harvesting Metrics
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24 Occu-Med
performance of medical testing, and completeness. This review will specifically include a focus on ensuring the examination components required by the City for the particular exam are completed. For instance, were three (3) attempts made during the Pulmonary Function Test? If any problem is identified (such as the omission by the clinic of a required exam component), Medical Exam Intake Specialists on Team Bailey will fax or telephone the clinic immediately (within one hour of identifying any problem). Occu-Med has institutionalized within its Medical Provider Network a goal of two-three days for the submission of a complete and accurate medical exam for review by Occu-Med. When the exam is deemed complete, it is forwarded for medical review by Team Bailey to Occu-Med’s medical review staff. This review takes place by identifying any medical conditions or physical limitations present (as documented by the medical history and medical exam) and comparing those conditions with the physical demands of the job (as documented by the Job Profile, Job Analysis information or Job Description). Occu-Med will review and submit our recommendation to the City of all complete exams that are submitted before 4:00pm PT on the same day as received. Since it is Occu-Med that reviews each exam, regardless of the physician that performed the physical or the location the exam was performed the City can be confident each exam is reviewed with consistency in order to ensure compliance wit the relevant medical guidance. When the Occu-Med recommendation is that an applicant or employee may only be placed with work restrictions or accommodations (that is, when the applicant is “Conditionally Qualified”—or “CQ”—under Occu-Med terminology), Occu-Med will prepare an Employment Agreement for the employee to sign agreeing to abide by the necessary restrictions. When appropriate, Occu-Med will also provide for the employee’s supervisor to sign the document acknowledging the agreement. If the demands of the essential functions of the job are too great for the existing medical condition or physical limitation identified, Occu-Med will recommend further follow-up prior to rendering a final placement decision. Occu-Med’s recommendation will be communicated by email (or by telephone, facsimile, or other method directed by the City) to the designated City staff also on the same day that the exam is received. That communication is submitted in the form of a written report for each The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

25 Occu-Med
exam. However, this communication is simply the notification of a delay, and does not contain any private medical information. 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 of the specific findings as well as the information that will be necessary to submit in order to be cleared for the job. Since City staff may not have the time or the medical expertise to contact each of these applicants to describe in detail the medical findings and to answer their questions about the medical information needed for clearance to be approved, Occu-Med staff communicates directly with these applicants. Further, there is also a growing fear by employers that they may be receiving medical information about job applicants from medical examinations 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 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. Applicants will have 5 days to respond to Occu-Med and 10 days to provide further information (unless the City dictates the application of different time requirements). City staff will simply be notified that such a review has been initiated, 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 clearance report.

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26 Occu-Med
Finally, for any medical examination that results in a Medical Disqualification (that is, where there is a finding that the applicant is determined to be unable to safely perform the essential duties of the job in question, with or without reasonable accommodation), Occu-Med will prepare a report for use by the City in notifying the applicant of this placement recommendation. This report will document the specific justification for the recommendation to disqualify and will also document the fact that Occu-Med has guided City staff through a discussion of “reasonable accommodation,” as required by law. Specific reasons why reasonable accommodation is not feasible will be included in the report. The City will send this report to the candidate directly. And the City is now prepared to perform (or continue to perform) “the interactive process.” A process Occu-Med encourages the City to allow us to assist with. FIT-FOR-DUTY CLASSIFICATIONS ARE AS FOLLOWS: Occu-Med commits to the submission of a recommendation and a written report for each exam submitted by 4 PM on the same day that the complete exam is received. Based upon the exam results, Occu-Med submits its recommendation report to the client: 1. Medically Qualified (“MQ”) - Applicant/Employee is an immediate safe placement. 2. Conditionally Qualified (“CQ”) - An applicant or employee may only be placed with work restrictions or accommodations and we prepare an Employment Agreement for the employee to sign agreeing to abide by the necessary restrictions; 3. Recommendation Delayed for Qualification (“RDQ”/”RDQA”) - When our recommendation is that a decision be delayed until certain medical information can be further explored. Under RDQA, Occu-Med communicates the further medical information needed directly to the applicant or employee, removing the client from the “middle-man” position whereby they were discussing matters often beyond their training. For both RDQ and RDQA, Occu-Med generates an additional report when the recommendation changes to either qualified or disqualified based upon the information submitted; this process is explained in detail on the previous page.

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27 Occu-Med

4. Medically Disqualified (“DQ”) - A recommendation of DQ is only appropriate after the RDQ step has been completed due to the legal requirement of “individualized assessment” of any medical findings. 8. Fee Proposal Please find Occu-Med’s fee proposal attached to the City’s completed Vendor Quote Form. Our fees consist of the medical examination services ordered by the City but also includes all the following services: • 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 the United States • Occu-Portal • 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 • Employment Agreements for any employees placed with accommodations • Additional reviews for applicants with medical or physical conditions requiring further 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 hiring recommendations • Assistance with reasonable accommodation recommendations • Policy Assistance • Consultation relative to pre-placement, and periodic medical evaluations • Assurance of excellent clinic performance issues, as needed • Periodic reports documenting the results of Occu-Med’s work • One-Stop Shopping for all services requested in the City’s RFP The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

28 Occu-Med
• Clinic Invoice Accuracy Review (described below). Medical Examination Billing Occu-Med began its clinic invoice review service in 2006 as part of its service to ITT, a company charged with deploying employees to Iraq, Kuwait, Qatar and Afghanistan for various major federal projects in that region. We have evaluated more than 4,000 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. 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, a description of the services provided, contract number and Occu-Med’s Federal Tax ID. What does this mean for the City? Instead of receiving hundreds or potentially thousands of invoices each year from each clinic the City will only receive one clear-straightforward invoice from Occu-Med for only the services authorized (sample next page).

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29 Occu-Med

9. Insurance Please find the complete Vendor Acknowledgement of Insurance Requirements Form. 10. Litigation Occu-Med has not beed involved in any litigation in the past five (5) years.

Invoice No.0413111Invoice Date: 6/5/17
SERVICES PROVIDED (Completed Activity Through 5/31/17)
Name Date of Service Physical Blood CKHP Urinalysis Audiology Spirometry Resting EKG Vision Immunization and infectious 26+$ screeningTB Testing +HSatitiV 7itHUTreadmill PSA CXR +HaYy 0Htal )lX 5 Panel Drug Screen
Invoiced Amount
Smith, Joe 12/01/2017 xx x x x xx x x x xx x x x $ - Kelly, Ronald 1/07/2017 xx x x x xx x x x x x x $ - -TOTAL DUE BY 7/05/17 $
For questions please contact:

Ruth Santos(559) 435-2800 x 117
Please remit payment to: Occu-Med, Ltd.Federal Tax ID# 52-23335192121 W. Bullard Ave.Fresno, CA 93711

STATEMENT FOR SERVICES
RENDERED FOR:
$ttn
City of Plano

The City of San Bernardino RFP# F-26-1054 – Occu-Med QA2 Occupational Health Program 5/21/26

30 Occu-Med

11. Other Information - Periodic Reports As requested by the City Occu-Med is able to provide weekly Reports documenting the current status of all applicants/employees in process as well as previously submitted results. Our reports are generated from our internal database and can be customized to meet any request. (Sample right.) Occu-Med also performs DOT medical review services for dozens of its municipal and private sector clients. Our clinic’s Medical Director, Dr. Lee, is a FMCSA certified examiner. - Electronic Medical Records Occu-Med retains all medical records electronically (in .pdf format), in accordance with HIPAA and OSHA regulations. Additionally, all electronic records are stored within Occu-Med’s database accompanied by all relevant examination and evaluation data. This information is available at the request of the client within 1-business day. Real time access to current exams in process, and results can also be accessed via our online customer login, Occu-Portal. Occu-VAX POST and other Occupational Health Publications contain recommendations for vaccination compliance for specific job classifications. Occu-VAX is the scheduling and coordination, immunization record management and the on-going management of all immunizations for applicants

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31 Occu-Med
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 or 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 Cal-OSHA, in addition to other 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 Hepatitis B Titer as part of a pre-placement medical evaluation so that Hepatitis B immunity can be immediately documented, or providing on-site flu immunizations during the flu season.

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32 Occu-Med

12. Certification of Proposal Thank you for this opportunity to respond to The City of San Bernardino’s RFP. We hope you find our response clear and of value to you. We look forward to hearing from you regarding the City’s decision and we hope to begin a business relationship. The undersigned hereby submits its proposal and, by doing so, agrees to furnish services to the City in accordance with the Request for Proposal (RFP), and to be bound by the terms and conditions of the RFP. 13. Appendices Enclosed. Proposal respectfully submitted by:

Christopher St. George Business Development Director

PROPOSAL CHECKLIST
(as detailed in Chapter II. Request for Proposals, Section E. of the RFP) # REQUIRED DOCUMENT INCLUDED IN

BID PACKAGE
1 Required - Proposal

Technical Proposal
• Executive Summary (E.1)
• Table of Contents (E.2)
• Identification of Proposer (E.3)
• Staffing Resources (e.g., Assigned Personnel experience) (E.4) • Experience and Technical Competence (E.6)
• Proposed Method to Accomplish the Work (E.7)
• Litigation History (if any) (E.10)
• Other Information (pertinent to proposal) (E.11)
➢ Completion of other similar projects;
➢ Community involvement (if any);
➢ Prior projects, agreements, involvement with the City (if any); ➢ No Conflict-of-Interest statement.
• Certification of Proposal (E.12)
➢ “The undersigned hereby submits its proposal and, by doing so, agrees to furnish services to the City in accordance with the Request for Proposal (RFP), and to be bound by the terms and conditions of the RFP.”
• Appendices (E.13)
• Statement of “No Deviations from RFP” (F.)
➢ If proposer does not take any exceptions or deviations from the terms and conditions indicated in the agreement, then the proposer must indicate this information by making a statement within the proposal documents.

Fiscal Stability (E.5)
• Current report from any Commercial Credit Rating Service (e.g. Dunn & Bradstreet); or
• Line of credit; and
• Financial Statement.

☐
2 Required - Fee Proposal (E.8) ☐

3 Required - Certificate of Insurance (E.9) ☐
4 Required - Vendor Quote Form ☐

5 Required - Acknowledgement of Insurance Requirements ☐

6 Required - Applicable Licenses ☐

7 Optional - DBE Form ☐

Submittal Instructions: Electronic PDF file format via Planetbids on the date and time stated in the RFP.

Please allow time for system to process your proposal. The City shall not be responsible for proposals that are not received on time. The City will not be responsible for and will not accept late bids due to slow internet connection, or incomplete transmissions.

X
X
X
X
X
X
X

VENDOR QUOTE FORM

VENDOR NAME: PHONE:

ADDRESS:

The undersigned, hereby declare that they have carefully examined the location of the proposed work, familiarized themselves with the local conditions affecting the cost of the work, and have read and examined the terms and conditions for the following Project:

RFP F-26-1054

PRE-EMPLOYMENT MEDICAL SCREENING SERVICES

The undersigned, hereby propose to furnish all labor, materials, equipment, tools, transportation, and services, and to discharge all duties and obligations necessary and required to perform and complete the Project in strict accordance with the Vendor Pri ce Quote for the ELECTRONICALLY SUBMITTED TOTAL VENDOR QUOTE PRICE.

ITEM NO. DESCRIPTION QUANTITY UNIT COST TOTAL AMOUNT

TOTAL VENDOR QUOTE
Total Number of Additional Pages:

Should the proposer be requested to perform additional finance related services, please list the proposed positions and hourly rate:

PERSONNEL SPECIFY TITLE & POSITION ASSIGNED HOURLY RATE Staff Manager (or similar)
Staff Associate (or similar)
I hereby declare under penalty of perjury that the foregoing is true and correct.

SUBMITTED BY: TITLE: ____
(Authorized Representative Signature)

PRINT NAME: CONTRACTOR LICENSE NO: __ __ (If Applicable)
CLASSIFICATION: DIR REGISTRATION NO: __ _

Occu-Med Ltd.
559.435.2800 x207
2121 West Bullard Ave. Fresno, CA 93711
See attached
1 BD Director
Chris St. George
City of San Bernardino - Fee Schedule - May 21, 2026
Exam Component California NetworkCOMPLabCorpRiverside Cardiology Associates Altaf Ali, MD
General Physical Examination 155.25$ 141.75$ Physical Exam (POST) 155.25$ 141.75$ Audiogram 65.00$ 49.00$ Audiogram with OSHA Sound Booth67.50$ 49.00$ PPD (TB) Test 58.50$ 63.00$ Pulmonary Function Test 56.00$ 65.80$ Chest X-Ray (PA) 108.00$ 91.00$ Chest X-Ray (PA and LAT) 129.60$ 112.00$ Chest X-Ray (PA) with B-Read Overread 252.00$ N/AResting EKG 93.60$ 58.80$ Treadmill Stress Test 396.09$ N/A 175.00$ 337.50$ DOT Exam 148.50$ 153.90$ Vision (standalone): Hardy-Rand-Rittler (HRR) Color75.40$ 53.20$ Vision (standalone): Ishihara Color65.00$ 39.20$ OSHA Respirator Fit Test – Qualitative98.00$ 70.00$ OSHA Respirator Fit Test - Quantitative155.25$ N/A Laboratory TestingVenipuncture (Blood Draw) 41.80$ 54.00$ 18.00$ Blood Glucose 35.00$ 35.00$ 35.00$ Complete Blood Count 40.00$ 40.00$ 40.00$ Chemistry Panel 45.00$ 45.00$ 45.00$ Lipid Panel 40.00$ 40.00$ 40.00$ Liver Function Test 30.00$ 30.00$ 30.00$ Abo/Rh Blood Typing 36.00$ 36.00$ 36.00$ Hepatitis A Titer 42.00$ 42.00$ 42.00$ Hepatitis B Core Antibody, HBcAB35.00$ 35.00$ 35.00$ Hepatitis B Surface Antibody 35.00$ 35.00$ 35.00$ Hepatitis C Antibody 38.00$ 38.00$ 38.00$ Hepatitis B & C Panel 93.00$ 93.00$ 93.00$ MMR Titer 58.00$ 58.00$ 58.00$ Varicella Titer 36.00$ 36.00$ 36.00$ Rubella Antibody Screen 35.00$ 35.00$ 35.00$ Rubeola Antibody Screen 36.00$ 36.00$ 36.00$ Blood Lead 43.00$ 43.00$ 43.00$ QuantiFERON 113.40$ 113.40$ 113.40$ Drug Screen Collection 48.10$ 40.50$ 20.00$ 4-Panel Drug Screen 41.00$ 41.00$ 41.00$ DOT Drug Screen 41.00$ 41.00$ 41.00$ Urinalysis Gross & Microscopic15.00$ 15.00$ 15.00$ Instant Drug Screen – 11 panel 94.15$ 110.60$ 70.00$ Breath Alcohol Testing (E.B.T./B.A.T.)70.00$ 101.25$ 61.57$ Marijuana (THC) Oral Fluid Drug Screen75.00$ 97.65$ 75.00$ Vaccinations (Occu-Med Network)Twinrix 205.79$ 205.79$ Hepatitis A Vaccine 134.39$ 134.39$ Hepatitis B Vaccine 125.99$ 125.99$ Influenza Vaccine 50.40$ 50.40$ Varicella Vaccine 265.90$ 265.90$ MMR Vaccine 145.60$ 145.60$ TDAP 189.00$ 189.00$ Occu-VAX Management Fee(charged only once per year when vaccination services are used) 45.00$ 45.00$ Review Fees:OSHA Respirator Questionnaire Admin/Review 40.00$ 40.00$ Scheduling Fee (charged once per exam) 40.00$ 40.00$ Review Fee(charged once per exam) 60.00$ 60.00$

2. Occupational/environmental health exams and evaluations (e.g., respiratory, hearing etc.).

1. Physiological measurements required of non- sedentary job applicants that include, but may not be limited to blood pressure, pulse, respiration, temperature, height, weight, visual acuity (corrected and/or uncorrected), color vision, hearing and urinalysis.

2. Such job-specific examinations of candidates and employees are to be based on the City’s position- specific examination protocols.
a) Such screenings and examinations may include, but may not be limited to providing:
i. Chest x-ray;
ii. Electrocardiogram (EKG);
iii. Musculoskeletal screening with emphasis on back and knees for all applicants for jobs requiring heavy work;
iv. Tuberculosis screening for applicants in specific job classifications; v. Proof from applicants of immunity to measles, rubella, rubeola, varicella, hepatitis B, and tetanus for specific job classifications that require such proof.

Applicants without such proof may be tested and/or immunized by the medical provider or by medical provider of their choice at their own expense; vi. Examinations of Safety personnel per City protocol, following Peace Officers Standards and Training (P .O.S.T.) guidelines;
vii. Bloodwork for testing glucose, lead, or other applicable blood component levels required;
viii. Hearing and vision testing; and
ix. Respiratory Clearance (Pulmonary Function Test/Spirometry):
a. To help ensure your employees are physically able to work safely with a respirator, we offer respirator clearance medical examinations. As required by the Occupational Safety and Health Administration (OSHA), clearance takes place before fit testing or training for respirator use. The assessment includes:
i. Physician or registered nurse review of respirator questionnaire ii. Focused occupational and medical history
iii. N-95 fit testing
iv. Focused physical examination
v. Spirometry
vi. Physician interpretation and written clearance
b. Examinations comply with regulatory agencies (federal, state, and local), accreditation agencies, and the Center for Disease Control and Prevention (CDC)/National Institute for Occupational Safety and Health (NIOSH) guidelines. If the physician identifies potential risk factors for the employee in the respirator questionnaire, the patient history or examination, other tests, such as exercise stress testing, may be

required before clearance. Supplementary tests can often be performed by us, at an additional cost and
b) Contractor must:
i. Inform City of any irregular or otherwise pertinent test results that require additional testing or services prior to conducting additional testing/services; ii. Notify the Applicant/Employee of any recommendation for follow-up with the individual's personal physician. Ensure that such notification to Applicant/Employee states that such follow-up may be the financial responsibility of the Applicant/Employee;
iii. Obtain prior City approval for all referrals for additional examinations or testing other than what is stated in examination protocol for the job classification.

3. Prepare and submit a written summary of medical exam/test results to the City in complete, accurate and understandable style, no later than forty-eight (48) hours after an exam or P.O.S.T. exam. All results, including drug and alcohol results, must be included in this summary. Inform City departmental contact by email within forty-eight (48) hours with complete medical screening results. Provider shall advise City Departmental Contact of any delays. If exam is inconclusive and additional time is required, Provider shall contact the City Departmental contact within the forty-eight (48) hour time period to provide status report.

Examination Results:

Contractor must prepare and submit a written summary of medical examination/test results to City representative that is complete, accurate and understandable on medical clearance forms no later than three business days after the conclusion of the examination:
a) Format and content of reports/clearance forms must be approved by the City. All outcomes must be included in this summary.
b) Contractor must notify the City representative by telephone within three business days of completing medical examinations and tests. Provider must also transmit such results in written format via a City-approved method, such as facsimile or email. c) The documentation sent to the City representative must also be copied to the City representative and sent as a batch with the monthly invoices. Any clearances with restrictions must be sent by the provider promptly to the City’s Risk Manager. d) If an examination is inconclusive or if there are delays and additional time is required, medical provider must contact the City’s representative within three business days with a status report.

4. Initiate and/or update and maintain medical/health records on all employees and applicants for whom Contractor provides services. Initiate health records on all City job applicants including, but not limited to the following: health questionnaire, results of all tests, proofs of immunity, examinations, physician

consultations, and progress notes with rationale for any additional tests or reports outside of the scope of usual examination. These records and all related materials shall remain the property of the City.

5. Maintain and store all medical records for the term of the contract at no additional cost and in a secure and confidential manner. Should the Agreement be cancelled or expire, these records are the property of the City and shall be made available to the City within two (2) weeks of cancellation or expiration, at no charge to the City.

6. Physical exams must be able to occur within two (2) working days of being requested to do so by the City. Applicants/Employees should wait no longer than thirty (30) minutes from the time of actual appointment, before services are begun.

7. Contractor shall maintain examination centers located within San Bernardino or San Bernardino County and convenient to the City. The City will consider proposals whose facilities are not in close proximity to the City. The Contractor shall provide services during normal business hours Monday-Friday, City holidays excluded. Location of services shall be handicapped-accessible and shall conform to all applicable federal, state, and local safety disability laws.

A. Contractor must provide:
i. California-licensed examining physicians, clinicians and professionals who are experienced in occupational medicine and familiar with state and federal laws. Providers must indicate in their proposal which, if any, physicians and/or support staff are located at a location different from the examining facility;
ii. All appropriate support staff, such as licensed nurses, medical technicians, and administrative staff;
iii. Necessary facilities, equipment, supplies and materials.

Bidders must acknowledge all requirements of previous section, including all categories and sub-points.

Please Sign and Acknowledge Here: __________________________________________

_________________________________________________________________________

(Acknowledged)

ACKNOWLEDGEMENT OF INSURANCE REQUIREMENTS

VENDOR NAME: PHONE:

ADDRESS:

The Proposer shall demonstrate the willingness and ability to provide the required insurance coverage as set forth in the City requirements within ten (10) calendar days of notification of selection for contract award. The insurance requirements are detailed below:

RFP F-26-1054

PRE-EMPLOYMENT MEDICAL SCREENING SERVICES

MINIMUM INSURANCE REQUIREMENTS

COVERAGE TYPE MINIMUM POLICY LIMITS
Commercial General Liability $2,000,000 per occurrence/$4,000,000 aggregate for bodily injury, personal injury,
and property damage

Automobile Liability $1,000,000 per occurrence for bodily injury and property damage

Employer’s Liability $1,000,000 per occurrence

Professional Liability $1,000,000 per claim and aggregate (errors and omissions)

Cyber Liability (IF APPLICABLE) $1,000,000 per occurrence and aggregate

By signing below, the Proposer acknowledges that they have reviewed the City’s insurance requirements and confirm their ability to meet these requirements within the specified timeframe.

SUBMITTED BY: DATE: ___________________
(Authorized Representative Signature)

PRINT NAME: TITLE: ___________________
Occu-Med Ltd.
559.45.2800 x207
2121 West Bullard Ave. Fresno, CA 93711
Chris St. George
5-19-26
BD Director

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE
INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #
NAME:

CONTACT
(A/C, No):

FAX
E-MAIL
ADDRESS:

PRODUCER
(A/C, No, Ext):

PHONE

INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY
Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-

STATUTE
PER

LIMITS(MM/DD/YYYY)

POLICY EXP
(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR

CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE

DAMAGE TO RENTED
$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED

AUTOS ONLY
5/19/2026
Arthur J. Gallagher Risk Management Services, LLC
45 E River Park Place W Ste 605
Fresno CA 93720
Morgan Schneider
559-436-0833
559-256-6590
[email protected]
License#: 0D69293
Employers Compensation Insurance Company
11512
OCCULTD-01
Citizens Insurance Company of America
31534
Occu-Med, Ltd.
2121 W Bullard Ave
Fresno CA 93711
Allmerica Financial Benefit Insurance Co
41840
Columbia Casualty Company
31127
Harco National Insurance Company
26433
Syndicate 2633/623 at Lloyd's
1674874074
B
X
2,000,000
X
300,000
5,000
2,000,000
4,000,000
X
OBF9262847-18
8/13/2025
8/13/2026
4,000,000
C
1,000,000
X
X
X
AWF-J606301-04
1/17/2026
6/6/2026
B
X
X
4,000,000
OBF9262847-18
8/13/2025
8/13/2026
4,000,000
A
X
Y
EIG600967500
6/6/2025
6/6/2026
1,000,000
1,000,000
1,000,000
D
E
F
Errors & Omissions
Employment Practices Liability
Cyber Liability
652456438
PML0003330 01
D31D06260501
8/22/2025
9/13/2025
3/19/2026
6/6/2026
6/6/2026
6/6/2027
Claim/Aggregate
Aggregate
Claim/Aggregate
$5,000,000
$1,000,000
$5,000,000
City of San Bernardino
290 North D Street
San Bernardino CA 92401

Lt Col (Ret) JOSEPH G. KELLY, Doctor of Nursing Practice 2783 Segrest Rd, Pace, FL 32571
(813)716-8404
[email protected]

QUALIFICATIONS: I have over 31 years of nursing experience in all aspects of the continuum of Mental Health care. This experience ranges from civilian inpatient psychiatry, serving in combat zones and currently working as Senior Nurse Practitioner consultant at Occu-Med and working in a maximum-security prison inpatient program.

PROFESSIONAL EXPERIENCE:

November 2023-present Senior Nurse Practitioner consultant and advisor, Occu-Med Advisor and primary provider for the redeployment program at Occu-Med. Consults with a dynamic team of specialists to ensure medical and mental health documentation is captured and reported according to guidance and policy.

June 2023-present Inpatient DNP Provider, Santa Rosa Correctional Institution Works in collaboration with medical and mental health assets to provide the full continuum of care to inmates Incarcerated suffering with a wide range of mental health/medical disturbances.

June 2019-June 2023 Assistant Clinical Professor/Phase II Site Director, USUHS Oversees P-MHNP DNP clinical program at Travis AFB, Senior Chair for Evidence Based Projects, member of Evidence Based Review Panel, coordinates eIRB submissions, behavioral chair for Clinical Investigation Facility, Medical Director of Psychiatric Nurse Transition Program and co- professor of two DNP classes
Aug 2017-June 2019 Allied Health Professional, 11th Medical Squadron, JB Anacostia Bolling Providing P-MHNP activities, sole medication provider for high interest level patients.

Aug 2017-May 2019 DNP Student, University of Florida
Apr 2014-Aug 2017 Flight Commander, Mental Health 579MDG, JB Anacostia Bolling Deputy Squadron Commander of 55+ Airmen, Sole Mental Health medication provider in Medical Group, Alternate Air Force/Surgeon General P-MHNP Consultant for 45 P-MHNP’s , Air Force District Washington BH Consultant, Medical Group Wing Investigation Team Chief, Suicide Prevention Program Manager, NCR Multi-Service Market Process Improvement Member, Alternate White House Psychologist
Oct 2010-Apr 2014 Deputy Chief of Clinical Operations, USCENTCOM, MacDill AFB Sole Behavioral Health Action Officer for USCENTCOM Surgeon and USCENTCOM Area of Operations, Deputy Chief of Clinical Operations, Co-Author of MOD 12: USCENTCOM Pre- Deployment Standards, Medical Waiver Officer, Mental Health PA/Congressional Inquiry Responder Dec 2007-Oct 2010 P-MHNP, 3RD MDG, Elmendorf AFB
Primary Medication Provider for 160K population, Alcohol and Drug Abuse Program Medical Director, Outreach Manager
Aug 2006-Dec: 2007 MSN Student, University of Florida

EXHIBIT 1
Jul 2003-Aug 2006 Psychiatric Nurse, Sheppard AFB, 82d MDG Staff Nurse: Internal Medicine and Life Skills, Alt MDG Infection Control Officer, Manager High Risk Program May 1994-May 2003 Psychiatric Nurse, River Oaks Psychiatric Hospital, River Ridge, LA Acting Director of Nursing for 225 bed and 227 nursing staff, Nurse Manager of Child and Adolescent Program, Evening Supervisor, Staff Nurse, Assistant Director of Nursing FORMAL EDUCATION: May 2019 DNP University of Florida December 2007 MSN University of Florida January 2003 BSN University of Phoenix December 1993 ADN Mount Aloysius College DEPLOYMENT EXPERIENCE: Nov 2012-Dec 2012: 45 days in Afghanistan. Lead in Afghanistan South and Southwest Infection Control Team. Visited 15 bases/FOBs/COPs. Inspected infection control standards in surgery and patient care wards. Co-authored US Central Command Regulation on Infection Control January 2009-Aug 2009: Orgun-E, East Patika AFG. Primary Mental Health (MH) provider in Area of Operations. 14K km battle space, 10 FOBS, 4 Battalions and 3.5K soldier Area of Responsibility. Sept 2005-Feb 2006: Balad, Iraq. Chief of Mental Health in Contingency Air Staging Facility. Provided expertise for all MH evacuations, worked in Balad ATF to see individual patients. Traveled to screen re-deployers. Sept 2004-Feb 2005: Guantanamo Bay Cuba: Division Officer, Delta Block. CURRENT NATIONAL CERTIFICATION: Board certified by ANCC as an Adult Psychiatric Mental Health Nurse Practitioner since 2008. Certification expires July 31, 2028 CURRENT MEMBERSHIP/PARTICIPATION IN PROFESSIONAL ORGANIZATIONS: American Nurses Association Sigma Theta Tau International Nursing Honor Society National League of Nurses OTHER INFORMATION: Awards won: United States Air Force Medical Services Nurse Practitioner of the Year 2009, Pacific Air Command Air Force Mental Health Nurse of the year 2008/2009 Medals earned: Defense Meritorious Service, Meritorious Service Medal X 3, Joint Service Commendation Medal, Iraqi Campaign Medal, Air Force Commendation Medal, Afghanistan Campaign Medal x 2 TRACY JOON LEE MD, MPH, MS
[email protected] § (478) 207-0235 § 2609 Way Lane, Corona del Mar, CA 92625

EDUCATION
- American Board of Preventive Medicine Occupational Medicine Board Certification, Jan 2020 - Oc
cupational Medicine Chief Resident (PGY3), University of CA, Irvine, July 2018 – Jun 2019 - Occupational Medicine Resident (PGY2), University of CA, Irvine, July 2017 – Jul 2018 - MS (Master of Science, Environmental Health Sciences - Toxicology), University of CA, Irvine, Sep 2017 – Mar 2019 - MPH, Medical College of Wisconsin, Milwaukee, WI, Sep 2014 – Aug 2016 - MD
, Medical College of Georgia, Augusta, GA, July 2005 – May 2009 - Internal Medicine Internship, Naval Medical Center Portsmouth, VA, Jul 2009 – Jun 2010 - BS (H
ighest/ Faculty Honors), Georgia Institute of Technology, Atlanta, GA, Aug 2002 – Jun 2005 PROFESSIONAL EXPERIENCE
- Medical Director, Akeso Occupational Health, Irvine, CA, Jan 2020– current • Sta
ff physician providing comprehensive clinical occupational health care services to clients throughout Orange Co
unty, CA.
- Part-time Staff Physician, School of Medicine, University of California, Irvine, Dec 2020 – current •
Center for Occupational and Environmental Health Clinic and occupational medicine residency program part- time staff physician.
- Physician, WorkCare, Inc., Anaheim, CA, Oct 2019 – current • In
cident Intervention Department physician providing occupational medicine consultation services to clients th
roughout the U.S.
- Per diem physician, Concentra Medical Group (formerly US HealthWorks), CA, Feb 2014 – Jun 2022 •
Staff physician providing comprehensive clinical occupational health care services to clients and urgent care servi
ces throughout CA.
- Physician, Naval Medical Center San Diego Occupational Health Unit, Jul 2015 – Jul 2017 • Fu
ll time licensed civilian physician responsible for the occupational health of 58,000 military and civilian personnel and 260 Navy and Marine Corps commands in the San Diego area. - U.S. Navy Medical Officer (Physician), Lieutenant Commander, US Navy Selected Reservist, Deployment Processing Command – Reserve Support Unit – East (DPC-RSU-E), Jul 2014 – Jul 2017 • Phy
sician coordinating a medical team of officers and corpsman to provide medical care such as deployment processing for military personnel. Also served as assistant officer in charge Oct 2015- Dec 2016. - U.S. Navy Medical Officer (Physician), Jul 2010-Jul 2014 West CSF DET (Center for Security Forces Detachment) North Island, SERE (Survival, Evasion, Resistance, Escape) Medical Department Head, San Diego, CA, Jul 2012 – Jul 2014
• Med
ical department head for MWSS (Marine Wing Support Squadron) 371 in Yuma, AZ (2010-2012), which in
cluded a 7-month deployment to Afghanistan as part of Operation Enduring Freedom (OEF). Also served as medical department head at the SERE (Survival, Evasion, Resistance, Escape) School (2012-2014) overseeing a me
dical staff and students during 20 high-risk survival training evolutions per year at Naval Air Station North Is
land, San Diego, CA and Remote Training Site Warner Springs, CA.

TRACY JOON LEE MD, MPH, MS [email protected] § (478) 207-0235 § 2609 Way Lane, Corona del Mar, CA 92625 ADDITIONAL TRAINING AND CERTIFICATIONS - TeamSTEPPS Instructor, UCI Medical Center, Apr-Jun 2019 - Lean Six Sigma, Yellow Belt Certification, Sep 2017 - Radiation Health Indoctrination (RHI) Certification, Naval Undersea Medical Institute, Jun 2015 - Medical Review Officer, Medical Review Officer Certification Council (MROCC), May 2014 - Department of Transportation (DOT) National Registry of Certified Medical Examiners (NRCME) Certification, Apr 2014 - Helms Medical Institute for Medical Acupuncture Certification, Tempe, AZ, Dec 2012 – May 2013 - SERE (Survival, Evasion, Resistance, Escape) Level “C” Code of Conduct Graduate, San Diego, CA, May 2012 - Fleet Marine Force Qualified Officer (FMFQO), Camp Leatherneck, Afghanistan, Feb 2012 - Field Medical Service Officer (FMSO) Course, Camp Pendleton CA, Jul 2010 - Combat Casualty Care Course, The Defense Medical Readiness Training Institute, Fort Sam Houston, TX, Sep 2009 AWARDS AND HONORS - American Occupational Health Conference (AOHC) Research Abstract Presenter, Apr 2019 - American College of Occupational and Environmental Medicine (ACOEM) Public Safety Medicine Section Scholarship, Mar 2019 - Western Occupational and Environmental Medical Association (WOEMA) Resident Scholarship, Jul 2018 - Chief Resident, Occupational Medicine Residency Program, University of CA, Irvine, Jul 2018-current - Western Occupational and Environmental Medical Association (WOEMA) Resident Scholarship, Jul 2017 - Navy and Marine Corps Commendation Medal (Gold Star in lieu of the second award), Jun 2014 - Henry M. Jackson Foundation for the Advancement of Military Medicine Scholarship, Nov 2012 - North Atlantic Treaty Organization (NATO) International Security Assistance Force Medal, Apr 2012 - Afghanistan Campaign Medal, Apr 2012 - Navy and Marine Corps Commendation Medal, Mar 2012 VOLUNTEER AND EXTRACURRICULAR ACTIVITIES - Western Occupational and Environmental Medical Association (WOEMA) Educational Committee Member, Aug 2017 – Jul 2019 - Orange County Medical Association, Jul 2017 – 2019 - Aria Homeowner’s Association Social Committee Chair, Jul 2014 – Sep 2016 - Morale Enhancement Committee Officer, CSF DET North Island, Jul 2013 – Jul 2014 - United Service Organization (USO) Volunteer, Oct 2012 – Jul 2014 - Naval Medical Center Internal Medicine Intern Class Vice-president, Aug 2009 – Jun 2010 Additional work experience, references, training, and awards available upon request.

5292 N Palm Ave
Fresno CA 93704

Date 04/29/2025

Andrew Johnson
President
Occu-Med, LTD
2121 W. Bullard
Fresno, CA 93711

To Whom it May Concern:

As of April 29, 2025, there have been no adverse actions taken regarding Occu-med, LTD line of credit and/or its accounts.

Occu-med, LTD has been a commercial client of Bank of America for 18 years. See below for Account Balances and Credit availability with Bank of America.

• $750,000 Line of Credit with Bank of America with $750,000 in availability as of 4/25/2025

Please reach out if you have further questions.

Complimentary close,

Raul Samora
Vice President, SR Relationship Manager
Business Banking
–––
RJ.am
cc:

EXHIBIT 2

2121 West Bullard Avenue, Fresno, California 93711 ½ 559.435.2800 ½ Fax: 559.435.7200 ½ www.occu-med.com May 21, 2026
City of San Bernardino
Re: Occu-Med’s 2025 Financial Statements
Lynn Schmidt:

Please find enclosed Occu-Med’s 2025 Profit & Loss Statement and Balance Sheet.

These financial statements were prepared by me, Sherri Conley, on an accrual basis and in accordance with Generally Accepted Accounting Principes (GAAP).

Thanks,
Sherri Conley, Controller
Occu-Med
2121 West Bullard Avenue
Fresno, CA 93711
P: (559) 435-2800 ext. 120
E: [email protected]
Enclosed: 2025 Profit & Loss Statement and 2025 Balance Sheet for Occu-Med James A. Johnson
President & CEO
Occu-Med, Ltd. 10:26 AM
Profit & Loss 05/08/2026
January through December 2025 Accrual Basis
Jan - Dec 25
Income 16,751,254.13
Expense
Company Match 401(k) 131,955.16
Consultants 155,907.50
Depreciation and amortization 121,021.00
Employee Benefits 453,232.12
Exam Expenses 7,418,938.40
Insurance 105,622.60
Interest 265.32
Marketing 32,289.64
Meetings and Conferences 84,526.31
Office Expenses 43,288.94
Other Operational Expenses 158,416.53
Postage and Printing 82,456.92
Professional Fees 26,444.95
Rent 284,817.98
Repairs and Maintenance 32,170.77
Salaries - Officers 586848.55
Salaries and Wages 5,211,469.10
Software Costs 200,954.77
Taxes and Licenses 591,181.08
Telephone 86,423.78
Travel and Entertainment 181,929.98
Utilities 55,939.49
Total Expenses 16,046,100.89
Interest income 14,102.94
Gain (Loss) on sale of asset 22,600.00
Net Income 741,856.18
Occu-Med, Ltd. 11:26 AM
Balance Sheet 05/08/2026
As of December 31, 2025 Accrual Basis
Dec 31, 25
Current Assets
Cash 623,084.33
Accounts Receiveable 4,590,302.60
Other Current Assets 14,000.00
Total Current Assets 5,227,386.93
Property and Equipment
Automotive equipment 800,229.51
Furniture and Fixtures 860,033.91
Office Equipment 873038.34
Leasehold improvements 548,666.53
Accumulated Depreciation -2 ,5 0 6 ,8 0 6 .4 6
Property and Equipment, Net 575,161.83
TOTAL ASSETS 5,802,548.76
Current Liabilities
Accounts Payable 1,749,164.07
Fed Unemployment Tax Payable 6,182.17
Current Portion of LT Debt 6,700.37
Total Current Liabilities 1,762,046.61
Long Term Debt
Installment Notes Payable 6,700.37
2800 · (Less) Current Portion -6 ,7 0 0 .3 7
Total Long Term Liabilities 0.00
Equity
3010 · Common Stock 1,500.00
3200 · Retained Earnings 3,297,145.97
Net Income 741,856.18
Total Equity 4,040,502.15
TOTAL LIABILITIES & EQUITY 5,802,548.76

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Occu-Med
Marquie Lugo
200 North Cherry Ave, Ontario, CA 91764
The City of Ontario
909.395.2191



[email protected]
Current
The City of Oxnard
300 West Third St, Oxnard, CA 93030
Ricci Conrad 805.385.7488
[email protected]
Current
The City of Covina
125 E. College Street, Covina, CA 91723
626.384.5554
[email protected]
Current
The City of Monterey Park
320 West Newmark Avenue, Monterey Park, CA 91754
Christine Tomikawa 626.307.1334
[email protected]
Current
The City of Riverside
3900 Main Street, Riverside, CA 92522
Maggie Tanner

 951.826.5459



[email protected]
Current
Joanna Espinosa
EXHIBIT 3
3/4/25, 9:42 AMCity of San Bernardino - Class Specification Bulletin

City of San Bernardino
Electrician II
CLASS CODE 30841 SALARY $29.72 - $36.13 Hourly
$5,152.04 - $6,262.81 Monthly
$61,824.48 - $75,153.72 Annually
ESTABLISHED DATE July 07, 2014 REVISION DATE November 03, 2021 Job Summary
Under general supervision, the Electrician II performs a wide variety of skilled and journey-level duties in the construction, installation, maintenance, and repair of electrical and electronic systems, machinery, and devices used in City buildings and facilities.

Distinguishing Characteristics
This is a skilled advanced journey-level class responsible for performing a wide variety of skilled and lead electrician tasks. Incumbent performs a full range of journey-level electrical work associated with street lighting systems, fire alarm systems, automatic gate openers, automated fueling station, sewage lift station, sport field lighting, and various other electrical equipment. Electrician II provides lead work direction and guidance to other employees in addition to performing the full range of Electrician I duties.

Essential Duties & Responsibilities
Essential Functions: -- Essential functions, as defined under the Americans with Disabilities Act, may include any of the following representative duties, knowledge, and skills. Essential duties and responsibilities may include, but are not limited to, the following:

Constructs, installs, maintains, and repairs a variety of electrical and electronic systems; handles sensing mechanisms, relays, electronic and solid-state controls, and other electrical apparatus; tests and troubleshoots circuits, recording devices, timing devices, and transformers.

Performs construction, installation, maintenance, and repair of street lighting systems; provides expertise and may lead crews handling lamps and fixtures, wiring, conduit, transformers, circuit breakers, switches, power and lighting panels, bus bars, relays, and other electrical equipment and apparatus.

Performs the installation, maintenance, and repair of fire alarm lines and boxes, heating, ventilating and air- conditioning systems, automatic gate openers, automated fueling stations, sewage lift stations, high and low- EXHIBIT 4
3/4/25, 9:42 AMCity of San Bernardino - Class Specification Bulletin

voltage wire and cable, lighting facilities at public parks, playgrounds, ball fields, and complete electrical grounding systems.

Leads, supports, assists, and provides expertise to crews working to solve various electrical problems or perform maintenance on electrical equipment; ensures work order and submitted requests are completed in a timely and efficient manner.

Reads and interprets electrical plans, specifications, blueprints and sketches; estimates labor and materials for minor electrical installations and repairs; lays out work at project sites; prepares report of time and materials expended.

Searches for interrupted or broken circuits; performs routine repairs on a variety of electrical circuitry and equipment; tests power distribution, street lighting transformers, circuit breakers, meters, and other apparatus.

Leads cable crews when required and performs the pulling, installing, and splicing of electrical cable and wiring; digs holes and lifts devices as necessary.

Operates a variety of power and hand tools commonly used in utility work; safely uses and maintains jack hammers, airlifts and man-lifts, metal saws and drill presses; sets up scaffolding, sets forms for light poles, guides drivers and crane operators, performs routine maintenance of related equipment and supplies, and cleans and maintains tools and supplies.

Participates in emergency and standby electrical maintenance and repair work in case of fire and power failure.

Communicates and responds to citizen requests for inoperable or problematic lights; assists with traffic signal troubleshooting and repairs.

Performs other duties as assigned.

Job Requirements

Knowledge of –
Methods, materials, tools, and equipment used in electrical installation, maintenance, and repair work.

Basic electrical theory and calculation of formulas.

Applicable codes and regulations including health and safety regulations.

Shop mathematics applicable to the electrical trade.

National electrical and electrical safety codes.

Underground Service Alerts and other Systems.

Safe work practices and safety procedures.

Electrical and electronic installations in City facilities.

Equipment maintenance practices and methods.

Skill in –
Performing skilled electrical work in the repair, maintenance, alteration and construction of buildings, facilities and systems.

Repairing, installing, and maintaining a wide variety of electrical systems and equipment.

Making arithmetic calculations related to specialty quickly and accurately. 3/4/25, 9:42 AMCity of San Bernardino - Class Specification Bulletin

Working from blueprints, shop drawings, and sketches.

Using a variety of hand and power tools and machines utilized in the trade.

Understanding and following oral and written directions.

Working independently with little direction.

Analyzing situations accurately and adopting effective courses of action.

Preparing cost estimates for electrical projects.

Providing work direction and lead guidance to others.

Operating power and hand equipment used in electrical and related activities.

Performing shop math.

Establishing and maintaining effective relationships with co-workers and others encountered in the course of work.

Providing customer service.

Minimum Qualifications
Education and Experience
High School Diploma or G.E.D.; and three (3) years of journey-level electrical experience or experience as an Electrician I; or an equivalent combination of training and experience. Electrician II is expected to be capable of meeting the proficiency criteria for the higher-level class within a 12-18 month period, depending on an individual's prior experience and progression in performing the full range of Electrician II duties as described.

Licenses, Certifications, and Equipment
A valid State driver’s license is required.

Physical Requirements and Work Environment
Employees work in indoor and outdoor environments. Employees are exposed to noises, vibrations, odors and dust; work in inclement weather conditions; and climb and work safely at considerable heights above the ground, on ladders, scaffolds or tower trucks. Employee is regularly required to use hands to finger, handle, feel or operate objects, tools or controls and reach with hands and arms. The employee must frequently lift and/or move up to 50 pounds and occasionally lift and/or move over 100 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

OCCU-MED JOB PROFILE
November 20
23 EMPLOYER: CITY OF ROSEVILLE
JOB CLASS: ELECTRONIC TECHNICIAN I/II/SENIOR
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

3.0 3.5

4.5 5.5

3.5 5.0

4.5 3.5

4.5 5.0

5.0 4.5

4.0 6.0

4.0 4.0

3.5 4.0

4.0 Climb to top of building to repair/replace
equipment
Install electrical equipment over head
Pull cable through conduit
Lift/move rigid pipe/equipment for installation
Climb in/out of vehicle
Install equipment while on ladder
Lift parts/field equipment from ground to truck
Saw/wrench/tighten/loosen parts on equipment
Use whacker to obt ain level surface
Install equipment while on ladder
Solder on PC board; install wires into terminals
Repair PC board with hand tools
Splice electronic components
Read blueprints/schematics/labels
Drive to/from installation sites
Identify color-coded wire
Listen for alarm/co-worker
Walk throughout building to make repairs
Install electrical equipment overhead

1. EXPOSURE TO SUN: 10%
or less of work time spent
outside a building and
exposed to the sun.

2. WORK

ABOVE FLOOR
LEVEL: Some work done on
ladders, scaffolds, or other
equipment more than 12 feet
abov
e the ground.

3. HIGH TEMP: Considerable
work time spent in light and
moderate work in
temperatures above 80
degrees.

4. LOW TEMP: Considerable
work time spent at 40-60
degrees.

5. SUDD

EN TEMPERATURE
CHANGES: Infre quently
subjected to changes of 20-40
degrees.

6. CONF

INED OR CRAMPED
BODY POSITIONS:

Occasional work in confined
or cramped positions less than
1/3 of the time.

7. WETN
ESS: Occasional work
requires getting part or all of
the body and/or clothing wet.

8. NOISE: Occasionally there
are unusually loud sounds.

9. VIBRATION: Minor strain or
vibration.

10. INJURY POTENTIAL:

Frequent possibility of bodily
injury.

11. BURNS: Possibility of
superficial burns.

12. ELECTRICAL HAZARDS:

Potential electrical shock
exposure.

13. DUST: Works in or around
areas with minor amounts of
dust.

14. HAZA
RDOUS
MATERIALS: Exposure is a
regular part of the job.

15. COMMON ALLERGEN
EXPOSURES: Frequent
exposure to common allergy-
causing agents.

16. IRREGULAR OR

EXTENDED WORK
HOURS: Occasionally
required to change working
hours or work overtime.

RESPIRATOR USE
Required? No
EXHIBIT 4

MEDICAL EXAM COMPONENT PROFILE

CREATED FEBRUARY
2024
EMPLOYER: CITY OF ROSEVILLE
JOB CLASS: ELECTRONIC TECHNICIAN I/II/SENIOR

THE FOLLOWING ARE THE RECOMMENDED ACTIVITI ES AND TESTS, WHICH SHOULD BE COMP LETED FOR THIS JOB CLASS. THESE MEDICAL EVALUATION COMPONENTS ARE BASED ON MINIMUM REQ UIREMENTS 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 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 physic ian 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. Range 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 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 Code Test Name
a. 4-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 5

OCCU-MED MEDICAL HISTORY QUESTIONNAIRE

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 ADDRESS PASSPORT NUMBER Home: Cell:

EMPLOYER JOB CLASS OR JOB TITLE

DISCLAIMER
A thorough evaluation of the information provided will permit 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 U NDERSIG NED, DO HEREBY CONSENT TO U NDERGO A MEDICAL EXAMI NATIO N, I NCLUDI NG BLOOD

SPECIME N, X-RAYS, SKI N TESTS, A ND OTHER EXAMI NATIO NS WHICH ARE NECESSARY TO DOCUME NT MY ABILITY

TO SAFELY PERFORM THE ESSE NTIAL DUTIES OF THE JOB THAT I AM CURRE NTLY PERFORMI NG (PERIODIC

EXAM) OR HAVE BEEN OFFERED CONTINGENT UPO N PASSI NG THIS MEDICAL EXAMI NATION (PRE-PLACEME NT EXAM). I CERTIFY THAT ALL I NFORMATIO N PROVIDED IS TRUE A ND CORRECT TO THE BEST OF MY K NOWLEDGE,

AND I AGREE A ND U NDERSTAN D THAT A NY MISSTATEME NT OF MATERIAL FACT HEREI N MAY RESULT I N DISCIPLINARY ACTION, AS DETERMINED BY MY EMPLOYER.

SIGNATURE IN FULL DATE COMPLETED
MEDICAL HISTORY – Page 1

1. Please list all prescription medications you regularly use.

2. Please list any other prescription medications, not taken regularly, which you have taken in the last 2 months.

A. Reasons for Medications Taken (Questions 1 & 2)
Medication Medical Condition Treated Side Effects Experienced Date Started Date Ended Frequency Taken 3 . Please list any known allergies (e.g., Latex, Bee or Wasp Stings, etc.).

4. Have you ever had a positive reaction to a PPD (Tuberculosis) Skin Test? Yes No Date:

EXHIBIT 6
Name:

MEDICAL HISTORY QUESTIONNAIRE

MEDICAL HISTORY – Page 2

5. Please list your last three (3) hospitalizations, beginning with the most recent (excluding routine childbirth):

REASON 1 HOSPITAL / CITY DATE (MM/DD/YYYY)

REASON 2 HOSPITAL / CITY DATE (MM/DD/YYYY)

REASON 3 HOSPITAL / CITY DATE (MM/DD/YYYY)

6. Please list any operations you may have had or were advised to have which are not listed above.

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:

Yes No Please provide dates and explain any ‘Yes’ responses to the following questions in the space provided.

7. Substances that irritated your skin or eyes?
Explanation:

8. Substances that caused you breathing difficulties? Explanation:

9. Have you ever had a bad reaction to high environmental temperatures? Explanation:

10. Have you ever had a bad reaction to low environmental temperatures? Explanation:

Please respond to the following:

Yes No Please provide dates and explain any ‘Yes’ responses to the following questions in the space provided.

11. Have you ever been injured?
Explanation:

12. Have you ever had a limiting injury?
Explanation:

13. Have you been determined to be disabled through VA, Federal, State or Medical Disability assessments? Explanation:

Information relative to Workers’ Compensation claims cannot be used by an employer in making employment decisions. Your responses to questions 11, 12, and 13 will be used by the medical examiner in determining your current health status as it pertains to the safe performance of essential job duties.

MEDICAL HISTORY
Have you ever had, now have or believe you may have any of the following:

Yes No Please provide dates and explain any ‘Yes’ responses to the following questions in the space provided.

14. Tuberculosis

15. Emphysema

16. Asthma

17. Shortness of Breath

18. High Blood Pressure

19. Heart Murmur, Heart
Disease

20. Stroke

21. Blood Disorders (e.g.,
Anemia, etc.)
Name:

MEDICAL HISTORY QUESTIONNAIRE
MEDICAL HISTORY – Page 3
Have you ever had, now have or believe you may have any of the following:

Yes No Please provide dates and explain any ‘Yes’ responses to the following questions in the space provided

22. Psychological Conditions (PTSD,
ADHD, Bipolar Disorder, depression)

23. Pulmonary or Other Embolism

24. Pneumothorax

25. Infection

26. Hernia

27. Loss of Consciousness

28. Chest Pains

29. Dizziness, Vertigo or Motion
Sickness

30. Problems with Eyes/Vision

31. Back or Joint Surgery

32. Epilepsy, Seizures

33. Encephalitis, Meningitis

34. Glaucoma

35. Vascular Problems (e.g.,
PVD, phlebitis, etc.)

36. Gall Bladder Trouble

37. Liver Trouble or Hepatitis

38. Sleep Apnea

39. Diabetes

40. Kidney Disease or Stones

41. Rheumatism,
Arthritis/Gout

42. Ear or Ear Drum Issues

43. Migraines

44. Frequent Headaches

45. Cancer

46. Skin Cancer(s)

47. Hyperthyroidism

48. Hypothyroidism
Name:

MEDICAL HISTORY QUESTIONNAIRE

MEDICAL HISTORY – Page 4
Have you ever had, now have or believe you may have any of the following:

Yes No Please provide dates and explain any ‘Yes’ responses to the following questions in the space provided.

49. Thyroid Trouble

50. Immune Disorders

51. Back or Joint Pain

52. Back Injury

53. Cervical Neck Injury or
Problem

54. Knee Surgery

55. Upper extremity injury or
problem

56. Lower Extremity injury or
problem

57. Medical Conditions or concerns you have which are not listed above:

Please Explain:

58. Are you presently experiencing any pain or discomfort? IF YES, please mark the affected areas on the body diagram below:

Have you ever had, now have or believe you may have any of the following:

Yes No

59. Have you gained or lost more than 10 lbs. in the past 2 years without trying to do so? Explanation:

60. Have you had any changes in your appetite in the past 6 months? Explanation:

61. Have you noticed an unusual fatigue or weakness recently? Explanation:

62. Have you noticed a change in size or color of a mole (dark growth) or wart in the last year? Explanation:

63. Do you have a skin rash, burning, itching or other skin sensitivity? Explanation:

64. Have you coughed up blood or have/had chronic cough? Explanation:

65. Have you or are you currently being treated for alcoholism? Date:

Name:

MEDICAL HISTORY QUESTIONNAIRE

ACKNOWLEDGEMENT
I understand that any incomplete, misleading, or missing information (provided on or omitted from this questionnaire) relevant to my safe performance of the essential duties of the job that I have been offered could impact my employment, as determined by my employer.

Signature Date

MEDICAL HISTORY – Page 5
Have you ever had, now have or believe you may have any of the following:

Yes No

66. 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? Date:

67. Have you ever had, or do you currently have, repeated feelings of soreness or pain in either forearm or elbow?

Explanation:

68. Have you ever had, or do you currently have, repeated feelings of pain, discomfort, burning or tingling in your shoulder?

Left Right Date:

69. Have you had, or do you currently have, knee pain, popping, locking? Left Right Date:

70. Have you ever had, or do you currently have, foot pain? Left Right Date:

71. Have any of the above symptoms (numbness, tingling, soreness or pain) ever caused you to be awakened while sleeping?

Explanation:

72. Does/did discomfort in your wrists, arm, or shoulder interfere with your daily activities (eating, writing, sports, etc)?

Explanation:

73. Have you received, or do you currently receive, medical treatment for this pain or discomfort?

Explanation:

74. Have you ever received, or do you currently receive, medical help for any of the following? Condition Date of Surgery, if performed

Carpal Tunnel Syndrome
Ganglionic Cyst
Tendonitis
Bursitis
Arthritis

75. Have you ever had surgery because of, or experienced lasting pain from, an auto accident? Date:

76. Do you currently wear corrective lenses? Purpose: Date Prescribed:

This space has been provided in the event that the above space was inadequate to sufficiently explain a positive response from your history.

[Client] - Average Turnaround Time Report
Fiscal Year 2023 - 2024
Scheduling - TAT by Department
DoR to DSDoR to DoE
Business Days
0 1 2 3 4 5 6 7 8 9 10

2.75 0.81

3.59 0.88

1.22 0.25
Date of Referral to
Date Scheduled
Date of Referral to
Date of Exam Number of Exams
Police Department 0.25 1.22 303
Correctional Officer 0.32 1.29 118
Deputy Sheriff 0.23 1.19 99
[Additional Job Class] 0.88 3.59 40
[Additional Job Class] 0.00 0.00 46
Misc Departments 0.88 3.59 1091
Maintenance Worker 0.00 0.00 100
RN 3.00 5.50 549
Solid Waste Series 1.11 3.33 55
[Additional Job Class] 0.33 3.00 171
[Additional Job Class] 0.00 3.00 216
Fire Department 0.81 2.75 195
Firefighter Series 1.20 3.07 115
[Additional Job Class] 0.52 2.52 80
Total Average 0.35 1.56 1182
Month to Month Trend - Average Scheduling TAT (DoR to DoE) Business Days
0 2
4 6
8 10
12 July 2023
August 2023
September 2023
October 2023 November 2023 December 2023 January 2024 February 2024 March 2024 April 2024 May 2024 June 2024
Police
Misc
Fire
1 EXHIBIT 7
ExamQA - TAT by Department
DOE to DCDC to DOIDDOE to DOID
Business Days
0 1 2 3 4 5 6 7 8 9 10

6.34 0.73

5.62 3.89

0.51 3.38

2.66 0.31

2.35 Date of Exam to Date Complete
Date of Complete to Date of Initial Decision
Date of Exam to Date of Initial DecisionNumber of Exams Police Department 2.345 0.31 2.655 303
Correctional Officer 2.2 0.28 2.48 118
Deputy Sheriff 2.49 0.34 2.83 99
[Additional Job Class] 3.38 0.51 3.89 40
[Additional Job Class] 4.00 0.5 4.5 46
Misc Departments 3.38 0.51 3.89 1091
Maintenance Worker 4.00 0.5 4.5 100
RN 3.86 1.00 4.86 549
Solid Waste Series 3.38 0.28 3.66 55
[Additional Job Class] 2.67 0.11 2.78 171
[Additional Job Class] 3.00 0.67 3.67 216
Fire Department 5.62 0.73 6.34 195
Firefighter Series 5.73 0.35 6.08 115
[Additional Job Class] 5.5 1.1 6.6 80
Total Average 3.78 0.52 4.30 1182
Month to Month Trend - Average ExamQA TAT (DOE to DOID) Business Days
0 2
4 6
8 10
12 July 2023August 2023September 2023October 2023November 2023December 2023January 2024February 2024March 2024April 2024May 2024June 2024 Police
Misc
Fire
[Client] - Average TAT Report - Fiscal Year 2023-2024
2 Full Process - TAT by Department
DOE to DC
Business Days
0 1 2 3 4 5 6 7 8 9 10

9.09 7.48

3.88 Date of Referral to Date of Initial DecisionNumber of Exams Police Department 3.875 303
Correctional Officer 3.77 118
Deputy Sheriff 4.02 99
[Additional Job Class] 7.67 40
[Additional Job Class] 5.25 46
Misc Departments 7.48 1091
Maintenance Worker 4.5 100
RN 10.36 549
Solid Waste Series 6.99 55
[Additional Job Class] 5.78 171
[Additional Job Class] 6.67 216
Fire Department 9.09 195
Firefighter Series 9.15 115
[Additional Job Class] 9.12 80
Total Average 5.86 1182
Month to Month Trend - Average ExamQA TAT (DOE to DOID) Business Days
0 4
8 12
16 20
July 2023August 2023September 2023October 2023November 2023December 2023January 2024February 2024March 2024April 2024May 2024June 2024 Police
Misc
Fire
[Client] - Average TAT Report - Fiscal Year 2023-2024
3 [Client] - Reschedule ReportQuick Reference
Report Range: Sept 2023 - Feb 2024 (6 months)
Report Focus: Occu-Med Scheduling Service
Evaluation Type: Pre-Employment Exams
Excludes: Annual Exams, Drug Screen only

APPLICANTS
Applicants Scheduled 154
Applicants Archived (no appts)36
TOTAL 190

APPOINTMENTS
Initial Appointments Scheduled631
Rescheduled Appointments (1st time)235
Rescheduled Appointments (2nd time)74
TOTAL 940

TOTAL AVERAGE TAT (SCHEDULING)
DR > DS 3.25
DS > DOE 2.85
DR > DOE6.10

TOTAL APPOINTMENTS BY STATUS
Completed Appointments490
Canceled Appointments113
Future/Pending Appointments1
No Showed Appointments119
Rescheduled Appointments132
Rescheduled Components79
Total Reschedules 330
DOE > NO SHOW 2.72
DOE > RESCH 0.32

REFERRAL TAT
DR > CRC Date 16.77
Multiple Reschedules
35%
12%
53%
Completed ApptsCanceled ApptsTotal Reschedules
Initial Appts
58%
8%
9%
14%
10%
No ShowResch ApptsResch CompsCanceledCompleted
Resch Appts 1
45%
17%
3%
10%
24%
No ShowResch ApptsResch CompsCanceledCompleted
Resch Appts 2
20%
20%
10%
30%
20%
No ShowResch ApptsResch CompsCanceledCompleted
•[Insight #1]
•[Insight #2]
•[Insight #3]
33% 37%
Turnaround TimeReschedule Reasons
ExpectedActual
Business Days012345678910

2.85 3.00

3.25 2.00
DR > DSDS > DOE
•[Insight #1]
•[Insight #2]
•[Insight #3]
OF THE NO SHOWS…
Applicant cause4264%
Client request12%
Unknown 2335%
TOTAL 66
OF THE RESCHEDULED APPTS…
Applicant cause5460%
Client request11%
Clinic issue1011%
Internal/Unknown2528%
TOTAL 90
OF THE RESCHEDULED COMPONENTS…
Added CXR due to +TB1119%
Applicant cause916%
Clinic issue3662%
Other 23%
TOTAL 58
Common applicant reasons: Sick, family emergency, withdrew application, didn’t see the notifications Common applicant reasons: No longer available, wanted a different location, sick Common applicant reasons: refused hernia check
1 Date Of ReferralEmployerApplicant Full Name First LastDept/ContractJob ClassExam TypeDate ScheduledDate Of ExamDate ReceivedDate CompletedInitial Decision DateInitial DecisionRDQARDQA Date InitiatedRDQA DeadlineFinal Decision DateFinal DecisionCreation UserDate Referral InitiatedDoR to DSDoR to DoEDoE to DCDoE to DoIDDoR to DoIDDoID to DoFDDoR to DoFDHolidays1/11/2024City XYZ Sheriff (POST)Correctional OfficerCorrectional Officer1/26/20241/30/20241/31/20242/9/20242/12/2024RDQAYes2/12/20242/27/20242/26/[email protected]/30/2024-08991019 Monday, January 2, 2023New YearsRow LabelsAverage of DoR to DSAverage of DoR to DoEAverage of DoE to DCAverage of DoE to DoIDAverage of DoR to DoIDAverage of DoID to DoFDAverage of DoR to DoFD1/23/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff1/26/20242/5/20242/6/20242/12/20242/13/2024CQNo [email protected]/5/2024-0566-- Monday, January 16, 2023MLK Day(blank) 2/8/2024City XYZ Sheriff (POST)Correctional OfficerCorrectional Officer2/14/20242/15/20242/20/20242/26/20242/27/2024CQNo [email protected]/8/2024457813-- Monday, February 20, 2023President's Day(blank) 2/22/2024City XYZ Sheriff (POST)Correctional OfficerCorrectional Officer2/27/20243/5/20243/7/20243/14/20243/15/2024MQNo 3/15/[email protected]/5/2024-078808 Monday, May 29, 2023Memorial Day(blank) 3/7/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff3/11/20243/19/20243/21/20244/1/20244/2/2024CQNo [email protected]/7/20242891018-- Monday, June 19, 2023Juneteenth National Independence DayCity XYZ1.843.8511.5810.4212.069.9520.373/28/2024City XYZ Sheriff (POST)Correctional OfficerCorrectional Officer3/29/20244/4/20244/5/20244/24/20244/25/2024CQNo [email protected]/4/2024-0141515-- Tuesday, July 4, 2023Independence DaySheriff (POST)2.003.6010.2110.5511.8310.3920.113/28/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff3/29/20244/1/20244/2/20244/8/20244/8/2024MQNo 4/8/[email protected]/28/20241255707 Monday, September 4, 2023Labor DayCorrectional Officer2.501.409.3310.0010.005.5013.503/28/2024City XYZ Sheriff (POST)Correctional OfficerCorrectional Officer3/29/20244/1/20244/3/20244/16/20244/16/2024MQNo 4/16/[email protected]/28/202412111113013 Friday, November 10, 2023Veterens DayDeputy Sheriff2.335.2011.4611.9212.3817.0026.293/28/2024City XYZ Sheriff (POST)Correctional OfficerCorrectional Officer3/29/20244/2/20244/3/20244/15/20244/15/2024RDQAYes4/15/20245/3/20245/1/[email protected]/11/2024--9921214 Thursday, November 23, 2023Thanksgiving DayDistrict Attorney Investigator I/II/Senior0.000.009.509.509.500.009.505/21/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff5/22/20245/28/20245/29/20246/11/20246/12/2024RDQAYes6/12/20248/30/20248/15/[email protected]/6/2024--101144650 Friday, November 24, 2023Day After ThanksgivingCorrectional Deputy I/II1.503.888.869.0012.889.2021.005/23/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff5/24/20245/30/20246/3/20246/17/20246/17/2024MQNo 6/17/[email protected]/23/202415121217017 Monday, December 25, 2023Christmas DaySheriff Office1.007.0024.338.5015.502.0025.006/3/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff6/4/20246/10/20246/11/20247/1/20247/1/2024RDQAYes7/1/20248/27/20248/21/[email protected]/3/2024151515203757Sheriff Security Officer0.503.0029.505.008.00#DIV/0!#DIV/0!6/10/2024City XYZ Sheriff (POST)District Attorney Investigator I/II/SeniorDistrict Attorney Investigator I/II/Senior6/13/20246/13/20246/14/20246/25/20246/25/2024MQNo 6/25/[email protected]/13/20240088808Coroner's Investigator2.0011.0014.0012.0023.002.0025.006/11/2024City XYZ Sheriff (POST)District Attorney Investigator I/II/SeniorDistrict Attorney Investigator I/II/Senior6/14/20246/25/20246/26/20247/10/20247/10/2024MQNo 7/10/[email protected]/25/2024-0111111011Grand Total1.843.8511.5810.4212.069.9520.376/18/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff6/18/20246/20/20246/21/20248/20/20248/22/2024CQNo [email protected]/2/2024--434514--6/24/2024City XYZ Sheriff (POST)Correctional Deputy I/IICorrectional Deputy I/II6/26/20247/11/20247/12/20247/18/20247/18/2024RDQAYes7/18/20249/16/20248/16/[email protected]/24/2024213551821397/9/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff7/12/20247/17/20247/17/20247/29/20247/30/2024MQNo 7/30/[email protected]/29/2024--891018/22/2024City XYZ Sheriff OfficeSheriff Security OfficerSheriff Security Officer8/22/20246/10/20248/22/20248/23/2024No [email protected]/22/20240-54----8/26/2024City XYZ Sheriff OfficeCoroner's InvestigatorCoroner's Investigator8/28/20249/10/20249/11/20249/30/20249/26/2024RDQAYes9/26/202410/10/20249/30/[email protected]/26/20242111412232259/10/2024City XYZ Sheriff (POST)Correctional Deputy I/IICorrectional Deputy I/II9/12/20249/17/20249/18/202410/8/202410/8/2024MQNo 10/8/[email protected]/16/2024-11515160169/10/2024City XYZ Sheriff (POST)Correctional Deputy I/IICorrectional Deputy I/II9/12/20249/17/20249/18/202410/15/202410/15/2024CQNo [email protected]/17/2024-0202020--9/18/2024City XYZ Sheriff (POST)Correctional Deputy I/IICorrectional Deputy I/II9/20/20249/26/20249/27/202410/8/202410/8/2024RDQAYes10/8/202410/31/202410/28/[email protected]/23/2024-38811142510/21/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff10/21/202410/22/202410/23/202410/28/202410/28/2024RDQAYes10/28/202411/15/202411/15/[email protected]/21/202401445141910/31/2024City XYZ Sheriff OfficeSheriff Security OfficerSheriff Security Officer11/1/202411/5/202411/8/202411/12/202411/12/2024RDQYes11/12/202412/13/[email protected]/31/202413558--11/7/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff11/19/202411/20/202411/22/202412/5/202412/5/2024CQNo [email protected]/7/202489111120--11/26/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff11/27/202412/5/202412/5/202412/17/202412/17/2024CQNo [email protected]/26/2024178815--11/26/2024City XYZ Sheriff (POST)Correctional Deputy I/IICorrectional Deputy I/II1/2/20251/6/20251/8/20251/17/2025RDQAYes1/17/20252/3/[email protected]/30/202435-914--11/26/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff12/3/202412/5/202412/9/202412/11/202412/11/2024RDQAYes12/11/20241/10/20251/10/[email protected]/26/2024574411223311/26/2024City XYZ Sheriff (POST)Correctional Deputy I/IICorrectional Deputy I/II12/4/202412/16/202412/17/202412/20/202412/23/2024RDQAYes12/23/20241/8/20251/7/[email protected]/16/2024-0455111612/10/2024City XYZ Sheriff (POST)Correctional Deputy I/IICorrectional Deputy I/II12/11/202412/16/202412/16/202412/23/202412/23/2024MQNo 12/23/[email protected]/10/2024145590912/17/2024City XYZ Sheriff (POST)Deputy SheriffDeputy Sheriff12/19/202412/27/202412/30/20241/17/20251/17/2025RDQAYes1/17/20252/3/[email protected]/17/202428151523--12/31/2024City XYZ Sheriff (POST)Correctional Deputy I/IICorrectional Deputy I/II12/31/20241/7/20251/9/20251/14/20251/14/2025RDQAYes1/14/20251/29/[email protected]/31/2024055510--