DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8
AGREEMENT WITH CONCENTRA MEDICAL CENTER
THIS AGREEMENT is made and entered into on this 16th day of January, 2024 by the State of California ("City").
RECITALS
A. The City desires to retain a Consultant having special skill and knowledge in the field of pre-employment medical examinations and screenings, post-exposure medical examinations and screenings,
examinati comd serial as, ines for diver aliense physical examinations coidi Department of Transportation ("DOT") related drug and alcohol examinations and screenings, and California Occupational Safety and Health Act ("OSHA") occupational testing. To that end, City released Request for Proposal ("RFP") 23-115.
B. Consultant represents that Consultant is able and willing to provide such services to the City and submitted a proposal in response to RFP 23-115.
C. City evaluated all proposal submitted in response to RFP 23-115 based on the vendor's qualifications and experience,
competitiveness and responsiveness and selected Consultant.
D. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its tield and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows:
SCOPE OF SERVICES
Consultant shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Scope of Services - Exhibit A, attached hereto and incorporated by reference.
COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City, the rates and charges identified in Compensation - Exhibit B. The total amount to be expended during the term of this Agreement shall not exceed $750,000 consisting of $450,000 for the Initial Term and $150,000 for each of the optional one (1) year
#335916v1
DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8 renewals.
The pricing set forth in Exhibit B shall be eligible for an increase of up to five percent (5%) at the beginning of the third year and any potential option years with communications to the City of intent Lo increase with at least six (6) nonths notice in c. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. City and Consultant agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Consultant agrees to execute the City's standard ACH Vendor Payment Authorization and provide requirec documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Consultant's account(s) with financial institutions. d. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City.
3. TERM
This Agreement shall commence on January 31, 2024 for a three (3) year term ending January 30, 2027 with the option for the City to grant up to a two (2) one (1)-year renewals. exercisable by a writing signed by the Consultant, City Manager, and the City Attorney, unless terminated earlier in accordance with Section 15, below.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an independent Consultant and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes.
5. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in writing that City is granted a non-exclusive and
#335916v2
DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8 perpetual license for any Documents & Data the subcontractor prepares under this Agreement.
Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data which were provided to Consultant by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk.
6. INSURANCE
Consultant shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder and the results of that work by the Consultant, its agents, representatives, employees or subcontractors.
Coverage shall be at least as broad as:
1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 05 09 or 25 04 05 09) or the general aggregate limit shall be twice the required occurrence limit.
2. Automobile Liability: ISO Form Number CA 00 01 covering any auto (Code 1), or if Consultant has no owned autos, covering hired, (Code 8) and non-owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage.
3. Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease.
Professional Liability (Errors and Omissions): Insurance appropriate to the Consultant's profession, with limit no less than $1,000,000 per occurrence or claim, $2,000,000 aggregate.
If the Consultant maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or higher limits maintained by the Consultant.
Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following provisions:
Additional Insured Status
The City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Consultant including materials, parts or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to
#335916v1
DocuSign Envelope ID: A55F15CO-1E47-4E4E-AD3E-815FB09D12D8 the Consultant's insurance (at least as broad as ISO Form CG 20 10 11 85 or both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 forms if later revisions used).
Primary Coverage
For any claims related to this contract, the Consultant's insurance coverage shall be primary insurance coverage at least as broad as ISO CG 20 01 04 13 as respects the City, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of the Contractor's insurance and shall not contribute with it.
Notice of Cancellation
Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the City.
Waiver of Subrogation
Consultant hereby grants to City a waiver of any right to subrogation which any insurer of said Consultant may acquire against the City by virtue of the payment of any loss under such insurance.
Consultant agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer.
Self-Insured Retentions
Self-insured retentions must be declared to and approved by the City. The City may require the Consultant to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. The policy language shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the named insured or City.
Acceptability of Insurers
Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M. Best's rating of no less than A:VII, unless otherwise acceptable to the City.
Claims Made Policies
If any of the required policies provide claims-made coverage:
1. The Retroactive Date must be shown, and must be before the date of the contract or the beginning of contract work.
2. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work.
3. If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a Retroactive Date prior to the contract effective date, the Consultant must purchase "extended reporting" coverage for a minimum of five (5) years after completion of work.
#335916v1
DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8 Verification of Coverage
Consultant shall furnish the City with original certificates and amendatory endorsements or copies of the applicable policy language effecting coverage required by this clause. All certificates and endorsements are to be received and approved by the City before work commences. However, failure to obtain the required documents prior to the work beginning shall not waive the Consultant's obligation to provide them. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time.
Special Risks or Circumstances
City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances.
7. INDEMNIFICATION
Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Contractor, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Contractor's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor.
INTELLECTUAL PROPERTY INDEMNIFICATION
Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by Consultant to the City pursuant to this Agreement.
#335916v1
DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8
9. RECORDS
Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement.
10. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City.
11. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement.
12. NON-DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations.
#335916v1
DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8
13. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and Contractor, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Contractor. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein.
14. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City.
15. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work products) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate.
b. Payment need not be made for work which fails to , meet the standard of performance specified in the Recitals of this Agreement.
16. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies.
#335916v1
DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8
17. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement.
18. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement.
19. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by irst class or certified mail, postage prepaid, or sent by fax or other telegraphic communication i the manner provided in this Section, to the following persons:
To City:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax: 714-647-6956
With courtesy copies to:
Executive Director,
Human Resources Agency
City of Santa Ana
20 Civic Center Plaza (M-24)
P.O. Box 1988
Santa Ana, California 92702
To Contractor:
Kathy T. Le, M.D. MPH
President and Treasurer
Occupational Health Centers of California, a Medical Corporation dba Concentra Medical Centers
5080 Spectrum Drive, 1200 West Tower
#33591 Addison, Texas 75001
DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded.
20. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnity City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written.
ATTEST: CITY OF SANTA ANA
Jennifer L. Hall Steven Mendoza
City Clerk Acting City Manager
APPROVED AS TO FORM:
SONIA R. CARVALHO CONSULTANT:
City Attorney Occupational Health Centers of California, A Medical Corporation, dba Concentra Medical Centers
By: Laura A. Rossini DocuSigned b
Laura A. Rossini Kathy Le, M.D. MPH 12/18/2023
Chief Assistant City Attorney President and Treasurer
RECOMMENDED FOR APPROVAL:
Ramon Fiquer
Ramon Figueroa
Executive Director (Acting)
Human Resources Agency
#335916vl
DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8
EXHIBIT A
SCOPE OF SERVICES
DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8
CITY OF SANTA ANA
EXHIBIT I
SCOPE OF SERVICES
Consultant shall perform services as set forth below:
I. GENERAL REQUIREMENTS
Consultant shall be an independent contractor capable of providing experienced, knowledgeable, licensed and professional staff. Consultant shall be responsive and maintain excellent working 'elationships with City residents, businesses, government officials and City staff. Consultant shall provide adequate staffing levels at all times and adhere to established schedules.
Consultant shall comply with all federal, state and local laws, rules, regulations, ordinances, and statutes, including but not limited to the Americans with Disabilities Act (ADA), the Health Insurance Portability and Accountability Act (HIPAA), the Federal Motor Carrier Safety Administration (FMCSA) rules and regulations, the U.S. Department of Transportation (DOT) rules and regulations, and the California Public Records Act (Cal. Govt. Code Sections 6250 et seq.)
II. DESCRIPTION AND SCOPE OF SERVICES
A. The City of Santa Ana is issuing this RFP for a medical services review program; such program to include organizing, scheduling, managing, and/or evaluating a comprehensive range of medical services and examinations, including but not limited to:
1. For prospective and current City employees to perform the duties of the position for which they are being considered (pre-employment assessments), using pre-determined medical protocols for each job classification such protocols may be modified by the physician, in consultation with the City's Executive Director of the Human Resources Department, or his/her designee, as is necessary to make a determination as to suitability for employment;
2. For current City employees being considered for employment in DOT and non-DOT positions requiring pre-placement or pre-assignment drug screens;
3. Fitness for Duty examinations (industrial and non-industrial), and provide reports and recommendations regarding the suitability of current employees to continue to perform their duties;
4. Urine and breath specimen collection, laboratory analysis and Medical Review Officer (MRO) responsibilities;
5. DMV Driver's License physical examinations;
6. DOT-mandated drug and alcohol testing of employees considered 'safety sensitive' as defined under DOT regulations and City policy. Consultant shall ensure all such testing complies with DOT testing procedures as per 49 CFR, Part 40; such testing to include pre-employment and pre-assignment.
B. City shall be responsible for the organization, scheduling, and management of DOT and non-DOT random and reasonable suspicion drug and alcohol testing, and DOT post-accident drug and alcohol testing. Consultant shall evaluate results of said testing, in accordance with the provisions of the Agreement and relevant laws and regulations.
23-115 Pre-Employment Medical Screening Services Page 17 of 34 DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8
CITY OF SANTA ANA
C. Consultant shall ensure clinic(s) used for DOT-related drug and alcohol testing maintain a current valid contract with a Substance Abuse and Mental Health Services Administration (SAMSHA)- certified laboratory that is agreed upon with the City of Santa Executive Director of Human Resources throughout the entire term of the awarded agreement, including any extension periods.
Consultant shall ensure turn-around time from specimen collection to obtained test results shall be a maximum of three (3) working days for a negative test, and a maximum of five (5) working days for a positive test.
D. As part of the medical services review program, Consultant shall:
1. Analyze current job classification specifications and make recommendations for the City's use in the pre-employment medical examination and drug testing process, random drug screen inclusion for safety sensitive positions inclusive of Department of Justice (DOJ) regulations, and occupational injury medical examination for return-to-work/fitness for duty.
2. Provide training to Human Resources personnel in administration procedures of Consultant's medical services review process.
3. Communicate with City Human Resources staff regarding applicants' or employees' progress throughout the medical services review process.
4. Communicate directly with applicants and City Human Resources staff throughout the pre- employment or pre-assignment process in regard to results and medical conditions as ascertained through the medical or physical examinations.
5. Provide an electronic final report in a format established by City Human Resources staff at its sole discretion, outlining each candidate's pre-employment placement medical evaluation and results.
6. Provide quarterly electronic activity reports, in a format established by Human Resources in its sole discretion, on the nature and number of examinations conducted, including but not limited to results and final dispositions.
7. Provide a detailed quarterly explanation and summary of charges incurred.
8. Provide all quarterly and annual summaries as required under the DOT.
9. Provide consultation as needed to Human Resources staff regarding medical services provided and outlined in the Agreement.
10. Consultant solely shall review all pre-employment/pre-placement medical evaluation services and maintain records, pursuant to the Agreement, in accordance with State and Federal laws, or as otherwise reasonably required by the City, and to the fullest extent permitted by law.
11. Consultant agrees to permit duly-authorized agents and employees of the City to review such
12. Consultant shall maintain all books, documents, papers, accounting records, and other evidence pertaining to the fee paid under this Agreement. Consultant will make materials available at their offices at reasonable times and notice, during the period of the Agreement and for three (3) years after date of final payment under the Agreement for inspection by the City or by any other governmental entity or Department participating in the funding of the Agreement, or any authorized agents thereof.
13. Consultant's documents shall not be used, duplicated, or disclosed to any other third party without written permission from the City, unless such disclosure is required by law. Consultant shall not be required to create or maintain books and records not required in the ordinary course of Consultant's business operations, nor will the Consultant be required to disclose any information, including but not limited to product cost or pricing data, which Consultant considers confidential or proprietary.
14. Any Agreement changes which are mutually agreed upon by and between the parties shall be incorporated in written amendments to the Agreement.
23-115 Pre-Employment Medical Screening Services Page 18 of 34 DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8
CITY OF SANTA ANA
15. If the circumstances on a particular hearing and/or court proceeding warrant the presence of a competent and knowledgeable representative of the Consultant, in the sole discretion of the City, City will request and contractor shall provide such representative, at no additional cost to City.
E. Additionally, as part of the medical services review program, Consultant shall:
1. Maintain a network of qualified and trained medical providers and medical specialists for necessary exams;
2. Orient City staff in the legal/medical/risk management and human resources aspects of Consultant services;
3. Communicate directly with applicants to obtain the confidential medical information that is needed for clearance for a particular job
4. Manage all bill review functions for the medical exams performed by clinics; and,
5. Provide access for City staff to Consultant's tracking system.
F. Depending on job classification, pre-employment, and pre-assignment medical examination components may include:
1. job profile review;
2. review of medical history;
3. check vital signs;
4. detailed vision exam, including check of near/far/peripheral vision, Ishihara 14 and primary color;
5. audiogram (if classification has specific occupational noise exposure or critical hearing demands;
6. chest x-ray;
7. EKG or treadmill stress EKG;
8. Spirometry;
9. chem panel 20;
10. CBC w/diff;
11. dipstick UA, or UA w/Micro (to lab);
12. venipuncture & collection.
G. Individual medical exams, such as post exposure, fit for duty, or others, may include one or more of the following:
1. Audiogram
2. Back X-ray
3. Blood Lead Level ZZP
4. Blood screens - 7 panel drug screen
5. Blood chemistry profile (SMA 24 or equivalent)
6. Complete blood count (CBC w/diff)
7. Chest X-ray
8. DMV Physicals
9. Electrocardiogram
10. Hepatitis "A" blood screen
11. Hepatitis "B" blood screen
12. Hepatitis "B" booster
13. Hepatitis "B" titer
14. Hepatitis "B" Vaccine
15. Hepatitis "A" Vaccine
23-115 Pre-Employment Medical Screening Services Page 19 of 34 DocuSign Envelope ID: A55F15CO-1E47-4E4E-AD3E-815FB09D12D8
CITY OF SANTA ANA
16. Hepatitis "C" blood screen
17. HIV blood screen
18. Pulmonary function test
19. Respirator Fit test
20. Respirator Physical
21. Respirator Questionnaire if PX is not required with clearance
22. TB test
23. Urinalysis with microscopy (UA w/micro)
24. Urinalysis with dipstick (Dipstick UA)
III. IMPLEMENTATION
Upon award of the Agreement, City shall work with Consultant to develop effective implementation protocols to ensure Services commence on January 31, 2024. 23-115 Pre-Employment Medical Screening Services Page 20 of 34 DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8
EXHIBIT B
COMPENSATION
Fee Proposal including hourly rates if applicable
DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8
CITY OF SANTA ANA
ATTACHMENT A
PROPOSER'S CERTIFICATION, PROPOSAL PRICING
Certification - I certify that I have read, understand and agree to the terms and conditions of this Request for Proposals. I have examined the Scope of Services (Exhibit I) and am qualified to provide services being requested as specified herein. I understand and agree that I am responsible for reporting any errors, omissions or discrepancies to the City for clarification prior to the submission of my proposal.
Proposal Item Price - Pricing shall be based on the services performed, for services described in Exhibit
1. Fee must be inclusive of all costs, including but not limited to, direct and indirect costs for labor, overhead, incidental supplies, travel, mileage, and fuel. Attach additional pages as needed.
PROPOSER'S STATEMENT: I have read, understood and agree to the terms and conditions on all pages of the Request for Proposals. Upon request, I will transfer and deliver goods or services to the City in accordance with said terms and conditions.
ESTIMATED COST PER ESTIMATED
TYPE OF MEDICAL PROCEDURE # OF TESTS TEST TOTAL COST
Audiogram 77 $40.00 $3,080
Back X-Ray Unknown $60.00 Per Test
Blood Lead Level ZZP Unknown $64.00 Per Test
Unknown $38.00 Per Test
Breath Alcohol Test
Blood Chemistry Profile (SMA 24/Equivalent) 86 $83.00 $7,138 Complete Blood Count (CBC w/Diff) 86 $55.00 $4,730
Chest X-Ray 1 View
92 $74.00 $6,808
Occupational Health Centers of Califomia, a Medical Corporation dba Concentra Medical Centers 714.288.8303 714.744.1991
PHONE AND FAX NUMBERS
BUSINESS ADDRESS
Kathy T. Le, MD, MPH President and Treasurer
PRINTED NAME OF AUTHORIZED AGENT TITLE
August 30, 2023 [email protected] (contact)
SIGNATURE OF AUTHORIZED AGENT DATE E-MAIL ADDRESS
NA
FEDERAL ID NUMBER (IF APPLICABLE) CONTRACTOR LICENSE NUMBER (IFAPPLICABLE)
THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL.
PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. 23-115 Pre-Employment Medical Screening Services Page 28 of 34 DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8 Additional Pricing
Concentra appreciates the opportunity to present our proposed fee schedule. We affirm all information contained herein is current, complete, accurate, and remains valid for 180 days following the date of our submittal Estimated # of tests based on T12 actual where applicable
Component Price Estimated number of tests
TB Test $39 168
Urinalysis with microscopy (UA w/micro) $29 86
Urinalysis with dipstick (dipstick UA) $29 Unknown
Court Fee Proceedings $250.00 per Unknown
hour
Vision (Titmus) $39 Unknown
Vision (Ishihara 14 panel) $23 118
Treadmill Stress Test $150 Unknown
Chem Panel 23 $83 86
CBC w/diff $55 86
Venipuncture $35 Unknown
Collection Fee $23 2
Lipid Panel $60 86
Physical PrePlacement $84 365
Rapid 10 panel UDS $95 18
Non Reg UDS 10 Panel $75 190
Note regarding any applicable immunization services: After the first twelve months of an awarded and executed contract, if the current market price for the above services change due to market conditions, demand(s) and/or shortage(s), the City would be billed the then current market rate.
DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8 Additional Pricing
Concentra appreciates the opportunity to present our proposed fee schedule. We affirm all information contained herein is current, complete, accurate, and remains valid for 180 days following the date of our submittal. Estimated # of tests based on T12 actual where applicable
Component Price Comment
DMV Physical $104 Unknown
Electrocardiogram (EKG) $68 38
Hepatitis "A" blood screen $67 Unknown
Hepatitis "B" blood screen $67 Unknown
Hepatitis B Surface Antigen 498SB $63 Unknown
Hepatitis "B" booster $83 Unknown
Hepatitis "B" titer $65 Unknown
Hepatitis "B" vaccine $105/x3 Per shot/set of 3
Hepatitis "A" vaccine $145/x2 Per shot/set of 2
Hepatitis "C" blood screen $65 Unknown
HIV blood screen $86 Unknown
Pulmonary Function Test (Spirometry) $46 87
Respirator Fit Test $53 Unknown
Respirator Physical $92 Unknown
Respirator Questionnaire $33 Unknown
Blood Screens-7 Panel Drug Screen N/A N/A
Note regarding any applicable immunization services: After the first twelve months of an awarded and executed contract, if the current market price for the above services change due to market conditions, demand(s) and/or shortage(s), the City would be billed the then current market rate.