HomeMy WebLinkAboutFD09-224 - Original - HealthForce Occupational Medicine, Inc. - Medical Examinations - 10/01/2009 S �(
Records Mariftgement-1,
KENO Document
WA9MINGTDN
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to City Clerks Office. All portions are to be completed.
If you have questions, please contact City Clerk's Office.
Vendor Name: HealthForce Occupational Medicine, Inc.
Vendor Number:
JD Edwards Number
Contract Number: FM -c,99
This is assigned by City Clerk's Office
Project Name: Professional Services Agreement Between the City of Kent and
HealthForce Occupational Medicine, Inc.
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract
❑ Other:
lbfl )09
Contract Effective Date: Termination Date: 12/31/11
Contract Renewal Notice (Days): 7 days
Number of days required notice for termination or renewal or amendment
Contract Manager: Mike Scott Department: Fire
Detail: (i.e. address, location, parcel number, tax id, etc.):
��w� A
C� 9f/s�o 9
S•Publ ic\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08
PROFESSIONAL SERVICES AGREEMENT
Between the City of Kent and
HealthForce Occupational Medicine, Inc.
THIS AGREEMENT is made between the City of Kent, a Washington municipal
corporation (hereinafter the "City"), and HealthForce Occupational Medicine, Inc. organized
under the laws of the State of Washington, located and doing business at 11805 North
Creek Parkway S., Suite 113, Bothell, Washington 98011 (hereinafter the "Contractor").
I. DESCRIPTION OF WORK.
Contractor shall perform the following services for the City:
Annual medical examinations, pre-employment medical
examinations, Hazardous Materials Team medical examinations,
and follow-up and referral examinations services in accordance
with the City's May 17, 2009, Request for Proposals, attached
and incorporated as Exhibit A, and the Contractor's June 4,
2009, Proposal Response, attached and incorporated as Exhibit
B.
Contractor further represents that the services furnished under this Agreement will be
performed in accordance with generally accepted professional practices within the Puget
Sound region in effect at the time those services are performed.
II. TIME OF COMPLETION. The parties agree that work will begin on the tasks
described in Section I above immediately upon the effective date of this Agreement, and
Contractor shall complete the work by December 31, 2011. At its option, the City may elect
to extend the terms of this Agreement for up to three (3) additional one (1) year terms.
However, in no event shall the total term of this contract extend beyond December 31,
2014. Each year of this contract is contingent upon the availability of funds to be allocated
through the City's budget process by the Kent City Council.
III. COMPENSATION. The City shall pay Contractor a total amount not to
exceed one hundred thousand dollars ($100,000) for the services described in this
Agreement. The Contractor's compensation schedule in any option year shall be mutually
agreed upon. Each year the parties will evaluate whether an increase in Contractor's
compensation schedule is warranted by an amount equal to the percentage increase in the
Consumer Price Index (CPI) for Seattle Tacoma-Bremerton (All Urban Consumers) for the
previous calendar year, or due to unanticipated costs associated with individual medical
testing components of the physical examination on a case by case basis. The Contractor
shall invoice the City monthly based on time and materials incurred during the preceding
month. The hourly rates charged for Contractor's services shall be as delineated in the
attached and incorporated Exhibit B All hourly rates charged shall remain locked at the
negotiated rates throughout the term of this Agreement.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent
Contractor-Employer Relationship will be created by this Agreement. By their execution of
this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following
representations:
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 1 of 7
A. The Contractor has the ability to control and direct the performance
and details of its work, the City being interested only in the results
obtained under this Agreement.
B. The Contractor maintains and pays for its own place of business from
which Contractor's services under this Agreement will be performed.
C. The Contractor has an established and independent business that is
eligible for a business deduction for federal income tax purposes that
existed before the City retained Contractor's services, or the
Contractor is engaged in an independently established trade,
occupation, profession, or business of the same nature as that
involved under this Agreement.
D. The Contractor is responsible for filing as they become due all
necessary tax documents with appropriate federal and state agencies,
including the Internal Revenue Service and the state Department of
Revenue.
E. The Contractor has registered its business and established an account
with the state Department of Revenue and other state agencies as
may be required by Contractor's business, and has obtained a Unified
Business Identifier (UBI) number from the State of Washington.
F. The Contractor maintains a set of books dedicated to the expenses and
earnings of its business.
V. TERMINATION. Either party may terminate this Agreement, with or without
cause, upon providing the other party seven (7) calendar days written notice at its address
set forth on the signature block of this Agreement.
VI. DISCRIMINATION. In the hiring of employees for the performance of work
under this Agreement or any subcontract, the Contractor, its subcontractors, or any person
acting on behalf of the Contractor or subcontractor shall not discriminate against any person
who is qualified and available to perform the work to which the employment relates as
provided for by the City of Kent's Equal Employment Opportunity Policy. Contractor shall
execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply
with City Administrative Policy 1.2, and upon completion of the contract work, file the
attached Compliance Statement.
VII. INDEMNIFICATION. Contractor shall defend, indemnify and hold the City,
its officers, officials, employees, agents and volunteers harmless from any and all claims,
injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of
or in connection with the Contractor's performance of this Agreement, except for that
portion of the injuries and damages caused by the City's negligence. The City's inspection
or acceptance of any of Contractor's work when completed shall not be grounds to avoid
any of these covenants of indemnification. The provisions of this section shall survive the
expiration or termination of this Agreement.
VIII. INSURANCE. The Contractor shall procure and maintain for the duration of
the Agreement, insurance of the types and in the amounts described in Exhibit C attached
and incorporated by this reference.
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 2 of 7
XII. CONTRACTOR'S WORK AND RISK. The Contractor agrees to comply with
all federal, state, and municipal laws, rules, and regulations that are now effective or in the
future become applicable to Contractor's business, equipment, and personnel engaged in
operations covered by this Agreement or accruing out of the performance of those services.
All work shall be done at Contractor's own risk, and Contractor shall be responsible for any
loss of or damage to materials, tools, or other articles used or held for use in connection
with the work.
XIII. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the
City requires its contractors and consultants to use recycled and recyclable products
whenever practicable. A price preference may be available for any designated recycled
product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict
performance of any of the covenants and agreements contained in this Agreement, or to
exercise any option conferred by this Agreement in one or more instances shall not be
construed to be a waiver or relinquishment of those covenants, agreements or options, and
the same shall be and remain in full force and effect.
C. Resolution of Disputes and Governing Law. This Agreement shall be governed
by and construed in accordance with the laws of the State of Washington. If the parties are
unable to settle any dispute, difference or claim arising from the parties' performance of this
Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be
by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior
Court, King County, Washington, unless the parties agree in writing to an alternative
dispute resolution process. In any claim or lawsuit for damages arising from the parties'
performance of this Agreement, each party shall pay all its legal costs and attorney's fees
incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to
any other recovery or award provided by law; provided, however, nothing in this paragraph
shall be construed to limit the City's right to indemnification under Section VII of this
Agreement.
D. Written Notice. All communications regarding this Agreement shall be sent to
the parties at the addresses listed on the signature page of the Agreement, unless notified
to the contrary. Any written notice hereunder shall become effective three (3) business
days after the date of mailing by registered or certified mail, and shall be deemed
sufficiently given if sent to the addressee at the address stated in this Agreement or such
other address as may be hereafter specified in writing.
E. Assignment. Any assignment of this Agreement by either party without the
written consent of the non-assigning party shall be void.
F. Modification. No waiver, alteration, or modification of any of the provisions of
this Agreement shall be binding unless in writing and signed by a duly authorized
representative of the City and Contractor.
G. Entire Agreement. The written provisions and terms of this Agreement,
together with any Exhibits attached hereto, shall supersede all prior verbal statements of
any officer or other representative of the City, and such statements shall not be effective or
be construed as entering into or forming a part of or altering in any manner this Agreement.
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 3 of 7
Should any language in any of the exhibits to this Agreement conflict with any language
contained in this Agreement, the terms of this Agreement shall prevail.
IN WITNESS, the parties below execute this Agreement, which shall become
effective on the last date entered below.
CO7Ne-
R: CITY OF KENT:
By: �-, By:
(signature' (signature)
Princ c�� Ll Pn e: Suzette Cooke
Its: IIts Mayor
(title)
DATE: DATE: �� o
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONTRACTOR: CITY OF KENT:
Dann R. Smith Mike Scott, Fire Battalion Chief
Health Force Partners, Inc. City of Kent
11805 North Creek Parkway South, Suite 113 220 Fourth Avenue South
Bothell, WA 98011 Kent, WA 98032
425-806-5735 (desk) (253) 856-4308 (telephone)
425-527-1814(facsimile) (253) 856-6300 (facsimile)
A PROVE AS TO FORM:
i
K nt Law I
epartment
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 4 of 7
T
1
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal
opportunity. As such all contractors, subcontractors and suppliers who perform work with
relation to this Agreement shall comply with the regulations of the City's equal employment
opportunity policies.
The following questions specifically identify the requirements the City deems necessary for
any contractor, subcontractor or supplier on this specific Agreement to adhere to. An
affirmative response is required on all of the following questions for this Agreement to be
valid and binding. If any contractor, subcontractor or supplier willfully misrepresents
themselves with regard to the directives outlines, it will be considered a breach of contract
and it will be at the City's sole determination regarding suspension or termination for all or
part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis
of sex, race, color, national origin, age, or the presence of all sensory, mental or
physical disability.
3. During the time of this Agreement the prime contractor will provide a written
statement to all new employees and subcontractors indicating commitment as an
equal opportunity employer.
4. During the time of the Agreement I, the prime contractor, will actively consider
hiring and promotion of women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me,
the Prime Contractor, that the Prime Contractor complied with the requirements as
set forth above.
By signing below, I agree to fulfill the five requirements referenced above.
Dated this -7 day of `�� r w,lotl , 200�.
By:
For: e iP� Y7<
Title: D
Date•
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 5 of 7
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and
state laws. All contractors, subcontractors, consultants and suppliers of the City must
guarantee equal employment opportunity within their organization and, if holding
Agreements with the City amounting to $10,000 or more within any given year, must take
the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating
commitment as an equal opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City's
nondiscrimination and equal opportunity requirements shall be considered in breach of
contract and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and
Public Works Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these
regulations are familiar with the regulations and the City's equal employment
opportunity policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and
guidelines.
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 6 of 7
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded
the Agreement.
I, the undersigned, a duly represented agent of
Company, hereby acknowledge and declare that the before-mentioned company was the
prime contractor for the Agreement known as that was entered
into on the (date) between the firm I represent and
the City of Kent.
I declare that I complied fully with all of the requirements and obligations as
outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of
Kent Equal Employment Opportunity Policy that was part of the before-mentioned
Agreement.
Dated this day of , 200_.
By:
For:
Title:
Date:
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 7 of 7
EXHIBIT A
Exhibit A
CITY OF KENT, WASHINGTON
REQUEST FOR PROPOSALS
Medical Examinations for City of Kent Fire Department Personnel
PROJECT TITLE: Medical Examinations for City of Kent Fire
Department Personnel
PROPOSAL DUE DATE: June 10th, 2009, at 3:00 p.m., Pacific Time
EXPECTED TIME PERIOD June 30th, 2009, to December 31, 2011
FOR CONTRACT:
PROPOSER ELIGIBILITY: This process is open to those Proposers registered to
do business in Washington State that exhibit the
experience, resources, and skills necessary to
accomplish the services described in the Request for
Proposal Document.
CONTENTS OF THE
REQUEST FOR PROPOSALS: 1. Introduction
2. General Information for Proposers
3. Proposal Contents
4. Evaluation and Award
5. Exhibits:
Exhibit A: Certifications and Assurances
Exhibit B: Draft Contract
Exhibit C: Insurance Requirements
Exhibit D: Medical Examination Criteria for
General Physical Exams
Exhibit E: Medical Examination Criteria for
Hazardous Materials Team
Members
Exhibit F: Medical Examination Criteria for
Pre-Employment Exam
Exhibit G: Follow-up Medical Examination
and Referral by Health Care
Provider
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 1 of 18
TABLE OF CONTENTS
1. Introduction
1.1 Purpose, Background, and Objective
1.2 Period of Performance
1.3 Definitions
2. General Information for Proposers
2.1 RFP Coordinator
2.2 Estimated Schedule of Procurement Activities
2.3 Submission of Proposals
2.4 Proprietary Information/Public Disclosure
2.5 Revisions to the RFP
2.6 Minority & Women-Owned Business Participation
2.7 Acceptance Period
2.8 Responsiveness
2.9 Most Favorable Terms
2.10 Contract and General Terms & Conditions
2.11 Costs to Propose
2.12 No Obligation to Contract
2.13 Rejection of Proposals
2.14 Commitment of Funds
2.15 Insurance Coverage
3. Proposal Contents
3.1 Letter of Submittal
3.2 Proposer's Experience
3.3 Medical Examination and Cost of Proposal
4. Evaluation and Contract Award
4.1 Evaluation Procedure
4.2 Clarification of Proposal
4.3 Evaluation Weighting and Scoring
4.4 Oral Presentations May Be Required
4.5 Notification to Proposers
4.6 Debriefing of Unsuccessful Proposers
5. RFP Exhibits
Exhibit A Certifications and Assurances
Exhibit B Draft Contract
Exhibit C Insurance Requirements
Exhibit D Medical Examination Criteria for General Physical Exams
Exhibit E Medical Examination Criteria for Hazardous Materials Team Members
Exhibit F Medical Examination Criteria for Pre-Employment Exam
Exhibit G Follow-up Medical Examination and Referral by Health Care Provider
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 2 of 18
1. INTRODUCTION
1.1 PURPOSE, BACKGROUND, and OBJECTIVE
The City of Kent (City) is initiating this Request for Proposal (RFP) to
solicit proposals from health care providers interested in conducting
annual medical examinations, pre-employment medical examinations, and
Hazardous Materials Team medical examinations for City of Kent Fire
Department personnel.
The City of Kent is a community of approximately 85,000 citizens, with
future projections estimating a population of 130,000 in the next 10
years. The City's vision statement is "Leading through excellence and
public trust. . . let us show you." Its organizational values are: integrity,
caring, communication, teamwork, innovation, and achievement. We will
have a high level of expectation from the firm chosen to work with the
City of Kent on this project.
The City of Kent Fire Department has adopted a health maintenance
program, which includes a physical fitness program as well as a program
of regularly scheduled medical evaluations based on the risk level of Fire
personnel. The purpose of this Request for Proposals is to ultimately
contract with a health care provider to provide these medical
examinations.
1.2 PERIOD OF PERFORMANCE
The period of performance of any Contract resulting from this RFP is tentatively
scheduled to begin on or about July 5th, 2009, ending on or about December 31,
2011. At its option, the City may elect to extend the term of any Contract up to
three (3) additional one (1) year terms.
1.4 DEFINITIONS
Definitions for the purposes of this RFP include:
Contractor - Individual or company whose proposal has been accepted
by the City as the most responsive and responsible proposal, is awarded
the Contract, and executes a written Contract with the City of Kent.
Contract - The Contract(s) entered into between the City of Kent and the
successful Proposer for the performance of the work that is described in
this RFP.
Proposer - Individual or company submitting a proposal in order to
obtain a contract with the City of Kent.
Proposal - A formal offer submitted in response to this solicitation.
Request for Proposals (RFP) - Formal procurement document in which
a service or need is identified but no specific method to achieve it has
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 3 of 18
I r �
been chosen. The purpose of an RFP is to permit qualified firms to
suggest various approaches to meet the need at a given price.
City - The City of Kent, Washington.
2. GENERAL INFORMATION FOR PROPOSERS
2.1 RFP COORDINATOR
The RFP Coordinator is the sole point of contact for this procurement.
Upon receipt of this RFP, all communication between the Proposer and the
City shall be with the RFP Coordinator as follows:
Name Mike Scott Fire Battalion Chief
Address 220 47t Ave. S.
City, State Zip Code Kent Washington 98032
Phone Number 253 856-4308
Fax Number 253 856-6300
E-Mail Address mscott@ci.kent.wa.us
Any other communication will be considered unofficial and non-binding on
the City.
Proposers are to rely on written statements issued by the RFP
Coordinator. Communication directed to parties other than the RFP
Coordinator may result in disqualification of the Proposer.
2.2 ESTIMATED SCHEDULE OF PROCUREMENT ACTIVITIES
Issue of Request for Proposals May 20 2009
Question and Answer period May 21h through
June 4 2009
Last Date for Questions Regarding RFP June 1st 2009
Issue Addendum to RFP (if applicable) June 4t 2009 through
June 9th 2009
Proposals Due June 10t , 2009, by
3:00 .m. Pacific time
June 11rh through
Evaluate Proposals
June 17 2009
Announce "Apparent Successful Contractor" and
Send Notification Via Fax or E-mail to June 17th , 2009
Unsuccessful Proposers
June 17t , 2009
Negotiate and sign contract through
July 5th 2009
Council Authorization to Sign Contract July 21 2009
The City reserves the right to revise the above schedule within its sole
discretion.
2.4 SUBMISSION OF PROPOSALS
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 4 of 18
4 ♦ 4
Proposers are required to submit three (3) sets of their sealed Proposal,
which must have original signatures. The proposal, whether mailed or
hand-delivered, must arrive no later than 3:00 p.m., Pacific Time, on June
4th, 2009.
The proposal is to be sent to the City Clerk for the City of Kent. The
envelope should be addressed on the outside of the envelope/package in
the following manner:
City Clerk's Office
City of Kent
220 4,nAve. S.
Kent Washington 98032
Proposal for Conducting Medical Examinations for the Kent Fire
Department
Proposers submitting proposals by mail or delivery service should allow
sufficient delivery time to ensure timely receipt of their proposals by the
City Clerk. Proposers assume the risk for the method of delivery chosen.
The City assumes no responsibility for delays caused by mail or any
delivery service. Proposals may not be transmitted using electronic media
such as facsimile transmission or electronic mail.
Late proposals may not be accepted and may automatically disqualify a
Proposal from further consideration. All proposals and any accompanying
documentation become the property of the City and will not be returned.
2.5 PROPRIETARY INFORMATION/PUBLIC DISCLOSURE
BY SUBMITTING A PROPOSAL, ANY PROPOSER AGREES TO FORGO
MAKING ANY PUBLIC RECORDS REQUEST FOR ANY PROPOSAL
SUBMITTED FOR THIS RFP AND, TO THE EXTENT ALLOWED BY LAW,
WAIVES ITS RIGHT TO MAKE SUCH A REQUEST UNTIL THE CONTRACT IS
AWARDED TO THE SELECTED PROPOSER AND SIGNED BY THE MAYOR.
To the extent allowed by law, all proposals received shall remain strictly
confidential until the Contract, if any, resulting from this RFP is signed by
the Mayor and the apparent successful contractor.
Any information in the proposal that the Proposer desires to claim as
proprietary and exempt from disclosure under the provisions of
Washington State Public Records Act must be clearly designated. The
page must be identified as well as the particular exemption from
disclosure upon which the Proposer is making the claim. Each page
claimed to be exempt from disclosure must be clearly identified by the
word "Confidential" printed on the lower right hand corner of the page.
HOWEVER, IDENTIFYING PORTIONS OF A PROPOSAL IN THIS MANNER
DOES NOT GUARANTEE THAT THE MATERIALS WILL NOT BE DISCLOSED,
AND THE CITY CANNOT GUARANTEE OR WARRANTY THE SAME.
The City will consider a Proposer's request for exemption from disclosure;
however, the City will make a decision based on its interpretation of state
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 5 of 18
law. Marking the entire proposal exempt from disclosure will not be
honored. The Proposer must be reasonable in designating information as
confidential. If any information is marked as proprietary in the proposal,
such information will not be made available until the affected Proposer has
been given at least 24 hours prior notice so that the Proposer may seek a
protective order in a court of appropriate jurisdiction against the
requested disclosure.
BY SUBMITTING A PROPOSAL, THE PROPOSER AGREES THAT IT IS NOT
THE RESPONSIBILITY OF THE CITY OF KENT TO SEEK ANY PROTECTIVE
ORDERS ON BEHALF OF THAT PROPOSER AND PROPOSER WAIVES ALL
RIGHTS IN THAT REGARD.
2.6 REVISIONS TO THE RFP
All questions and requests for clarification must be put in writing and
submitted to the RFP Coordinator by May 29th, 2009, and will be formally
answered in the form of a written addendum that will be sent by email or
facsimile to all prospective Proposers who have requested this Request for
Proposal Document. Such addenda will become part of the RFP. All
revisions to this RFP will be in the form of such written addenda, and no
oral revision should be relied on by any Proposer for any purpose.
The City also reserves the right to cancel or to rescind and reissue the RFP
in whole or in part, at any time prior to execution of a Contract.
2.7 MINORITY & WOMEN-OWNED BUSINESS PARTICIPATION
The City encourages participation in all of its contracts by women and
minority owned firms or companies. Participation may be either on a
direct basis in response to this solicitation or on a subcontractor basis.
However, no preference will be included in the evaluation of proposals, no
minimum level of MWBE participation shall be required as a condition for
receiving an award, and proposals will not be rejected or considered non-
responsive on that basis.
2.8 ACCEPTANCE PERIOD
Proposals must provide sixty (60) days for acceptance by the City from
the due date for receipt of proposals.
2.9 RESPONSIVENESS
All proposals will be reviewed by the RFP Coordinator to determine
compliance with administrative requirements and instructions specified in
this RFP. Proposers are specifically notified that failure to comply with
any part of the RFP may result in rejection of the proposal as non-
responsive.
The City reserves the right, in its sole discretion, to waive minor
irregularities that do not confer a material advantage to a given proposal.
2.10 MOST FAVORABLE TERMS
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 6 of 18
The City reserves the right to make an award without further discussion of
the proposal submitted. Therefore, the proposal should be submitted
initially on the most favorable terms that the Proposer can propose.
There will be no best and final offer procedure. The City does reserve the
right to contact a Proposer for clarification of its proposal during the
evaluation process. In addition, if the Proposer is selected as the
apparent successful contractor, the City reserves the right to enter into
Contract negotiations with the apparent successful contractor, which may
include discussion regarding the terms of the proposal. Contract
negotiations may result in incorporation of some or all of the Proposer's
proposal submission. The Proposer should be prepared to accept this RFP
for incorporation into a Contract resulting from this RFP. It is also
understood that the proposal will become part of the official procurement
file.
2.11 CONTRACT AND GENERAL TERMS & CONDITIONS
The apparent successful contractor will be expected to enter into a
Contract that is substantially the same as the sample Contract attached
and incorporated as Exhibit B. In no event is a Proposer to submit its
own standard contract terms and conditions in response to this
solicitation. The Proposer may submit exceptions as allowed in the
Certifications and Assurances section, attached as Exhibit A to this
solicitation. The City will review requested exceptions and accept or
reject the same at its sole discretion.
2.12 COSTS TO PROPOSE
The City will not be liable for any costs incurred by the Proposer in
preparation of a proposal submitted in response to this RFP, in conduct of
a presentation, or any other activities related to responding to this RFP.
2.13 NO OBLIGATION TO CONTRACT
This RFP does not obligate the City to contract for services specified
herein. Participation in this RFP and/or submission of a proposal does not
confer any legal right or entitlement to Proposers, nor create any
obligation thereto on the part of the City.
2.14 REJECTION OF PROPOSALS
The City reserves the right at its sole discretion to reject any and all
proposals received without penalty and not to issue a Contract as a result
of this RFP.
2.15 COMMITMENT OF FUNDS
The Mayor or the Mayor's delegate is the only individual who may legally
commit the City to the expenditures of funds for a Contract resulting from
this RFP. No cost chargeable to the proposed Contract may be incurred
before receipt of a fully executed Contract.
2.16 INSURANCE COVERAGE
The Contractor shall, at its own expense, obtain and keep in force
insurance coverage that shall be maintained in full force and effect during
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 7 of 18
the term of the Contract. The insurance provided shall be in the minimum
types and amounts set forth in the attached Exhibit C. The Contractor
shall furnish evidence, in the form of a Certificate of Insurance, that
insurance shall be provided, and a copy shall be forwarded to the City
prior to the effective date of any Contract entered into as a result of this
RFP.
3. PROPOSAL CONTENTS
Proposals must be submitted on eight and one-half by eleven (8 1/2 x 11) inch
paper with tabs separating the major sections of the proposal. The sections of
the proposal are to be submitted in the order noted below:
A. Signed or Certified Letter of Submittal, including signed Certifications and
Assurances (Exhibit A to this RFP)
B. Proposer's Experience
C. Medical Examination and Cost Proposal
1. Medical Examination Criteria for General Physical Exam (Exhibit D
to this RFP)
2. Medical Examination Criteria for Hazardous Materials Team Member
Exam (Exhibit E to this RFP)
3. Medical Examination Criteria for Pre-Employment Exam (Exhibit F
to this RFP)
4. Follow-Up and Referral by Health Care Provider (Exhibit G to this
RFP)
Proposals must provide information in the same order as presented in this
document with the same headings.
3.1 LETTER OF SUBMITTAL
The Letter of Submittal and the attached Certifications and Assurances
form (Exhibit A to this RFP) must be signed and dated by a person
authorized to legally bind the Proposer to a contractual relationship, e.g.,
the President or Executive Director in a corporation, the managing partner
if a partnership, or the proprietor if a sole proprietorship. Along with
introductory remarks, the Letter of Submittal is to include, by attachment,
the following information about the Proposer and any proposed
subcontractors:
A. Name, address, principal place of business, telephone number, and
fax number/e-mail address of legal entity or individual with whom
Contract would be written.
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 8 of 18
B. Name, address, and telephone number of each principal officer
(President, Vice President, Treasurer, Chairperson of the Board of
Directors, etc.).
C. Legal status of the Proposer (sole proprietorship, partnership,
corporation, etc.), and the year the entity was organized to do
business as the entity now substantially exists.
D. Federal Employer Tax Identification Number or Social Security
Number, and the Washington Uniform Business Identification (UBI)
number issued by the state of Washington Department of Revenue.
Proposals of entities not registered to do business in Washington
State will be rejected as not responsive.
E. Identity of any City employee or former City employee employed or
on the firm's governing board as of the date of the proposal.
Include his or her position and responsibilities within the Proposer's
organization. If following a review of this information it is
determined by the City that a conflict of interest exists, the
Proposer may be disqualified from further consideration for the
award of a Contract.
3.2 PROPOSER'S EXPERIENCE
The experience portion of the Proposal must contain information regarding
the Proposer's staff qualifications, related experience, and references.
A. Description of the Proposer - A succinct description of why the
Proposer's company is the best qualified choice to provide medical
examination services to the Kent Fire Department.
B. Philosophy - Include an overview of the Proposer's operating
concept and philosophy.
C. Experience - Indicate the experience the Proposer has had in
providing the medical examination services described in this RFP.
In responding to this portion of the proposal, the Proposer should:
1. Indicate the experience the Proposer has had in providing
medical examination services, including experience in
providing those services to fire department personnel.
2. List contracts the Proposer may have had in the last five (5)
years that relate to the Proposer's ability to provide medical
examination services under this RFP. List contract reference
numbers, contract period of performance, contact persons,
telephone numbers, and fax numbers/e-mail addresses.
3. Number of full time personnel committed to providing
medical examination services.
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 9 of 18
4. The names and qualifications of personnel who will be
assigned to carry out contract responsibilities if contract is
awarded.
5. Indicate any other experience that indicates the
qualifications of the Proposer for the performance of the
potential Contract.
D. Subcontractors - In the event the Proposer intends to subcontract
or joint venture any of the proposed work stated in its Proposal,
the Proposer shall submit the information required by this section
3.2 for each proposed subcontractor or joint venturer.
E. References - List names, addresses, telephone numbers, and fax
numbers/e-mail addresses of three (3) business references for
which work has been accomplished and briefly describe the type of
service provided. The Proposer and staff proposed to provide the
products and services set forth in this RFP must grant permission
to the City to contact references, and others for whom services
have been provided. References will be contacted and scored for
the finalist proposal(s) only.
F. Related Information
1. If any member of the Proposer's staff, or its subcontractor's
staff, was an employee of the City during the past 24
months, or is currently a City employee, identify the
individual by name, job title, or position held, and separation
date.
2. If the Proposer has had a contract terminated for default in
the last five (5) years, describe such incident. Termination
for default is defined as notice to stop performance due to
the Proposer's non-performance or poor performance and
the issue of performance was either: (a) not litigated due to
inaction on the part of the Proposer, or (b) litigated and such
litigation determined that the Proposer was in default.
3. Submit full details of the termination for default including
the other party's name, address, and phone number.
Present the Proposer's position on the matter. The City will
evaluate the facts and may, at its sole discretion, reject the
proposal on the grounds of the past experience. If no such
termination for default has been experienced by the
Proposer in the past five (5) years, so indicate.
3.3 MEDICAL EXAMINATION AND COST PROPOSAL
This portion of the Proposal must contain a comprehensive description of
services including the following elements:
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 10 of 18
A. Generally.
1. Standards of Care Required. All medical examination
services shall be conducted in accord with the Standard on
Comprehensive Occupational Medical Program for Fire
Departments, published by the National Fire Protection
Association, which has been adopted by the City's Civil
Service Commission as the basis for all examinations. A
copy of this program may be obtained by contacting:
National Fire Protection Association
1 Batterymarch Park
PO Box 9101
Quincy, MA 02269-9101
http://www.nfr)a.org/catalog
2. Exceptions and Additions to Care. At a minimum, all tests,
examinations, and services reflected in this Request for
Proposal shall be conducted. Any exceptions shall be noted
as provided for in Section 21 above. If Proposer
recommends additional services be performed beyond those
set forth in this Request for Proposals Document, the City
requests that the Proposer identify those services, and any
applicable fees associated with those additional services.
3. Exam Location. Each proposal shall affirm that all tests and
medical examination services will be provided on site at a
designated Kent Fire Department facility, and shall state the
length of time associated with each examination. Note: All
tests and exams shall be conducted in one visit, unless an
alternative arrangement is agreed to by the City. Any
exceptions shall be noted as provided for in Section 2.1
above.
4. Follow-up Exams. Each proposal shall include a follow-up
visit with the health care provider on all annual medical
examinations and a follow-up visit for all applicants who are
hired after their pre-employment medical examination, as
provided for in this Request for Proposal Document.
5. Release of Information. The results of all examinations shall
generally be kept confidential by the health care provider.
The health care provider shall only be allowed to provide to
the City information that relates to the employee's medical
fitness for duty in accordance with HIPPA, NFPA 1582, and
the union agreement between the City and its fire personnel,
and any follow-ups or referrals that impact the employee's
ability to perform emergency duties. Prior to notifying the
City of the results of the examination and any tests
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 11 of 18
conducted, the health care provider shall first notify the Fire
employee of those results in a timely manner, unless in the
health care provider's opinion, immediate notification to the
City is necessary. Subject to federal and state laws, no
information shall be released to any other party without
prior written permission by the Fire employee, for each
requested release of information.
6. Lab Results. The health care provider shall also provide
results of all lab tests and analysis to the employee.
7. Blood or Airborne Exposure. The Proposal shall include
provisions for handling any and all blood or airborne
exposure incidents experienced by Kent Fire Department
personnel while in the performance of their duties.
Personnel exposed off-duty are to be allowed access to the
same systems, without expense incurred to the City beyond
those provided for in this Request for Proposals. Proposals
will include provisions for access to a knowledgeable, live
contact person 24 hours per day, 7 days a week, who will
give the requesting Fire employee a detailed explanation of
the correct procedures to follow for the proper handling of
the exposure.
8. Billing. All invoices for care rendered shall be submitted
periodically as the successful contractor and the City may
provide for in any resulting contract. However, all invoices
submitted shall contain an accounting of the medical
services actually performed as agreed to in any resulting
contract for approved services and costs, and the name of
each employee receiving services.
B. Medical Examination Criteria for General Physical Exams.
1. Medical Services to Be Performed and the Cost of those
Services In providing general physical exams, the
successful contractor shall provide, at a minimum, those
services provided for in Exhibit D to this Request for
Proposals. All Proposers shall submit Exhibit D with its
Proposal and identify the fee charged by it for the identified
services.
If a Proposer recommends additional services be performed
beyond those set forth on Exhibit D, the City requests that
the Proposer identify those services, and any applicable fees
associated with those services, as a supplement to Exhibit D.
2. Freguency of General Physical Exam. The Kent Fire
Department has adopted a schedule, based on age and risk,
of the frequency of when general medical examinations will
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 12 of 18
be provided to Fire personnel. A general physical would be
given by age as follows:
Age Exam Frequency
18 - 29 Years Old Every 4 Years
30 - 36 Years Old Every 3 Years
37 - 45 Years Old Every 2 Years
46 Years Old and Older Every Year
Despite this frequency schedule, and in accordance with the
union agreement between the City and its fire personnel, an
employee may request a medical examination be performed
by the health care provider under this Request for Proposal
Document.
Based on this schedule, approximately 140 general physicals
are conducted every year. The timing of those examinations
may vary, but generally all physical examinations will be
conducted between September and November of each
calendar year.
3. Additional Exams or Follow-Ups, If Necessary or Requested.
Fire personnel with known health problems that might
predispose them to injury or illness may arbitrarily be
assigned to more frequent examinations at the health care
provider's discretion. Likewise, if a Fire employee feels the
need for an examination, he or she may request one. Upon
request, the health care provider shall perform an
examination reasonable and appropriate for the condition
causing the request, and if necessary, may refer the
employee to another health care provider.
C. Medical Examination Criteria for Hazardous Materials Team
Members.
1. Medical Services to Be Performed and the Cost of those
Services. In providing examinations for Hazardous Materials
Team Members, the successful contractor shall provide, at a
minimum, those services provided for in Exhibit E to this
Request for Proposals. All Proposers shall submit Exhibit E
q P P
with its Proposal and identify the fee charged by it for the
identified services.
If a Proposer recommends additional services be performed
beyond those set forth on Exhibit E, the City requests that
the Proposer identify those services, and any applicable fees
associated with those services, as a supplement to Exhibit E.
2. Number of Examinations for Hazardous Materials Team
Members. Approximately 20 examinations are conducted
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 13 of 18
every year for Hazardous Materials Team Members. All new
members to the Hazardous Materials Team receive a
baseline exam. Thereafter, examinations are conducted on
an annual basis, and a final examination is conducted at the
time the employee leaves the Hazardous Materials Team for
reassignment. These medical examinations are generally
conducted at the same time as the general physical.
Additional examinations will occur when personnel are
exposed to hazardous materials.
D. Medical Examination Criteria for Pre-Employment Exam.
1. Medical Services to Be Performed and the Cost of those
Services. In providing pre-employment medical
examinations, the successful contractor shall provide, at a
minimum, those services provided for in Exhibit F to this
Request for Proposals. All Proposers shall submit Exhibit F
with its Proposal and identify the fee charged by it for the
identified services.
If a Proposer recommends additional services be performed
beyond those set forth on Exhibit F, the City requests that
the Proposer identify those services, and any applicable fees
associated with those services, as a supplement to Exhibit F.
2. Number of Pre-Employment Examinations. Approximately
15 pre-employment examinations are conducted every year.
These examinations will be scheduled based upon the City's
need to fill vacancies.
3. Follow-Up Exam. If an applicant has been offered
conditional employment by the City, the successful
contractor shall conduct a pre-employment examination as
set forth in Exhibit F, and provide a follow-up interview with
the prospective employee.
E. Follow-up Medical Examination and Referral by Health Care
Provider. For follow-up examinations and referrals, the successful
contractor shall provide, at a minimum, those services provided for
in Exhibit G to this Request for Proposals. All Proposers shall
submit Exhibit G with its Proposal and identify the fee charged by it
for the identified services.
F. Creativity. Proposers may present any creative approaches that
might be appropriate. The Proposer may also provide supporting
documentation that would be pertinent to this RFP, but not
mentioned by the City in this RFP.
4. EVALUATION AND CONTRACT AWARD
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 14 of 18
4.1 EVALUATION PROCEDURE
The City will select finalist(s) from the Proposers' responses to the RFP,
any requested written submittals, and any requested oral presentations.
The City may contact the finalist(s) to schedule a date, time, and location
for further discussion, clarification, negotiation, or interviews. If the City
elects to continue its selection process with more than one Proposer, it
will inform the finalists at that time of the final selection process. If the
City selects a single finalist, it will enter into and seek to complete
contract negotiations immediately. Should negotiations fail with any
finalist at any time, the City may reopen discussions or negotiations with
any of the other initial Proposers.
The City's final decision will be based on the scoring process in
combination with references and the informed judgment of the evaluation
team regarding the creativity, willingness, and ability of the apparent
successful Proposer to meet the City's requirements. The City reserves its
unqualified right to select the proposal it determines best meets all of the
City's needs and goals. The evaluation team, and not any Proposer, is
best qualified to make that decision.
By submitting to this RFP process, the Proposer acknowledges and accepts
that the City evaluation team decision will be made on both objective and
subjective criteria, further agrees it will not subsequently file any claim or
suit pertaining to the City's decision on this RFP based on this process and
specifically waives any right it might have to file such a suit or claim and
accepts that any protest will be limited to the process described in Section
4.7.
4.2 CLARIFICATION OF PROPOSAL
The RFP Coordinator may contact the Proposer for clarification of any
portion of the Proposer's proposal submission.
4.3 EVALUATION WEIGHTING AND SCORING
The following weighting and points will be assigned to the proposal for
evaluation purposes:
Ability of Proposer to Meet the Needs of the City 40% percent
Experience of Proposer 20% percent
Cost of Proposal 30% percent
References 10% percent
4.4 ORAL PRESENTATIONS MAY BE REQUIRED
Should oral presentations become necessary, the City will contact the top-
scoring firm(s) to schedule a date, time, and location. Commitments made
by the Proposer at the oral interview, if any, will be considered binding.
The score from the oral presentation will determine the apparent
successful Proposer.
4.5 NOTIFICATION TO PROPOSERS
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 15 of 18
Firms whose proposals have not been selected for further participation or
award will be notified via FAX or by e-mail.
4.6 DEBRIEFING OF UNSUCCESSFUL PROPOSERS
Upon request, a debriefing conference will be scheduled with an
unsuccessful Proposer. The request for a debriefing conference must be
received by the RFP Coordinator within three (3) business days after the
Notification of Unsuccessful Proposer letter is faxed/e-mailed to the
Proposer. The debriefing will be held within three (3) business days of the
request or at such later date as is identified by the City. Discussion will
be limited to a critique of the requesting Proposer's proposal submission.
Comparisons between proposals or evaluations of the other proposals will
not be allowed. Debriefing conferences may be conducted in person or on
the telephone and will be scheduled for a maximum of one (1) hour.
5. RFP EXHIBITS
Exhibit A Certifications and Assurances
Exhibit B Draft Contract
Exhibit C Insurance Requirements
Exhibit D Medical Examination Criteria for General Physical Exams
Exhibit E Medical Examination Criteria for Hazardous Materials Team Members
Exhibit F Medical Examination Criteria for Pre-Employment Exam
Exhibit G Follow-up Medical Examination and Referral by Health Care Provider
CITY OF KENT RFP: MEDICAL EXAMINATIONS
FOR KENT FIRE DEPARTMENT PERSONNEL Page 16 of 18
Exhibit A
to Medical Examinations for City of Kent Fire Department Personnel
CERTIFICATIONS AND ASSURANCES
I/we make the following certifications and assurances as a required element of the proposal to
which it is attached, understanding that the truthfulness of the facts affirmed here and the
continuing compliance with these requirements are conditions precedent to the award or
continuation of the related contract(s):
1. I/we declare that all answers and statements made in the proposal are true and correct.
2. The prices and/or costs data have been determined independently, without consultation,
communication, or agreement with others for the purpose of restricting competition.
However, I/we may freely join with other persons or organizations for the purpose of
presenting a single proposal.
3. The attached proposal is a firm offer for a period of 60 days following receipt, and it may
be accepted by the City of Kent, Washington without further negotiation (except where
obviously required by lack of certainty in key terms) at any time within the 60-day
period.
4. In preparing this proposal, I/we have not been assisted by any current or former
employee of the City of Kent whose duties relate (or did relate) to this proposal or
prospective contract, and who was assisting in other than his or her official, public
capacity. (Any exceptions to these assurances are described in full detail on a separate
page and attached to this document.)
5. I/we understand that the City of Kent will not reimburse me/us for any costs incurred in
the preparation of this proposal All proposals become the property of the City of Kent,
and I/we claim no proprietary right to the ideas, writings, items, or samples, unless so
stated in this proposal.
6. Unless otherwise required by law, the prices and/or cost data which have been submitted
have not been knowingly disclosed by the Proposer and will not knowingly be disclosed
by him/her prior to opening, directly or indirectly, to any other Proposer or to any
competitor.
7. I/we agree that submission of the attached proposal constitutes acceptance of the
solicitation contents and the attached sample contract and general terms and conditions.
If there are any exceptions to these terms, I/we have described those exceptions in
detail on a page attached to this document.
8. No attempt has been made or will be made by the Proposer to induce any other person
or firm to submit or not to submit a proposal for the purpose of restricting competition.
9. I/we grant the City of Kent the right to contact references and others, who may have
pertinent information regarding the Proposer's prior experience and ability to perform the
services contemplated in this pro /ent
SW,L✓l
Signature of Proposer
Title bate
Exhibit A — Certifications and Assurances to
RFP for Medical Examinations for City of Kent Fire Department Page 1 of 1
Exhibit B
to Medical Examinations for City of Kent Fire Department Personnel
SAMPLE CONTRACT
PROFESSIONAL SERVICES AGREEMENT
Between the City of Kent and
[Insert Contractor's Company Name]
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and [Insert Contractor's Co. Name] organized under the laws of the State
of [Insert State Co Formed Under], located and doing business at [Insert Contractor's Address and
Phone Number] (hereinafter the "Contractor").
I. DESCRIPTION OF WORK.
Contractor shall perform the following services for the City:
Annual medical examinations, pre-employment medical examinations,
Hazardous Materials Team medical examinations, and follow-up and
referral examinations services in accordance with the City's
, 2009, Request for Proposals, attached and incorporated
as Exhibit A, and the Contractor's , 2009, Proposal
Response, attached and incorporated as Exhibit B.
Contractor further represents that the services furnished under this Agreement will be
performed in accordance with generally accepted professional practices within the Puget Sound
region in effect at the time those services are performed
II. TIME OF COMPLETION. The parties agree that work will begin on the tasks
described in Section I above immediately upon the effective date of this Agreement, and Contractor
shall complete the work by December 31, 20 At its option, the City may elect to extend the
terms of this Agreement for uD to three (3) additional one (1) year terms.
III. COMPENSATION. The City shall pay Contractor a total amount not to exceed
[Insert maximum dollar amount to be paid for services. You may type out the dollar amount and
place the numerical dollar amount in parentheses or you may just enter the numerical dollar
amount.] for the services described in this Agreement. The Contractor shall invoice the City
monthly based on time and materials incurred during the preceding month. The hourly rates
charged for Contractor's services shall be as delineated in the attached and incorporated Exhibit B.
All hourly rates charged shall remain locked at the negotiated rates throughout the term of this
Agreement.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent
Contractor-Employer Relationship will be created by this Agreement. By their execution of this
Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following
representations:
A. The Contractor has the ability to control and direct the performance and
details of its work, the City being interested only in the results obtained under
this Agreement
B. The Contractor maintains and pays for its own place of business from which
Contractor's services under this Agreement will be performed.
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 1 of 7
C. The Contractor has an established and independent business that is eligible
for a business deduction for federal income tax purposes that existed before
the City retained Contractor's services, or the Contractor is engaged in an
independently established trade, occupation, profession, or business of the
same nature as that involved under this Agreement.
D. The Contractor is responsible for filing as they become due all necessary tax
documents with appropriate federal and state agencies, including the Internal
Revenue Service and the state Department of Revenue.
E. The Contractor has registered its business and established an account with
the state Department of Revenue and other state agencies as may be
required by Contractor's business, and has obtained a Unified Business
Identifier (UBI) number from the State of Washington.
F. The Contractor maintains a set of books dedicated to the expenses and
earnings of its business
V. TERMINATION. Either party may terminate this Agreement, with or without cause,
upon providing the other party seven (7) calendar days written notice at its address set forth on
the signature block of this Agreement
VI. DISCRIMINATION. In the hiring of employees for the performance of work under
this Agreement or any subcontract, the Contractor, its subcontractors, or any person acting on
behalf of the Contractor or subcontractor shall not discriminate against any person who is qualified
and available to perform the work to which the employment relates as provided for by the City of
Kent's Equal Employment Opportunity Policy. Contractor shall execute the attached City of Kent
Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1 2, and
upon completion of the contract work, file the attached Compliance Statement.
VII. INDEMNIFICATION. Contractor shall defend, indemnify and hold the City, its
officers, officials, employees, agents and volunteers harmless from any and all claims, injuries,
damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection
with the Contractor's performance of this Agreement, except for that portion of the injuries and
damages caused by the City's negligence. The City's inspection or acceptance of any of
Contractor's work when completed shall not be grounds to avoid any of these covenants of
indemnification. The provisions of this section shall survive the expiration or termination of this
Agreement.
VIII. INSURANCE. The Contractor shall procure and maintain for the duration of the
Agreement, insurance of the types and in the amounts described in Exhibit C attached and
incorporated by this reference.
XII. CONTRACTOR'S WORK AND RISK. The Contractor agrees to comply with all
federal, state, and municipal laws, rules, and regulations that are now effective or in the future
become applicable to Contractor's business, equipment, and personnel engaged in operations
covered by this Agreement or accruing out of the performance of those services. All work shall be
done at Contractor's own risk, and Contractor shall be responsible for any loss of or damage to
materials, tools, or other articles used or held for use in connection with the work.
XIII. MISCELLANEOUS PROVISIONS.
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 2 of 7
A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City
requires its contractors and consultants to use recycled and recyclable products whenever
practicable. A price preference may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of
any of the covenants and agreements contained in this Agreement, or to exercise any option
conferred by this Agreement in one or more instances shall not be construed to be a waiver or
relinquishment of those covenants, agreements or options, and the same shall be and remain in
full force and effect.
C. Resolution of Disputes and Governing Law. This Agreement shall be governed by
and construed in accordance with the laws of the State of Washington. If the parties are unable to
settle any dispute, difference or claim arising from the parties' performance of this Agreement, the
exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively
under the venue, rules and jurisdiction of the King County Superior Court, King County,
Washington, unless the parties agree in writing to an alternative dispute resolution process. In any
claim or lawsuit for damages arising from the parties' performance of this Agreement, each party
shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or
lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided,
however, nothing in this paragraph shall be construed to limit the City's right to indemnification
under Section VII of this Agreement.
D. Written Notice. All communications regarding this Agreement shall be sent to the
parties at the addresses listed on the signature page of the Agreement, unless notified to the
contrary. Any written notice hereunder shall become effective three (3) business days after the
date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the
addressee at the address stated in this Agreement or such other address as may be hereafter
specified in writing.
E. Assignment Any assignment of this Agreement by either party without the written
consent of the non-assigning party shall be void.
F. Modification. No waiver, alteration, or modification of any of the provisions of this
Agreement shall be binding unless in writing and signed by a duly authorized representative of the
City and Contractor
G. Entire Agreement. The written provisions and terms of this Agreement, together
with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or
other representative of the City, and such statements shall not be effective or be construed as
entering into or forming a part of or altering in any manner this Agreement. Should any language
in any of the exhibits to this Agreement conflict with any language contained in this Agreement,
the terms of this Agreement shall prevail.
IN WITNESS, the parties below execute this Agreement, which shall become
effective on the last date entered below.
CONTRACTOR: CITY OF KENT:
By: By:
(signature) (signature)
Print Name: Print Name: Suzette Cooke
Its: Its Mayor
(title)
DATE: DATE:
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 3 of 7
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 4 of 7
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONTRACTOR: CITY OF KENT:
[Insert Contact Name] Mike Scott, Fire Battalion Chief
[Insert Company Name] City of Kent
[Insert Address] 220 Fourth Avenue South
[Address - Continued] Kent, WA 98032
[Insert Telephone Number] (telephone) (253) 856-4308 (telephone)
[Insert Fax Number] (facsimile) (253) 856-6300 (facsimile)
APPROVED AS TO FORM:
Kent Law Department
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 5 of 7
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal
opportunity. As such all contractors, subcontractors and suppliers who perform work with
relation to this Agreement shall comply with the regulations of the City's equal employment
opportunity policies.
The following questions specifically identify the requirements the City deems necessary for
any contractor, subcontractor or supplier on this specific Agreement to adhere to. An
affirmative response is required on all of the following questions for this Agreement to be
valid and binding. If any contractor, subcontractor or supplier willfully misrepresents
themselves with regard to the directives outlines, it will be considered a breach of contract
and it will be at the City's sole determination regarding suspension or termination for all or
part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis
of sex, race, color, national origin, age, or the presence of all sensory, mental or
physical disability.
3. During the time of this Agreement the prime contractor will provide a written
statement to all new employees and subcontractors indicating commitment as an
equal opportunity employer
4. During the time of the Agreement I, the prime contractor, will actively consider
hiring and promotion of women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me,
the Prime Contractor, that the Prime Contractor complied with the requirements as
set forth above.
By signing below, I agree to fulfill the five requirements referenced above.
Dated this day of 200_
By:
For:
Title:
Date:
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 6 of 7
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and
state laws. All contractors, subcontractors, consultants and suppliers of the City must
guarantee equal employment opportunity within their organization and, if holding
Agreements with the City amounting to $10,000 or more within any given year, must take
the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating
commitment as an equal opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City's
nondiscrimination and equal opportunity requirements shall be considered in breach of
contract and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and
Public Works Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these
regulations are familiar with the regulations and the City's equal employment
opportunity policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and
guidelines.
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 7 of 7
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded
the Agreement.
I, the undersigned, a duly represented agent of
Company, hereby acknowledge and declare that the before-mentioned company was the
prime contractor for the Agreement known as that was entered
into on the (date) , between the firm I represent and
the City of Kent.
I declare that I compiled fully with all of the requirements and obligations as
outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of
Kent Equal Employment Opportunity Policy that was part of the before-mentioned
Agreement.
Dated this day of , 200_.
By:
For:
Title:
Date:
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 8 of 7
,4
Exhibit C
to Medical Examinations for City of Kent Fire Department Personnel
INSURANCE REQUIREMENTS
Insurance
The Consultant shall procure and maintain for the duration of the Agreement, insurance
against claims for injuries to persons or damage to property which may arise from or in
connection with the performance of the work hereunder by the Consultant, its agents,
representatives, or employees.
A. Minimum Scope of Insurance
Consultant shall obtain insurance of the types described below:
1. Automobile Liability insurance covering all owned, non-owned, hired and
leased vehicles. Coverage shall be written on Insurance Services Office (ISO)
form CA 00 01 or a substitute form providing equivalent liability coverage. If
necessary, the policy shall be endorsed to provide contractual liability
coverage.
2. Commercial General Liability insurance shall be written on ISO occurrence
form CG 00 01 and shall cover liability arising from premises, operations,
independent contractors and personal injury and advertising injury. The City
shall be named as an insured under the Consultant's Commercial General
Liability insurance policy with respect to the work performed for the City.
3. Workers' Comoensation coverage as required by the Industrial Insurance laws
of the State of Washington.
4. Professional Liability insurance appropriate to the Consultant's profession.
B. Minimum Amounts of Insurance
Consultant shall maintain the following insurance limits:
1. Automobile Liability insurance with a minimum combined single limit for
bodily injury and property damage of$1,000,000 per accident
2. Commercial General Liability insurance shall be written with limits no less
than $1,000,000 each occurrence, $2,000,000 general aggregate.
3. Professional Liability insurance shall be written with limits no less than
$1,000,000 per claim and $1,000,000 policy aggregate limit.
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following provisions for
Automobile Liability, Professional Liability and Commercial General Liability insurance:
1. The Consultant's insurance coverage shall be primary insurance as respect
the City. Any insurance, self-insurance, or insurance pool coverage
Exhibit C - Insurance Requirements
RFP for Medical Examinations for City of Kent Fire Department Page 1 of 2
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded
the Agreement.
I, the undersigned, a duly represented agent of
Company, hereby acknowledge and declare that the before-mentioned company was the
prime contractor for the Agreement known as that was entered
into on the (date) between the firm I represent and
the City of Kent.
I declare that I complied fully with all of the requirements and obligations as
outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of
Kent Equal Employment Opportunity Policy that was part of the before-mentioned
Agreement.
Dated this day of 1200.
By:
For:
Title:
Date:
Exhibit B - PROFESSIONAL SERVICES AGREEMENT
RFP for Medical Examinations for City of Kent Fire Department Page 8 of 7
maintained by the City shall be excess of the Consultant's insurance and shall
not contribute with it.
2. The Consultant's insurance shall be endorsed to state that coverage shall not
be cancelled by either party, except after thirty (30) days prior written notice
by certified mail, return receipt requested, has been given to the City
3. The City of Kent shall be named as an additional insured on all policies
(except Professional Liability) as respects work performed by or on behalf of
the contractor and a copy of the endorsement naming the City as additional
insured shall be attached to the Certificate of Insurance. The City reserves
the right to received a certified copy of all required insurance policies The
Contractor's Commercial General Liability insurance shall also contain a clause
stating that coverage shall apply separately to each insured against whom
claim is made or suit is brought, except with respects to the limits of the
insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not less than
A:VI I.
E. Verification of Coverage
Consultant shall furnish the City with original certificates and a copy of the amendatory
endorsements, including but not necessarily limited to the additional insured endorsement,
evidencing the insurance requirements of the Consultant before commencement of the
work.
Exhibit C - Insurance Requirements
RFP for Medical Examinations for City of Kent Fire Department Page 2 of 2
Exhibit D
Medical Examination Criteria for General Physical Exams
1. Medical History Questionnaire $
An initial pre-employment history questionnaire must be completed to provide
baseline information with which to compare future medical concerns. A periodic
medical history questionnaire must be completed to provide follow-up information.
Periodic questionnaires focus on changes in health status An Annual respiratory
questionnaire is required.
2. Hands-on Physical Examination Included
• Vital Signs
• Head, eyes, ears, nose, and throat
Neck
• Cardiovascular
Inspection, auscultation, percussion and palpation
• Pulmonary
Inspection, auscultation, percussion and palpation
• Gastrointestinal
Inspection, auscultation, percussion and palpation
• Genitourinary
Hernia exam (also see cancer screening)
• Rectal
(See cancer screening)
• Lymph Nodes
The examination of organ systems must be supplemented with an evaluation
of lymph nodes in the cervical, auxiliary, and inguinal regions.
• Neurological
The neurological exam for uniformed personnel must include a general mental
status evaluation and general assessment of the major cranial/peripheral
nerves (motor, sensory, reflexes)
• Musculoskeletal
Includes an overall assessment of range of motion (ROM) of all joints.
Additionally, observation of the personnel performing certain standard office
exercises or functions is helpful in assessing joint mobility and function,
3. Blood Analysis $
The following are components of the blood analysis. At a minimum, laboratory
services must provide these components in their automated chemistry panel (a.k.a.
SMAC 20) and complete blood count (CBC) protocols.
• White Blood Cell Count
• Differential
• Red Blood Cell Count (Hematocrit)
• Platelet Count
Exhibit D - Medical Examination Criteria for General Physical Exams
Page 1 of 3
• Liver Function Tests
Includes SGOT/AST, SGPT/ALT, LDH, Alkaline Phosphatase, and Bilirubin
• Triglycerides
• Glucose
• Blood Urea Nitrogen
• Creatirnne
• Sodium
• Potassium
• Carbon Dioxide
• Total Protein
• Albumin
• Calcium
• Cholesterol
Includes Total Cholesterol, Low Density Lipoprotein (LDL-C) level, High
Density Lipoprotein (HDL-C), and Total Cholesterol/HDL Ratio.
4. Urinalysis
• Dip Stick Included w/ Above
Includes pH, Glucose, Ketones, Protein, Blood, and Bilirubin
• Microscopic Included w/ Above
Includes WBC, RBC, WBC Casts, RBC Casts, and Crystals
S. Vision Tests $
Assessment of vision must include evaluation of distance, near, peripheral, and color
vision Evaluate for common visual disorders including cataracts, macular
degeneration, glaucoma, and diabetic retinopathy.
6. Hearin Audio ram
9 ( 9 ) $
7. Pulmonary (Spirogram) $
S. Chest X-Ray - Every 5 years - mandatory $
9. EKG (Resting) $
10. Cancer Screening Elements
• May be provided to health care provider by employee's personal physician:
o Clinical Breast Examination $
o Mammogram $
o Pap Smear $
Exhibit D - Medical Examination Criteria for General Physical Exams
Page 2 of 3
• Prostate Specific Antigen $
Annual on all male uniformed personnel who have a positive family history of
prostate cancer or are African-Americans beginning at age 40. All male
uniformed personnel beginning at age 50.
• Digital Rectal Exam N/C
• Fecal Occult Blood Testing $
• Skin Exam N/C
• Testicular Exam N/C
11. Immunizations and Infectious Disease Screening
• Tuberculosis Screen - Annual $
• Tetanus/Diphtheria Vaccine (Booster every 10 yrs) $
• Hepatitis A Vaccine $
Vaccine shall be offered to high risk (HazMat, USAR, and SCUBA) and other
uniformed personnel with frequent or expected frequent contaminated water
exposures.
• Hepatitis C Virus Screen - OPTIONAL $
• HIV Screening (required that it be offered) $
HIV testing should be offered on a confidential basis as part of post-exposure
protocols and as requested by the physician and patient.
12. Annual Fitness Evaluation - identified at risk members and any member
over the age of 46.
• Aerobic Capacity
c Gherkin Protocol (Treadmill) $
o Maximal cardiopulmonary test with EKG $
Exhibit D - Medical Examination Criteria for General Physical Exams
Page 3 of 3
Exhibit E
Medical Examination Criteria for Hazardous Materials Team Members
1. Medical History Questionnaire $
An initial pre-employment history questionnaire must be completed to provide
baseline information with which to compare future medical concerns. A periodic
medical history questionnaire must be completed to provide follow-up information.
Periodic questionnaires focus on changes in health status. An Annual respiratory
questionnaire is required.
2. Hands-on Physical Examination Included
• Vital Signs
• Head, eyes, ears, nose and throat
Neck
• Cardiovascular
Inspection, auscultation, percussion and palpation
• Pulmonary
Inspection, auscultation, percussion and palpation
• Gastrointestinal
Inspection, auscultation, percussion and palpation
• Genitourinary
Hernia exam (also see cancer screening)
• Rectal
(See cancer screening)
• Lymph Nodes
The examination of organ systems must be supplemented with an evaluation
of lymph nodes in the cervical, auxiliary and rngurnal regions.
• Neurological
The neurological exam for uniformed personnel must include a general mental
status evaluation and general assessment of the major cranial/peripheral
nerves (motor, sensory, reflexes)
• Musculoskeletal
Includes an overall assessment of range of motion (ROM) of all joints.
Additionally, observation of the personnel performing certain standard office
exercises or functions Is helpful in assessing joint mobility and function.
3. Blood Analysis $
The following are components of the blood analysis. At a minimum, laboratory
services must provide these components in their automated chemistry panel (a.k.a.
SMAC 20) and complete blood count (CBC) protocols.
• White Blood Cell Count
• Differential
• Red Blood Cell Count (Hematocrit)
Exhibit E - Medical Examination Criteria for Hazardous Materials Team Members
Page 1 of 4
• Platelet Count
• Liver Function Tests
Includes SGOT/AST, SGPT/ALT, LDH, Alkaline Phosphatase, and Bilirubin
• Triglycerides
• Glucose
• Blood Urea Nitrogen
• Creatmine
• Sodium
• Potassium
• Carbon Dioxide
• Total Protein
• Albumin
• Calcium
• Cholesterol
Includes Total Cholesterol, Low Density Lipoprotein (LDL-C) level, High
Density Lipoprotein (HDL-C), and Total Cholesterol/HDL Ratio,
4. Urinalysis
• Dip Stick Included w/Above
Includes pH, Glucose, Ketones, Protein, Blood, and Bdirubin
• Microscopic Included w/Above
Includes WBC, RBC, WBC Casts, RBC Casts, and Crystals
S. Heavy Metal and Special Exposure Screening $
Baseline testing, for heavy metals may be assessed on the initial physical but is not
required under the Initiative since the utility of such testing has not been medically
established. However, evaluations are required to be done under special
circumstances, such as following a known exposure, for recurrent exposures, or
where required under Federal, State or Provincial regulations (e.g. OSHA standards).
• Arsenic (urine) $
• Mercury (urine) $
• Lead (urine) $
• Lead (blood) $
• Aluminum $
• Antimony $
• Bismuth $
• Cadmium $
• Chromium $
• Copper $
• Nickel $
• Zinc $
• Organophosphates (RB cholinesterase) $
• Polychlorinated Biphenyls (blood) $
Exhibit E - Medical Examination Criteria for Hazardous Materials Team Members
Page 2 of 4
6. Vision Tests $
Assessment of vision must include evaluation of distance, near, peripheral, and color
vision. Evaluate for common visual disorders including cataracts, macular
degeneration, glaucoma, and diabetic retinopathy.
7. Hearing (Audiogram) $
8. Pulmonary (Spirogram) $
9. Chest X-Ray - Every 5 years - mandatory $
10. EKG (Resting) $
11. Cancer Screening Elements
• May be provided to health care provider by employee's personal physician:
c Clinical Breast Examination $
o Mammogram $
o Pap Smear $
• Prostate Specific Antigen: $
Annual on all male uniformed personnel who have a positive family history of
prostate cancer or are African-Americans beginning at age 40. All male
uniformed personnel beginning at age 50.
Digital Rectal Exam N/C
Fecal Occult Blood Testing $
• Skin Exam N/C
• Testicular Exam N/C
12. Immunizations and Infectious Disease Screening
• Tuberculosis Screen - Annual $
• Tetanus/Diphtheria Vaccine (Booster every 10 yrs) $
• Hepatitis A Vaccine $
Vaccine shall be offered to high risk (HazMat, USAR, and SCUBA) and other
uniformed personnel with frequent or expected frequent contaminated water
exposures.
• Hepatitis C Virus Screen -p us Sc ee OPTIONAL $
• HIV Screening (required that it be offered) $
HIV testing should be offered on a confidential basis as part of post-exposure
protocols and as requested by the physician and patient.
Exhibit E - Medical Examination Criteria for Hazardous Materials Team Members
Page 3 of 4
13. Annual Fitness Evaluation - identified at risk members and any member
over the age of 46,
Aerobic Capacity
o Gherkin Protocol(Treadmill) $
o Maximal cardiopulmonary test with EKG $
14. Weight and Body Composition $
Body weight shall be measured and recorded. Body composition shall be conducted
solely for the purpose of departmental health surveillance.
Exhibit E - Medical Examination Criteria for Hazardous Materials Team Members
Page 4of4
Exhibit F
Medical Examination Criteria for Pre-Employment Exam
1. Medical History Questionnaire $
An initial pre-employment history questionnaire must be completed to provide
baseline information with which to compare future medical concerns A periodic
medical history questionnaire must be completed to provide follow-up information.
Periodic questionnaires focus on changes in health status. An Annual respiratory
questionnaire is required.
2. Hands-on Physical Examination Included
• Vital Signs
• Head, eyes, ears, nose and throat
Neck
• Cardiovascular
Inspection, auscultation, percussion and palpation
• Pulmonary
Inspection, auscultation, percussion and palpation
• Gastrointestinal
Inspection, auscultation, percussion and palpation
• Genitourinary
Hernia exam (also see cancer screening)
• Recta I
(See cancer screening)
• Lymph Nodes
The examination of organ systems must be supplemented with an evaluation
of lymph nodes in the cervical, auxiliary and inguinal regions.
• Neurological
The neurological exam for uniformed personnel must include a general mental
status evaluation and general assessment of the major cranial/peripheral
nerves (motor, sensory, reflexes)
• Musculoskeletal
Includes an overall assessment of range of motion (ROM) of all joints.
Additionally, observation of the personnel performing certain standard office
exercises or functions is helpful in assessing joint mobility and function.
3. Blood Analysis $
The following are components of the blood analysis. At a minimum, laboratory
services must provide these components in their automated chemistry panel (a.k.a.
SMAC 20) and complete blood count (CBC) protocols.
• White Blood Cell Count
• Differential
• Red Blood Cell Count (Hematocrit)
• Platelet Count
Exhibit F - Medical Examination Criteria for Pre-Employment Examination
Page 1 of 4
• Liver Function Tests
Includes SGOT/AST, SGPT/ALT, LDH, Alkaline Phosphatase, and Bilirubin
• Triglycendes
• Glucose
• Blood Urea Nitrogen
• Creatinme
• Sodium
• Potassium
• Carbon Dioxide
• Total Protein
• Albumin
• Calcium
• Cholesterol
Includes Total Cholesterol, Low Density Lipoprotein (LDL-C) level, High
Density Lipoprotein (HDL-C), and Total Cholesterol/HDL Ratio.
4. Urinalysis
• Dip Stick Included w/Above
Includes pH, Glucose, Ketones, Protein, Blood, and Bilirubin
• Microscopic Included w/Above
Includes WBC, RBC, WBC Casts, RBC Casts, and Crystals
S. Heavy Metal and Special Exposure Screening $
Baseline testing, for heavy metals may be assessed on the initial physical but is not
required under the Initiative since the utility of such testing has not been medically
established. However, evaluations are required to be done under special
circumstances, such as following a known exposure, for recurrent exposures, or
where required under Federal, State or Provincial regulations (e.g. OSHA standards).
• Arsenic (urine) $
• Mercury (urine) $
• Lead (urine) $
• Lead (blood) $
• Aluminum $
• Antimony $
• Bismuth $
• Cadmium $
• Chromium $
• Copper $
• Nickel $
• Zinc $
• Organophosphates (RB cholinesterase) $
• Polychlorinated Biphenyls (blood) $
Exhibit F - Medical Examination Criteria for Pre-Employment Examination
Page 2 of 4
6. Vision Tests $
Assessment of vision must include evaluation of distance, near, peripheral, and color
vision. Evaluate for common visual disorders including cataracts, macular
degeneration, glaucoma, and diabetic retinopathy.
7. Hearing (Audiogram) $
S. Pulmonary (Spirogram) $
9. Chest X-Ray - Every 5 years - mandatory $
10. EKG (Resting) $
11. Cancer Screening Elements
• May be provided to health care provider by employee's personal physician:
o Clinical Breast Examination $
o Mammogram $
o Pap Smear $
• Prostate Specific Antigen: $
Annual on all male uniformed personnel who have a positive family history of
prostate cancer or are African-Amencans beginning at age 40. All male
uniformed personnel beginning at age 50.
• Digital Rectal Exam N/C
• Fecal Occult Blood Testing $
• Skin Exam N/C
• Testicular Exam N/C
12. Immunizations and Infectious Disease Screening
• Tuberculosis Screen - Annual $
• Tetanus/Diphtheria Vaccine (Booster every 10 yrs) $
• Hepatitis A Vaccine $
Vaccine shall be offered to high risk (HazMat, USAR, and SCUBA) and other
uniformed personnel with frequent or expected frequent contaminated water
exposures.
• Hepatitis B Virus Vaccine Series (mandatory at initial) $
Includes Titre testing
• Hepatitis C Virus Screen (entry baseline) - $
HIV Screening (required that it be offered) $
Exhibit F - Medical Examination Criteria for Pre-Employment Examination
Page 3 of 4
F
HIV testing should be offered on a confidential basis as part of post-exposure
protocols and as requested by the physician and patient.
• Measles, Mumps, Rubella Vaccine (MMR) Measles Vaccine (entry baseline—verify
or provide. $
Vaccine is required for all uniformed personnel born in or after 1957 if there is
no medical contraindication and no evidence of at least one dose of live
vaccine on or after one's first birthday.
• Mumps Vaccine (entry baseline - verify or provide) $
Vaccine is required for all uniformed personnel born in or after 1957 if there is
no documentation of physician-diagnosed mumps, no adequate immunization
with live mumps after their first birthday and no evidence of laboratory
immunity.
• Rubella Vaccine (entry baseline - verify or provide) $
Vaccine is required unless proof of immunity is available.
• Polio Vaccine (entry baseline - verify or provide) $
Vaccine shall be given to uniformed personnel if vaccination or disease is not
documented.
• Vancella Vaccine (required to be offered) $
• Influenza Vaccine (required to be offered) $
13. Annual Fitness Evaluation - identified at risk members and any member
over the age of 46.
• Aerobic Capacity
o Gherkin Protocol (Treadmill) $
o Maximal cardiopulmonary test with EKG $
• Push-up Evaluation $
• Leg Strength Evaluation $
• Arm Strength Evaluation $
• Grip Strength Evaluation $
• Curl-Up Evaluation $
• Flexibility Evaluation $
14. Weight and Body Composition $
Body weight shall be measured and recorded. Body composition shall be conducted
solely for the purpose of departmental health surveillance.
Exhibit F - Medical Examination Criteria for Pre-Employment Examination
Page 4 of 4
Exhibit G
Follow-up Medical Examination and Referral by Health Care Provider
1. Follow-up or Consultation by Health Care Provider $
The Wellness-Fitness Initiative as established by the International Association of Fire
Chiefs and International Association of Firefighters Joint Labor Management defines
minimum recommendations for fire agency health and fitness programs. In orincinal,
the Kent Fire Department endorses recommendations contained in this report. The
Kent Fire Department recognizes the importance of consultation and/or referral to
outside health care providers and/or specialists.
Aspects of the follow-up and referral program include:
a. Abnormal findings on the annual physical must be addressed by follow-up or
referral.
b. Revaccination or intervention following exposures must be managed by
follow-up or referral.
C. Managed care or other provider referrals are appropriate for non-service
connected problems.
d. Return to work determinations for employees require clearance by the fire
department physician or other provider following a consult with an outside
physician or after extended leave.
e. Follow-up findings from an annual physical examination must be reviewed by
the fire department physician.
2. Individualized Health Risk Appraisal $
The health care provider (organization or individual) shall provide written
documentation regarding their follow-up/referral program or procedures.
Written feedback to uniformed personnel concerning health risks and health status is
required following the annual examination. Reporting findings and risks suggesting
plans for modifying risks improve the physician-patient relationship and helps
uniformed personnel claim ownership of their health status. Individualized health risk
appraisals also must include questions that attempt to accurately measure the
uniformed employee's perception of their health. Health perception can be a useful
indicator of potential problems.
Exhibit G - Follow-Up Medical Examination and Referral by Health Care Provider
Page 1of1
EXHIBIT B
Exhibit B to Professional Services Agreement
between the City of Kent and HealthForce Occupational Medicine, Inc.
Wellness Fitness Initiative Services
July 2009
WX
DEPgp���.
T R y
T V
�Cf�RE•SPCa
NEALTE0RCE
WORKPLACE HEALTH SOLUTIONS
Please contact Darin Smith, HealthForce Vice President of Sales&Customer Relations
at(425) 806-5735 or by E-mail darins@healthforcepartners com
11805 North Creek Parkway S , Suite 113
Bothell, WA 98011
www Health Force Partners com
This document contains confidential and proprietary information belonging to HealthForce Partners,Inc Any reproduction,
dissemination or other use of this document without the prior written consent of HealthForce Partners,Inc,is strictly prohibited
Kent Fire Department: Health Services Proposal.
Proposal Outline
■ Process and Budget Summary
■ Wellness Fitness Initiative Services
° Phase One Advance Paperwork
• Phase Two General and Hazmat Team Pre-Screening and
Audiometric Services
• Phase Three: Diagnostic Testing and Examination
° Phase Four Fitness Assessment
• Phase Five Scheduling and Reporting
■ New Recruit Physical Exam
■ 24-Hour Blood Borne Pathogen Support Services
■ Follow-up Medical Examination and Referral by Healthcare Provider
■ Immunizations and Infectious Disease Screening
HealthFarce Partner,Inc 0 2009 e
Kent Fire Department: Health Services Proposal
Process and Bud et Summer
HealthForce's approach Is to give clients the best value available We do this by offering
appropriate testing and medical services at the right time In order to minimize costs and
maximize convenience for our customers
Charge per Test
over Minimum
Phase Timing Tests per Day Daily Charge Minimum
Paperwork Weeks 1 to 3 n/a Included Included
Pre-Screening Week 4 12(min)to 15 (max) $2,400(up to 12) $200 (each for over 12)
i
Diagnostic Testing Week 5 to 6 10(min)to 14(max) - $5,550 (up to 10) $555 (each for over 10)
and Examination
Fitness Anytime after 8(min)to 10(max) $880(up to 8) $110(each for 8 to 10)
Assessment exam
Reporting and 3 weeks n/a Included Included
Tracking following exams
HealfhForce Partners,Inv 0 2000
Kent Fire Department: Health Services Proposal
The following service outline is designed to be performed at the station and available to all
department members Including the Hazmat Team
U-..
Phase One-Advance Paperwork:
HealthForce will prepare individual packets for each firefighter that contain all of the patient
registration, consent forms, confidential health history, respiratory questionnaires, and
instruction for the WFI program
Timing: Packets provided to department three weeks prior to Phase Two
• HealthForce WFI Packet Distribution (hard copy or digital)
Gene at Teai r*"��*"
Pre-Screening and Audiometric Services:
Timing: Approximately three weeks following the advance paperwork distribution
Hours of service: 7 00 a m to 8 30 a m
Screening capacity: 15 perday
Staff requirement:
• Phlebotomist(Medical Assistant)
• Hearing Conservationist
Services include:
• Patient (firefighter) Registration
• Collection of Examination Paperwork
• Blood Draw- 12-hour fasting
• Blood Chemistry Analysis (blood analysis)
• Plaque II Test
•Audiometric Test (six-person test capability every 15 minutes)
Additional Services(Hazmat Team):
• Heavy metal and special exposure screening $130
• Blood lead/ZPP $50
NOTE: Following the blood draws,the firefighters will be provided with a light snack
Minimum Minimum Each additional screen
pre-screens per day day rate overthe minimum
12 $2,400 $200 per person(non-hazmat) ,
$380(hazmat)
NeelfhForce Partners,Inc ®2009 e
Kent Fire Department: Health Services Proposal
Phase Three- Diagnostic Testing and Examination
HealthForce will set-up the on-site clinic at a predetermined location within the department
All testing, diagnostic and examinations will be performed in a station-to-station format using
privacy screens and private rooms
Timing: 7-10 days following pre-screening
Hours of service: Typically 7 00 a m to 4 30 p m.
Testing and examination capacity: 10-14 per day
Staff requirement:
• One Physician
• Registered Nurse
• Two Medical Assistants
•X-Ray Technician
Services include:
• Blood pressure, pulse, respiration, height, weight, temperature, vision, and
unnalysls dip
• Computerized body composition testing/waist-to-hip ratio
• Pulmonary function testing
• Chest X-Ray (one view)
• CIMT- Carotid Intima-Media Thickness
• EKG (Resting)
• Medical examination and hands-on physical*
*In order to comply with the Wellness Fitness Initiative and any grant requirements,the medical exam
and hands-on physical includes review by the department physician of lab work, completed health history
questionnaires and the diagnostic testing described above This provides the physician with valuable medical
information to advance of the examination and one-on-one consultation regarding wellness and personal health
goals
• Treadmill — If medically indicated $250
TjTUffWjje5XjEFX3
Examinations per day day rate overthe minimum
t
10 $5,550 $555
Ilk
HeallhForce Partners,Inc 9 2009
Kent Fire Department: Health Services Proposal
Phase Four- Fitness Assessmen
Based on the results of the Screening, Diagnostic and Examination Phase the department
physician determines whether the firefighter is an appropriate candidate for the Fitness
Assessment Phase described below
Timing: 7 00 a m to 4 00 p m.
Hours of service: At a time that works for the department/members
Assessment capacity: 12 per day
Staff requirement:
• Exercise Specialist
Services include:
• Pre-evaluation procedures
• Muscular strength evaluation Content TBD (Functional)
• Muscular endurance evaluation Content TBD (Functional)
• Flexibility Includes sit-and-reach testing
•Aerobic capacity FDNY Stairmill Protocol
• Fitness prescription - individual program detail for each department member
Assessments per day day rate over the minimum
12 $880 $110
3
Fy r
4
Y�
l
HeetthForee Partners,W 0 2009
Kent Fire Department: Health Services Proposal
Phase Five -Scheduling and Reporting:
Scheduling:
Our worksite services group partners with department personnel to identify convenient
times for each phase of the service We design our delivery model around department
shifts and rotating schedules to optimize our on-site presence at each station We can
provide reminders and follow-up communication for department administration that makes
compliance and participation easy to manage and track
Reporting:
The HealthForce worksite services team is highly flexible and able to accommodate complex
reporting requirements For example, we can provide authorized department personnel with
a confidential report that indicates a firefighter has completed their examination in addition to
privately sending a more detailed report directly to the individual firefighter
For the majority of the examination services that do not require laboratory analysis,
HealthForce can provide written examination results soon after the physician's examination
is completed If a department prefers, results can also be communicated by phone, fax or
e-mail
The turnaround time from our laboratory vendor is typically very efficient with blood test
results usually available within 72 hours Following review of the examination, diagnostic
and laboratory results, the department physician will generate reporting as defined by
the department All final clearances and reports are sent within two weeks following the
examination.
HealthForce Partners,Inc 0 2009 '®
Kent Fire Department: Health Services Proposal
New Recruit Physical Exam:
• Examination, respirator clearance, waist-to-hip ratio
• Drug screen (five panel)
• Pulmonary function testing
• EKG
• Blood draw
• Chemistry panel
• TB test
•Audiogram
• Chest X-Ray
NOTE: Immunizations will be offered to each new hire in order to be up-to-date
Package Fee: $476 per person +
Exposure Case Coordination Fee n„
• Physician time is billed at an hourly rate $400 per hour
• Minimum fee $200 per case managed (1/2 hour)
I
• Physician consulting rate $400 per hour
HealthForce Partners,Inc 0 2009
Kent Fire Department: Health Services Proposal
Fol-low-V Medical Examination and Referral b Healthcare Provide,
The Wellness-Fitness Initiative as established by the International Association of Fire
Chiefs and International Association of Firefighters Joint Labor Management defines
minimum recommendations for fire agency health and fitness programs Two additional
WFI components that are not part of the annual program are listed below
;follow-up or Consultation by Healthcare Provider
Aspects of the follow-up and referral program include:
Abnormal findings on the annual physical must be addressed by follow-up or
referral
• Revaccination or intervention following exposures must be managed by follow-up
or referral
• Managed care or other provider referrals are appropriate for non-service connected
problems
• Return to work determinations for employees require clearance by the fire
department physician or other provider following a consult with an outside
physician or after extended leave
• Follow-up findings from an annual physical examination must be reviewed by the
fire department physician
Simple - up to 20 minutes $160
Moderate - 20 to 40 minutes $300
Complex-40 to 60 minutes $450
Billed in 15-minute increments for consultations over 1 hour $450 per hour
AndiviliNJOled Health Risk Ap
praisal
The healthcare provider (organization or individual) shall provide written documentation
regarding their follow-up/referral program or procedures
Written feedback to uniformed personnel concerning health risks and health status is
required following the annual examination Reporting findings and risks suggesting
plans for modifying risks improve the physician-patient relationship and helps uniformed
personnel claim ownership of their health status Individualized health risk appraisals also
must include questions that attempt to accurately measure the uniformed employee's
perception of their health Health perception can be a useful indicator of potential
problems
HRA fee $32
HeR thFarce Partners Inc 0 2009
Kent Fire Department: Health Services Proposal
mmuniza ions, es ing and Infectious iseise creeping:
• Hepatitis A Virus Vaccine $75
• Hepatitis B Virus Vaccine $70
•TDAP (Tetanus/Diphtheria/Pertussis) $50
• Tetanus/Diphtheria Vaccine (Booster) $48
• Measles, Mumps, Rubella Vaccine (MMR) $68
• Polio Vaccine $25
• Hepatitis A Vaccine $75
•Vancella Vaccine $155
• Influenza Vaccine $25
• HbA1c $56
• Lead/ZPP - Special Exposure Screening $50
• Tuberculosis Screen (annual PPD) $28
• 24-hour Heavy Metal-Arsenic, Mercury, Cadmium, Chromium $130
• Repeat Chest X-Ray (baseline, every 5 years, mandatory) $55
• Hemocult $32
• PSA (Prostate Specific Antigen) $75
• Hepatitis C Virus Screen 1w, $50-
• HIV Counseling (required to be offered) $85
• HIV I Screening (required to be offered) $80
• HIV I &2 Screening (required to be offered) jkjLt $186 ,
Health Force Partners,Inc 0 2009
EXHIBIT C
Exhibit C
to Medical Examinations for City of Kent Fire Department Personnel
INSURANCE REQUIREMENTS
Insurance
The Consultant shall procure and maintain for the duration of the Agreement, insurance
against claims for injuries to persons or damage to property which may arise from or in
connection with the performance of the work hereunder by the Consultant, its agents,
representatives, or employees.
A. Minimum Scope of Insurance
Consultant shall obtain insurance of the types described below:
1. Automobile Liability insurance covering all owned, non-owned, hired and
leased vehicles. Coverage shall be written on Insurance Services Office (ISO)
form CA 00 01 or a substitute form providing equivalent liability coverage. If
necessary, the policy shall be endorsed to provide contractual liability
coverage.
2. Commercial General Liability insurance shall be written on ISO occurrence
form CG 00 01 and shall cover liability arising from premises, operations,
independent contractors and personal injury and advertising injury. The City
shall be named as an insured under the Consultant's Commercial General
Liability insurance policy with respect to the work performed for the City.
3. Workers' Compensation coverage as required by the Industrial Insurance laws
of the State of Washington.
4. Professional Liability insurance appropriate to the Consultant's profession.
B. Minimum Amounts of Insurance
Consultant shall maintain the following insurance limits:
1. Automobile Liability insurance with a minimum combined single limit for
bodily injury and property damage of$1,000,000 per accident.
2. Commercial General Liability insurance shall be written with limits no less
than $1,000,000 each occurrence, $2,000,000 general aggregate.
3. Professional Liability insurance shall be written with limits no less than
$1,000,000 per claim and $1,000,000 policy aggregate limit.
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following provisions for
Automobile Lability, Professional Liability and Commercial General Liability insurance:
1. The Consultant's insurance coverage shall be primary insurance as respect
the City. Any insurance, self-insurance, or insurance pool coverage
h Exhibit C — Insurance Requirements
RFP for Medical Examinations for City of Kent Fire Department Page 1 of 2
maintained by the City shall be excess of the Consultant's insurance and shall
not contribute with it.
2. The Consultant's insurance shall be endorsed to state that coverage shall not
be cancelled by either party, except after thirty (30) days prior written notice
by certified mail, return receipt requested, has been given to the City.
3. The City of Kent shall be named as an additional insured on all policies
(except Professional Liability) as respects work performed by or on behalf of
the contractor and a copy of the endorsement naming the City as additional
insured shall be attached to the Certificate of Insurance. The City reserves
the right to received a certified copy of all required insurance policies. The
Contractor's Commercial General Liability insurance shall also contain a clause
stating that coverage shall apply separately to each insured against whom
claim is made or suit is brought, except with respects to the limits of the
insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not less than
A NII.
E. Verification of Coverage
Consultant shall furnish the City with original certificates and a copy of the amendatory
endorsements, including but not necessarily limited to the additional insured endorsement,
evidencing the insurance requirements of the Consultant before commencement of the
work.
Exhibit C - Insurance Requirements
RFP for Medical Examinations for City of Kent Fire Department Page 2 of 2
Client#:579460 HEALTPAR5
ACORDTM CERTIFICATE OF LIABILITY INSURANCE 09101/09DmYY,
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Kibble&Prentice,a USI Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 370 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Seattle,WA 98111
206 441-6300 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA American Economy Insurance Company 19690
HealthForce Partners Inc. INSURER
11805 N Creek Pky S#113 INSURER
Bothell,WA 98011 INSURER
INSURER E
COVERAGES COVERAGES AS OF 09/01/09
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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR ii POLICYEFFECTIVE POLICY EXPIRATION
LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MMIDD LIMITS
A GENERAL LIABILITY 02CE1717173 07/01109 07/01/10 EACH OCCURRENCE $100 0000
COMMERCIAL GENERAL LIABILITY DAMAGES( RENTED $200 DUD
CLAIMS MADE OCCUR MED EXP(Any one person) $10000
PERSONAL B ADV INJURY $1 00U 000
GENERAL AGGREGATE $2 ODU ODD
GE GATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $2 DOO OOO
POLICY PRO LOC
JECT
A AUTOMOBILE LIABILITY 02CE1717173 07/01/09 07/01/10 COMBINED SINGLE LIMIT $1 000,000
X ANY AUTO (Ea accident) r
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Perperaon) $
X HIREDAUTOS
BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE S
(Per accdent)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY AGG 5
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE 5
OCCUR CLAIMS MADE AGGREGATE S
DEDUCTIBLE $
RETENTION $ S
TATUj
WORKERS COMPENSATION AND I
W SFR
C LIMIT OTH•
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E L DISEASE-EA EMPLOYEE $
If yes,describe under
SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is named as Additional Insured as respects their
interest in the operations of the Named Insured
*10 Days notice of cancellation for non-payment of premium.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Emergency Medical Services, DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *3n DAYS WRITTEN
Logistics-Kent Fire Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
20717 132nd Ave SE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Kent,WA 98042 REPRESENTATIVES
AU�THHO�RIZEED REPRESENTATIVE
is �
ACORD 25(2001108)1 of 2 #4008498 EDGJU 0 ACORD CORPORATION 1988
i
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)
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)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing msurer(s), authorized representative or producer,and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon
ACORD 25-S(2001108) 2 of 2 #4008498
Client#:579460 HEALTPAR5
ACORD. CERTIFICATE OF LIABILITY INSURANCE 06129109Dnvvv>
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Kibble&Prentice,a USI Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O.Box 370 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Seattle,WA 98111
206 441-6300 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA Darwin Select Insurance Company 24319
HealthForce Partners Inc. INSURER B
11805 N Creek Pky S#113 INSURER C
Bothell,WA 98011 INSURER D
INSURER E
COVERAGES COVERAGES AS OF 06129/09
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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS
LTR N TYPE OF INSURANCE POLICY NUMBER POLTE 1MM/DDCTIVE PDATE fMMfDDiYn
TION LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO REoNTEDPREMISES(Ea ccurfercal $
CLAIMS MADE DOCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $
POLICYEl PRO LOC
JECT
AUTOMOBILE LIABILITY
COMEINED SINGLE LIMIT $
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODILY INJURY
NON-OWNEDAUTOS (Per accident) $
PROPERTY DAMAGE $
(Par accident)
GARAGE LIABILITY ALTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG $
EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
S
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND WC LIMITS OTHFIR
-
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNER/EXECUTNE EL EACH ACCIDENT S
OFFICER/MEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE S
If Yes,describe under
SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $
A OTHER Prof Liab 03040067 07/01/09 07/01/10 $1,000,000 ea claim
Claims Made 12/12/02 $5,000,000 aggregate
DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of Insurance Only HealthForce Partners-1211612002 retroactive
date*10 Days Notice of Cancellation for Non-Payment of Premium
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Evidence of Insurance DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAIL �* 5 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES
AUTH RED REPRESENATIVE
ACORD 25(2001/08)1 of 2 #M3906506 EDGJU 0 ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)
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)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon
ACORD 25S(2001108) 2 of 2 #M3906506
'-••REPRINTED FROM THE FORMS LIBRARY"••
COMMERCIAL GENERAL LIABILITY
CG 76 35 02 07
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LIABILITY PLUS ENDORSEMENT
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
City of Kent
ADDITIONAL INSURED — BY WRITTEN lease or occupy, subject to the following
CONTRACT, AGREEMENT OR PERMIT, OR additional provisions
SCHEDULE (a) This insurance does not apply to
The following paragraph is added to WHO IS AN any °occurrence"which takes place
INSURED (Section II): after you cease to be a tenant in
any premises leased to or rented to
4. Any person or organization shown in the Sched- you,
ule or for whom you are required by written con- (b) This insurance does not apply to
tract, agreement or permit to provide insurance any structural alterations, new con-
is an insured, subject to the following additional struction or demolition operations
provisions- performed by or on behalf of the
a. The contract, agreement or permit must be person or organization added as an
in effect during the policy period shown in insured,
the Declarations, and must have been exe- (2) Your ongoing operations for that in-
cuted prior to the "bodily injury", aproperty sured, whether the work is performed
damage", or "personal and advertising by you or for you;
injury".
person or organization added as an in- (3) The maintenance, operation or use by
b. The
P 9 you of equipment leased to you by such
sured by this endorsement is an insured only person or organization, subject to the
to the extent you are held liable due to following additional provisions
(1) The ownership, maintenance or use of (a) This insurance does not apply to
that part of premises you own, rent, any "occurrence"which takes place
after the equipment lease expires,
Includes Copyrighted Material of Insurance Services Office, Inc., with its permission
Copyright, Insurance Services, 2001
CG 76 35 02 07 Page 1 d 4 EP
r
—REPRINTED FROM THE FORMS LIBRARY'-"
(b) This insurance does not apply to This exclusion applies even if the claims
"bodily Injury" or "property dam- against any Insured allege negligence or
age" arising out of the sole negli- other wrongdoing in the supervision, hiring,
gence of such person or employment, training or monitoring of others
organization, by that Insured, if the "occurrence" which
caused the "bodily injury" or "property
(4) Permits issued by any state or political damage" involved the ownership, mainte-
subdivision with respect to operations nance, use or entrustment to others of any
performed by you or on your behalf, aircraft, "auto" or watercraft that is owned
subject to the following additional pro- or operated by or rented or loaned to any in-
vision sured
This insurance does not apply to "bodily This exclusion does not apply to
injury", "property damage", or (1) A watercraft while ashore on premises
"personal and advertising injury" arising you own or rent,
out of operations performed for the state
or municipality (2) A watercraft you do not own that is:
c. The insurance with respect to any architect, (a) Less than 52 feet long, and
engineer, or surveyor added as an insured (b) Not being used to carry persons or
by this endorsement does not apply to property for a charge,
"bodily injury", "property damage", or "per-
sonal and advertising injury" arising out of (3) Parking an "auto" on, or on the ways
the rendering of or the failure to render any next to, premises you own or rent, pro-
professional services by or for you, mclud- vided the "auto" is not owned by or
Ing, rented or loaned to you or the insured,
(1) The prepanng, approving, or failing to (4) Liability assumed under any "insured
prepare or approve maps, drawings, contract" for the ownership, mainte-
nance or use of aircraft or watercraft, or
opinions, reports, surveys, change or-
ders, designs or specifications, and (5) "Bodily injury" or "property damage"
(2) Supervisory, inspection or engineering arising out of
services (a) the operation of machinery or
equipment that is attached to, or
d. This insurance does not apply to "bodily part of, a land vehicle that would
injury" or "property damage" included within qualify under the definition of
the "products-completed operations haz- "mobile equipment" if it were not
ard" subject to a compulsory or financial
responsibility law or other motor ve-
A person's or organization's status as an insured un- hicle insurance law in the state
der this endorsement ends when your operations for where it is licensed or principally
that insured are completed garaged,or
(b) the operation of any of the machin-
No coverage will be provided If, in the absence of this ery or equipment listed in Paragraph
endorsement, no liability would be imposed by law on f.(2) or f.(3) of the definition of
you Coverage shall be limited to the extent of your "mobile equipment".
negligence or fault according to the applicable princi-
ples of comparative fault. {6) An aircraft you not own provided it is
a
not operated by any insured.
NON-OWNED WATERCRAFT AND NON-OWNED TENANTS' PROPERTY DAMAGE LIABILITY
AIRCRAFT LIABILITY
Exclusion g. of COVERAGE A (Section 1) is replaced When a Damage To Premises Rented To You Limit is
by the following shown in the Declarations, Exclusion i, of Coverage
A, Section I is replaced by the following
g. "Bodily injury" or "property damage" arising
out of the ownership, maintenance, use or J. Damage To Property
entrustment to others of any aircraft, "auto" "Property damage"to.
or watercraft owned or operated by or rented
or loaned to any insured Use includes oper- (1) Property you own, rent, Dr occupy, including
ation and 'loading or unloading" any costs or expenses incurred by you, or
Page 2 of 4
—REPRINTED FROM THE FORMS LIBRARY^"
any other person, organization or entity, for WHO IS AN INSURED — MANAGERS
repair, replacement, enhancement, restora-
tion or maintenance of such property for any The following is added to Paragraph 2.a. of WHO IS
reason, including prevention of injury to a AN INSURED (Section II)
person or damage to another's property;
(2) Premises you sell, give away or abandon, if Paragraph(1)does not apply to executive officers, or
the "property damage"arises out of any part to managers at the supervisory level or above
of those premises;
SUPPLEMENTARY PAYMENTS — COVERAGES A
(3) Property loaned to you, AND B — BAIL BONDS — TIME OFF FROM
(4) Personal property in the Care, Custody or WORK
control of the insured,
Paragraph 1.b. of SUPPLEMENTARY PAYMENTS —
(5) That particular part of real property on which COVERAGES A AND B is replaced by the following:
you or any contractors or subcontractors
working directly or indirectly on your behalf b. Up to $3,000 for cost of bad bonds required
are performing operations, if the "property because of accidents or traffic law violations
damage" arises out of those operations, or arising out of the use of any vehicle to which
the Bodily Injury Liability Coverage applies
(6) That particular part of any property that must We do not have to furnish these bonds
be restored, repaired or replaced because
"your work"was Incorrectly performed on it Paragraph 1.d. of SUPPLEMENTARY PAYMENTS —
Paragraphs (1), (3) and (4) of this exclusion do COVERAGES A AND B is replaced by the following:
not apply to "property damage" (other than d. All reasonable expenses incurred by the in-
damage by fire) to premises, Including the con- sured at our request to assist us in the in-
tents of such premises, rented to you A separate vestigation or defense of the claim or "suit',
limit of insurance applies to Damage To Prem- Including actual loss of earnings up to $500
ises Rented To You as described in Section III a day because of time off from work
— Limits Of Insurance
Paragraph (2) of this exclusion does not apply If EMPLOYEES AS INSUREDS — HEALTH CARE
the premises are 'your work" and were never SERVICES
occupied, rented or held for rental by you
Provision 2.a.(1)(d) of WHO IS AN INSURED {Section
Paragraphs (3), (4), (5) and (6) of this exclusion II) is deleted, unless excluded by separate endorse-
do not apply to liability assumed under a side- ment
track agreement.
Paragraph (6) of this exclusion does not apply to EXTENDED COVERAGE FOR NEWLY ACQUIRED
"property damage" included in the "products- ORGANIZATIONS
completed operations hazard"
Provision 3 a of WHO IS AN INSURED (Section II) is
Paragraph 6. of LIMITS OF INSURANCE (Section 111) replaced by the following:
Is replaced by the following a. Coverage under this g provision Is afforded
6. Subject to 5. above, the Damage To Premises only until the end of the policy period
Rented To You Limit is the most we will pay un-
der Coverage A for damages because of
"property damage" to any one premises, white rented to you, or in the case of damage by fire, Exclusion a. of COVERAGE A (Section 1) is replaced while rented to you or temporarily occupied by by the following.
you with permission of the owner. a. "Bodily injury" or "property damage" expected
or intended from the standpoint of the Insured
The Damage To Premises Rented To You limit Is the This exclusion does not apply to "bodily injury"
higher of the Each Occurrence Limit shown in the or "property damage" resulting from the use of
Declarations or the amount shown in the Declarations reasonable force to protect persons or property.
as Damage To Premises Rented To You Limit.
CS 76 35 02 07 Page 3 of 4 EP
a
-REPRINTED FROM THE FORMS LIBRARY""
EXTENDED DEFINITION OF BODILY INJURY Interrupted only by a street, roadway, waterway, or
right-of-way of a railroad
Paragraph 3. of DEFINITIONS (Section V) is replaced
by the following INCREASED MEDICAL EXPENSE LIMIT
3. "Bodily Injury" means bodily injury, sickness or The Medical Expense Limit is amended to$10,000.
disease sustained by a person, Including mental
arguish or death resulting from any of these at KNOWLEDGE OF OCCURRENCE
any time.
The following is added to Paragraph 2. Duties In The
TRANSFER OF RIGHTS OF RECOVERY Event Of Occurrence, Offense, Claim Or Suit of
COMMERCIAL GENERAL LIABILITY CONDITIONS
The following is added to Paragraph 8. Transfer Of (Section IV)•
Rights Of Recovery Against Others To Us of COM-
MERCIAL GENERAL LIABILITY CONDITIONS (Sec- Knowledge of an "occurrence", claim or "suit" by
tion IV)- your agent, servant or employee shall not in itself
constitute knowledge of the named insured unless an
We waive any rights of recovery we may have against officer of the named insured has received such notice
any person or organization because of payments we from the agent,servant or employee
make for injury or damage arising out of your ongoing
operations or "your work" done under a contract with UNINTENTIONAL FAILURE TO DISCLOSE ALL
that person or organization and included in the HAZARDS
"products-completed operations hazard" This waiver
applies only to a person or organization for whom you The following is added to Paragraph 6. Representa-
are required by written contract, agreement or permit tions of COMMERCIAL GENERAL LIABILITY CONDI-
to waive these rights of recovery TIONS (Section IV)-
AGGREGATE LIMITS OF INSURANCE — PER If you unintentionally fail to disclose any hazards ex-
LOCATION isting at the inception date of your policy, we will not
deny coverage under this Coverage Form because of
For all sums which the insured becomes legally obli- such failure However, this provision does not affect
gated to pay as damages caused by "occurrences" our right to collect additional premium or exercise our
under COVERAGE A (Section 1), and for all medical right of cancellation or non-renewal
expenses caused by accidents under COVERAGE C
(Section 1),which can be attributed only to operations LIBERALIZATION CLAUSE
at a single location".
The following paragraph is added to COMMERCIAL
Paragraphs 2.a. and 2 b. of Limits of Insurance(Sec- GENERAL LIABILITY CONDITIONS (Section IV):
tion III) apply separately to each of your locations"
owned by or rented to you 10 If a revision to this Coverage Part, which would
provide more coverage with no additional pre-
`Location" means premises involving the same or mium, becomes effective during the policy period
connecting lots, or premises whose connection is in the state shown in the Declarations, your pol-
icy will automatically provide this additional cov-
erage on the effective date of the revision
Page 4 of 4
REQUEST FOR MAYOR'S SIGNATURE
KENT Please Fill in All Applicable Boxes
WASHINGTON
Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT)
g Ori Jane Ogren Phone Oii inator 4306
g rnator:
Date Sent. 9/25/2009 Date Required: 10/1/2009
Retuin Signed Document to: Jane Ogren CONTRACT TERMINATION DATE: 12/31/11
VENDOR NAME: HealthForce Occupational DATE OF COUNCIL APPROVAL: 9/15/09
Brief Explanation of Document:
Medical physical examinations must be performed on a regular basis, per the Collective
Bargaining Agreement between the City of Kent and Kent Firefighters Local 1747.
Medical physical examinations are performed to ensure the employee is medically fit for
duty. /Zak 7V a .
P /Ao� Ooa
All Contracts Must Be Routed Through the Law Department
(This Area to be Completed By the Law Department)
Received:
Approval of Law Dept.:
tiEP
✓r
Law Dept Comments- 20iJq
t-- A V � j ��f � ���
APT �TI,9II �
Date Forwarded to Mayor
Shaded Areas to Be Completed by Administration Staff
Received:
Recommendations & Comments:
Disposition: /0 / Olr
Date Returned:
IaneS870 3;Oi