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HomeMy WebLinkAboutRESPONSE - FAX QUOTE - 8637 DOT MEDICAL EXAMSHeidi Collins Account Executive 7401 Church Ranch Road Blvd., Suite 202 Westminster, Colorado 80021 Phone: 303.388.3627 Email: hecampbell@concentra.com City of Fort Collins DUE: December 15, 2017 3:00 p.m. MT PRESENTED TO Request for Quote: DOT Medical Exams No. 8637 PRESENTED BY concentra.com ● 5080 Spectrum Drive, 1200 West Tower, Addison, Texas 75001 ● Phone 800.232.3550 ● Fax 972.725.6439 December 15, 2017 Beth Diven Buyer City of Fort Collins purchasing@fcgov.com Reference: DOT Medical Exams, No. 8637 Dear Ms. Diven: In response to the Request for Quote (RFQ) No. 8637, Occupational Health Centers of the Southwest, P.A. d/b/a Concentra Medical Centers (Concentra), submits our response to provide Department of Transportation (DOT) medical exam services to the City of Fort Collins (City). Concentra’s proposal includes our response to the City’s RFQ specifications and relevant attachments. As an industry leader in occupational health since 1979, our mission to improve the health of America’s workforce, one patient at a time, positions us as the optimate partner for the City. In this proposal, we will show you how:  We will help the City keep your employees safe and in compliance with DOT, the Federal Motor Carriers Safety Administration (FMCSA) and Federal Transit Administration (FTA), and all other applicable regulations providing DOT medical exams.  Our DOT exams will be conducted by licensed medical examiners who are listed on the FMCSA’s National Registry. Heidi Campbell, account executive, will serve as the initial contact and liaison between the City and Concentra. Should you have any questions or concerns regarding our response, please contact Ms. Campbell via phone: 303.388.3627 or email: hecampbell@concentra.com. Concentra affirms that all information contained herein is current, complete, accurate, and remains valid for 90 days following the due date, December 15, 2017, and the City anticipates a contract term of one year with up to four additional one-year renewals. Concentra values the City’s consideration of our response. We are confident that when the City considers our experience, qualifications, and account management strategy, Concentra will emerge as the ideal partner to provide the City DOT medical exams services. We look forward to the opportunity to serve as the preferred DOT medical exams partner to the City of Fort Collins and its employees. Respectfully submitted, Robert G. Hassett, DO, MPH President, Director, Secretary, and Treasurer Occupational Health Centers of the Southwest P.A. d/b/a Concentra Medical Centers DocuSign Envelope ID: 32C181DC-5215-481C-AFC7-657AAC21701E City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Table of Contents © 2017 Concentra Operating Corporation. All rights reserved. Table of Contents A. Qualifications .............................................................................................................. 1 B. References ............................................................................................................... 10 C. Fee Schedule ........................................................................................................... 11 D. Facilities and Locations ............................................................................................ 12 E. Signed Vendor Statement ......................................................................................... 15 F. Sustainability ............................................................................................................. 16 G. Attachments ............................................................................................................. 17 City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 1 A. Qualifications History and Background Concentra was founded in 1979 and has grown to be the largest provider of occupational health services in the country. We are considered an authority on occupational health, a distinction we have held for the past 25 years. We know how to deliver care that works for companies and their employees.  Concentra treats one in every seven workplace injuries in the US  Concentra treated more than 18 million injured workers since 1979  In 2016, Concentra performed 1.43 million physicals and 1.83 million drug screens  30,000 people are seen at Concentra Medical Centers each day  Concentra has 178,000 clients and more than 300 community-based medical centers nationwide in markets representing 60 percent of the nation's workforce Product and Services Concentra offers an extensive suite of services, categorized as follows: Concentra’s Suite of Services Occupational Health Care  Pre-placement services, including examinations, substance abuse testing, etc.  Regulatory and employer mandated physicals  Medical surveillance examinations  Clinical testing (X-ray, audiograms, EKG)  Work-related vaccinations and infectious disease screenings  Travel health  Functional capacity and human performance evaluations  Office and industrial ergonomic evaluations  Occupational therapy  Medical advisory services  Utilization review services (Medical ReviewStream™) Training and Education  General injury prevention education  Job-specific injury prevention education  Workplace office and industrial stretching and exercise programs  Back care and back injury prevention  Drug and alcohol screening training  Wellness and illness prevention education  Online reasonable suspicion training (Concentra Medical Compliance Administration) Urgent Care  Diagnosis and treatment of minor non-work- related illnesses and injuries, such as colds, flu, skin conditions, back pain, and sprains  Over 350 different types of laboratory tests  X-rays  Immunizations  Infectious disease tests and screenings Injury Care  Primary work-related injury care (workers’ compensation)  Workplace injury medication dispensing* and prescribing  Physical therapy  Specialist care City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 2 Concentra’s Suite of Services Pharmacy Services*  Pre-packaged formulary  Medication dispensing for occupational medicine and travel health*  E-prescribing *Where allowed by state law. Preventive Care  Biometric screenings  Vaccinations/immunizations  Immigration examinations  School and sports physicals Clinical Experience Department of Transportation Experience Annually, Concentra performs more than 800,000 DOT examinations, making us the nation’s largest provider of screening services for drivers of commercial motor vehicles. We provide DOT physical examinations for employers who operate in various industries, including:  Aviation (FAA)  Roadways and Bridges (FHWA)  Trucking (FMCSA)  Railways (FRA)  Public Transit (FTA)  Maritime (MARAD)  Pipelines and Hazmat (PHMSA), and more Concentra maintains current, comprehensive knowledge of DOT rules and regulations. We require all Concentra physicians to be Federal Motor Carriers Safety Administration (FMCSA) National Registry certified to complete DOT examinations. In addition, Concentra offers the FMCSA curriculum as part of our training program to educate medical examiners on multiple topics within 13 different training modules on FMCSA regulations. Concentra’s participants who complete the program are prepared to:  Apply knowledge of FMCSA’s driver physical qualification standards and advisory criteria to findings gathered during the driver’s medical examination  Make sound determination of the driver’s medical and physical qualifications for safely operating a commercial motor vehicle (CMV) in interstate commerce  Accurately complete the Medical Examination Report Form As a recognized expert in DOT, Concentra also provides a suite of DOT-related services to keep employers and their drivers safe and compliant, including:  DOT Drug Testing – DOT drug screenings test for the presence of illegal drugs, alcohol, and other substances  DOT Policy Development – Concentra helps employers develop written drug and alcohol policies in accordance with DOT regulations  Concentra’s Sleep Evaluation Program – Objective and consistent evaluation of drivers who are at a risk of collision due to excessive sleepiness Concentra is proud of its experience and attributes much of our success to our resident expert. Former Concentra physician, Ellison Wittels, MD, FACP, was the former senior consultant to the FMCSA. Dr. Wittels chaired the 2002 Cardiac Advisory Panel, which was empowered to provide City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 3 cardiac interpretive guidelines to all physicians performing DOT medical examinations. Dr. Wittels provided training and guidance to all Concentra and non-Concentra physicians regarding DOT examination procedures and interpretations. In addition, he published a book, Concentra Guide to Medical Certification of Commercial Drivers, in response to the FMCSA referring physicians, nationwide, to Dr. Wittels for medical certification interpretations. The Concentra Guide integrates and defines the federal standards, FMCSA guidelines, recent literature, and opinion, thus providing a framework for the medical examiner’s assessment of the driver and determination of fitness. The City will benefit from Concentra’s vast experience as a means to maintaining the health and safety of your commercial drivers. Non-injury Experience Concentra has been performing physical examinations, conducting drug and alcohol testing, and administering immunizations and vaccinations since our inception more than three decades ago. We maintain written guidelines on all relevant regulatory standards and create client- specific service packages tailored to meet the unique needs of each client’s program requirements. Furthermore, we assure that only qualified individuals will perform the requested services in accordance with all local, state, and federal guidelines. Colorado Experience For years, Colorado employers have trusted Concentra to manage multiple facets of their employees’ occupational health care needs. Our experience in the state runs the gamut of all clinic-related services, including DOT exams, requested by the City's RFQ. In addition, we have direct experience performing DOT exams for the City. We currently perform two to five DOT exams for City employees per month. We are knowledgeable of Colorado guidelines and we adhere to the state’s regulatory requirements pertaining to the provision of health care services. DOT Medical Exams Process The purpose of this examination is to detect the presence of physical, mental, or organic conditions of such a character and extent as to affect the driver’s ability to safely operate a commercial motor vehicle. The examination should be conducted carefully and should at least include all information requested in the applicable form. A history of certain conditions may be cause for disqualification, or may indicate the need for further testing and/or require evaluation by a specialist. The Concentra medical examiner, who we require to be certified and listed on FMCSA National Registry of Certified Medical Examiners, adheres to the physical examination components outlined in the FMCSA regulations, 391.41-Physical Qualifications for Drivers. If the driver passes, the medical examiner immediately generates the required Medical Examiner Certificate. The certificate may be issued for up to 24 months; however, the medical examiner may limit certification based on a driver’s medical history. Specifically, the medical examiner will examine the following: Year-to-date, Concentra’s Fort Collins medical center has performed 4,690+ physicals. City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 4  General appearance and development. Note marked overweight. Note any postural defect, perceptible limp, tremor, or other conditions that might be caused by alcoholism, thyroid intoxication or other illnesses.  Head-eyes. When charts other than the Snellen chart are used, the results must be expressed in values comparable to the standard Snellen test. If the driver wears corrective lenses for driving, these should be worn while driver’s visual acuity is being tested. If contact lenses are worn, there should be sufficient evidence of good tolerance of and adaptation to their use.  Ears. Note evidence of any ear disease, symptoms of aural vertigo, or Meniere’s Syndrome. When recording hearing, record distance from patient at which a forced whispered voice can first be heard. If the individual fails the whispered voice test, the audiometric test should be administered. For the audiometric test, record decibel loss at 500 Hz, 1,000 Hz, and 2,000 Hz. Average the decibel loss at 500 Hz, 1,000 Hz and 2,000 Hz and record as described on the form. If the individual fails the audiometric test and the whispered voice test has not been administered, the whispered voice test should be performed to determine if the standard applicable to that test can be met.  Throat. Note any permanent deformities likely to interfere with breathing or swallowing.  Heart. Note murmurs and arrhythmias, and any history of an enlarged heart, congestive heart failure, or cardiovascular disease that is accompanied by syncope, dyspnea, or collapse. Indicate onset date, diagnosis, medication, and any current limitation. An electrocardiogram is required when findings so indicate.  Blood pressure (BP). If a driver has hypertension and/or is being medicated for hypertension, he or she should be recertified more frequently. An individual diagnosed with Stage 1 hypertension (BP is 140/90-159/99) may be certified for one year. At recertification, an individual with a BP equal to or less than 140/90 may be certified for one year; however, if his or her BP is greater than 140/90 but less than 160/100, a one-time certificate for three months can be issued. An individual diagnosed with Stage 2 (BP is 160/100-179/109) should be treated and a one-time certificate for three-month certification can be issued.  Lungs. Note abnormal chest wall expansion, respiratory rate, breath sounds including wheezes or alveolar rales, impaired respiratory function, dyspnea, or cyanosis. Abnormal finds on physical examination may require further testing such as pulmonary tests and/or X- ray of chest.  Abdomen and viscera. Note enlarged liver, enlarged spleen, abnormal masses, bruits, hernia, and significant abdominal wall muscle weakness and tenderness. If the diagnosis suggests that the condition might interfere with the control and safe operation of a commercial motor vehicle, further testing and evaluation is required.  Genital-urinary and rectal examination. A urinalysis is required. Protein, blood, or sugar in the urine may be an indication for further testing to rule out any underlying medical problems.  Neurological. Note impaired equilibrium, coordination, or speech pattern; paresthesia; asymmetric deep tendon reflexes; sensory or positional abnormalities; abnormal patellar and Babinski’s reflexes; ataxia. Abnormal neurological responses may be an indication for further testing to rule out an underlying medical condition. Any neurological condition should be evaluated for the nature and severity of the condition, the degree of limitation present, the likelihood of progressive limitation, and the potential for sudden incapacitation.  Spine, musculoskeletal. Previous surgery, deformities, limitation of motion, and tenderness should be noted. Findings may indicate additional testing and evaluation should be conducted. City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 5  Extremities. Carefully examine upper and lower extremities and note any loss or impairment of leg, foot, toe, arm, hand, or finger. Note any deformities, atrophy, paralysis, partial paralysis, clubbing, edema, or hypotonia.  Laboratory and other testing. Other test(s) may be indicated based upon the medical history or findings of the physical examination.  Diabetes. If insulin is necessary to control a diabetic driver’s condition, the driver is not qualified to operate a commercial motor vehicle in interstate commerce. If mild diabetes is present and it is controlled by use of an oral hypoglycemic drug and/or diet and exercise, it should not be considered disqualifying. However, the driver must remain under adequate medical supervision. ePhysicals Concentra offers ePhysicals, a digital solution powered by FormFox, a new electronic Custody and Control Forms (eCCF) software. This solution is designed to make it easier and more convenient for clients to manage their driver’s physicals by enabling online scheduling and electronic pre-authorizations, decreasing errors associated with paper forms, expediting results, and improving payment turnaround times. This also cuts down time drivers spend in the center and how much paperwork they fill out when they arrive. Reporting Individual patient encounters provide the basis for the reporting system. The system creates a report for each employee seen at Concentra and makes it available to the City via the Employer Portal. Concentra can set up notification for multiple contacts, if desired. The following table outlines examples of our standard visit-based report output. Sample Reports and Communications Non-Injury Status Report  Generated after each non-injury visit  Report includes the employee's name and demographics, date seen, time checked in and out of the center, results, and remarks Missed Appointment Letter  Generated the day after a missed an appointment  Report includes the employee and employer demographics, time and date of the missed appointment, and provider’s name Patient Referral  Generated when a referral to a specialist takes place  Report includes basic demographics, billing information, specialist information, and referrals details (i.e., type of referral, recommendations, priority, notes) Physical Examination Results Reporting Concentra will integrate, review, and report all medical information back to the City’s designated representative within 24 hours of receipt of all relevant data. The report will provide a recommendation based on the results, any recommended referrals, and/or restrictions, and recommendations for necessary follow up to remedy the referral. The clinician will note if additional testing is necessary and advise of the clearance status for job placement. If the results require supplemental testing, Concentra will notify the City’s designated representative prior to performing any additional testing. Depending on the specific components tested for (i.e., blood or urine analysis), results may take up to five days to report. City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 6 Employer Portal Concentra offers a self-service, online tool that provides the City with convenient access to account information, test results, and reporting. The Concentra Employer Portal (the Portal) uses advanced security software to ensure privacy and protection of employee information. The Portal includes:  Online account management  Access to make edits to your company and location addresses and contacts  View capabilities of all service packages, components, payers, third-party administrators, and medical review officers  Timely updates to your employee’s non-injury and injury visit results and work restrictions  Full integration of existing employer reports for easy access  Export and print functionality for all accessible reports  Archive and search functions for stored reports provided  Ability to create, manage, and review employee authorizations online  Electronic creation of authorization forms  Print and email functionality to communicate authorizations to your employees  Search and archive functions  Enhanced security features protect your information  Access control  Database monitoring  Malware and virus protection  Intrusion detection and prevention Staff Qualifications Concentra carefully considers each project and its unique goals when assigning an account management team. We take a collaborative approach that combines local operational and clinical support to ensure quality and service excellence. The individuals we select will bring valuable, relevant experience to the program and provide ongoing support within their respective areas of expertise. We include their resumes as Attachment A – Staff Qualifications. Initial Contact Heidi Campbell, account executive, will serve as the City’s initial point of contact throughout the procurement and contracting phases. She will be responsible for ensuring Concentra colleagues know and understand the City’s program requirements and be available to answer any questions you may have throughout this initial phase of engagement. Operational Oversight Sandy Banda Baquera, MA, center operations director (COD) serves as the day-to-day contact for program operations. Ms. Banda Baquera regularly monitors processes and procedures to ensure ongoing compliance with applicable regulations and guidelines, as well as the City’s specific program Account Executive Heidi Campbell 18 years with Concentra Center Operations Directors Sandy Banda Baquera 6.5+ years with Concentra City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 7 specifications. She will be invaluable to the success of the program and is available to answer questions, address issues, and ensure the program continues to operate efficiently. Ms. Banda Baquera’s responsibilities include:  Serves as the liaison between Concentra and the City  Oversees day-to-day center operations  Implements and ensures ongoing compliance with operational policies, procedures, and training programs within the center  Manages patient care issues and other center issues requiring resolutions  Ensures a clear understanding of contract objectives and deliverables to ensure successful execution of programs and projects  Collaborates with center, area, and regional leadership teams to ensure we effectively deliver the agreed upon scope of work, monitor program outcomes, and maintain the City’s account Clinical Oversight Rosalinda Pineiro, MD, FAAFP, center medical director (CMD) provides primary oversight for clinical practices, ensuring continued compliance. Dr. Pineiro ensures that the medical interpretations and associated clearances comply with the most recent medical standards and guidelines, and adhere to applicable regulations. Her expertise relevant to the desired scope of work will be instrumental in the provision of services. Dr. Pineiro’s responsibilities include:  Reviewing all medical history and performing medical physical examinations  Understanding all medical surveillance requirements of DOT, the Occupational Safety and Health Administration (OSHA), the American with Disabilities Act (ADA), and other regulated examinations  Reporting the results of the medical evaluation to the employee, including any medical condition(s) identified during the evaluation  Providing the recommendation as to whether the employee is medically certified to safely perform the essential job tasks  Forwarding copies of any abnormal results, along with patient instructions regarding primary care follow-up, to individuals who were instructed to seek medical follow-up to address any medical conditions or abnormal laboratory results identified during the evaluation  Providing or arranging for a prescriptive rehabilitation and/or fitness program when indicated to aid in the employee’s recovery from illness or injury and enhance his/her ability to safely perform essential job tasks  Reviewing medical evaluations conducted by other clinicians  Reviewing individual medical evaluations and aggregate data to detect evidence of occupational exposure(s) or clusters of occupational disease Clinic Staff Concentra employs skilled and experienced health care professionals to deliver services relevant to our offering. Our staff includes any combination of physicians, mid-levels, nurses, physical therapists, radiology technicians, and medical assistants. Center Medical Director Rosalinda Pineiro, MD, FAAFP 22 years with Concentra City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 8 Clinical Professionals Concentra will only utilize qualified and appropriately licensed and credentialed clinical professionals to serve the occupational health needs of the City’s workforce. These professionals are skilled in their respective area of expertise and undergo extensive annual training in addition to continuing education classes. Furthermore, our clinical professionals are vigilant in applying their knowledge to recognize and diagnose potential exposures and resulting health issues. They regularly monitor OSHA, DOT, ADA, and other applicable federal and state regulations to ensure all associated services remain in compliance and adhere to best practice guidelines. Support Staff Concentra Medical Centers employ qualified support personnel whom we train and fully certify to perform their associated tasks. Specifically, our staff includes drug specimen collectors certified to perform DOT collections, certified breath alcohol technicians, National Institute for Occupational Safety and Health (NIOSH)-certified pulmonary function testers, Council for Accreditation in Occupational Hearing Conservation (CAOHC)-certified personnel to perform audiometric testing, certified radiologic technologists, certified medical assistants, and certified phlebotomists. Credentialing Practices All Concentra clinicians undergo a stringent credentialing process. Once the Credentials Committee Chair/Medical Advisor clears the candidate for hire/credentialing, we follow National Committee for Quality Assurance (NCQA) guidelines for credentialing, which require primary source verification of licensure, education and training, board certifications, and any provider sanctions. In addition, we perform a System for Award Management (SAM) query to identify if a candidate is barred from contracting with the federal government and use secondary sources (copies of documentation) to verify Drug Enforcement Administration (DEA) and state controlled substance certifications. Finally, we check the National Practitioner Databank for malpractice history and the Office of Inspector General (OIG) for Medicare/Medicaid sanctions. We re- credential our clinicians every three years and, in the interim, we monitor clinicians’ licensures to ensure that they remain active and current. All Concentra personnel, regardless of position, are required to have a background check consisting of a felony/misdemeanor check, Social Security validation and trace, national sex offender check (for staff rendering patient care), national criminal search, drug screen, and a check against the Office of Foreign Assets Control list. Commitment to Service Excellence Concentra’s customer service philosophy is focused on going above and beyond to deliver a superior patient experience. This philosophy is at the root of our core values and motivates Concentra team members in their ongoing pursuit of excellence. Concentra has a long and distinguished history and we are proud of our role in shaping the occupational health care consumer experience. More than a decade ago, we recognized that the people we served were expecting more and better services from their health care providers. As a result, Concentra took steps that would revolutionize care delivery and shift the paradigm to create a best-in-class occupational health care approach. We worked with leading consulting firms specializing in customer satisfaction to build and refine our methodology. We benchmarked our approach against other consumer-driven organizations (i.e. Southwest Airlines, Starbucks and Nordstrom), meeting with their executive teams and incorporating their City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 9 best practices. In addition, Concentra worked directly with Fred Reichheld, a Fellow at Bain & Company and the bestselling author of “The Loyalty Effect” and “The Ultimate Question 2.0” (see page 240 for Concentra reference) to create and shape our program. What started as a good business exercise became a virtual movement at Concentra. We:  Redesigned our medical centers for a more customer-friendly layout and look  Redefined our mission/vision/values  Developed our award-winning “Orange Book” – a ‘how to’ guide for Concentra team members with specific, common-sense actions that create great service  Established the Concentra Hall of Fame, recognizing colleagues who embody outstanding service and exemplify our core values  Introduced the net promoter score (NPS); we were among the first to do so in health care arena The impact of this effort and our commitment to delivering a superior experience is evident in our patient and customer satisfaction scores even today. Measuring Satisfaction As a leading national provider of occupational, urgent, preventive, and primary health care services, Concentra understands the importance of combining quality medicine with superior customer service. To track satisfaction, Concentra uses Net Patient Experience Rating (NPER) and Net Promoter Score (NPS) tools to gauge our performance.  The NPER asks employees details about their experience with Concentra following their most recent visit. We ask employees to rate us based on factors such as wait times, the condition of our clinic, and the quality of our team members.  The NPS is an index that measures overall satisfaction and customer loyalty. Consistently high NPS's indicate that our clinic is doing well and that employees can be expected to return and likely to refer other employees to our clinic. Because our goal is to optimize utilization, this is an important metric. Concentra began working with NPS in April of 2008, becoming one of the first health care companies to utilize this innovative measure which spans 23 industries and more than 250 brands. Concentra's rich culture embraces employee satisfaction as an anchor to our customer experience management program. This is important to employees who utilize our services today, and gives us meaningful information that we use to continually improve the breadth and quality of service we provide in the future. City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 10 B. References Concentra offers the following current client references for the City’s review. We encourage the City to contact these entities as they can attest to our ability to perform DOT medical exams like those requested in the City’s RFQ. We perform these listed services per each client’s specifications and in full compliance with all regulatory guidelines. Client References Entity Contact Name, Phone, Email Information Services Performed Benchmark Electrical Kim Page, 970.229.1885 kim@besemail.com DOT physicals with drug screens, injury care, pre-placement physicals with human performance evaluations Piersons Concrete Natalie Pierson 970.221.1509 natalie@piersonconcrete.com DOT physicals with regulated drug screens, injury care, return- to-work physicals Haz-Mat Response Josh Summers 303.520.8174 vripley@savatree.com DOT physicals Northern Colorado Yellow Cab Megan Kaliczak Megan.kaliczak@transdev.com DOT physicals City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 11 C. Fee Schedule Concentra appreciates the opportunity to present our proposed fee schedule for City’s DOT medical exams program. In the table, below, we provide our fee schedule. We affirm all information contained herein is current, complete, accurate, and remains valid for 90 days following the due date, December 15, 2017. Fee Schedule – DOT Physicals Year Price 1 2 3 4 5 $67.00/physical $68.50/physical $68.50/physical $70.00/physical $70.00/physical City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 12 D. Facilities and Locations Primary Facility Location Within the hundreds of clinics in operation nationwide, 18 are in Colorado and one is in the Fort Collins market. Concentra proposes our Fort Collins center to serve as the primary site for the City. This facility maintains the necessary equipment and staffing resources and employs clinicians who are thoroughly knowledgeable of all applicable state and federal regulations. We provide location and contact information for the Fort Collins center below. Concentra Medical Centers – Fort Collins Address 620 South Lemay Avenue Fort Collins, Colorado 80524 Contact Information Phone: 970.221.5811 Fax: 970.221.5817 Hours of Operation Monday – Friday, 7:00 a.m. – 7:00 p.m. Saturday, 9:00 a.m. – 1:00 p.m. Facility Layout Since inception, Concentra’s affiliated physicians and management have continued to evaluate the layout of our centers to ensure we design each location to promote the most efficient patient flow throughout each area. Therefore, the physical dimension, layout, and staffing of each Concentra Medical Center varies depending on the location. Our centers average in size between 3,100 and 9,000 square feet, maintain security services, most offer free parking on property or adjacent to the center, and all are handicapped- accessible and conform to all applicable federal, state, and local safety and disability laws. As described in the following table, each center’s layout consists of support/ common areas and clinical areas. Concentra Medical Centers Layout Support/Common Areas  Waiting Room – seating for patients with television and magazines  Business Office – work area for clerical staff  Manager Office  Break Room  Marketing Office  Restroom  Records Storage Area  Telephone/Electrical Area Clinical Areas City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 13 Concentra Medical Centers Layout Support/Common Areas  Procedure Rooms – for minor procedures  Exam Rooms  Lab Area – separate restrooms (ADA-compliant) for drug and alcohol collections, blood collection area  Breath Analysis/Exam Room – to maximize privacy for federally- mandated testing  Audio Testing Room – a single-person booth with a microprocessor  Physician’s Office  Physician Station –X-ray viewing areas and privacy to enter patient data into computer system  X-ray Facilities (with darkroom and file storage) – a full service X-ray room  Storage Area – for patient charts  Physical Therapy Area – with whirlpool, treatment areas, strength and flexibility equipment, hydroculator/freezer, and a wide variety of therapy modalities Examination Rooms Our examination rooms consist of the following:  Treatment Table  Foot Stool  Clinton Exam Stool  Oto/Opth Wall Unit  Sharps Container with Glove Holder  Sink/Soap Dispenser  Detecto Metal Trash Can  Chart Holder/Flag System Equipment All Concentra clinics maintain the necessary equipment to perform a variety of health care services, including physical examinations, functional testing, and drug and alcohol screening services. We maintain all equipment in accordance with appropriate guidelines, including, but not limited to, DOT, OSHA, ADA, and the Center for Disease Control. Concentra Medical Centers – Sample Equipment/Supply List Area Equipment/Supplies Audio  Acoustic system RE-125 mini booth  Audiometer/printer/simulator  Oscar (OtoCheck) Exam Room  Opthalmoscope Head-Wall  Wall mount aneroid Blood Pressure  Wall Unit Oto/Opth 3.5V w/ Handles Intake Room/Hall  Titmus eye vision w/slides DOT City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 14 Concentra Medical Centers – Sample Equipment/Supply List Area Equipment/Supplies Procedures Room  Aneroid, hand-held BP Cuff  Autoclave  Double pane built in X-ray viewer  EKG Atria 6100  IV Stand  Kick Bucket  Mayo stand  Opthalmic Buhr (Instramed)  Otoscope Head-Wall Power procedure table Base - NAVY  Power procedure table Top - NAVY  Sharps container, wall mount, with gloves  Slit lamp/Marcus table  Stress cart with shelf  Wall Unit Oto/Opth 3.5V w/ Handles  Wheel chair X-ray Room  Hot lamp X-ray  Single pane view box  X-ray Accessory Package (Hover for Detail)  X-ray Cassettes  X-ray equipment/accessories  X-ray High Volume Processor 201A  X-ray Tabletop Processor 101A City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 15 E. Signed Vendor Statement We include the City’s signed vendor statement as Attachment B – Signed Vendor Statement. City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 16 F. Sustainability Concentra appreciates the City’s commitment to providing a sustainable environment for its employees. Concentra affirms that if selected, we will put forth our best efforts to meet the City’s sustainability requirements as they pertain to our business operations. Our staff will support the City’s existing sustainability programs. Internally, Concentra maintains policies and procedures that support organizational sustainability goals and objectives. In the following table, we highlight our strategies for practicing environmental responsibility throughout our organization. Concentra’s Green Initiatives Recycling: Iron Mountain bins recycled by vendors regularly ♦ Office trash is separated by “wet trash” and “dry trash” at Concentra’s corporate office, and is recycled by the building's janitorial service/vendor (plastic, cans and paper are recycled) Energy Efficiency: Colleagues are instructed to power down computers at night in administrative office locations (unless specifically requested otherwise by IT for system maintenance, etc.) ♦ Lights in the corporate building are automatically shut off at 10:00 pm (except those required for emergency) if not shut off by an individual ♦ Energy efficient light bulbs are used (or are currently being placed) in offices and centers ♦ Purchase and use copiers with the capability of two-sided printing and energy- saving features Other Practices: A meeting “paper/presentation” policy has been created including guidelines on the reduction in copying, two-sided paper usage, etc. for meetings and presentations ♦ “Green” notice placed on emails: “Before printing, please consider the environment” ♦ Old equipment and furniture is donated to resale stores or otherwise reused/recycled ♦ Request janitorial vendors and service providers use environmentally friendly products City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 17 G. Attachments In this section, Concentra includes the following information for the City’s review:  Attachment A – Staff Qualifications  Attachment B – Signed Vendor Statement  Attachment C – Legal and Risk Documents City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 18 Attachment A Staff Qualifications Heidi E. Campbell 3800 Pike Rd. 26-202 Longmont CO 80503 HECampbell@concentra.com Cell 303-918-5013 August 2017-Present Account Executive Concentra Fort Collins, Boulder, Thornton Work for each clinic to sell Concentra services to employers in the surrounding areas. Hit monthly sales goals set for me. Communicate with each clinic on employers expectations of the center. Build relationships with employers by excellent communication and following up with employers starting the communication between them and the center operations director. September 2014-August Physical Therapy Operations/Front Office Specialist Concentra Boulder CO Work to organize, schedule and maintain a busy Physical Therapy and Front Office clinic through communication, follow up and problem solving. Build relationships with employer by providing communication on injured workers status, setting up new service packages and helping solve conflict appropriately. January 2013- July 2014/June 2008-November 2012 Personal Trainer 24 Hour Fitness/ Holy Family Memorial Wellness Center Denver CO /Manitowoc WI While at both jobs I introduced new programs to the centers that helped increase revenue for the clinic and my personal training business while building lasting relationships with prominent people in the community. Increased Personal Training revenue at the Wellness Center for the first time since opened and continued to pull new business in through referrals and different incentives that I created. September 2006-January 2008 Fitness Coordinator/Manager Two Rivers LIFE Fitness Center Two Rivers, WI Served on a corporate wellness committee to bring programs/wellness knowledge to company employees and the community. Helped increase club usage and revenue by creating new programs, monthly newsletters and working on a marketing strategy with the club owner. Ensured the daily operations of the fitness center went smoothly. Education: Bachelor of Science Exercise Science/Health Promotion UW Oshkosh Graduated May 2006 Current Professional Certifications FST Fascial Stretch Therapist since 2011 Stretch To Win Institute Tempe AZ Current CPR & AED Professional References available upon request SANDRA BANDA BAQUERA OBJECTIVE To obtain a full time position with opportunities for advancement, encourage my professional growth, and further my education within the field of Health Care Administration. SKILLS & ABILITIES Bilingual- English/Spanish, experience with Microsoft Office, reliable, accountable, excellent attendance, multitasker, client relations and communication, operations management, time card management, account maintenance/management, leadership and colleague management skills, Efficient time management, organized. Clinical Skills: EMR experience, phlebotomy skills, vaccine administration, acquiring patient vital signs, PFT/spirometry, EKGs, peak flows, and Audiograms. Certifications: CPR Certified, Certified Drug & Alcohol technician, CAOHC certified technician, Preceptor and trainer for new/current staff. Receptionist experience- Answering phones, scheduling, Checking patients in/out, experience with referrals, management of physician schedules. EXPERIENCE CENTER OPERATIONS DIRECTOR/MEDICAL ASSISTANT CONCENTRA NOVEMBER 2011- CURRENT Concentra has allowed me to progress within my professional career aspirations. I started as a Medical Assistant and within a year was promoted to a Back Office Lead position/ extended hours manager. My clinical skills were assessed yearly, and I was responsible for managing the other Medical Assistants. After 6 years with the company I received two additional promotions from Assistant Operations Director to now the Center Operations Director. My responsibilities include but are not limited to, operations management, patient facilitation, implementation of policies and procedures, Relationship building with clients, employers and patients. I manage most of our employer accounts through consistent communication, and maintenance any accounts as needed. MEDICAL ASSISTANT HERITAGE FAMILY MEDICINE APRIL 2015-OCTOBER 2015 Medical Assistant, also remained prn with Concentra during this time. Gained eMD’s EMR system skills. Clinical skills were exercised daily, performed in house lab tests, electronic prescription refills. The clinic was privately owned, and started going out of business which resulted in my short stay with the company. MEDICAL ASSISTANT GENERAL CARE MEDICAL CLINIC JANUARY 2011- NOVEMBER 2011 Gained clinical skills, obtained patient medical history and vital signs. Performed any available in-house testing requested by the physicians i.e. Spirometry, Respirator Fit Testing, EKG’s, phlebotomy, and vaccine administration. Became a certified drug and alcohol technician. Managed the schedule for the back office staff. MEDICAL ASSISTANT ALPINE FAMILY PRACTICE MAY 2010- JULY 2010 Externship for school was completed at this facility. Worked mostly on the OBGYN side of the facility, assisted with basic patient vitals, phlebotomy and vaccine administration. Assisted in numerous pelvic exams, and placements of IUD’s. SALES ASSOCIATE MACYS JULY 2008- MAY 2010 Worked as a sales associate, and department specialist. Gained customer services skills, as well as cash register experience. Managed inventory, and daily cash fund. PAGE 2 SALES ASSOCIATE ROCKY MOUNTAIN CHOCOLATE FACTORY OCTOBER 2006- JULY 2008/ JULY 2010-JULY 2013 Worked as a sales associate, and was promoted to a manager position. Was responsible for inventory management, employee schedules, hiring and termination of employees as well - as daily deposits. EDUCATION COLORADO CHRISTIAN UNIVERSITY, LOVELAND, CO PURSUING A BACHELORS DEGREE IN HEALTH CARE ADMINISTRATION I will be receiving a Bachelors Degree in Health Care Administration Summer of 2018. I will also plan on retaining a degree as RN-BSN in the future as well. ANTHEM COLLEGE, AURORA, CO MEDICAL ASSISTINT DIPLOMA Seven months of accelerated courses towards my Medical Assisting Diploma with a month and half of full time externship worked. Graduated with honors in excellent grades as well as attendance. Was also able to participate in the Channel 9 News health fair for phlebotomy experience. FORT COLLINS HIGH SCHOOL, FORT COLLINS, CO HIGH SCHOOL DIPLOMA DIPLOMA General education, completed all years of high school. REFERENCES JEFF WINKLER, PHYSICIAN ASSISTANT CONCENTRA MEDICAL CENTER 970-430-1917 LEANNE CHACON, OFFICE MANAGER GENERAL CARE MEDICAL CENTER 970-213-2235 JULIE BALDERSON, PHYSICIAN ASSISTANT CONCENTRA MEDICAL CENTER 970-290-4329 CHARLES RAEL OPERATIONS DIRECTOR CONCENTRA MEDICAL CENTER 970-286-9633 ROSALINDA PINEIRO, MD MEDICAL DIRECTOR CONCENTRA MEDICAL CENTER 970-221-5811 To become Board Certified, a physician must achieve expertise in a medical specialty or subspecialty that meets the profession-driven standards and requirements of one (or more) of the 24 ABMS certifying boards. To maintain Board Certification, the certifying boards may require physicians, depending on their date of initial certification, to participate in on-going programs of continuing learning and assessment (Maintenance of Certification) designed to help them remain current in an increasingly complex practice environment. Rosalinda Pineiromora ( ABMSUID - 345165 ) Viewed:10/3/2017 5:15:30 PM CST DOB: Private Education: 1982 MD (Doctor of Medicine) Address: Private Fort Collins, CO 80524-3543 (United States) Individual NPI : 1528183050 Certification: 1 NPI: Not for Primary Source Verification (PSV). 2 State of Licensure provided by Federation of State Medical Boards (FSMB): Not for Primary Source Verification (PSV). ABMS ® Board Certification Credentials Profile A service provided by the American Board of Medical Specialties New Search | Search Results | Email For Feedback | Save Physician | Print Profile Show Active Medical License(s) : American Board of Family Medicine Family Medicine - General Status: Certified Status Duration Occurrence Start Date - End Date Reverification Date Participating in MOC Active MOC Recertification 11/17/2016 - 02/15/2018 Yes Expired Time-Limited Recertification 12/03/2005 - 12/31/2015 Expired Time-Limited Recertification 07/10/1998 - 12/31/2005 Expired Time-Limited Initial Certification 07/10/1992 - 12/31/1999 Learn more about Family Medicine MOC program Notice: It is up to the user to determine if the physician record obtained from this service is that of the physician being sought. With the exception of our Medical Specialists Online (MSO) product, all information as presented by ABMS Solutions products are approved for business use and are considered Primary Source Verified (PSV) and meet the primary source verification requirements as set by The Joint Commission, NCQA, URAC and other key accrediting agencies. The ABMS physician specialty certification data provided by ABMS Solutions/CertiFACTS Online is proprietary and copyrighted by the American Board of Medical Specialties (ABMS ® ) and subject to the intellectual property laws of the United States. © 2017, ABMS Solutions, LLC, All Rights Reserved. Product names and logos are all marks of the American Board of Medical Specialties. 1 2 ABMS Board Certification Credentials Profile Page 1 of 1 https://certifacts.abms.org/DCReport.aspx?singleresult=true&abmsuid=345165 10/3/2017 Lookup Detail View Licensee Information This serves as primary source verification* of the license. *Primary source verification: License information provided by the Colorado Division of Professions and Occupations, established by 24-34-102 C.R.S. Name Public Address Rosalinda Pineiro 620 S Lemay Ave Fort Collins, CO 80524-3543 Credential Information License Number License Method License Type License Status Original Issue Date Effective Date Expiration Date DR.0033954 Original Physician Active 08/19/1994 05/01/2017 04/30/2019 Supervision Relationship Supervisor/Supervisee License Start Date Relationship Type Supervises Amber R Payne PA.0002011 06/25/2013 Supervisor Supervises Joel Willis Schwartzkopf PA.0002917 11/13/2014 Supervisor Supervises Julia Lynn Balderson PA.0000933 12/20/2013 Supervisor Board/Program Actions Discipline There is no Discipline or Board Actions on file for this credential. Generated on: 11/18/2017 7:56:58 AM Print Lookup Details Page 1 of 1 https://apps.colorado.gov/dora/licensing/Lookup/PrintLicenseDetails.aspx?cred=413224... 11/18/2017 City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 19 Attachment B Signed Vendor Statement City of Fort Collins ♦ No. 8637 DOT Medical Exams December 15, 2017 Page 20 Attachment C Legal and Risk Documents RFQ – DOT Medical Exams 2017 Page 1 of 15 REQUEST FOR QUOTE 8637 DOT MEDICAL EXAMS The City of Fort Collins is requesting quotes from qualified medical facilities to provide DOT medical exams. As part of the City’s commitment to Sustainable Purchasing, quotes submission via email is preferred. Quotes shall be submitted in a single Microsoft Word or PDF file under 20MB and e-mailed to: purchasing@fcgov.com. Quotes must be received before 3:00 p.m. (our clock), December 15, 2017 and referenced as Quote No. 8637. The City encourages all Disadvantaged Business Enterprises (DBEs) to submit quotes in response to all requests for quotes. No individual or business will be discriminated against on the grounds of race, color, sex, or national origin. It is the City’s policy to create a level playing field on which DBEs can compete fairly and to ensure nondiscrimination in the award and administration of all contracts. Questions concerning the scope of the quote should be directed to Jane Johnson, DOT Compliance Specialist, at jjohnson@fcgov.com. Questions regarding quote submittal or process should be directed to Beth Diven, Buyer at (970) 221-6216 or bdiven@fcgov.com All questions must be submitted in writing via email to Jane Johnson, with a copy to Beth Diven, no later than 12:00 PM our clock on December 11, 2017. Questions received after this deadline will not be answered. A copy of the RFQ may be obtained at www.rockymountainbidsystem.com. The City of Fort Collins is subject to public information laws, which permit access to most records and documents. Proprietary information in your response must be clearly identified and will be protected to the extent legally permissible. Quotes may not be marked ‘Proprietary’ in their entirety. All provisions of any contract resulting from this request for quote will be public information. New Vendors: The City requires new vendors receiving awards from the City to fill out and submit an IRS form W-9 and to register for Direct Deposit (Electronic) payment. If needed, the W-9 form and the Vendor Direct Deposit Authorization Form can be found on the City’s Purchasing website at www.fcgov.com/purchasing under Vendor Reference Documents. Sales Prohibited/Conflict of Interest: No officer, employee, or member of City Council, shall have a financial interest in the sale to the City of any real or personal property, equipment, material, supplies or services where such officer or employee exercises directly or indirectly any decision- Financial Services Purchasing Division 215 N. Mason St. 2nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707 fcgov.com/purchasing RFQ – DOT Medical Exams 2017 Page 2 of 15 making authority concerning such sale or any supervisory authority over the services to be rendered. This rule also applies to subcontracts with the City. Soliciting or accepting any gift, gratuity favor, entertainment, kickback or any items of monetary value from any person who has or is seeking to do business with the City of Fort Collins is prohibited. Collusive or sham quotes: Any quote deemed to be collusive or a sham quote will be rejected and reported to authorities as such. Your authorized signature of this quote assures that such quote is genuine and is not a collusive or sham quote. The City of Fort Collins reserves the right to reject any and all quotes and to waive any irregularities or informalities. Utilization of Award by Other Agencies: The City of Fort Collins reserves the right to allow other state and local governmental agencies, political subdivisions, and/or school districts to utilize the resulting award under all terms and conditions specified and upon agreement by all parties. Usage by any other entity shall not have a negative impact on the City of Fort Collins in the current term or in any future terms. Sustainability: Consulting firms/teams participating in the quote are to provide an overview of the organization’s philosophy and approach to Sustainability. In no more than two (2) pages please describe how your organization strives to be sustainable in the use of materials, equipment, vehicles, fuel, recycling, office practices, etc. The City of Fort Collins incorporates the Triple Bottom Line into our decision process by including economic (or financial), environmental, and social factors in our evaluation. The selected Service Provider shall be expected to sign the City’s standard Agreement without revision prior to commencing Services (see sample attached to this Quote). Sincerely, Gerry S. Paul Director of Purchasing RFQ – DOT Medical Exams 2017 Page 3 of 15 I. BACKGROUND AND OBJECTIVE A. Objective The City of Fort Collins is requesting quotes from qualified medical facilities to provide DOT medical exams. It is the City's intent to award contracts to the two lowest responsive and responsible bidders. The contracts will be for a one (1) year term which can be renewed for up to an additional four (4) one-year terms. Fees will be reviewed and negotiated on an annual basis ninety (90) days prior to each annual expiration date. An example of the City’s standard Services Agreement is included at the end of this RFQ for your reference. B. Background The City of Fort Collins is seeking vendors that are experienced in the medical requirements set forth by the Department of Transportation (DOT) in Section 391.41 and 391.43 including the Federal Motor Carriers Safety Administration (FMCSA) and the Federal Transit Administration (FTA) and their policies, regulations, requirements and guidelines. Medical examiners must be a member of the National Registry of Certified Medical Examiners. II. SCOPE OF WORK A. Services to Be Provided DOT Medical Exams B. Deliverables The medical examiner will furnish one copy of the results to the person who was examined and a complete Medical Examiner’s Certificate. The DOT Medical Exam long form and Medical Card should be emailed to the City of Fort Collins, DOT Compliance Specialist by the end of each business day that exams are conducted. C. Minimum Mandatory Requirements A DOT physical examination must be conducted by a licensed “medical examiner” listed on the FMCSA National Registry. We prefer a doctor of medicine but will also accept physicians assistants (PA) or advanced practice nurses (APN). D. HIPAA The medical examiner and their agents will safeguard Participants’ health records and other personal and confidential information to ensure that the information is not improperly disclosed and to comply with any applicable law, rule or regulation, including, but not limited to, regulations promulgated by the United States Department of Health and Human Services, pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) as the same may be amended from time to time (collectively the “HIPAA Regulations”), the Health Information Technology for Economic and Clinical Health (HITECH) Act, and other federal and state regulations governing the confidentiality of health information RFQ – DOT Medical Exams 2017 Page 4 of 15 III. QUOTE SUBMITTAL As part of your quote submittal package, please provide the following: A. Qualifications of your firm & staff B. Three references from other firms for whom you provide a similar service C. Fee Schedule D. General description of your facilities including locations E. Signed Vendor Statement RFQ – DOT Medical Exams 2017 Page 5 of 15 IV. VENDOR STATEMENT Vendor hereby acknowledges receipt of the City of Fort Collins Request for Quote and acknowledges that it has read and agrees to be fully bound by all of the terms, conditions and other provisions set forth in the RFQ. Additionally, Vendor hereby makes the following representations to City: a. All of the statements and representations made in this submittal are true to the best of the Vendor’s knowledge and belief. b. Vendor commits that it is able to meet the terms provided in this quote. c. This quote is a firm and binding offer, for a period of 90 days from the date hereof. d. Vendor further agrees that the method of award is acceptable. e. Vendor also agrees to complete the proposed Agreement with the City of Fort Collins within 30 days of notice of award. f. If contract is not completed and signed within 30 days, City reserves the right to cancel and award to the next lowest quote. g. Vendor acknowledge receipt of addenda. Firm Name: Physical Address: Remit to Address: Phone: Authorized Agent of Firm Name: Signature of Authorized Agent: Primary Contact for Project: Title: Email Address: Phone: Cell Phone: NOTE: VENDOR STATEMENT IS TO BE SIGNED & RETURNED WITH YOUR QUOTE. Official Purchasing Document Last updated 10/2017 RFQ – DOT Medical Exams 2017 Page 6 of 15 V. SAMPLE SERVICES AGREEMENT – FOR REFERENCE ONLY – DO NOT SIGN SERVICES AGREEMENT THIS AGREEMENT made and entered into the day and year set forth below by and between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter referred to as the "City" and , hereinafter referred to as "Service Provider". WITNESSETH: In consideration of the mutual covenants and obligations herein expressed, it is agreed by and between the parties hereto as follows: 1. Scope of Services. The Service Provider agrees to provide services in accordance with the scope of services attached hereto as Exhibit A, consisting of ( ) page(s) and incorporated herein by this reference. Irrespective of references in Exhibit A to certain named third parties, Service Provider shall be solely responsible for performance of all duties hereunder. 2. The Work Schedule. [Optional] The services to be performed pursuant to this Agreement shall be performed in accordance with the Work Schedule attached hereto as Exhibit , consisting of ( ) page(s), and incorporated herein by this reference. 3. Time of Commencement and Completion of Services. The services to be performed pursuant to this Agreement shall be initiated within ( ) days following execution of this Agreement. Services shall be completed no later than . Time is of the essence. Any extensions of the time limit set forth above must be agreed upon in a writing signed by the parties. 4. Contract Period. This Agreement shall commence , 20 , and shall continue in full force and effect until , 20 , unless sooner terminated as herein provided. In addition, at the option of the City, the Agreement may be extended for additional one year periods not to exceed ( ) additional one year periods. Renewals and pricing changes shall be negotiated by and agreed to by both parties. Written notice of renewal shall be provided to the Service Provider and mailed no later than thirty (30) days prior to contract end. 5. Delay. If either party is prevented in whole or in part from performing its obligations by unforeseeable causes beyond its reasonable control and without its fault or negligence, then the party so prevented shall be excused from whatever performance is prevented by such cause. To the extent that the performance is actually prevented, the Service Provider must provide written notice to the City of such condition within fifteen (15) days from the onset of such condition. 6. Early Termination by City/Notice. Notwithstanding the time periods contained herein, the City may terminate this Agreement at any time without cause by providing written notice of Official Purchasing Document Last updated 10/2017 RFQ – DOT Medical Exams 2017 Page 7 of 15 termination to the Service Provider. Such notice shall be delivered at least fifteen (15) days prior to the termination date contained in said notice unless otherwise agreed in writing by the parties. All notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to the following addresses: Service Provider: City: Copy to: Attn: City of Fort Collins Attn: PO Box 580 Fort Collins, CO 80522 City of Fort Collins Attn: Purchasing Dept. PO Box 580 Fort Collins, CO 80522 In the event of early termination by the City, the Service Provider shall be paid for services rendered to the date of termination, subject only to the satisfactory performance of the Service Provider's obligations under this Agreement. Such payment shall be the Service Provider's sole right and remedy for such termination. 7. Contract Sum. The City shall pay the Service Provider for the performance of this Contract, subject to additions and deletions provided herein, ($ ) as per the attached Exhibit " ", consisting of page(s), and incorporated herein by this reference. 8. City Representative. The City will designate, prior to commencement of the work, its representative who shall make, within the scope of his or her authority, all necessary and proper decisions with reference to the services provided under this agreement. All requests concerning this agreement shall be directed to the City Representative. 9. Independent Service provider. The services to be performed by Service Provider are those of an independent service provider and not of an employee of the City of Fort Collins. The City shall not be responsible for withholding any portion of Service Provider's compensation hereunder for the payment of FICA, Workmen's Compensation or other taxes or benefits or for any other purpose. 10. Subcontractors. Service Provider may not subcontract any of the Work set forth in the Exhibit A, Statement of Work without the prior written consent of the city, which shall not be unreasonably withheld. If any of the Work is subcontracted hereunder (with the consent of the City), then the following provisions shall apply: (a) the subcontractor must be a reputable, qualified firm with an established record of successful performance in its respective trade performing identical or substantially similar work, (b) the subcontractor will be required to comply with all applicable terms of this Agreement, (c) the subcontract will not create any contractual relationship between any such subcontractor and the City, nor will it obligate the City to pay or see to the payment of any subcontractor, and (d) the work of the subcontractor will be subject to inspection by the City to the same extent as the work of the Service Provider. 11. Personal Services. It is understood that the City enters into the Agreement based on the special abilities of the Service Provider and that this Agreement shall be considered as an agreement for personal services. Accordingly, the Service Provider shall neither assign any Official Purchasing Document Last updated 10/2017 RFQ – DOT Medical Exams 2017 Page 8 of 15 responsibilities nor delegate any duties arising under the Agreement without the prior written consent of the City. 12. Acceptance Not Waiver. The City's approval or acceptance of, or payment for any of the services shall not be construed to operate as a waiver of any rights or benefits provided to the City under this Agreement or cause of action arising out of performance of this Agreement. 13. Warranty. a. Service Provider warrants that all work performed hereunder shall be performed with the highest degree of competence and care in accordance with accepted standards for work of a similar nature. b. Unless otherwise provided in the Agreement, all materials and equipment incorporated into any work shall be new and, where not specified, of the most suitable grade of their respective kinds for their intended use, and all workmanship shall be acceptable to City. c. Service Provider warrants all equipment, materials, labor and other work, provided under this Agreement, except City-furnished materials, equipment and labor, against defects and nonconformances in design, materials and workmanship/workwomanship for a period beginning with the start of the work and ending twelve (12) months from and after final acceptance under the Agreement, regardless whether the same were furnished or performed by Service Provider or by any of its subcontractors of any tier. Upon receipt of written notice from City of any such defect or nonconformances, the affected item or part thereof shall be redesigned, repaired or replaced by Service Provider in a manner and at a time acceptable to City. 14. Default. Each and every term and condition hereof shall be deemed to be a material element of this Agreement. In the event either party should fail or refuse to perform according to the terms of this agreement, such party may be declared in default thereof. 15. Remedies. In the event a party has been declared in default, such defaulting party shall be allowed a period of ten (10) days within which to cure said default. In the event the default remains uncorrected, the party declaring default may elect to (a) terminate the Agreement and seek damages; (b) treat the Agreement as continuing and require specific performance; or (c) avail himself of any other remedy at law or equity. If the non-defaulting party commences legal or equitable actions against the defaulting party, the defaulting party shall be liable to the non-defaulting party for the non-defaulting party's reasonable attorney fees and costs incurred because of the default. 16. Binding Effect. This writing, together with the exhibits hereto, constitutes the entire agreement between the parties and shall be binding upon said parties, their officers, employees, agents and assigns and shall inure to the benefit of the respective survivors, heirs, personal representatives, successors and assigns of said parties. 17. Indemnity/Insurance. Official Purchasing Document Last updated 10/2017 RFQ – DOT Medical Exams 2017 Page 9 of 15 a. The Service Provider agrees to indemnify and save harmless the City, its officers, agents and employees against and from any and all actions, suits, claims, demands or liability of any character whatsoever brought or asserted for injuries to or death of any person or persons, or damages to property arising out of, result from or occurring in connection with the performance of any service hereunder. b. The Service Provider shall take all necessary precautions in performing the work hereunder to prevent injury to persons and property. c. Without limiting any of the Service Provider's obligations hereunder, the Service Provider shall provide and maintain insurance coverage naming the City as an additional insured under this Agreement of the type and with the limits specified within Exhibit , consisting of one (1) page, attached hereto and incorporated herein by this reference. The Service Provider before commencing services hereunder, shall deliver to the City's Purchasing Director, P. O. Box 580, Fort Collins, Colorado 80522, one copy of a certificate evidencing the insurance coverage required from an insurance company acceptable to the City. 18. Entire Agreement. This Agreement, along with all Exhibits and other documents incorporated herein, shall constitute the entire Agreement of the parties. Covenants or representations not contained in this Agreement shall not be binding on the parties. 19. Law/Severability. The laws of the State of Colorado shall govern the construction interpretation, execution and enforcement of this Agreement. In the event any provision of this Agreement shall be held invalid or unenforceable by any court of competent jurisdiction, such holding shall not invalidate or render unenforceable any other provision of this Agreement. 20. Prohibition Against Employing Illegal Aliens. Pursuant to Section 8-17.5-101, C.R.S., et. seq., Service Provider represents and agrees that: a. As of the date of this Agreement: 1. Service Provider does not knowingly employ or contract with an illegal alien who will perform work under this Agreement; and 2. Service Provider will participate in either the e-Verify program created in Public Law 208, 104th Congress, as amended, and expanded in Public Law 156, 108th Congress, as amended, administered by the United States Department of Homeland Security (the “e-Verify Program”) or the Department Program (the “Department Program”), an employment verification program established pursuant to Section 8- 17.5-102(5)(c) C.R.S. in order to confirm the employment eligibility of all newly hired employees to perform work under this Agreement. b. Service Provider shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or knowingly enter into a contract with a subcontractor that knowingly employs or contracts with an illegal alien to perform work under this Agreement. Official Purchasing Document Last updated 10/2017 RFQ – DOT Medical Exams 2017 Page 10 of 15 c. Service Provider is prohibited from using the e-Verify Program or Department Program procedures to undertake pre-employment screening of job applicants while this Agreement is being performed. d. If Service Provider obtains actual knowledge that a subcontractor performing work under this Agreement knowingly employs or contracts with an illegal alien, Service Provider shall: 1. Notify such subcontractor and the City within three days that Service Provider has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and 2. Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to this section the subcontractor does not cease employing or contracting with the illegal alien; except that Service Provider shall not terminate the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. e. Service Provider shall comply with any reasonable request by the Colorado Department of Labor and Employment (the “Department”) made in the course of an investigation that the Department undertakes or is undertaking pursuant to the authority established in Subsection 8-17.5-102 (5), C.R.S. f. If Service Provider violates any provision of this Agreement pertaining to the duties imposed by Subsection 8-17.5-102, C.R.S. the City may terminate this Agreement. If this Agreement is so terminated, Service Provider shall be liable for actual and consequential damages to the City arising out of Service Provider’s violation of Subsection 8-17.5-102, C.R.S. g. The City will notify the Office of the Secretary of State if Service Provider violates this provision of this Agreement and the City terminates the Agreement for such breach. 21. Special Provisions. Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit - Confidentiality, consisting of one (1) page, attached hereto and incorporated herein by this reference. Official Purchasing Document Last updated 10/2017 RFQ – DOT Medical Exams 2017 Page 11 of 15 THE CITY OF FORT COLLINS, COLORADO By: Gerry Paul Purchasing Director DATE: ATTEST: APPROVED AS TO FORM: SERVICE PROVIDER'S NAME By: Printed: Title: CORPORATE PRESIDENT OR VICE PRESIDENT Date: Official Purchasing Document Last updated 10/2017 RFQ – DOT Medical Exams 2017 Page 12 of 15 EXHIBIT A SCOPE OF SERVICES Official Purchasing Document Last updated 10/2017 RFQ – DOT Medical Exams 2017 Page 13 of 15 EXHIBIT (BID SCHEDULE/COMPENSATION) Official Purchasing Document Last updated 10/2017 RFQ – DOT Medical Exams 2017 Page 14 of 15 EXHIBIT INSURANCE REQUIREMENTS 1. The Service Provider will provide, from insurance companies acceptable to the City, the insurance coverage designated hereinafter and pay all costs. Before commencing work under this bid, the Service Provider shall furnish the City with certificates of insurance showing the type, amount, class of operations covered, effective dates and date of expiration of policies, and containing substantially the following statement: “The insurance evidenced by this Certificate will not reduce coverage or limits and will not be cancelled, except after thirty (30) days written notice has been received by the City of Fort Collins.” In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out and maintain, at the expense of the Service Provider, such insurance as the City may deem proper and may deduct the cost of such insurance from any monies which may be due or become due the Service Provider under this Agreement. The City, its officers, agents and employees shall be named as additional insureds on the Service Provider 's general liability and automobile liability insurance policies for any claims arising out of work performed under this Agreement. 2. Insurance coverages shall be as follows: A. Workers' Compensation & Employer's Liability. The Service Provider shall maintain during the life of this Agreement for all of the Service Provider's employees engaged in work performed under this agreement: 1. Workers' Compensation insurance with statutory limits as required by Colorado law. 2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee. B. Commercial General & Vehicle Liability. The Service Provider shall maintain during the life of this Agreement such commercial general liability and automobile liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of insurance for each coverage, Commercial General and Vehicle, shall not be less than $1,000,000 combined single limits for bodily injury and property damage. In the event any work is performed by a subcontractor, the Service Provider shall be responsible for any liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance. Official Purchasing Document Last updated 10/2017 RFQ – DOT Medical Exams 2017 Page 15 of 15 EXHIBIT CONFIDENTIALITY IN CONNECTION WITH SERVICES provided to the City of Fort Collins (the “City”) pursuant to this Agreement (the “Agreement”), the Service Provider hereby acknowledges that it has been informed that the City has established policies and procedures with regard to the handling of confidential information and other sensitive materials. In consideration of access to certain information, data and material (hereinafter individually and collectively, regardless of nature, referred to as “information”) that are the property of and/or relate to the City or its employees, customers or suppliers, which access is related to the performance of services that the Service Provider has agreed to perform, the Service Provider hereby acknowledges and agrees as follows: That information that has or will come into its possession or knowledge in connection with the performance of services for the City may be confidential and/or proprietary. The Service Provider agrees to treat as confidential (a) all information that is owned by the City, or that relates to the business of the City, or that is used by the City in carrying on business, and (b) all information that is proprietary to a third party (including but not limited to customers and suppliers of the City). The Service Provider shall not disclose any such information to any person not having a legitimate need-to-know for purposes authorized by the City. Further, the Service Provider shall not use such information to obtain any economic or other benefit for itself, or any third party, except as specifically authorized by the City. The foregoing to the contrary notwithstanding, the Service Provider understands that it shall have no obligation under this Agreement with respect to information and material that (a) becomes generally known to the public by publication or some means other than a breach of duty of this Agreement, or (b) is required by law, regulation or court order to be disclosed, provided that the request for such disclosure is proper and the disclosure does not exceed that which is required. In the event of any disclosure under (b) above, the Service Provider shall furnish a copy of this Agreement to anyone to whom it is required to make such disclosure and shall promptly advise the City in writing of each such disclosure. In the event that the Service Provider ceases to perform services for the City, or the City so requests for any reason, the Service Provider shall promptly return to the City any and all information described hereinabove, including all copies, notes and/or summaries (handwritten or mechanically produced) thereof, in its possession or control or as to which it otherwise has access. The Service Provider understands and agrees that the City’s remedies at law for a breach of the Service Provider’s obligations under this Confidentiality Agreement may be inadequate and that the City shall, in the event of any such breach, be entitled to seek equitable relief (including without limitation preliminary and permanent injunctive relief and specific performance) in addition to all other remedies provided hereunder or available at law. The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: CONCGRO-01 1 1 The Graham Company Occupational Health Centers of The Southwest PA c/o Select Medical Corporation 4716 Old Gettysburg Rd. Mechanicsburg PA 17055 25 CERTIFICATE OF LIABILITY INSURANCE KANSAS PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Continental Casualty Company - Policy #HAZ 4032244600-2; Effective 6/1/2017-2018 - $200,000 Each Medical Incident/$600,000 Aggregate Per Insured or Surgeon LOUISIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Columbia Casualty Company - Policy #HAZ 4032244614-2; Effective 6/1/2017-2018 - $100,000 Each Medical Incident/$300,000 Aggregate Per Insured or Surgeon NEBRASKA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Columbia Casualty Company - Policy #HAZ 4032244628-2; Effective 6/1/2017-2018 - $200,000 Each Medical Incident/$600,000 Aggregate Per Insured or Surgeon PENNSYLVANIA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Columbia Casualty Company - Policy #HAZ 4032244631-2; Effective 6/1/2017-2018 - $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon WISCONSIN PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Continental Casualty Company - Policy #HAZ 4032244659-2; Effective 6/1/2017-2018 - $1,000,000 Each Medical Incident/$3,000,000 Aggregate Per Insured or Surgeon PROPERTY COVERAGE: Risk of Physical Loss or Damage to Covered Property subject to policy terms and conditions. WORKERS COMPENSATION - Occupational Health Centers of California, A Medical Corporation - Policy #WA7-63D-510199-047; Effective: 6/1/2017-2018 WORKERS COMPENSATION - Occupational Health Centers of Southwest, P.A. - Policy #WA7-63D-510199-057 and WC7-631-510199-067; Effective: 6/1/2017-2018 ADDITIONAL WORKERS COMPENSATION POLICIES: OHC of Arkansas – Policy #WC7-631-510199-077; Effective: 6/1/2017-2018 OHC of Southwest (AZ/UT) – Policy #WC2-631-510199-117; Effective: 6/1/2017-2018 OHC of Delaware – Policy #WC2-631-510199-107; Effective: 6/1/2017-2018 OHC of Georgia/Hawaii – Policy #WC2-631-510199-177; Effective: 6/1/2017-2018 OHC of Illinois – Policy #WC2-631-510199-197; Effective: 6/1/2017-2018 OHC of Louisiana – Policy #WC2-631-510199-097; Effective: 6/1/2017-2018 OHC of Michigan – Policy #WC2-631-510199-187; Effective: 6/1/2017-2018 OHC of Nebraska – Policy #WC2-631-510199-147; Effective: 6/1/2017-2018 OHC of New Jersey – Policy #WC2-631-510199-137; Effective: 6/1/2017-2018 OHC of North Carolina – Policy #WC7-631-510199-087; Effective: 6/1/2017-2018 OHC of Southwest (KS) – Policy #WC2-631-510199-127; Effective: 6/1/2017-2018 Therapy Centers of Southwest I, PA (OR) - Policy #WC2-631-510199-167; Effective: 6/1/2017-2018 Therapy Centers of South Carolina, PA - Policy #WC2-631-510199-157; Effective: 6/1/2017-2018 CYBER LIABILITY - National Union Fire Insurance Company of Pittsburgh, PA - Policy #01-863-48-21; Effective 9/25/2016-2017 - Limit: $10,000,000 Security and Privacy Coverage is provided for all medical professionals employed or contracted by the above Named Insured, only while working for or on behalf of the above Named Insured. RE: OHC-SWPA/CMC IS BIDDING ON AN RFP UNDER # 8637 DOT MEDICAL EXAMS CITY OF FORT COLLINS IS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY, AUTOMOBILE LIABILITY AND EXCESS LIABILITY COVERAGES IF REQUIRED BY WRITTEN CONTRACT. PROPERTY DAMAGE $ $ $ $ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12/11/2017 The Graham Company The Graham Building 1 Penn Square West Philadelphia PA 19102- SelectMed Unit 215-567-6300 215-525-0243 SELECTMED_UNIT@grahamco.com Columbia Casualty Company 31127 CONCGRO-01 American Guarantee & Liability 26247 Occupational Health Centers of The Southwest PA c/o Select Medical Corporation 4716 Old Gettysburg Rd. Mechanicsburg PA 17055 Liberty Mutual Fire Insurance Company 23035 Allied World Assurance Company, Ltd. (DOMICILED Liberty Insurance Corporation 42404 780994633 A X 1,000,000 X 500,000 X Professional Lia 10,000 X $1M Claim/$3M Ag 1,000,000 3,000,000 X Y HAZ 4032244581-2 6/1/2017 6/1/2018 3,000,000 C 2,000,000 X Y AS2-631-510199-037 6/1/2017 6/1/2018 A X X 10,000,000 2,000,000 Y HMC 4032235752-2 X 10,000,000 6/1/2017 6/1/2018 E E N WA7-63D-510199-017 WC7-631-510199-027 6/1/2017 6/1/2017 6/1/2018 6/1/2018 X 1,000,000 1,000,000 1,000,000 B D Property Excess Liability ZMD0119116-02 C023701-003 6/1/2017 6/1/2017 6/1/2018 6/1/2018 SEE BELOW $10M Each Occurrence $10M Aggregate UMBRELLA LIABILITY COVERAGE includes Excess General Liability on an Occurrence Basis and Excess Professional Liability on a Claims Made Basis. Both Coverages are excess of a $2,000,000 Self-Insured Retention each Occurrence/Claim subject to a $10,000,000 Aggregate. PROFESSIONAL LIABILITY COVERAGE includes Case Management Services including the rendering of case management or utilization review performed by insured for others. INDIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Continental Casualty Company - Policy #HAZ 4032244595-2; Effective 6/1/2017-2018 - $250,000 Each Medical Incident/$750,000 Aggregate Per Insured or Surgeon See Attached... CITY OF FORT COLLINS PO BOX 580 ATTN: PURCHASING DIRECTOR FORT COLLINS CO 80522 NEW I400 Series  Scale with height measurer  Wall eye chart Physician Station  Desktop Oto/Opth 3.5v w/ handles  Holder - wall X-ray chart  Hot lamp X-ray  Ophthalmoscope head  Otoscope head  Printer (PFT machine)  Spirometer (PFT machine)  Return-to-work examinations *Where allowed by state law.