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PSA with Mount Sinai Medical Center of Florida, Inc. g PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF MIAMI BEACH AND MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. FOR MEDICAL SERVICES, PURSUANT TO RFP #2014-127-LR This Professional Services Agreement ("Agreement") is entered into this 16th day of February, 2015, ("Effective Date"), between the CITY OF MIAMI BEACH, FLORIDA, a municipal corporation organized and existing under the laws of the State of Florida, having its principal offices at 1700 Convention Center Drive, Miami Beach, Florida, 33139 ("City"), and Mount Sinai Medical Center of Florida, Inc., a Florida Corporation, whose address is 4300 Alton Road, Miami Beach, Florida 33140 (Consultant). SECTION 1 DEFINITIONS Agreement: This Agreement between the City and Consultant, including any exhibits and amendments thereto. City Manager: The chief administrative officer of the City. Consultant: For the purposes of this Agreement, Consultant shall be deemed to be an independent contractor, and not an agent or employee of the City. Services: All services, work and actions by the Consultant performed or undertaken pursuant to the Agreement. Fee: Amount paid to the Consultant as compensation for Services. Proposal Documents: Proposal Documents shall mean City of Miami Beach RFP No. 2014- 127-LR for Medical Services, together with all amendments thereto, issued by the City in contemplation of this Agreement (the RFP), and the Consultant's proposal in response thereto (Proposal), all of which are hereby incorporated and made a part hereof; provided, however, that in the event of an express conflict between the Proposal Documents and this Agreement, the following order of precedent shall prevail: this Agreement; the RFP, and the Proposal. Risk Manager: The Risk Manager of the City, with offices at 1700 Convention Center Drive, Third Floor, Miami Beach, Florida 33139: telephone number (305) 673-7000, Ext. 6435: and fax number(305) 673-7023. 1 SECTION 2 SCOPE OF SERVICES (SERVICES) 2.1 In consideration of the Fee to be paid to Consultant by the City, Consultant shall provide the work and services described in Exhibit"A" hereto (the Services). 2.2 Consultant's Services, and any deliverables incident thereto, shall be completed in accordance with the timeline and/or schedule in Exhibit "A" hereto. SECTION 3 TERM The term of this Agreement (Term) shall commence upon execution of this Agreement by all parties hereto, which shall be the effective date on page 1 hereof, and shall have an initial term of two (2) years, with three (3) one year renewal options, to be exercised at the City Manager's sole option and discretion, by providing Consultant with written notice of same no less than thirty(30) days prior to the expiration of the initial term Notwithstanding the Term provided herein, Consultant shall adhere to any specific timelines, schedules, dates, and/or performance milestones for completion and delivery of the Services, as same is/are set forth in the timeline and/or schedule referenced in Exhibit "A" hereto. SECTION 4 FEE 4.1 In consideration of the Services to be provided, Consultant shall be compensated based on the fees listed in Exhibit "B". 4.2 INVOICING Upon receipt of an acceptable and approved invoice, payment(s) shall be made within thirty (30) days for that portion (or those portions) of the Services satisfactorily rendered (and referenced in the particular invoice). Invoices shall include a detailed description of the Services (or portions thereof) provided, and shall be submitted to the City at the following address: City of Miami Beach Human Resources 1700 Convention Center Drive 3rd Floor Miami Beach, Florida 33139 Attention: Sonia Bridges Risk Manager 2 SECTION 5 TERMINATION 5.1 TERMINATION FOR CAUSE If the Consultant shall fail to fulfill in a timely manner, or otherwise violates, any of the covenants, agreements, or stipulations material to this Agreement, the City, through its City Manager, shall thereupon have the right to terminate this Agreement for cause. Prior to exercising its option to terminate for cause, the City shall notify the Consultant of its violation of the particular term(s) of this Agreement, and shall grant Consultant ten (10) days to cure such default. If such default remains uncured after ten (10) days, the City may terminate this Agreement without further notice to Consultant. Upon termination, the City shall be fully discharged from any and all liabilities, duties, and terms arising out of, or by virtue of, this Agreement. Notwithstanding the above, the Consultant shall not be relieved of liability to the City for damages sustained by the City by any breach of the Agreement by the Consultant. The City, at its sole option and discretion, shall be entitled to bring any and all legal/equitable actions that it deems to be in its best interest in order to enforce the City's right and remedies against Consultant. The City shall be entitled to recover all costs of such actions, including reasonable attorneys' fees. 5.1.2 TERMINATION FOR CONVENIENCE OF THE CITY The City may also, through its City Manager, and for its convenience and without cause, terminate the Agreement at any time during the term by giving written notice to Consultant of such termination; which shall become effective within thirty (30) days following receipt by the Consultant of such notice. If the Agreement is terminated for convenience by the City, Consultant shall be paid for any Services satisfactorily performed up to the date of termination; following which the City and Consultant shall be discharged from any and all liabilities, duties, and terms arising out of, or by virtue of, this Agreement. 5.3 TERMINATION FOR INSOLVENCY The City also reserves the right to terminate the Agreement in the event the Consultant is placed either in voluntary or involuntary bankruptcy or makes an assignment for the benefit of creditors. In such event, the right and obligations for the parties shall be the same as provided for in Section 5.2. 5.4 TERMINATION FOR NON-PAYMENT BY CITY If, following submittal of an invoice by Consultant pursuant to subsection 4.4 hereof, the City shall fail to make timely payment to Consultant for Services (of for portions of the Services) satisfactorily rendered, the Consultant shall provide written notice of such non-payment to the City Manager, and the City shall have ten (10) days from receipt of such notice to make payment of disputed amount to the Consultant. If such payment is not made within such ten (10) day period, then Consultant may terminate 3 the agreement without notice to the City, and Consultant shall be entitled to bring such legal and/or equitable actions as it deems necessary in order to collect the unpaid amounts due to it under this Agreement; provided, however, that in no event shall the City's liability or money damages exceed the amount referenced in Section 8 hereof; nor shall the City be liable to Consultant for any loss profits indirect and/or consequential damages. In the event the Consultant prevails in its action for non- payment against the City, it shall be entitled to recover all costs of such action, including reasonable attorney's fees. SECTION 6 INDEMNIFICATION AND INSURANCE REQUIREMENTS 6.1 INDEMNIFICATION Consultant agrees to indemnify and hold harmless the City of Miami Beach and its officers, employees, agents, and contractors, from and against any and all actions (whether at law or in equity), claims, liabilities, losses, and expenses, including, but not limited to, attorneys' fees and costs, for personal, economic or bodily injury, wrongful death, loss of or damage to property, which may arise or be alleged to have arisen from to the negligent acts, errors, omissions or other wrongful conduct of the Consultant, its officers, employees, agents, contractors, or any other person or entity acting under Consultant's control or supervision, in connection with, related to, or as a result of the Consultant's performance of the Services pursuant to this Agreement. To that extent, the Consultant shall pay all such claims and losses and shall pay all such costs and judgments which may issue from any lawsuit arising from such claims and losses, and shall pay all costs and attorney's fees expended by the City in the defense of such claims and leeses, including appeals. The parties agree that one percent (1%) of the total compensation to Consultant for performance of the Services under this Agreement is the specific consideration from the City to the Consultant for the Consultant's indemnity agreement. The provisions of this Section 6.1 and of this indemnification shall survive termination or expiration of this Agreement. 6.2 INSURANCE REQUIREMENTS The Consultant shall maintain and carry in full force during the Term, the following insurance: A. Worker's Compensation and Employer's Liability Insurance for all employees of the provider as required by Florida Statute 440. B. Commercial General Liability on a comprehensive basis in an amount not less than $1,000,000 combined single limit per occurrence and $2,000,000 in the aggregate, for bodily injury and property damage. City of Miami Beach must be shown as an additional insured with respect to this coverage. C. Professional Liability Insurance in an amount not less than $1,000,000 with the deductible per claim, if any, not to exceed 10% of the limit of liability. Original certificates of insurance must be submitted to the City's Risk Manager for approval (prior to any work and/or services commencing) and will be kept on file in the Office of the Risk Manager. The City shall have the right to obtain from the Consultant specimen copies 4 of such portions of any and all insurance policies necessary in the event that submitted certificates of insurance are inadequate to ascertain compliance with required coverage. The Consultant is also solely responsible for obtaining and submitting all insurance certificates for any sub-consultants. Compliance with the foregoing requirements shall not relieve the Consultant of the liabilities and obligations under this Section or under any other portion of this Agreement. The Consultant shall not commence any work and or services pursuant to this Agreement until all insurance required under this Section has been obtained and such insurance has been approved by the City's Risk Manager. SECTION 7 LITIGATION JURISDICTIONNENUE/JURY TRIAL WAIVER This Agreement shall be construed in accordance with the laws of the State of Florida. This Agreement shall be enforceable in Miami-Dade County, Florida, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for the enforcement of same shall lie in Miami-Dade County, Florida. By entering into this Agreement, Consultant and the City expressly waive any rights either party may have to a trial by jury of any civil litigation related to or arising out of this Agreement. SECTION 8 LIMITATION OF CITY'S LIABILITY The City desires to enter into this Agreement only if in so doing the City can place a limit on the City's liability for any cause of action, for money damages due to an alleged breach by the City of this Agreement, so that its liability for any such breach never exceeds the sum of $10,000. Consultant hereby expresses its willingness to enter into this Agreement with Consultant's recovery from the City for any damage action for breach of contract to be limited to a maximum amount of$10,000. Accordingly, and notwithstanding any other term or condition of this Agreement, Consultant hereby agrees that the City shall not be liable to the Consultant for damages in an amount in excess of $10,000 for any action or claim for breach of contract arising out of the performance or non-performance of any obligations imposed upon the City by this Agreement. Nothing contained in this section or elsewhere in this Agreement is in any way intended to be a waiver of the limitation placed upon the City's liability, as set forth in Section 768.28, Florida Statutes. 5 SECTION 9 [INTENTIONALLY DELETED] SECTION 10 GENERAL PROVISIONS 10.1 AUDIT AND INSPECTIONS Upon reasonable verbal or written notice to Consultant, and at any time during normal business hours (i.e. 9AM — 5PM, Monday through Fridays, excluding nationally recognized holidays), and as often as the City Manager may, in his/her reasonable discretion and judgment, deem necessary, there shall be made available to the City Manager, and/or such representatives as the City Manager may deem to act on the City's behalf, to audit, examine and/or inspect, any and all other documents and/or records relating to all matters covered by this Agreement. Consultant shall maintain any and all such records at its place of business at the address set forth in the "Notices" section of this Agreement. 10.2 [INTENTIONALLY DELETETD] 10.3 ASSIGNMENT, TRANSFER OR SUBCONSULTING Except for lab and other supporting clinical services, Consultant shall not subcontract, assign, or transfer all or any portion of any work and/or service under this Agreement without the prior written consent of the City Manager, which consent, if given at all, shall be in the Manager's sole judgment and discretion. Neither this Agreement, nor any term or provision hereof, or right hereunder, shall be assignable unless as approved pursuant to this Section, and any attempt to make such assignment (unless approved) shall be void. 10.4 PUBLIC ENTITY CRIMES Prior to commencement of the Services, the Consultant shall file a State of Florida Form PUR 7068, Sworn Statement under Section 287.133(3)(a) Florida Statute on Public Entity Crimes with the City's Procurement Division. 10.5 EQUAL EMPLOYMENT OPPORTUNITY In connection with the performance of the Services, the Consultant shall not discriminate against any employee or applicant for employment because of race, color, national origin, religion, sex, gender identity, sexual orientation, disability, marital and familial status, or age. 10.6 CONFLICT OF INTEREST The Consultant herein agrees to adhere to and be governed by all applicable Miami-Dade County Conflict of Interest Ordinances and Ethics provisions, as set forth in the Miami-Dade County Code, and as may be amended from time to time; and by the City of Miami Beach Charter and Code (as some may be amended from time to time); both of which are incorporated by reference herein as if fully set forth herein. The Consultant covenants that it presently has no interest and shall not acquire any interest, direct or indirectly, which could conflict in any manner or degree with the 6 performance of the Services. The Consultant further covenants that in the performance of this Agreement, no person having any such interest shall knowingly be employed by the Consultant. No member of or delegate to the Congress of the United States shall be admitted to any share or part of this Agreement or to any benefits arising there from. SECTION 11 NOTICES All notices and communications in writing required or permitted hereunder, shall be delivered personally to the representatives of the Consultant and the City listed below or may be mailed by U.S. Certified Mail, return receipt requested, postage prepaid, or by a nationally recognized overnight delivery service. Until changed by notice in writing, all such notices and communications shall be addressed as follows: TO CONSULTANT: Mount Sinai Medical Center of Florida, Inc. Attention: Linda Arama, Director 4300 Alton Road Miami Beach, Florida 33140 TO CITY: City of Miami Beach Sylvia Crespo-Tabak, Director Human Resources Department 1700 Convention Center Drive 3rd Floor Miami Beach, FL 33139 COPIES TO: City of Miami Beach Alex Denis, Director Procurement Department 1700 Convention Center Drive 3rd Floor Miami Beach, FL 33139 Notice may also be provided to any other address designated by the party to receive notice if such alternate address is provided via U.S. certified mail, return receipt requested, hand delivered, or by overnight delivery. In the event an alternate notice address is properly provided, notice shall be sent to such alternate address in addition to any other address which notice would otherwise be sent, unless other delivery instruction as specifically provided for by the party entitled to notice. Notice shall be deemed given on the day on which personally served, or the day of receipt by either U.S. certified mail or overnight delivery. 7 SECTION 12 MISCELLANEOUS PROVISIONS 12.1 CHANGES AND ADDITIONS This Agreement cannot be modified or amended without the express written consent of the parties. No modification, amendment, or alteration of the terms or conditions contained herein shall be effective unless contained in a written document executed with the same formality and of equal dignity herewith. 12.2 SEVERABILITY If any term or provision of this Agreement is held invalid or unenforceable, the remainder of this Agreement shall not be affected and every other term and provision of this Agreement shall be valid and be enforced to the fullest extent permitted by law. 12.3 ENTIRETY OF AGREEMENT The City and Consultant agree that this is the entire Agreement between the parties. This Agreement supersedes all prior negotiations, correspondence, conversations, agreements or understandings applicable to the matters contained herein, and there are no commitments, agreements or understandings concerning the subject matter of this Agreement that are not contained in this document. Title and paragraph headings are for convenient reference and are not intended to confer any rights or obligations upon the parties to this Agreement. 12.4 CONSULTANT'S COMPLIANCE WITH FLORIDA PUBLIC RECORDS LAW Pursuant to Section 119.0701 of the Florida Statutes, if the Consultant meets the definition of "Contractor" as defined in Section 119.0701(1)(a), the Consultant shall: a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order to perform the service; b) Provide the public with access to public records on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law; c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law; and d) Meet all requirements for retaining public records and transfer to the City, at no City cost, all public records created, received, maintained and/or directly related to the performance of this Agreement that are in possession of the Consultant upon termination of this Agreement. Upon termination of this Agreement, the Consultant shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the City in a format that is compatible with the information technology systems of the City. e) For purposes of this Article, the term "public records" shall mean all documents, papers, letters, maps, books, tapes, photographs, films, sound recordings, data processing software, or other material, regardless of the physical form, characteristics, or means of transmission, made or received pursuant to law or ordinance or in connection with the transaction of official business of the City. 8 Consultant's failure to comply with the public records disclosure requirement set forth in Section 119.0701 of the Florida Statutes shall be a breach of this Agreement. In the event the Consultant does not comply with the public records disclosure requirement set forth in Section 119.0701 of the Florida Statutes, the City may, at the City's sole discretion, avail itself of the remedies set forth under this Agreement and available at law. [REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK] 9 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their appropriate officials, as of the date first entered above. FOR CITY: CITY OF MIAMI BEACH, FLORIDA ATTEST: 11/By: I 6 � City Clerk Mayo j"��•l'L7''' ��^..:� ' a FOR CONSULTANT: INCORP'rI4R'`.ir �' "i � � I �� r � �: MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. ATTEST: 6 J / • / s By: - ' %if►A___ Secreta . Vice President ev,N ` �'a PA-Tr �1,� t,c-S V P rnGt ik cep Print Na a Print Name/Title 'APPROVED FORM &LANGUAGE &FOR EXECUTION City Attorney Date 10 EXHIBIT "A" SCOPE OF SERVICES Sinai Mount M E D I C A L C E N T E R SCOPE OF SERVICE A. GENERAL The Occupational Health Center will perform and review laboratory tests, x-rays, and other diagnostic tests as well as evaluate medical reports from other healthcare providers making appropriate recommendations as needed. Additionally, the Occupational Health Center will review special medical problems such as but not limited to contagious disease cases, return from sick leave evaluations, on-duty injuries, disability, and other medical issues as required and will provide reports and medical opinions when applicable. Other services will include counseling City employees and job applicants about personal medical conditions and providing referrals for appropriate follow-up care when necessary. The Occupational Health Center will supply the City with a Project Manager/primary contact, who will be assigned to address all questions and concerns of the City. The Project Manager will be available for pre-employment issues during business hours, Monday through Friday, 8:00 A.M. through 5:00 P.M. Additionally, the Program Coordinator, will act as the secondary contact person in case the Project Manager is unavailable. All staff providing services under this contract will be properly informed and trained on procedures, forms, changes, and requirements. Any special instructions will be communicated to all staff. The Occupational Health Center will evaluate all results and will report it to the City of Miami Beach, Human Resources Department within forty-eight (48) hours from the time the applicant or employee is first seen. All services will be available (7) days a week, twenty-four (24) hours a day. Actual service hours are open to negotiation. The Occupational Health Center will ensure the City of Miami Beach has the ability to schedule same day or next day appointments for all necessary services. 11 The Occupational Health Center will provide convenient parking adjacent to the Lowenstein Building at no cost to applicants, employees, and the City for individuals receiving services. The Occupational Health Center with the assistance of the City's Information Technology Department will develop up and utilize an electronic mail system compatible with the City. If requested by the City, all reports and other necessary communication will be distributed through this system. The Occupational Health Center will utilize City forms where required. We will review our own forms with the City, and allow for changes as needed. The Occupational Health Center will ensure that instructions, changes, and transfers of information and documents will be limited to those individuals designated by the City of Miami Beach Human Resources Director. The Occupational Health Center will provide immediate notification of"no-shows" or any problems with an individual's cooperation or compliance to designated City staff. The Occupational Health Center will give applicants deadlines for follow-up as determined by the City's policy. Individuals referred to the Occupational Health Center for reasonable suspicion or post- accident alcohol and/or drug testing will not have a waiting time that exceeds thirty (30) minutes. The Occupational Health Center will ensure the confidentiality of all records, information, and correspondence; verbal, electronic and written. The Occupational Health Center will offer applicants and employees locked, secure boxes for private articles and police weapons. The Occupational Health Center will submit a quarterly utilization summary report to the City. B. COMPREHENSIVE PHYSICAL EXAMINATIONS AND DRUG TESTING FOR PRE- . EMPLOYMENT AND PROMOTIONS The Occupational Health Center based on the physical requirements of the job description provided by the City, will conduct physical examinations and drug/alcohol testing, as required for pre-employment applicants and promotional employees. The Occupational Health Center will report results of the applicant's physical examination to the Human Resources Director's designee within forty-eight (48) hours from the time the applicants are first seen for results of their tuberculosis PPD test. 12 The Occupational Health Center will permit at least ten (10) appointments per day and provide capacity for up to twenty (20) appointments per day with three (3) days advance notice from the City. Occupational Health Center is flexible of all scheduling that is required by the City of Miami Beach. The Occupational Health Center will provide the City of Miami Beach with the ability to schedule same day or next day appointments for pre-employment examinations. The Occupational Health Center Medical Doctor will read Tuberculosis tests. Positive results will be read by a Medical Doctor and will not be referred to the Department of Health or other facility unless agreed to in writing by the City. In any case, there will be no additional charge to the applicant for this service. The Occupational Health Center will provide Police Officer and Firefighter applicant physical examinations which will include tests for evidence of heart disease, AIDS or HIV, Hepatitis, Pulmonary Tuberculosis, or Meningococcal Meningitis. C. MEDICAL RECORDS The Occupational Health Center will maintain health files for all City employees and applicants seen at its facilities. These files will include medical records related to City employees regarding injuries and accidents in accordance with all state and federal laws. Upon request by the City of Miami Beach Human Resources Director or their designee, we will provide medical records within twenty-four (24) hours of request. Medical records may only be released to the City of Miami Beach Human Resources Director, Risk Management Director, or their designees. All requests and designee assignments must be made and accepted in writing only (e-mail is acceptable). Upon awarding of the contract we will obtain all records from the current provider and will maintain those records provided. If this contract is awarded to another provider, all open medical and other records related to this contract will be delivered to the new provider within thirty (30) days of the expiration of the current provider's contract. The selected provider, if different from the current provider, will give copies of closed records within twenty-four hours of the request. D. PSYCHIATRIC SERVICES The Occupational Health Center upon request will be available to attend staff conferences, conduct on-site training, observe new police officers and firefighters or evaluate employees referred by the City and provide expert opinions, recommendations and reports related to the employee's psychological evaluations. 13 The Occupational Health Center, upon request, will be available to review and research psychological factors relating to personnel especially public safety. The Occupational Health Center, upon request, will be available to conduct stress- reduction meetings with spouses of Police personnel and other employees referred by the City. E. IMMUNIZATION PROGRAM The Occupational Health Center will administer an intradermal test for Tuberculosis exposure on all applicants. A chest x-ray may be done in lieu of an intradermal test for Tuberculosis. The Occupational Health Center will administer a Tetanus Toxoid Booster Immunization for Police Officers, Firefighters, Waste Collectors and Parks personnel. This may include other occupations depending on the job description or speculation and individual circumstances. The Occupational Health Center will administer Hepatitis B vaccine for those City employees with a potential risk exposure to infected blood or body fluids, as determined by the City. The Occupational Health Center will administer other vaccines that may be required such as measles, mumps and rubella vaccine, and any and additional vaccines, as required by local, state, or federal requirements, or by industry recommendations or guidelines or best practices. The Occupational Health Center will administer and make available, anti-viral medication against the AIDS virus for emergency responders according to current federal guidelines. These medications will be given within two hours of a significant exposure. The City's employees will have access to the administration of anti-viral medication on a twenty-four(24) hour basis. The Occupational Health Center will administer HIV/AIDS baseline tests to sworn Fire Department employees and perform other tests requested by the City to comply with future union contracts. 14 F. DRUG &ALCOHOL TEST PROGRAM The Occupational Health Center will conduct a Drug and Alcohol Test Program as required by local, state and federal law and regulations. The Occupational Health Center will staff a certified Substance Abuse Professional (SAP), Breath Alcohol Technician (BAT), Drug Screening Technician and Medical Review Officer (IMO) as defined by the U.S. Department of Transportation (DOT), Title 49 Code of Federal Regulations (CFR), and Part 40. The Occupational Health Center will conduct pre-employment drug and alcohol testing on all applicants, as well as conduct promotional drug and alcohol testing to all safety sensitive applicants before they actually perform safety sensitive functions for the first time. The Occupational Health Center will test annually approximately 350 Fraternal Order of Police, Williams Nichols Lodge, No.8 (FOP) employees, 60 Government Supervisors Association of Florida/OPEIU, Local 100 (GSA) employees, 440 American Federation of State, County and Municipal Employees, Local 1554 (AFSCME), and 190 International Association of Firefighters, Local 1510 (IAFF) bargaining unit employees, on an annual basis as well as conduct other random, unannounced or reasonable suspicion drug and/or alcohol testing as may be specified by the City. The Occupational Health Center will also test safety sensitive employees who drive vehicles that require Commercial Driver Licenses in accordance with Title 49 CFR, Part 40. The Occupational Health Center will conduct all alcohol and drug tests in compliance with procedures outlined out in 49 CFR, Part 40. The Occupational Health Center will also conduct random or unannounced drug and alcohol drug testing for all other City employees according to, the procedures set forth in Title 49 CFR, Part 40. The Occupational Health Center will conduct post-accident drug and alcohol drug testing as determined by the City. Mount Sinai Medical Center Emergency Department will be available twenty-four (24) hours a day, seven (7) days a week to conduct these tests. The Occupational Health Center will conduct testing on employees when the City observes behavior or appearance that is characteristic of drug use or abuse or alcohol use or misuse. The Occupational Health Center will conduct return-to-duty and follow-up drug and alcohol testing for employees who violate the City's drug free workplace standards at intervals determined solely by the City. 15 The Occupational Health Center will provide drug and alcohol testing services with licensed and certified personnel and laboratories as required by local, state, and federal law. Drug and Alcohol testing services will be overseen by the Medical Review Officer (MRO). The Occupational Health Center will conduct annual training for designated City employees on the Drug Free Workplace Act, including training on signs and symptoms of drug and/or alcohol abuse, if requested by the City. The Occupational Health Center will ensure proper and documented chain of custody during and after sample collection and testing. The Occupational Health Center will provide appropriately private facilities to conduct these tests, including locked, secured boxes for private articles and police weapons. G. FITNESS FOR DUTY EVALUATIONS Occupational Health Center will evaluate employees' ability to continue employment in their current capacity and to assess and recommend reasonable accommodation for which they may be qualified. This may include a physical examination, return to work evaluation, psychological and/or psychiatric evaluation, and/or any reports to be completed as requested by the City for fitness for duty. The Occupational Health Center will complete evaluations within two (2) working days of the request and on the same day in case of an emergency. A status report and recommendations will be forwarded to the City within twenty-four (24) hours of the appointment or receipt of test results. The Occupational Health Center shall assist the City in the evaluation and verification of Family Medical Leave requests as needed. H. PERFORMANCE CRITERIA AND EVALUATION The Occupational Health will meet with the City periodically each month to evaluate our performance based on the scope of services and feedback from employees, applicants and customer satisfaction by the Human Resources Department. The criteria to be rated will include, but is not limited to, responsiveness to the Cit4y's needs for pre- . employment, drug and alcohol screening, fitness for duty determinations, communication on all required results, and designated contact availability. The criteria to be rated may change based upon the needs of the City. The Occupational Health Center will make all efforts to remediate any services the City finds to have less than 80% compliance with any one item within the scope of services 16 over a thirty (30) day period. The City may utilize a fifteen (15.) day notice to correct such default. I. COMMUNICATION The Occupational Health Center will set up and utilize an electronic mail system compatible with the City's. All reports and other necessary communication will be utilized through this system. Any and all costs associated with the set up will be borne by Occupational Health Center. The Occupational Health Center will have qualified personnel available during all business hours to provide all services as outlined, including final physician sign-off for pre-employment examinations. All test results under the Scope of Services and the agreement will be communicated only to the Human Resources Director, or his/her designees, 17 EXHIBIT " B" FEES APPENDIX E "REVISED!! COST PROPOSAL FORM Fariure to.submit,Appendix A,Cost Proposal Form,in its,entirety and:fully executed`by the deadline established for the receipt of proposals will result in proposal being deemed non-responsive and being rejected. Proposer affirms that the prices stated on the tender form below represents the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance, The Cost Proposal Form shall be completed mechanically or, if manually, in ink. Cost Proposal Form completed in pencil shall be deemed non-responsive.All corrections on the Cost Proposal Form shall be initialed. F f it to=SeCf�Qti 0:500—Fees.590.graph=K) tconktgdescriptivti-;p,J.the'servi s•Incltid for ch ![i i ern bal.64 c • 1 Pre-Em•lo ment Ph stoats Each $ $ 3. 104-.00 a.Police end Fire 80 Each , ; ,90 /q D 616 00 b.General Em•fo ees 237 Each 7a-0O 1 06 1.0D 2 Immunization Services 350 Each $ $ a.Tetanus Toxoid Booster It 0 Each 31'o 0 $ — Q -- - b.He•atills B Vaccination corn•lefe series of three. 54 Each ►. 130 r®0 1'1 D20 •0 0 a He•atitis A&B Vaccination coin'late series of three. Each �- 3'�D•O 0 - — Q — d.Measles,Mum•s•and Rubella 0 Each .. 70 f 0 C) —0 — Anti-viral medlcatlon for HIV/Aids exposure 3 minimum 3da, su•pl . i Each ; , co,00 A 0290.04 — f 4 Chest X-ra O &k. . $lo r ( O — O 5 PPD Test 560 OM$ 10• 0 0 �' ZD•0o 6 EKG 5 Each $ 3S r 00 $ /75'. 0 0 , 7 Fitness for Cu Evaluations Each $ $ )! 4.00.00 a.Ph sica!and Drug/Alcohol Screens 7 Each . /.Z5.0© 875 f 00 b.Ps chol.•lcaUPs chiafric 3 Each P1? •00 5,D 5•o 0 Random,Reasonable Suspicion,Return to Work,and 8 Post-Accident Dru.and Alcohol Screenin•' 516 Each $ 35.o o $ t , O b 0.0© 9 Resonator Review and Clearance 3 Each $ b o r o o I$0.00 10 Mobil Unit — Clm • • 4 da $ x75,oo $ 3 500•o0 11 Cardiac Stress Test 0 & 4-50.00 '• -- 0 — 12 On-Site Service Tech Nurse or Ph ician Assistant 'O &a.i 1. GO 13 After Hours Diu+/Alcohol Testin'Technician 0 • Hcur 025.07 -- 0 14 After Hours Medical Personnel 1.0 Hour 150. 00 % 7500 r 00 x3 qtr :, R r a:-4 "'�� Z�F ^'��it.'�.; �}T�'k`a 1 S.'�;'�. }3 t.t $ .�•i� �s a�T}E„ 3" $ 4 Q r z\' r 7 v c ti s s �srt <r �' r 4'Ski.Y Sys } ,��i i -.`4Y1-fb r S. 1 u'x� T.,OTAL. $ 1 V `r DO • Miami Ee2ch (Liam fit' �-- v - RFP 2014-127-CR Appendix E-Page 1 CITY OF MIAMI BEACH ADDITIONAL SERVICE FEES: Audiometry Screening $30.00 Blood Alcohol Test $25.00 Hep A Titer $32.00 Hep B Titer $20.00 MMR Titer $45.00 Pregnancy Test $20.00 RFP NO . 2014- 127-LR AND ADDENDUMS MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov DEPARTMENT OF PROCUREMENT MANAGEMENT Tel: 305-673-7490 Fax: 786-394-4075 ADDENDUM NO. 4 REQUEST FOR PROPOSAL (RFP) NO. 2014-127-LR FOR MEDICAL SERVICES FOR PRE AND POST EMPLOYMENT SERVICES (the RFP) April 7, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. 1. REVISIONS: A. Deadline for the receipt of proposals is hereby changed to April 17, 2014 at 3:00 pm. B. Section 0300 Proposal Submittal Instructions and Format: Scope of Services Proposed, Submit detailed information addressing how proposer will achieve each portion of the scope of services and technical requirements outlined in Appendix C, Minimum Requirements and Specifications. Responses shall be in sufficient detail and include supporting documentation, as applicable, which will allow the Evaluation Committee to complete a fully review and score the proposed scope of services. C. Appendix E— Cost Proposal Form has been amended. Proposers are required to submit the amended Appendix E—Cost Proposal Form in order to be deemed responsive. 2. RESPONSES TO QUESTIONS RECEIVED: Q#1. Can you clarify the role of Medical Review Officer(MRO)? A#1. Please refer to the U.S. Department of Transportation (DOT), Code of Federal Regulations (CFR) Title 49, Part 40. Q#2. Tuberculosis PPD tests are to be read by the medical doctor, can this be done by the Medical Review Officer(MRO)? A#2. The PPD test can be read by any medical doctor licensed in the State of Florida. Q#3. Are the Breath Alcohol Tests (BAT)to be done on site? A#3. The BAT must be performed at the contractor's facility. Q#4. Can the Breath Alcohol Test be done by the Medical Review Officer(MRO)? A#4. Yes, if the MRO is certified as a BAT technician, he/she can conduct this test. Q#5. In terms of the 24/7, can it be someone on call? A#5. Yes, proposers can be on call but they must be accessible and on site within one hour. Page 1 of 1 RFP 2014-127-LR Medical Services for Pre and Post Employment Services Addendum No.4 Q#6. How about if there is an accident and that person is taken to the hospital. Who does the test, the hospital? A#6. The City prefers that the medical services provider conduct the post-accident drug and alcohol screen but recognizes that some hospitals may deny access to the patient. Q#7. Some hospitals will not allow contractor to conduct this test. A#7. True. The successful proposer's responsibility in this case is to inform appropriate hospital personnel of the need to conduct post-accident drug and alcohol screens. Most hospitals who deny access to the patients will run the tests themselves and the City will accept results. Q#8. Under Section C1, Minimum Requirements, Letter A, it states that the "Proposer shall document at least five (5) years providing services similar to those noted herein to at least one (1) public sector agency, state, county, or municipal government. Is this a must, as prospective proposer does not have the public sector experience requested herein? A#8. Yes, this is a mandatory requirement. Q#9. Can any services be subcontracted? For example, psychiatric services? What type of credentials would they need, psychologist or psychiatrist? A#9. The City prefers access to a psychiatrist, licensed to practice in the State of Florida and authorized to prescribe medications as needed. Q#10. Can you subcontract the psychiatrist? A#10. Yes, the prospective proposer can subcontract the psychiatric services. Q#11. As far as the subcontractor, what happens if the prospective proposer subcontracts with someone who does meet the minimum requirements of five (5) years providing similar services and at least one 1 q OY P 9 (1) public sector agency, state, county or municipal, would that count towards meeting the requirements for both the prime and subcontractor? A#11. Both the prime and subcontractor must meet the minimum requirements of the solicitation. Q#1 2. Prospective Proposer requested and received via an Addendum a copy of the current provider's rates and noticed that those cost and description are broken down more than in the current RFP, is there a reason? Can the cost proposal be revised to more closely follow the breakdown of categories listed in Appendix C, Letter K, Fees, as this will allow proposers to better provide a cost for each individual item listed under these categories? A#13. Yes, the City has revised Appendix E, Cost Proposal, to provide prospective proposers the ability to provide more accurate fees for each area. Appendix E — Cost Proposal Form has been amended. Proposers are required to submit the amended Appendix E —Cost Proposal Form in order to be deemed responsive. Q#14. Prospective Proposers finds that the City included numerous categories into letter "f" that are hard to measure and provide a cost, can the City revise the cost proposal to allow prospective proposers the ability to provide individual cost for the numerous areas covered under letter"f". A#14. Yes, the City has revised Appendix E, Cost Proposal. Proposers are required to submit the amended Appendix E—Cost Proposal Form in order to be deemed responsive. 2 I Page • 1 RFP 2014-127-LR Medical Services for Pre and Post Employment Services Addendum No.4 Q#15. In the Police and Fire Fighter physical you will then need to add the EKG right? On the pre you will need to add an EKG? A#15. Yes, these items have been included in the revised cost proposal. Q#16. The City did not include anything on the RFP as far as the need for a stress test? A#16. Stress tests are conducted on a case-by-case basis as ordered by the medical doctor evaluating the patient. Q#17. Are the based prices listed on the current contract dating back to 2010? A#17. Yes, the prices noted are for 2010, when the contract was executed. Q#18. You mention promotional PPD, drug test, etc., nowhere is it mentioned in the RFP? Are you lumping this as well, if so, what is your volume for promotional testing? A#18. Promotional tests are limited to drug and alcohol use/misuse screens. Q#19. This promotional testing is only for drugs, not alcohol? A#19. Promotional testing is for both drugs and alcohol. Q#20. Can the City breakdown of the cost of the Mobil Unit by PPD, Hepatitis B and C, TB, etc., as the cost for Hepatitis B and C are considerably different? A#20. The Hepatitis B and C series are not administered using the Mobil Unit. Q#21. Will the employees require flu shots? A#21. No, employees will not require flu shots. Q#22. The thirty (30) minutes is the expected maximum wait time for any employee once they arrive. Also, the expectations are that upon notification the selected proposer will respond within one (1) hour? A#22. Yes, upon notification by the City it is expected that the proposer will respond within one (1) hour, and the employee's expected maximum wait time is no more than thirty (30) minutes after they arrive. Q#23. On Appendix C, Page 7, under Section K— Fees (b) Police/Firefighter pre-employment physicals #16, OSHA complaint PA/LAT. Is the City requesting Chest X-Rays PA/LAT? A#23. Yes, the City is requesting PA/LAT chest x-rays. PA chest x-rays are post anterior and LAT are lateral x-rays, both are needed. Q#24. On Appendix C, Page 7, Section K — Fees (b) Police/Firefighter pre-employment physicals #17, Chest X- Ray with Cardiologic Interpretation, is the City requesting a Radiology interpretation? A#24. Yes, the radiologist needs to read the x-rays and provide findings. Q#25. Are questions 16 and 17 the same? Question 16 is the X-Ray itself and 17 is the interpretation? A#25. Yes, questions 16 and 17 are the same, with question 16 being the x-ray itself and question 17 the interpretation. 3IPage RFP 2014-127-LR Medical Services for Pre and Post Employment Services Addendum No.4 Q#26. How many psychological or psychiatric evaluations were performed during the current contract? A#26. There were a total of three (3) psychological or psychiatric evaluations performed during the current contract. Q#27. Out of the 350 employees that might have been immunized, what is the volume for the following? • Tetanus toxoid • Hepatitis B Vaccine (complete series of 3) • Hepatitis A& B Vaccine (complete series of 3) • Measles, Mumps and Rubella • Anti Viral medication for HIV/Aids exposure A#27. The volume for the immunizations is as follows: • Tetanus toxoid—0 • Hepatitis B Vaccine (complete series of 3)—54 • Hepatitis A& B Vaccine(complete series of 3)—0 • Measles, Mumps and Rubella—0 • Anti Viral medication for HIV/Aids exposure—1 Q#28. What is the employee volume for annual PPD screening? A#28. The average employee volume for annual PPDs is 560. Q#29. On the cost proposal form the following is not listed. Also, what is the volume for the series below from the current contract? • PPD • CXR • Post Exposure Exam • SAP Evaluations • Psychiatric Services • After hour medical personnel A#29. The volume is as follows: • PPD- 560 • CXR- 0 • Post Exposure Exam - 1 • SAP Evaluations- 10 • Psychiatric Services -3 • After hour medical personnel—50 Q#30. On Proposal Submittal Instructions and Format, Tab 4 — Approach and Methodology. Is the information in Tab 3 and Tab 4, the same? If not, can you please clarify the information that is needed more clearly? A#30. No, these two tabs are not the same. Tab 3, should be entitled Scope of Services. Please see revisions as noted above. Tab 3, Proposers shall submit information addressing how it will achieve each portion of the scope of services. In Tab 4, Proposers will address their approach and methodology in order to accomplish the scope of services. 4 I Page I ' RFP 2014-127-LR Medical Services for Pre and Post Employment Services Addendum No.4 Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado @miamibeachfl.gov Contact: Telephone: Email: Lourdes Rodriguez 305-673-7000 ext. 6652 LourdesRodriguez @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Sits er , ,al.&&x-Denis P 1ocurerryeR Director 5IPage APPENDIX E "REVISED" COST PROPOSAL FORM Failure to submit Appendix A,Cost Proposal Form, in its entirety and fully executed by the deadline established for the receipt of proposals will result in proposal being deemed non-responsive and being reected. Proposer affirms that the prices stated on the tender form below represents the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance. The Cost Proposal Form shall be completed mechanically or, if manually, in ink. Cost Proposal Form completed in pencil shall be deemed non-responsive. All corrections on the Cost Proposal Form shall be initialed. Refer to Section 0500 —Fees (paragraph K) for a complete description of the services included on each line item below. 1 Pre-Employment Physicals Each $ $ a. Police and Fire 80 Each b. General Employees 237 Each 2 , Immunization Services 350 Each $ $ a. Tetanus Toxoid Booster Each b. Hepatitis B Vaccination(complete series of three). 54 Each c. Hepatitis A&B Vaccination(complete series of three). Each d.Measles, Mumps and Rubella Each Anti-viral medication for HIV/Aids exposure 3 (minimum 3 day supply). 1 Each 4 Chest X-ray 5 PPD Test 6 EKG 5 Each $ $ 7 Fitness for Duty Evaluations Each $ $ a. Physical and Drug/Alcohol Screens 7 Each b. Psychological/Psychiatric 3 Each Random, Reasonable Suspicion, Return to Work,and 8 Post-Accident Drug and Alcohol Screening 516 Each $ $ 9 Respirator Review and Clearance 3 Each $ $ 10 Mobil Unit 4 day $ $ 11 Cardiac Stress Test 12 On-Site Service Tech(Nurse or Physician Assistant) 13 After Hours Drug/Alcohol Testing Technician , Hour 14 After Hours Medical Personnel Hour TOTAL $ Miami Beach RFP 2014-127-LR Appendix E—Page 1 Bidders Affirmation Company: Authorized Representative: Address: Telephone: Email: Authorized Representative's Signature: Miami Beach RFP 2014-127-LR, Appendix E—Page 2 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfl.gov DEPARTMENT OF PROCUREMENT MANAGEMENT Tel: 305-673-7490 Fax: 786-394-4075 ADDENDUM NO. 3 REQUEST FOR PROPOSAL(RFP) NO. 2014-127-LR FOR MEDICAL SERVICES FOR PRE AND POST EMPLOYMENT SERVICES (the RFP) March 28, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. 1. REVISION: Deadline for the receipt of proposals is hereby changed to April 11, 2014 at 3:00 pm. Deadline for the receipt of questions is hereby changed to April 4, 2014. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Contact: Telephone: Email: Lourdes Rodriguez 305-673-7000 ext. 6652 LourdesRodriguez @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Si erel , ---AT-x Denis • Procurement Director (P),, MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfl.gov DEPARTMENT OF PROCUREMENT MANAGEMENT Tel: 305-673-7490 Fax: 786-394-4002 ADDENDUM NO. 2 REQUEST FOR PROPOSAL NO. 2014-127-LR FOR MEDICAL SERVICES FOR PRE AND POST EMPLOYMENT SERVICES (the RFP) March 13, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. 1. RESPONSES TO QUESTIONS RECEIVED: Q#1: Can Prospective Proposer supply the City with financial reports since we don't report to Dun & Bradstreeet? A#1: No, the Dun & Bradstreet Supplier Qualification Report (SQR) is a requirement of the RFP. As requested in the solicitation document under Section 0300, Number 3. Proposal Format, Tab 2, no proposal will be considered without receipt, by the City, of the SQR directly from Dun & Bradstreet. For assistance with any portion of the SQR submittal process, contact Dun & Bradstreet at 800-424-2495. Q#2: Can the City provide Prospective Proposer with the current provider's pricing? A#2: Yes, please refer to the current contract attached, Exhibit B — Final Negotiated Fee Schedule. Q#3: How many times will the Mobile Health Unit be required per contract year? A#3: The City has not used the Mobile Unit under the current contract. However,the City has had the current provider's staff at Fire Station 2 to conduct the annual PPD testing, which could be construed as a Mobile Unit. The PPD testing is scheduled every other day, for a three (3) week period,for a total of twelve (12)site visits. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado @m iam ibeachfl.gov Contact: Telephone: Email: Lourdes Rodriguez 305-673-7000 ext. 6652 LourdesRodriguez @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Bidders"questionnaire with the reason(s)for not submitting a proposal. Sinerely, 0111,P •x Denis P ocurement Director RFP No. 2014-127-LR Addendum#2 3/17/2014 PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF MIAMI BEACH AND WORK INJURY SOLUTIONS OF DADE COUNTY, INC. d/bla HEALTH CARE CENTER OF MIAMI FOR MEDICAL SERVICES PURSUANT TO REQUEST FOR PROPOSALS (RFP) NO. 46-09/10 This Professional Services Agreement ("Agreement") is entered into this 1st day of December, 2010, between the CITY OF MIAMI BEACH, FLORIDA, a municipal corporation organized and existing under the laws of the State of Florida, having its principal offices at 1700 Convention Center Drive, Miami Beach, Florida, 33139 ("City"), and WORK INJURY SOLUTIONS OF DADE COUNTY, INC. d/b/a HEALTH CARE CENTER OF MIAMI, a Florida CORPORATION, whose address is 7911 NW - 72"d AVENUE, SUITE 111, MIAMI, FL 33166 (Consultant). SECTION 1 DEFINITIONS Agreement: This Agreement between the City and Consultant, including any exhibits and amendments thereto. City Manager: The chief administrative officer of the City. Consultant: For the purposes of this Agreement, Consultant shall be deemed to be an independent contractor, and not an agent or employee of the City. Services: All services, work and actions by the Consultant performed or undertaken pursuant to the Agreement. Fee: Amount paid to the Consultant as compensation for Services. Proposal Documents: Proposal Documents shall mean City of Miami Beach RFP No. 46- 09/10 for a Medical Services Provider for the Provision of Various Medical Services that may be Necessary or Required by the City of Miami Beach, Local, State, and Federal Laws, together with all amendments thereto issued by the City, and the Consultant's proposal in response thereto (Proposal), all of which are hereby incorporated and made a part hereof; provided, however, that in the event of an express conflict between the Proposal Documents and this Agreement, the following order of precedent shall prevail: this Agreement; the City's RFP; and the Proposal. i Risk Manager: The Risk Manager of the City, with offices at 1700 Convention Center Drive, Third Floor, Miami Beach, Florida 33139: telephone number (305) 673-7000, Ext. 6435: and fax number(305) 673-7023. 1 1 SECTION 2 SCOPE OF SERVICES (SERVICES) 2.1 In consideration of the Fee to be paid to Consultant by the City, Consultant shall provide the work and services described in Exhibit "A" hereto (the Services). SECTION 3 TERM The term of this Agreement (Term) shall commence on December 1, 2010 (the Effective Date) of this Agreement by all parties hereto, and shall have an initial term of two (2) years, with three (3) one year renewal options, to be exercised at the City Manager's sole option and discretion, by providing Consultant with written notice of same no less than thirty (30) days prior to the expiration of the initial term. SECTION 4 FEE 4.1 Consultant shall be compensated for the Services as set forth in accordance with its Price Proposal, as attached hereto and incorporated herein as Exhibit"B". 4.2 INVOICING • Upon receipt of an acceptable and approved invoice, payment(s) shall be made within thirty (30) days for that portion (or those portions) of the Services satisfactorily rendered (and referenced in the particular invoice). Invoices shall include a detailed description of the Services (or portions thereof) provided, and shall be submitted to the City at the following address: City of Miami Beach Human Resources Department Attn: Sue Radig, HR Administration l • 1700 Convention Center Drive Miami Beach, FL 33139 SECTION 5 TERMINATION 5.1 TERMINATION FOR CAUSE If the Consultant shall fail to fulfill in a timely manner, or otherwise violates, any of the covenants, agreements, or stipulations material to this Agreement, the City, through its City Manager, shall thereupon have the right to terminate this Agreement for cause. Prior to exercising its option to terminate for cause, the City shall notify the Consultant of its violation of the particular term(s) of this Agreement, and shall grant 2 Consultant ten (10) days to cure such default. If such default remains uncured after ten (10) days, the City may terminate this Agreement without further notice to Consultant. Upon termination, the City shall be fully discharged from any and all liabilities, duties, and terms arising out of, or by virtue of, this Agreement. Notwithstanding the above, the Consultant shall not be relieved of liability to the City for damages sustained by the City by any breach of the Agreement by the Consultant. The City, at its sole option and discretion, shall be entitled to bring any and all legal/equitable actions that it deems to be in its best interest in order to enforce the City's right and remedies against Consultant. The City shall be entitled to recover all costs of such actions, including reasonable attorneys' fees. 5.2 TERMINATION FOR CONVENIENCE OF THE CITY THE CITY MAY ALSO, THROUGH ITS CITY MANAGER, AND FOR ITS CONVENIENCE AND WITHOUT CAUSE, TERMINATE THE AGREEMENT AT ANY TIME DURING THE TERM BY GIVING WRITTEN NOTICE TO CONSULTANT OF SUCH TERMINATION; WHICH SHALL BECOME EFFECTIVE WITHIN THIRTY(30) DAYS FOLLOWING RECEIPT BY THE CONSULTANT OF SUCH NOTICE. IF THE AGREEMENT IS TERMINATED FOR CONVENIENCE BY THE CITY, CONSULTANT SHALL BE PAID FOR ANY SERVICES SATISFACTORILY PERFORMED UP TO THE DATE OF TERMINATION; FOLLOWING WHICH THE CITY SHALL BE DISCHARGED FROM ANY AND ALL LIABILITIES, DUTIES, AND TERMS ARISING OUT OF, OR BY VIRTUE OF, THIS AGREEMENT. 5.3 TERMINATION FOR INSOLVENCY The City also reserves the right to terminate the Agreement in the event the Consultant is placed either in voluntary or involuntary bankruptcy or makes an assignment for the benefit of creditors. In such event, the right and obligations for the parties shall be the same as provided for in Section 5.2. SECTION 6 INDEMNIFICATION AND INSURANCE REQUIREMENTS 6.1 INDEMNIFICATION Consultant agrees to indemnify and hold harmless the City of Miami Beach and its officers, employees, agents, and contractors, from and against any and all actions (whether at law or in equity), claims, liabilities, losses, and expenses, including, but not limited to, attorneys' fees and costs, for personal, economic or bodily injury, wrongful death, loss of or damage to property, which may arise or be alleged to have arisen from the negligent acts, errors, omissions or other wrongful conduct of the Consultant, its officers, employees, agents, contractors, or any other person or entity acting under Consultant's control or supervision, in connection with, related to, or as a result of the Consultant's performance of the Services pursuant to this Agreement. To that extent, the Consultant shall pay all such claims and losses and shall pay all such costs and judgments which may issue from any lawsuit arising from such claims and losses, and shall pay all costs and attorneys' fees expended by the City in the defense of such claims and losses, including appeals. The parties agree that one percent (1%) of the total compensation to Consultant for performance of the Services under this Agreement is the specific consideration from the City 3 to the Consultant for the Consultant's indemnity agreement. The provisions of this Section 6.1 and of this indemnification shall survive termination or expiration of this Agreement. 6.2 INSURANCE REQUIREMENTS The Consultant shall maintain and carry in full force during the Term, the following insurance: 1. Consultant General Liability, in the amount of$1,000,000; 2. Professional Liability/Medical Malpractice, in the amount of$300,000; and 3.Workers Compensation & Employers Liability, as required pursuant to Florida Statutes. The insurance must be furnished by insurance companies authorized to do business in the State of Florida. All insurance policies must be issued by companies rated no less than "B+" as to management and not less than "Class VI" as to strength by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All of Consultant's certificates shall contain endorsements providing that written notice shall be given to the City at least thirty (30) days prior to termination, cancellation or reduction in coverage in the policy. • Original certificates of insurance must be submitted to the City's Risk Manager for approval (prior to any work and/or services commencing) and will be kept on file in the Office of the Risk Manager. The City shall have the right to obtain from the Consultant specimen copies of the insurance policies in the event that submitted certificates of insurance are inadequate to ascertain compliance with required coverage. The Consultant is also solely responsible for obtaining and submitting all insurance certificates for any sub-consultants. Compliance with the foregoing requirements shall not relieve the Consultant of the liabilities and obligations under this Section or under any other portion of this Agreement. The Consultant shall not commence any work and or services pursuant to this Agreement until all insurance required under this Section has been obtained and such insurance has been approved by the City's Risk Manager. SECTION 7 LITIGATION JURISDICTIONNENUE/JURY TRIAL WAIVER This Agreement shall be construed in accordance with the laws of the State of Florida. This Agreement shall be enforceable in Miami-Dade County, Florida, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for the enforcement of same shall lie in Miami-Dade County, Florida. By entering into this Agreement, Consultant and the City expressly waive any rights either party may have to a trial by jury of any civil litigation related to or arising out of this Agreement. 4 SECTION 8 LIMITATION OF CITY'S LIABILITY The City desires to enter into this Agreement only if in so doing the City can place a limit on the City's liability for any cause of action, for money damages due to an alleged breach by the City of this Agreement, so that its liability for any such breach never exceeds the sum of $10,000. Consultant hereby expresses its willingness to enter into this Agreement with Consultant's recovery from the City for any damage action for breach of contract to be limited to a maximum amount of$10,000. Accordingly, and notwithstanding any other term or condition of this Agreement, Consultant hereby agrees that the City shall not be liable to the Consultant for damages in an amount in excess of $10,000 for any action or claim for breach of contract arising out of the performance or non-performance of any obligations imposed upon the City by this Agreement. Nothing contained in this section or elsewhere in this Agreement is in any way intended to be a waiver of the limitation placed upon the City's liability, as set forth in Section 768.28, Florida Statutes. SECTION 9 [INTENTIONALLY DELETED] SECTION 10 GENERAL PROVISIONS 10.1 AUDIT AND INSPECTIONS • Upon reasonable verbal or written notice to Consultant, and at any time during normal business hours (i.e. 9AM — 5PM, Monday through Fridays, excluding nationally recognized holidays), and as often as the City Manger may, in his/her reasonable discretion and judgment, deem necessary, there shall be made available to the City Manager, and/or such representatives as the City Manager may deem to act on the City's behalf, to audit, examine, and/or inspect, any and all other documents and/or records relating to all matters covered by this Agreement. Consultant shall maintain any and all such records at its place of business at the address set forth in the "Notices" section of this Agreement. 10.2 [INTENTIONALLY DELETETD] 10.3 ASSIGNMENT, TRANSFER OR SUBCONSULTING Consultant shall not subcontract, assign, or transfer all or any portion of any work and/or service under this Agreement without the prior written consent of the City Manager, which consent, if given at all, shall be in the Manager's sole judgment and discretion. Neither this Agreement, nor any term or provision hereof, or right hereunder, shall be assignable unless as approved pursuant to this Section, and any attempt to make such assignment (unless approved) shall be void. 5 10.4 PUBLIC ENTITY CRIMES, Prior to commencement of the Services, the Consultant shall file a State of Florida Form PUR 7068, Sworn Statement under Section 287.133(3)(a) Florida Statute on Public Entity Crimes with the City's Procurement Division. 10.5 EQUAL EMPLOYMENT OPPORTUNITY In connection with the performance of the Services, the Consultant shall not discriminate against any employee or applicant for employment because of race, color, national origin, religion, sex, gender identity, sexual orientation, disability, marital and familial status, or age. 10.6 CONFLICT OF INTEREST The Consultant herein agrees to adhere to and be governed by all applicable Miami-Dade County Conflict of Interest Ordinances and Ethics provisions, as set forth in the Miami-Dade ach County Code, and as may be amended from time to time; and by the City of Miami Bhe are Charter, and Code (as some may be amended from time to time); both incorporated by reference herein as if fully set forth The Consultant covenants that it presently has no interest and shall not acquire any interest, direct or indirectly, which could conflict in any manner orhdegree with the `r performance of the Services. The Consultant further covenants that performance of this Agreement, no person having any such interest shall knowingly be employed by the Consultant. No member of or delegate to the Congress of the United States shall be admitted to any share or part of this Agreement or to any benefits arising there from. SECTION.11 NOTICES All notices •and communications in writing required or permitted hereunder, shall be delivered personally to the representatives of the Consultant and the City listed below or may be mailed by U.S. Certified Mail, return receipt requested, postage prepaid, or by a nationally recognized overnight delivery service. Until changed by ntil chap ed b notice in writing, all such notices and communications shall be addressed as follows: TO CONSULTANT: Work Injury Solutions of Dade County, Inc. d/b/a Health Care Center of Miami Attn: Gustavo Gutierrez Jr., Vice-President 7911 NW 72"d Avenue, Suite 111 Miami, FL 33166 TO CITY: City of Miami Beach Human Resources Department Attn: Sue Radig, HR Administrator I 1700 Convention Center Drive Miami Beach, FL 33139 6 Notice may also be provided to any other address designated by the party to receive notice if such alternate address is provided via U.S. certified mail, return receipt requested, hand delivered, or by overnight delivery. In the event an alternate notice address is properly provided, notice shall be sent to such alternate address in addition to any other address which notice would otherwise be sent, unless other delivery instruction as specifically provided for by the party entitled to notice. Notice shall be deemed given on the day on which personally served, or the day of receipt by either U.S. certified mail or overnight delivery. SECTION 12 MISCELLANEOUS PROVISIONS 12.1 CHANGES AND ADDITIONS This Agreement cannot be modified or amended without the express written consent of the parties. No modification, amendment, or alteration of the terms or conditions contained herein shall be effective unless contained in a written document executed with the same formality and of equal dignity herewith. 12.2 SEVERABILITY If any term or provision of this Agreement is held invalid or unenforceable, the remainder of this Agreement shall not be affected and every other term and provision of this Agreement shall be valid and be enforced to the fullest extent permitted by law. 12.3 ENTIRETY OF AGREEMENT The City and Consultant agree that this is the entire Agreement between the parties. This Agreement supersedes all prior negotiations, correspondence, conversations, agreements or understandings applicable to the matters contained herein, and there are no commitments, agreements or understandings concerning the subject matter of this Agreement that are not contained in this document. Title and paragraph headings are for convenient reference and are not intended to confer any rights or obligations upon the parties to this Agreement. 7 t f IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their appropriate officials, as of the date first entered above. FOR CITY: CITY OF MIAMI BEACH, FLORIDA ATTEST: By: lt6AAA- L/,1/ City Clerk a or FOR CONSULTANT: WORK INJURY SOLUTIONS OF DADE COUNTY, INC. d/b/a HEALTH CARE CENTER OF MIAMI ATTEST: � . 11 By: _ Secretary P,esident (L'/c ' - / NA C=am Id-- r +�� P- Print Name Print Name/Title APPROVED AS TO FORM&LANGUAGE FOR EXECUTION 1 (2' IL 111/ e,, ' � Date 8 Exhibit A RFP NO. 46-09/10 f 9 REQUEST FOR PROPOSALS FOR A MEDICAL SERVICES PROVIDER FOR THE PROVISION OF VARIOUS MEDICAL SERVICES THAT MAY BE REQUIRED BY THE CITY OF MIAMI BEACH, AND OTHER LOCAL, STATE, AND FEDERAL LAWS RFP #46-09/10 PROPOSAL DUE DATE: August 25, 2010 AT 3:00 P.M. PAMELA LEJA-KATSARIS,CPPO,CPPB,SR.PROCUREMENT SPECIALIST CITY HALL PROCUREMENT DIVISION,3RD Floor • 1700 Convention Center Drive Miami Beach,FL 33139 Phone: 305.673.7490 Fax: 786.394.4006 E-mail: PamelaLeja©miamibeachfl.gov F:\PURC\$ALL\PAMELA\RFP\RFP 46-09-10 Medical Services Provider\RFP-46-09-10.doc RFP No.46-09/10 City of Miami Beach Page 1 of 39 Medical Services Provider 7/28/2010 ,•• tIA MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www,miamibeachfl.gov PROCUREMENT DIVISION Tel:305.673-7490, Fax:786-394-4006 PUBLIC NOTICE REQUEST FOR PROPOSALS (RFP) NO. 46-09/10 FOR A MEDICAL SERVICES PROVIDER FOR THE PROVISION OF VARIOUS MEDICAL SERVICES THAT MAY BE REQUIRED BY THE CITY OF MIAMI BEACH,AND OTHER LOCAL, STATE,AND FEDERAL LAWS The City has a need to establish an agreement with a professional medical services provider to perform pre-employment physical examinations, drug and alcohol testing, fitness for duty evaluations, and administer vaccines. The City seeks to retain the highest quality medical provider services available. The selected provider will provide a physician to serve as City Physician and Medical Review Officer. The provider will provide other medical services as may be necessary or required by the City and local, state and federal laws. The selected provider will also retain all related medical records. The City currently has an Agreement for these various medical services with Mount Sinai Medical Center that will expire on November 30, 2010, with no further options for renewal. The City contemplates entering into an agreement with the selected Provider for an initial term of two (2) years, with three (3) additional one (1) one-year renewal options, by mutual agreement between both parties. • Sealed Proposals will be received until 3:00 PM on August 25, 2010 at the following address: • City of Miami Beach. City Hall Procurement Division -Third Floor 1700 Convention Center Drive Miami Beach, Florida 33139 Any Proposal received after 3:00 PM on August 25, 2010 will be returned to the Proposer unopened. The responsibility for submitting Proposals before the stated time and date is solely the responsibility of the Proposer. The City will not be responsible for delays caused by mail, courier service, including U.S. Mail, or any other occurrence. A Pre-Proposal Submission Meeting is scheduled for 2:00 p.m. August 9, 2010, at the following address: City of Miami Beach City Hall—4th Floor 1700 Convention Center Drive City Manager's Large Conference Room Miami Beach, Florida 33139 Attendance (in person or via telephone)to this Pre-Proposal Submission Meeting is encouraged and recommended as a source of information, but is not mandatory. Proposers interested in participating in the Pre-Proposal Submission Meeting via telephone must follow these steps: RFP No.46-09/10 City of Miami Beach Page 2 of 39 Medical Services Provider 7/28/2010 • (1) Dial the TELEPHONE NUMBER: 1-877-491-3509 (Toll-free North America) (2) Enter the MEETING NUMBER: 9020453#(note that number is followed by the pound (#) key). Proposers who are interested in participating via telephone, please send an e-mail to PamelaLeja @miamibeachfl.gov expressing your intent to participate via telephone at least one business day in advance of the meeting. The City of Miami Beach is using BidSync a central notification system which provides bid notification services to interested vendors. BidSync allows for vendors to register online and receive notification of new bids, amendments and awards. Vendors with Internet access should review the registration options at the following website: www.bidsync.com. you If ou do not have Internet access, please call the BidSync vendor support group at 801-7 65-9245. The City of Miami Beach also utilizes BidNet as a central bid notification system created exclusively for state and local agencies located in South Florida. Created in conjunction with BidNet(s), this South Florida Purchasing system allows for vendors to register online and receive notification of new bids, amendments and awards. Vendors with Internet access should review the registration options at the following website: www.00vbids.com/scripts/southflorida/public/homel.asp. If you do not have Internet access, please call the BidNet(r) support group at 800-677-1997 extension#214. THE CITY OF MIAMI BEACH RESERVES THE RIGHT TO ACCEPT ANY PROPOSAL DEEMED TO BE IN THE BEST INTEREST OF THE CITY OF MIAMI BEACH, OR WAIVE ANY INFORMALITY IN ANY PROPOSAL. THE CITY OF MIAMI BEACH MAY ALSO REJECT ANY AND ALL PROPOSALS. YOU ARE HEREBY ADVISED THAT THIS REQUEST FOR PROPOSALS IS SUBJECT TO THE FOLLOWING ORDINANCES/RESOLUTIONS, WHICH MAY BE FOUND ON THE CITY OF MIAMI BEACH WEBSITE: http://www.miamibeachfl.gov • CONE OF SILENCE--ORDINANCE NO. 2002-3378 • CODE OF BUSINESS ETHICS— RESOLUTION NO. 2000-23879. • PROTEST PROCEDURES-- ORDINANCE NO. 2002-3344. • DEBARMENT PROCEEDINGS-- ORDINANCE NO. 2000-323 • LOBBYIST REGISTRATION AND DISCLOSURE OF FEES — ORDINANCE NO. 2002- 3363. • CAMPAIGN CONTRIBUTIONS BY VENDORS-ORDINANCE NO. 2003-3389. • EQUAL BENEFITS ORDINANCE—ORDINANCE NO. 2005-3494. Sincerely, Gus Lopez, CPPO Procurement Director RFP No.46-09/10 City of Miami Beach Page 3 of 39 Medical Services Provider 7/28/2010 ( 01 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov PROCUREMENT Division Tel:305.673.7490 Fax:786-394-4006 RFP No. 46-09/10 NOTICE TO PROSPECTIVE PROPOSERS If not submitting a Proposal at this time, please detach this sheet from the RFP documents, complete the information requested, and return to the address listed above. NO PROPOSAL SUBMITTED FOR REASON(S) CHECKED AND/OR INDICATED: Our Company does not handle this type of product/service. We cannot provide the services requested in the scope of services. Our Company is simply not interested in bidding at this time. Due to prior commitments, I was unable to submit a proposal. OTHER. (Please specify) We do do not want to be retained on your mailing list for future Request for Proposals (RFPs) for similar services outlined in this RFP. Signature: Title: Company: Note: Failure to respond, either by submitting a Proposal or this completed form, may result in your company being removed from the City's bid list. RFP No.46-09/10 City of Miami Beach Page 4 of 39 Medical Services Provider 7/28/2010 I i { frA MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov PROCUREMENT DIVISION Tel:305-673-7490,Fax:786-394-4006 TABLE OF CONTENTS PAGE I. OVERVIEW AND PROPOSAL PROCEDURES 6-11 II. SCOPE OF SERVICES 12-16 III. PROPOSAL FORMAT 17 IV. EVALUATION PROCESS/ CRITERIA FOR EVALUATION 18 V. SPECIAL TERMS AND CONDITIONS-INSURANCE 19-20 VI. PROPOSAL DOCUMENTS TO BE COMPLETED AND RETURNED TO CITY WITH PROPOSAL SUBMISSION -All items outlined as required under Proposal Format(Section III) And Scope of Services/Specifications (Section I1) -Signed Insurance Checklist 20 - Proposer Information 21 -Acknowledgment of Addenda 22 -Declaration 23 -Sworn Statement/Section 287.133(3) (a), Florida Statutes - Public Entity Crimes 24-25 -Questionnaire 26-29 -Declaration: Nondiscrimination in Contracts and Benefits 30-32 - Reasonable Measures Application (If Applicable) 33-34 -Substantial Compliance (If Applicable) 35-37 VII. DOCUMENTS TO BE COMPLETED BY CUSTOMERS OF THE RESPONDENTS - Performance Evaluation Letters 38 - Performance Evaluation Survey 39 RFP No.46-09/10 City of Miami Beach Page 5 of 39 Medical Services Provider 7/28/2010 SECTION I -OVERVIEW AND PROPOSAL PROCEDURES: A. INTRODUCTION/BACKGROUND The City has a need to establish an agreement with a professional medical services provider to perform pre-employment physical examinations, drug and alcohol testing, fitness for duty evaluations, and administer vaccines. The City seeks to retain the highest quality medical provider services available. The selected provider will provide a physician to serve as City Physician and Medical Review Officer. The provider will provide other medical services as may be necessary or required by the City and local, state and federal laws. The selected provider will also retain all related medical records. The City currently has an Agreement for these various medical services with Mount Sinai Medical Center that will expire on November 30, 2010, with no further options for renewal. The Mayor and City Commission at its July 14, 2010 meeting, authorized the Administration to issue this RFP for a professional medical services provider for the provision of medical services as may be necessary or required by the City, and local, state and federal laws. The City contemplates entering into an agreement with the selected Provider for an initial term of two (2) years, with three (3) additional one, (1) one-year renewal options, by mutual agreement between both parties. B. RFP TIMETABLE The anticipated schedule for this RFP and contract approval is as follows: RFP Issued July 28, 2010 Pre-Proposal Submission Meeting August 9, 2010 at 2:00 p.m. Deadline for receipt of questions August 11, 2010 by 5:00 pm Deadline for receipt of Proposals August 25, 2010 no later than 3:00 p.m. Evaluation Committee meeting September 2010 City Commission approval of award October 20, 2010 Contract negotiations October/November 2010 Projected contract start date December 1, 2010 C. PROPOSAL SUBMISSION • An original and ten (10) copies of complete Proposals must be received no later than 3:00 pm on August 25, 2010 at the following address: City of Miami Beach, City Hall Procurement Division—3rd Floor 1700 Convention Center Drive Miami Beach, Florida 33139 • The original and all copies must be submitted to the Procurement Division in a sealed envelope or container stating on the outside the Proposers name, address, telephone number, RFP number and title, and due date. No facsimile, electronic, or e-mail responses will be considered. The responsibility for submitting Proposals to the Procurement Division on or before the stated time and date will be solely and strictly that of the Proposer. The City will in no way be responsible for delays caused by the U.S. Post Office or caused by any other entity or by any other RFP No.46-09/10 City of Miami Beach Page 6 of 39 Medical Services Provider 7/28/2010 r occurrence. Proposals received after the RFP due date and time will not be accepted and will not be considered. D. REQUIREMENT FOR CITY CONTRACTORS TO PROVIDE EQUAL BENEFITS FOR DOMESTIC PARTNERS Proposers are advised that this RFP and any contract awarded pursuant to this procurement process shall be subject to the applicable provisions of Ordinance No. 2005-3494, entitled "Requirement for City Contractors to Provide Equal Benefits for Domestic Partners" (the "Ordinance"). The Ordinance applies to all employees of a Contractor who works within the city limits of the City of Miami Beach, and the Contractor's employees located in the United States, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami Beach. All Proposers shall complete and return, with their Proposal, the "Declaration: Non-discrimination in Contracts and Benefits" form contained herein. The City shall not enter into any contract • unless the Proposer certifies that it does not discriminate in the provision of Benefits between employees with Domestic Partners and employees with spouses and/or between the Domestic Partners and spouses of such employees. Proposers may also comply with the Ordinance by providing an employee with the Cash Equivalent of such Benefit or Benefits, if the City Manager or his designee determines that: a. The Proposer shall complete and return the "Reasonable Measures Application" contained herein, and the Cash Equivalent proposed; AND. b. The Proposer shall complete and return the "Substantial Compliance Authorization Form" contained herein. It is important to note that Proposer is considered in compliance if Proposer provides benefits neither to employees' spouses nor to employees' Domestic Partners. E. PRE-PROPOSAL SUBMISSION MEETING A Pre-Proposal Submission Meeting is scheduled for August 9, 2010 at 2:00 p.m. at the following address: City of Miami Beach, City Hall City Manager's Large Conference Room—4th Floor 1700 Convention Center Drive Miami Beach, Florida 33139 Attendance (in person or via telephone) is encouraged and recommended as a source of information, but is not mandatory. Proposers interested in participating in the Pre-RFP Submission Meeting via telephone must follow these steps: (1) Dial the TELEPHONE NUMBER: 877-491-3509 (Toll-free North America) (2) Enter the MEETING NUMBER: 9020453#(note that number is preceded and followed by the pound (#) key). Proposers, who are interested in participating via telephone, please send an e-mail to the contact person listed below, expressing your intent to participate via telephone. RFP No.46-09/10 City of Miami Beach Page 7 of 39 Medical Services Provider 7/28/2010 • F. CONTACT PERSON/ADDITIONAL INFORMATION/ADDENDA The contact person for this RFP is Pamela Leja, Sr. Procurement Specialist, who may be reached by phone: 305-673-7490; fax 786-394-4006; or e-mail: PamelaLejana,miamibeachfl.gov. Communications between a Proposer, bidder, lobbyist, and/or consultant and the Procurement Director are limited to matters of process or procedure. Requests for additional information or clarifications must be made in writing to the Procurement Division. Facsimile or e-mail requests are acceptable. Please send all questions to PamelaLeiaCa)miamibecahfl.gov and copy the City Clerk's Office RobertParcherCa�miamibeachfl.gov no later than the date specified in the RFP timetable. The Procurement Division will issue replies to inquiries and any other corrections or amendments, as it deems necessary, in written addenda issued prior to the deadline for responding to the RFP. Proposers should not rely on representations, statements, or explanations, other than those made in this RFP or in any written addendum to this RFP. Proposers should verify with the Procurement Division prior to submitting a Proposal that all addenda have been received. Proposers are advised that oral communications between the Proposer, or their representatives, and the Mayor and City Commissioners and their respective staff, or members of the City's Administrative staff (including but not limited to the City Manager and his staff), or evaluation committee members, is prohibited. G. MODIFICATION/WITHDRAWALS OF PROPOSALS A Proposer may submit a modified Proposal to replace all or any portion of a previously submitted Proposal up until the Proposal due date and time. Modifications received after the date and time will not be considered. Proposal due Proposals shall be irrevocable until contract award unless withdrawn in writing prior to the Proposal due date or after expiration of 120 calendar days from the opening of Proposals without a contract award. Letters of withdrawal received after the Proposal due date and before said expiration date and letters of withdrawal received after contract award will not be considered. H. RFP POSTPONEMENT/CANCELLATION/REJECTION The City may, at its sole and absolute discretion, reject any and all, or parts of any and all, Proposals; re-advertise this RFP; postpone or cancel, at any time, this RFP process; or waive any irregularities in this RFP, or in any Proposals received as a result of this RFP. I. COSTS INCURRED BY PROPOSERS All expenses involved with the preparation and submission of Proposals to the City, or any work performed in connection therewith, shall be the sole responsibility of the Proposer and shall not be reimbursed by the City. J. EXCEPTIONS TO RFP Proposers must clearly indicate any exceptions they wish to take to any of the terms in this RFP, and outline what alternative is being offered; which exceptions and alternatives shall be included and clearly delineated in Proposer's submittal response. The City, at its sole and absolute discretion, may accept or reject any or all exceptions. In cases in which exceptions are rejected, RFP No.46-09/10 City of Miami Beach Page 8 of 39 Medical Services Provider 7/28/2010 the City shall require the Proposer to comply with the particular term and/or condition of the RFP which Proposer takes exception to (as said term and/or condition was originally set forth on the RFP). K. SUNSHINE LAW Proposers are hereby notified that all Proposals including, without limitation, any and all information and documentation submitted therewith, will be available for public inspection after opening of Proposals, in compliance with Chapter 286, Florida Statutes (the Florida "Government in the Sunshine Law"). L. NEGOTIATIONS The City reserves the right to enter into further negotiations with the top-ranked Proposer, and/or successful Proposer (following authorization of negotiations by the City). Notwithstanding the preceding, the City is in no way obligated to enter into a contract with the top-ranked and/or successful Proposer in the event the parties are unable to negotiate a contract. It is also understood and acknowledged by Proposer's that by submitting a Proposal, no property interest or legal right of any kind shall be created at any time until and unless a contract has been agreed to and executed by the parties. M. PROTEST PROCEDURE Proposers that are not selected may protest any recommendation for selection of award in accordance with the proceedings established pursuant to the City's bid protest procedures (Ordinance No. 2002-3344), as codified in Sections 2-370 and 2-371 of the City Code. Protest(s) not timely made pursuant to the requirements of Ordinance No. 2002-3344 shall be barred. N. OBSERVANCE OF LAWS Proposers are expected to be familiar with, and comply with, all Federal, State, County, and City laws, ordinances, codes, rules and regulations, and all orders and decrees of bodies or tribunals having jurisdiction or authority which, in any manner, may affect the services and/or project contemplated by this RFP (including, without limitation, the Americans with Disabilities Act, Title VII of the Civil Rights Act, the EEOC Uniform Guidelines, and all EEO regulations and guidelines). Ignorance of the law(s) on the part of the Proposer will in no way relieve it from responsibility for compliance. O. DEFAULT Failure or refusal of the successful Proposer to execute a contract following award by the City Commission, or untimely withdrawal of a Proposal before such award is made and approved, may result in forfeiture of that portion of any surety required as liquidated damages to the City. Where surety is not required, such failure may result in a claim for damages by the City and may be grounds for removing the Proposer from the City's vendor list. P. CONFLICT OF INTEREST All Proposers must disclose, within their Proposal, the name(s) of any officer, director, agent, or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Further, all Proposers must disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates. RFP No.46-09/10 City of Miami Beach Page 9 of 39 Medical Services Provider 7/28/2010 Q. COMPLIANCE WITH THE CITY'S LOBBYIST LAWS This RFP is subject to, and all Proposers are expected to be or become familiar with, all City lobbyist laws, as amended from time to time. Proposers shall ensure that all City lobbyist laws are complied with, and shall be subject to any and all sanctions, as prescribed therein, including, without limitation, disqualification of their Proposals, in the event of such non-compliance. R. PROPOSER'S RESPONSIBILITY Before submitting a Proposal, each Proposer shall be solely responsible for making any and all investigations and examinations, as it deems necessary, to ascertain all conditions and requirements affecting the full performance of the contract. ignorance of such conditions and requirements, and/or failure to make such investigations and examinations, will not relieve the Proposer from any obligation to comply with every detail and with all provisions and requirements of the contract, and will not be accepted as a basis for any subsequent claim whatsoever for any monetary consideration on the part of the Proposer. S. RELATIONSHIP TO THE CITY It is the intent of the City, and Proposers hereby acknowledge and agree, that the successful Proposer is considered to be an independent contractor and that neither the Proposer, nor the Proposer's employees, agents, and/or contractors, shall, under any circumstances, be considered employees or agents of the City. T. PUBLIC ENTITY CRIME A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crimes may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, sub-contractor, or consultant under a contract with a public entity , and may not transact business with any public entity in excess of the threshold amount provided in Sec. 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list. U. CONE OF SILENCE Proposers are hereby advised that this RFP is subject to the City's Cone of Silence requirements, as set forth in Section 2-486 of the City Code. V. DEBARMENT ORDINANCE Proposers are hereby advised that this RFP is City's to the Ci 's Debarment Ordinance J (Ordinance No. 200-3234), as codified in Section 2-397 through 2-406 of the City Code. W. COMPLIANCE WITH THE CITY'S CAMPAIGN FINANCE REFORM LAWS This RFP is subject to, and all Proposers are expected to be or become familiar with, the City's Campaign Finance Reform laws, as codified in Sections 2-487 through 2-490 of the City Code, as amended from time to time. Proposers shall insure that all applicable provisions of the City's Campaign Finance Reform laws are complied with, and shall be subject to any and all sanctions, RFP No.46-09/10 City of Miami Beach Page 10 of 39 Medical Services Provider 7/28/2010 1 as prescribed therein, including disqualification of their Proposals, in the event of such non- compliance. X. CODE OF BUSINESS ETHICS • - each person or entity that seeks to do business with Pursuant to City Resolution No.2000-23879 p ty the City shall adopt a Code of Business Ethics ("Code") and submit that Code to the Procurement Division with its bid/response or within five (5) days upon receipt of request. • The Code shall, at a minimum, require the Proposer, to comply with all applicable governmental rules and regulations including, among others, the conflict of interest, lobbying and ethics provision of the City of Miami Beach and Miami Dade County. Y. AMERICAN WITH DISABILITIES ACT (ADA) Call 305-673-7490NOICE to request material in accessible format; sign language interpreters (five days in advance when possible), or information on access for persons with disabilities. For more information on ADA compliance, please call the Public Works Department, at 305-673-7080. Z. ACCEPTANCE OF GIFTS, FAVORS, SERVICES Proposers shall not offer any gratuities, favors, or anything of monetary value to any official, employee, or agent of the City, for the purpose of influencing consideration of this Proposal. Pursuant to Sec. 2-449 of the City Code, no officer or employee of the City shall accept any gift, favor or service that might reasonably tend improperly to influence him in the discharge of his official duties. RFP No.46-09/10 City of Miami Beach Page 11 of 39 Medical Services Provider 7/28/2010 fI j , l SECTION II -- SCOPE OF SERVICES A. GENERAL The Provider will conduct and review laboratory results, x-rays, and other medical reports; evaluate reports and make appropriate recommendations as needed; review special medical problems such as but not limited to contagious disease cases, return from sick leave, on-duty injuries, disability, and other medical issues as required; provide reports and medical opinions when applicable; counsel personnel and job applicants about medical conditions and findings; and refer to appropriate follow-up care when indicated. The Provider will supply the City with a primary contact or Project Manager who will be assigned to address all questions and concerns of the City. This contact will be available for pre- employment issues during all business hours. A back-up contact will be designated in case the Project Manager is unavailable. The designated back-up will be fully informed in all areas. All other staff providing services under this contract will be properly informed and trained on procedures, forms, changes, and requirements. Any special instructions will be communicated to all staff. All medical evaluation results will be reported to the Human Resources Department within 48 hours from the time the applicant is first seen. All services will be available a minimum of five (5) days per week during business hours. The preferred hours are from 7:00 a.m. until 5:00 p.m. The actual service hours are subject to negotiation. The City will have the ability to schedule same day or next day appointments with the Provider for all services if necessary. . In special cases, and with at least 3 days advanced notice by the City, the Provider will make arrangements to provide services outside normal business hours, such as evenings and weekends. The Provider will provide convenient parking at no cost to applicants, employees, and the City for individuals referred. - • The Provider will set up and utilize an electronic mail system compatible with the City. If requested by the City, all reports and other necessary communication will be utilized through this system. The Provider will utilize City forms where required. The Provider will review their own forms with the City and allow for changes as needed. The Provider will assure that instructions, changes, and transfer of information and documents will be only with those individuals or firms designated by the Human Resources Director. • Immediate notification will be made to designated City staff of"no-shows" or any problems with an individual's cooperation or compliance. The Provider will provide applicant deadlines for follow up as needed as determined by City policy. RFP No.46-09/10 City of Miami Beach Page 12 of 39 Medical Services Provider 7/28/2010 f j Individuals referred to the Provider must not have a waiting time that exceeds 30 minutes. The Provider will assure confidentiality of all records, information, and correspondence, both verbal and written. The Provider will submit a quarterly utilization summary report to the City. B. COMPREHENSIVE PHYSICAL EXAMINATIONS AND DRUG TESTING FOR PRE- EMPLOYMENT AND PROMOTIONS Based on the physical requirements of the job description provided by the City, the Provider will conduct physical examinations and drug testing as required for pre-employment on all new hires and exams on promotional applicants where physical duties greatly vary. Results of the applicant's physical examination will be reported to the Human Resources Department within 48 hours from the time the applicant is seen for results of their tuberculosis PPD test. The Provider will permit at least 10 appointments per day and provide capacity for up to 20 appointments per day with 3 days advance notice from the City. The City will have the ability to schedule same day or next day appointments for pre-employment examinations. Tuberculosis PPD tests are to be read by the Provider. Positive results will be handled by the Provider and will not be referred to the Department of Health or other facility unless agreed to in writing by the City. In any case, there will be no additional charge to the applicant for this service. Police Officer applicants' physical examinations must include tests for heart disease evaluation. Firefighter pre-employment examination must include tests for evidence of AIDS, Hepatitis, Pulmonary Tuberculosis, or Meningococcal Meningitis. C. MEDICAL RECORDS The Provider will maintain health files for all City employees and/or applicants. These files are to include medical records regarding injuries and accidents related to employees in accordance with all state and federal laws as applicable. Upon request of the Human Resources Director or their designee, the Provider will provide medical records within 24 hours of request. Medical records may only be released to the Human Resources Director, Claims Coordinator, or their designee. All requests and designee's assignments must be made and accepted in writing only (e-mail is acceptable). The selected Provider, if different from the current Provider, will obtain all records from the current Provider and will maintain such records. If and when this contract is awarded to another Provider, all open medical and other records related to this contract will be delivered to the new Provider within 30 days of the expiration of the current Provider's contract. The Provider will give copies of closed records within twenty-four hours of the request. RFP No.46-09/10 City of Miami Beach Page 13 of 39 Medical Services Provider 7/28/2010 i . D. PSYCHIATRIC SERVICES The Provider may be requested to attend staff conferences and conduct on-site training and observation of new Police Officers and Firefighters and conduct ongoing meetings with all Police Officers, other employees referred by the City,their supervisors, and top ranking officers. The Provider may be requested to review and research psychological factors relating to personnel especially public safety. The Provider may be requested to conduct stress-reduction meetings with spouses of Police personnel and other employees referred by the City. The Provider may be requested to conduct psychological or psychiatric consultations with general City employees as requested by the City and prepare appropriate summary and recommendation reports. E. IMMUNIZATION PROGRAM The Provider will administer an intradermal test for Tuberculosis exposure on all employees as necessary and requested. A chest x-ray may be done in lieu of an intradermal test for Tuberculosis. The Provider will administer a Tetanus Toxoid Booster Immunization for Police Officers, Firefighters, Waste Collectors, and Parks personnel. This may include other occupations depending on the job specification and/or individual requirements. The Provider will administer Hepatitis B vaccine for those City employees with a potential risk exposure to infected blood or body fluids as determined by the City. The Provider will administer other vaccines that may be required such as measles, mumps and rubella vaccine, or any additional immunizations, tests, vaccines, as required by local, state, or federal requirements, or by industry recommendations or guidelines. The Provider will administer and make available anti-viral medications against the AIDS virus for emergency responders according to current federal guidelines. These medications must be given within two hours of a significant exposure to the AIDS virus. Employees must have access to the administration of anti-viral medications for the AIDS virus on a twenty-four hour basis. The Provider will administer HIV/AIDS baseline tests to sworn Fire Department employees and perform other tests requested by the City to comply with future union contracts. F. DRUG &ALCOHOL TEST PROGRAM The Provider will have the ability to conduct a Drug and Alcohol Test Program as required by local, state, and federal laws and regulations. This includes a certified Substance Abuse Professional, Breath Alcohol Technician, and Medical Review Officer. The Provider will conduct pre-employment drug testing on all applicants, as well as conduct promotional drug and alcohol testing to all safety sensitive applicants before they actually perform safety sensitive functions for the first time. The Provider will test yearly approximately 350 Fraternal Order of Police, Williams Nichols Lodge, No. 8 (FOP) employees, 60 Government Supervisors Association of Florida/OPEIU, Local 100 RFP No.46-09/10 City of Miami Beach Page 14 of 39 Medical Services Provider 7/28/2010 r _ • (GSA) employees, 440 American Federation of State, County and Municipal Employees, Local 1554 (AFSCME), and 190 International Association of Firefighter, Local 1510 (IAFF) employees, and conduct other random drug and/or alcohol testing as may be specified by the City. This includes full-time and part-time employees. The Provider will conduct random testing on safety sensitive employees who drive vehicles that require Commercial Driver Licenses in compliance with the U.S. Department of Transportation (DOT). 49 CFR Part 40. The Provider will also conduct random testing all other City employees pursuant to union contracts. The Provider will conduct testing on employees whose performance could have contributed to an accident even if the employee was not cited for a traffic violation. This would require Provider access and availability 24 hours per day and 7 days per week. The Provider will conduct testing on employees when the City observes behavior or appearance that is characteristic of drug use or abuse or alcohol use or misuse. The Provider will conduct return-to-duty and follow-up testing for employees who violate the prohibited alcohol or drug conduct standards. At least six (6) unannounced tests must be conducted in the first twelve (12) months after an employee returns to duty. Follow-up testing may be extended for up to 60 months following return-to-duty. The Provider will provide drug and alcohol testing services with licensed and certified personnel and laboratories as required by local, state, and federal law. The Provider's drug and alcohol testing services will be overseen by a Medical Review Officer(MRO). The Provider will conduct annual training for designated City employees on the Drug Free Workplace Act including training on signs and symptoms of drug and/or alcohol abuse if requested by the City. The Provider will insure proper and documented chain of custody during and after sample collection and testing. The Provider will provide private and appropriate facilities to conduct these tests. The Provider will provide a locked, secured box for private articles and Police weapons. G. WELLNESS PROGRAM The Provider will provide annual health screening and health education at a minimum of two (2) job site areas within the City. Topics will be mutually agreed upon by the City and Provider. H. FITNESS FOR DUTY EVALUATIONS The Provider will evaluate employees' ability to continue employment in their current capacity and to assess and recommend reasonable accommodation for other job opportunities for which they may be qualified. This may include a physical examination, return to work evaluation, psychological and/or psychiatric evaluation, and/or any reports to be completed as requested by the City for fitness for duty. RFP No.46-09/10 City of Miami Beach Page 15 of 39 Medical Services Provider 7/28/2010 I , r' Evaluations are to be completed within two working days of the request and on the same day in case of an emergency. A status report and recommendations will be forwarded to the City within 24 hours of the appointment. The Provider will assist the City in the evaluation and verification of questionable family leave requests. I. PERFORMANCE CRITERIA AND EVALUATION Each month, the City will evaluate the Provider's performance based on the scope of services and feedback from employees, applicants, and the Human Resources Department. The criteria to be rated will include but is not limited to pre-employment, drug and alcohol screening, fitness for duty determinations, communication on all requested results, and designated contact availability. The criteria to be rated will change based upon the needs of the City. If the City finds the Provider to have less than an 80% compliance with any of the Scope of Services over a 30 day period, the City may utilize a fifteen (15) day notice to correct such default. J. COMMUNICATION The Provider will set up and utilize an electronic mail system compatible with the City. All reports and other necessary communication will be utilized through this system. Any and all associated costs with the set up will be absorbed by the Provider. The Provider will have qualified personnel available during all business hours to supply all services including final physician sign-off for pre-employment examinations. All test results under the Scope of Services and the Agreement will be communicated only to the Human Resources Director or his/her designees. K. STAFFING The Provider will staff sufficiently to supply all services stated in the Scope of Services and the Agreement. The Provider will increase staffing if they are unable to fully comply with what has been stated herein. • RFP No.46-09/10 City of Miami Beach Page 16 of 39 Medical Services Provider 7/28/2010 • SECTION III—PROPOSAL FORMAT!MINIMUM REQUIRMENTS Proposals must contain the following documents, each fully completed and signed, as required. If any items are omitted, Proposers must submit the documentation within five (5) calendar days upon request from the City, or the Proposal shall be deemed non-responsive. The City will not accept fee/cost information after deadline for receipt of Proposals. 1. Table of Contents Outline in sequential order the major areas of the Proposal, including enclosures. All pages must be consecutively numbered and correspond to the table of contents. 2. Proposal Points to Address: Proposers must respond to all minimum requirements listed below. Proposals which do not contain such documentation may be deemed non-responsive. a) Introduction letter: outlining the Proposer's professional specialization; provide past experience to support the qualifications of the Proposer. • b) Proposer's must provide documentation: Proposer's shall submit such supporting documentation as they deem necessary to demonstrate the capability to provide and implement the services that provide evidence as to the capability to . provide and implement the services as outlined in this RFP. c) References: List at least three (3) client references, to include contact name, title, company, address, telephone number, e-mail address, fax number. d) Qualifications of Proposer/Management Team and Key Personnel: Outline in detail the experience and qualifications of the Proposers entity, and the Proposer's management team, in providing similar projects/programs as outlined in this RFP. e) Fee Information: Fee information must be submitted with Proposal, as requested in the RFP. Notwithstanding any fee submitted, the City reserves the right to further negotiate same with the successful Proposer. f) Past Performance Client Survey Information: Past performance information will be collected on all Proposers. Proposers are required to identify and submit their best projects. Proposers will be required to send out Performance Evaluation Surveys to each of their clients. Please provide your client with the Performance Evaluation Letter and Survey attached herein, and request that your client submit the completed survey to • Pamela Leja, at (Fax) 786-394-4006 or e-mail PamelaLeja @miamibeachfl.gov. The City will not accept Client Surveys sent to the Procurement Division from the office of the Proposer. Surveys must be sent to the Procurement Division directly from your client's office(s). Proposers are responsible for making sure their clients return the Performance Evaluation Surveys to the City. The City reserves the right to verify and successful Proposer any information submitted in this process. Such verification may include, but is not limited to, speaking with current and former clients, review of relevant client documentation, site-visitation, and other independent confirmation of data. g) Methodology and Approach 3. Acknowledgment of Addenda: (IF REQUIRED BY ADDENDUM) and Proposer Information 4. Any other Documents Required by this RFP. RFP No.46-09/10 City of Miami Beach Page 17 of 39 Medical Services Provider 7/28/2010 SECTION IV—EVALUATION PROCESS/CRITERIA FOR EVALUATION The procedure for Proposal evaluation and selection is as follows: 1. Request for Proposals issued. 2. Receipt of Proposals. 3. Opening of Proposals and determination if they meet the minimum standards of responsiveness. 4. An Evaluation Committee, appointed by the City Manager, will meet to evaluate each Proposal in accordance with the requirements of this RFP. Proposers may be requested to make additional written submissions or oral presentations to the Evaluation Committee. 5. The Evaluation Committee shall recommend to the City Manager the Proposal or Proposals acceptance of which the Evaluation Committee deems to be in the best interest of the City. 6. The Evaluation Committee shall base its recommendations on the following factors, for a total of 100 possible points: • Ability to Provide All Requested Services Within the Designated Timeframes 15 points • Cost of Services Provided 15 points • Convenience of Obtaining Service and Proximity to Miami Beach 15 points • Overall Reputation Within the Community 10 points • Experience Level and Credentials of Assigned Staff 15 points • Designated Contact Availability 5 points • Appointment and Next Day Scheduling for Each Service 10 points • Number of Appointments That Can Be Scheduled Daily for Each Service 15 points Total 100 points 7. After considering the recommendation(s) of the Evaluation Committee, the_City Manager • will recommend to the City Commission the response or responses, acceptance of which the City Manager deems to be in the best interest of the City. The Committee's recommendation(s)will adhere to the criteria in Item No. 6 above. 8. The City Commission will consider the City Manager's recommendation(s) (in light of the recommendations(s) and evaluation of the Evaluation Committee) and, as appropriate, approve the City Manager's recommendation(s); may reject the recommendation(s) and select another proposal or proposals; or may reject all proposals. 9. Contract negotiations between the selected Proposer(s) and the City commence. If the City Commission has so directed, the City may proceed to negotiate a contract with a respondent other than the top-ranked Proposer, if the negotiations with the top-ranked Proposer fail to produce a mutually acceptable contract within a reasonable period of time. 10. A proposed contract (or contracts) may be presented to the City Commission for approval, modification and approval, or rejection. 11. If and when a contractor contracts) acceptable to the respective parties is approved) p p p pproved by the Mayor and Commission, the Mayor and City Clerk sign the contract(s) after the selected Proposer(s) has (or have) done so. By submitting a Proposal, all Proposers shall be deemed to understand and agree that no property interest or legal right of any kind shall be created at any point during the • aforesaid evaluation/selection process until and unless a contract has been agreed to and signed by both parties. RFP No.46-09/10 City of Miami Beach Page 18 of 39 Medical Services Provider 7/28/2010 SECTION V—SPECIAL TERMS AND CONDITIONS: INSURANCE INSURANCE: The successful Proposer shall obtain, provide and maintain during the term of the contract the following types and amounts of insurance, which shall be maintained with insurers licensed to sell insurance in the State of Florida and have a B+ VI or higher rating in the latest edition of AM Best's Insurance Guide. Said policies of insurance shall be primary to and contributing with any other insurance maintained by Proposer or City, and shall name the City of Miami Beach, as an additional insured. No policy can be canceled without thirty (30) days prior written notice to the City. The successful Proposer shall file and maintain certificates of all insurance policies with the City's Risk Management Department showing said policies to be in full force and effect at all times during the course of the contract. Such insurance shall be obtained from brokers of carriers authorized to transact insurance business in Florida and satisfactory to City. Evidence of such insurance shall be submitted to and approved by City prior to commencement of any work or tenancy under the proposed contract. If any of the required insurance coverages contain aggregate limits, or apply to other operations or tenancies of Proposer outside the proposed contract, Proposer shall give City prompt written notice of any incident, occurrence, claim settlement or judgment against such insurance which may diminish the protection such insurance affords the City. Proposer shall further take immediate steps to restore such aggregate limits or shall provide other insurance protection for such aggregate limits. FAILURE TO PROCURE INSURANCE: The successful Proposer's failure to procure or maintain required the insurance program shall constitute a material breach of the contract by which City may immediately terminate same. i RFP No.46-09/10 City of Miami Beach Page 19 of 39 Medical Services Provider 7/28/2010 • INSURANCE CHECK LIST XXX 1. Workers' Compensation and Employer's Liability per the statutory limits of the state of Florida. XXX 2. Comprehensive General Liability (occurrence form), limits of liability $ 1,000,000.00 per occurrence for bodily injury property damage to include Premises/ Operations; Products, Completed Operations and Contractual Liability. Contractual Liability and Contractual Indemnity(Hold harmless endorsement exactly as written in "insurance requirements"of specifications). 3. Automobile Liability - $1,000,000 each occurrence- owned/non-owned/hired automobiles included. 4. Excess Liability- $ . 00 per occurrence to follow the primary coverages. XXX 5. The City must be named as and additional insured on the liability policies; and it must be stated on the certificate. XXX 6. Other Insurance as indicated: Builders Risk completed value $ . 00 Liquor Liability $ . 00 Fire Legal Liability $ . 00 Protection and Indemnity $ . 00 XXX Professional Liability/Medical Malpractice $ 300,000.00 Employee Dishonesty Bond $ .00 Theft Covering Money and/or Property Of Others $ .00 XXX 7. Thirty(30) days written cancellation notice required. XXX 8. Best's guide rating B+:VI or better, latest edition. XXX 9. The certificate must state the RFP number and title PROPOSER AND INSURANCE AGENT STATEMENT: We understand the Insurance Requirements of these specifications and that evidence of this insurance may be required within five (5) days after Proposal opening. Proposer Signature of Proposer RFP No.46-09/10 City of Miami Beach Page 20 of 39 Medical Services Provider 7/28/2010 • 1 i PROPOSER INFORMATION Submitted by: Proposer(Entity): Signature: Name (Printed: • Address: City/State: Telephone: Fax: E-mail: Tax ID# It is understood and agreed by Proposer that the City reserves the right to reject any and all Proposals, to make awards on all items or any items according to the best interest of the City, and to waive any irregularities in the RFP or in the Proposals received as a result of the RFP. It is also understood and agreed by the Proposer that by submitting a Proposal, Proposer shall be deemed to understand and agree than no property interest or legal right of any kind shall be created at any time until and unless a contract has been agreed to and signed by both parties. For Proposer: (Authorized Signature) (Date) (Printed Name) RFP No.46-09/10 City of Miami Beach Page 21 of 39 Medical Services Provider 7/28/2010 REQUEST FOR PROPOSALS NO. 46-09/10 ACKNOWLEDGEMENT OF ADDENDA Directions: Complete Part I or Part H, whichever applies. Part I: Listed below are the dates of issue for each Addendum received in connection with this RFP: Addendum No. 1, Dated Addendum No. 2, Dated Addendum No. 3, Dated Addendum No.4, Dated Addendum No. 5, Dated Part II: No addendum was received in connection with this RFP. Verified with Procurement staff Name of staff Date Proposer- Name Date Signature • RFP No.46-09/10 City of Miami Beach Page 22 of 39 Medical Services Provider 7/28/2010 l t DECLARATION TO: City of Miami Beach City Hall 1700 Convention Center Drive Procurement Division Miami Beach, Florida 33139 Submitted this day of , 2010 The undersigned, as Proposer, declares that the only persons interested in this Proposal are named herein; that no other person has any interest in this responses or in the contract to which this response pertains; that this response is made without connection or arrangement with any other person; and that this response is in every respect fair and made in good faith, without collusion or fraud. The Proposer agrees if this response is accepted, to execute an appropriate City of Miami Beach document for the purpose of establishing a formal contractual relationship between the Proposer and the City, for the performance of all requirements to which the response pertains. The Proposer sates that the response is based upon the documents identified by the following number: RFP No. 46-09110. i . WITNESS PROPOSER SIGNATURE PRINTED NAME PRINTED NAME i . WITNESS TITLE ( PRINTED NAME • RFP No.46-09/10 City of Miami Beach Page 23 of 39 Medical Services Provider 7/28/2010 SWORN STATEMENT UNDER SECTION 287.133(3) (a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. This sworn statement is submitted to [print name of public entity] By [print individual's name and title] For [print name of entity submitting sworn statement] Whose business address is And (if applicable) its Federal Employer Identification Number(FEIN) is (If the Entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: ). understand that a "public entity crime" as defined in Paragraph 2 7 Florida p ty n 8 .133(1)(8), Statutes, means a violation of any state or federal law by a person with respect to and directly • related to the transaction of business with any business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public.entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere. I understand that an "affiliate" as defined in Paragraph 287.133 (1)(a), Florida Statutes, means: 1) A predecessor or successor of a person convicted of a public entity crime; Or 2) An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the • management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. - RFP No.46-09/10 City of Miami Beach Page 24 of 39 Medical Services Provider 7/28/2010 3) I understand that a "person" as defined in Paragraph 287.133 (1)(e), Florida Statutes means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. [Indicate which statement applies.] Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who are active in neither the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members or agents who are active in management of the entity or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. [Attach a copy of the final order] I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. [Signature] Sworn to and subscribed before me this day of ,2010 Personally known OR Produced identification Notary Public-State of My commission expires (Type of Identification) • (Printed typed or stamped Commissioned name of Notary Public) RFP No.46-09110 City of Miami Beach Page 25 of 39 Medical Services Provider 7/28/2010 • /' QUESTIONNAIRE Proposer's Name: Principal Office Address: Official Representative: I . Individual Partnership (Circle One) Corporation If a Corporation, answer this: When Incorporated: In what State: If a Foreign Corporation: Date of Registration with Florida Secretary of State: Name of Resident Agent: Address of Resident Agent: • • President's Name: Vice-President's Name: Treasurer's Name: RFP No.46-09/10 City of Miami Beach Page 26 of 39 Medical Services Provider 7/28/2010 Questionnaire (continued) Members of Board of Directors: If a Partnership: Date of organization: General or Limited Partnership*: Name and Address of Each Partner: NAME ADDRESS * Designate general partners in a Limited Partnership 1. Number of years of relevant experience in operating ratin g same or similar business: 2. Have any agreements held by Proposer for a project ever been canceled?Yes ( )No ( ) If yes, give details on a separate sheet. 3. Has the Proposer or any principals of the applicant organization failed to qualify as a responsible bidder/proposer, refused to enter into a contract after an award has been made, failed to complete a contract during the past five (5)years, or been declared to be in default in any contract in the last 5 years? If yes, please explain: RFP No.46-09/10 City of Miami Beach Page 27 of 39 Medical Services Provider - 7/28/2010 Questionnaire (continued) 4. Has the Proposer or any of its principals declared bankrupt or reorganized under Chapter 11 or put into receivership? Yes ( ) No( ) If yes, give date, court jurisdiction, action taken, and any other explanation deemed necessary on a separate sheet. 5. Person or persons interested in this RFP and Qualification Form have ( ) have not ( ) been convicted by a Federal, State, County, or Municipal Court of any violation of law, other than traffic violations. To include stockholders over ten percent(10%). (Strike out inappropriate words) Explain any convictions: 6. Lawsuits (any) pending or completed involving the corporation, partnership or individuals with more than ten percent(10%) interest: A. List all pending lawsuits: E. List all judgments from lawsuits in the last five(5)years: C. List any criminal violations and/or convictions of the Proposer and/or any of its principals: 7. Conflicts of Interest. The following relationships are the only potential, actual, or perceived conflicts of interest in connection with this Proposal: (If none, state same.) 8. Public Disclosure. In order to determine whether the members of the Evaluation Committee for this Request for Proposals have any association or relationships which would constitute a conflict of interest, either actual or perceived, with any Proposer and/or individuals and entities comprising or representing such Proposer and in an attempt to ensure full and complete disclosure regarding this contract, all Proposers are required to disclose all persons and entities who may be involved with this Proposal. This list shall include public relation firms, lawyers and lobbyists. The Procurement Division shall be notified in writing if any person or entity is added to this list after receipt of Proposals. RFP No.46-09/10 City of Miami Beach Page 28 of 39 Medical Services Provider 7/28/2010 • Questionnaire (continued) The Proposer understands that information contained in this Questionnaire will be relied upon by the City in awarding the RFP, and such information is warranted by the Proposer to be true and accurate. The Proposer agrees to furnish such additional information, prior to acceptance of any Proposal, relating to the qualifications of the Proposer, as may be requested by the City Manager. The Proposer further understands that the information contained in this Questionnaire may be confirmed through a background investigation conducted by the City, through the Miami Beach Police Department. By submitting this Questionnaire the Proposer oser agrees to cooperate erate with this investigation, including but not limited to, fingerprinting and providing information for a credit check. PROPOSER WITNESS: IF INDIVIDUAL: Signature Signature Print Name Print Name WITNESS: IF PARTNERSHIP: Signature Print Name of Successful Proposer Print Name Address By: General Partner Print Name ATTEST: IF CORPORATION: Secretary Print Name of Corporation Print Name Address By: President (Print Name) (CORPORATE SEAL) RFP No.46-09/10 City of Miami Beach Page 29 of 39 Medical Services Provider 7/28/2010 • z,_ tv\i' Br: " r /A,/ CITY OF MIAMI BEACH DECLARATION: NONDISCRIMINATION IN CONTRACTS AND BENEFITS Section 1.Vendor Information Name of Company: Name of Company Contact Person: Phone Number: Fax Number. E-mail: Vendor Number(if known): Federal ID or Social Security Number: Approximate Number of Employees in the U.S.: (If 50 or less,skip to Section 4,date and sign) Are any of your employees covered by a collective bargaining agreement or union trust fund? Yes No Union name(s): • Section 2.Compliance Questions Question 1. Nondiscrimination-Protected Classes A. Does your company agree to not discriminate against your employees, applicants for employment, employees of the City, or members of the public on the basis of the fact or perception of a person's membership in the categories listed below? Please note: a"YES" answer means your company agrees it will not discriminate; a "NO" answer means your company refuses to agree that it will not discriminate. Please answer yes or no to each category. 0 Race _Yes_No ❑ Sex _Yes_No 0 Color _Yes_No 0 Sexual orientation _Yes_No 0 Creed _Yes_No ❑Gender identity(transgender status) _Yes_No ❑ Religion _Yes_No ❑ Domestic partner status _Yes_No ❑ National origin Yes No 0 Marital status Yes No ❑Ancestry _Yes_No ❑ Disability _Yes_No ❑Age _Yes_No ❑AIDS/HIV status _Yes_No ❑ Height _Yes_No 0 Weight _Yes_No B. Does your company agree to insert a similar nondiscrimination provision in any subcontract you enter into for the performance of a substantial portion of the contract you have with the City? Please note: you must answer this question, even if you do not intend to enter into any subcontracts. Yes No RFP No.46-09/10 City of Miami Beach Page 30 of 39 Medical Services Provider 7/28/2010 Question 2. Nondiscrimination-Equal Benefits for Employees with Spouses and Employees with Domestic Partners Questions 2A and 2B should be answered YES even if your employees must pay some or all of the cost of spousal or domestic partner benefits. A. Does your company provide or offer access to any benefits to employees with spouses or to spouses of employees? _Yes_No B. Does your company provide or offer access to any benefits to employees with(same or opposite sex)domestic partners*or to domestic partners of employees? _Yes No *The term Domestic Partner shall mean any two (2) adults of the same or different sex, who have registered as domestic partners with a government body pursuant to state or local law authorizing such registration, or with an internal registry maintained by the employer of at least one of the domestic partners. A Contractor may institute an internal registry to allow for the provision of equal benefits to employees with domestic partner who do not register their partnerships pursuant to a governmental body authorizing such registration,or who are located in a jurisdiction where no such governmental domestic partnership exists. A Contractor that institutes such registry shall not impose criteria for registration that are more stringent than those required for domestic partnership registration by the City of Miami Beach If you answered "NO" to both Questions 2A and 2B, go to Section 4 (at the bottom of this page), complete and sign the form,filling in all items requested. If you answered"YES"to either or both Questions 2A and 2B,please continue to Question 2C below. Question 2.(Continued) C. Please check all benefits that apply to your answers above and list in the "other" section any additional benefits not already specified. Note: some benefits are provided to employees because they have a spouse or domestic partner, such as bereavement leave; other benefits are provided directly to the spouse or domestic partner,such as medical insurance. BENEFIT Yes for Yes for Employees No,this Documentation of this Employees with with Domestic Benefit is Not Benefit is Submitted Spouses Partners Offered with this Form Health ❑ ❑ ❑ ❑ Dental ❑ ❑ ❑ ❑ Vision ❑ ❑ ❑ ❑ Retirement(Pension, ❑ ❑ ❑ ❑ 401(k),etc.) Bereavement o ❑ ❑ ❑ Family Leave ❑ ❑ ❑ ❑ Parental Leave ❑ ❑ o a Employee Assistance ❑ ❑ ❑ ❑ Program Relocation&Travel ❑ ❑ ❑ ❑ Company Discount, ❑ ❑ ❑ ❑ Facilities& Events Credit Union ❑ ❑ ❑ ❑ Child Care ❑ ❑ ❑ ❑ Other ❑ ❑ ❑ ❑ Note: If you can not offer a benefit in a nondiscriminatory manner because of reasons outside your control, (e.g., there are no insurance providers in your area willing to offer domestic partner coverage) you may be eligible for Reasonable RFP No.46-09/10 City of Miami Beach Page 31 of 39 Medical Services Provider 7/28/2010 Measures compliance. To comply on this basis, you must agree to pay a cash equivalent, submit a completed Reasonable Measures Application with all necessary attachments, and have your application approved by the City Manager, or his designee. Section 3. Required Documentation YOU MUST SUBMIT SUPPORTING DOCUMENTATION to verify each benefit marked in Question 2C. Without proper documentation, your company cannot be certified as complying with the City's Equal Benefits Requirement for Domestic Partner Ordinance. For example, to document medical insurance submit a statement from your insurance provider or a copy of the eligibility section of your plan • document; to document leave programs, submit a copy of your company's employee handbook. If documentation for a particular benefit does not exist, attach an explanation. Have you submitted supporting documentation for each benefit offered? Yes_No Section 4. Executing the Document I declare under penalty of perjury under the laws of the State of Florida that the foregoing is true and correct, and that I am authorized to bind this entity contractually: Executed this day of in the year , at , City State • Signature Mailing Address Name of Signatory(please print) City,State,Zip Code Title RFP No.46-09/10 City of Miami Beach Page 32 of 39 Medical Services Provider 7/28/2010 el Al\I !/\ B E 1AC i-1 CITY OF MIAMI BEACH REASONABLE MEASURES APPLICATION Declaration: Nondiscrimination in Contracts and Benefits Submit this form and supporting documentation to the City's Procurement Division ONLY IF you: a. Have taken all reasonable measures to end discrimination in benefits; and b. Are unable to do so; and c. Intend to offer a cash equivalent for employees to whom equal benefits are not available. You must submit the following information with this form: 1. The names, contact persons and telephone numbers of benefits providers contacted for the purpose of acquiring nondiscriminatory benefits; 2. The dates on which such benefits providers were contacted; 3. Copies of any written response(s) you received from such benefits providers, and if written responses are unavailable, summaries of oral responses; and 4. Any other information you feel is relevant to documenting your inability to end discrimination in benefits, including, but not limited to, reference to federal or state laws which preclude the ending of discrimination in benefits. I declare(or certify) under penalty of perjury under the laws of the State of Florida that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Name of Company (please print) Mailing Address of Company • Signature City, State, Zip Name of Signatory(please print) Telephone Number • Title Date Definition of Terms RFP No.46-09/10 City of Miami Beach Page 33 of 39 Medical Services Provider 7/28/2010 I A. REASONABLE MEASURES The City of Miami Beach will determine whether a City Contractor has taken all reasonable measures provided by the City Contractor that demonstrates that it is not possible for the City Contractor to end discrimination in benefits. A determination that it is not possible for the City Contractor to end discrimination in benefits shall be based upon a consideration of such factors as: (1) The number of benefits providers identified and contacted, in writing, by the City Contractor, and written documentation from these providers that they will not provide equal benefits; (2) The existence of benefits providers willing to offer equal benefits to the City Contractor; and (3) The existence of federal or state laws which preclude the City Contractor from ending discrimination in benefits. B. CASH EQUIVALENT "Cash Equivalent" means the amount of money paid to an employee with a Domestic q Y p Partner (or spouse, if applicable) in lieu of providing Benefits to the employees' Domestic partner (or spouse, if applicable). The Cash Equivalent is equal to the employer's direct expense of providing Benefits to an employee for his or her spouse. Cash Equivalent. The cash equivalent of the following benefits applies: a. For bereavement leave, cash payment for the number of days that would be allowed as paid time off for death of a spouse. Cash payment would be in the form of wages of the domestic partner employee for the number of days allowed. b. For health benefits, the cost to the Contractor of the Contractor's share of the single monthly premiums that are being paid for the domestic partner employee, to be paid on a regular basis while the domestic partner employee maintains the such insurance in force for himself or herself. c. For family medical leave, cash payments for the number of days that would be allowed as time off for. an employee to care for a spouse that has a serious health condition. Cash payment would be in the form of wages of the domestic partner employee for the number of days allowed. RFP No.46-09/10 City of Miami Beach Page 34 of 39 Medical Services Provider 7/28/2010 i +. Iv'\i ,I j I.�,1\1T' BE ;1 CITY OF MIAMI BEACH SUBSTANTIAL COMPLIANCE AUTHORIZATION FORM Declaration: Nondiscrimination in Contracts and Benefits This form, and supporting documentation, must be submitted to the Procurement Division by entities seeking to contract with the City of Miami Beach that wish to delay ending their discrimination in benefits pursuant to the Rules of Procedure, as set out below. Fill out all sections that apply. Attach additional sheets as necessary. A. Open Enrollment Ending discrimination in benefits may be delayed until the first effective date after the first open enrollment process following the date the contract with the City begins, provided that the City Contractor submits to the Procurement Division evidence that reasonable efforts are being undertaken to end discrimination in benefits. This delay may not exceed two years from the date the contract with the City is entered into, and only applies to benefits for which an open enrollment process is applicable. Date next benefits plan year begins: Date nondiscriminatory benefits will be available: Reason for Delay: • Description of efforts being undertaken to end discrimination in benefits: B. Administrative Actions and Request for Extension RFP No.46-09/10 City of Miami Beach Page 35 of 39 Medical Services Provider 7/28/2010 • Ending discrimination in benefits may be delayed to allow administrative steps to be taken to incorporate nondiscriminatory benefits into the City Contractor's infrastructure. The time allotted for these administrative steps shall apply only to those benefits for which administrative steps are necessary and may not exceed three months. An extension of this time may be granted at the discretion of the Procurement Director, upon the written request of the City Contractor. Administrative steps may include, but are not limited to, such actions as computer systems modifications, personnel policy revisions, and the development and distribution of employee communications. Description of administrative steps and dates to be achieved: If requesting extension beyond three months, please explain basis: C. Collective•Bargaining Agreements (CBA) Ending discrimination in benefits may be delayed until the expiration of a City Contractor's Current collective bargaining agreement(s)where all of the following conditions have been met: 1. The provision of benefits is governed by one or more collective bargaining agreement(s); 2. The City Contractor takes all reasonable measures to end discrimination in benefits either by requesting that the Unions involved agree to reopen the agreements in order for the City Contractor to take whatever steps necessary to end discrimination in benefits or by ending discrimination in benefits without reopening the collective bargaining agreements; and 3. In the event that the City Contractor cannot end discrimination in benefits despite taking all reasonable measures to do so, the City Contractor provides a cash equivalent to eligible employees for whom benefits are not available. Unless otherwise authorized in writing by the Procurement Director, this cash equivalent payment must begin at the time the Unions refuse to allow the collective bargaining agreements to be reopened, or in any case no longer than three (3) months from the date the contract with the City is entered into. For a delay to be granted under this provision, written proof must be submitted with this form that: • • The benefits for which the delay is requested are governed by a collective bargaining agreement; RFP No.46-09/10 City of Miami Beach Page 36 of 39 Medical Services Provider 7/28/2010 • • All reasonable measures have been taken to end discrimination in benefits (see Section C.2, above); and • A cash equivalent payment will be provided to eligible employees for whom benefits are not available. I declare (or certify) under penalty of perjury under the laws of the State of Florida that the is true and correct, and that I am authorized to bind this entity contractually. . foregoing s t ue a Y Y Name of Company (please print) Mailing Address of Company Signature City, State, Zip Name of Signatory (please print) Telephone Number Title Date • RFP No.46-09/10 City of Miami Beach Page 37 of 39 Medical Services Provider 7/28/2010 r' MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive;Miami Beach,Florida 33139,www.miamibeachfl.gov PROCUREMENT DIVISION Tel:305-673-7490,Fax:786-394-4006 To: • Phone: Fax: E-mail: Subject: Performance Evaluation of: Number of pages including cover: 2 To Whom It May Concern: The City of Miami Beach has implemented a process that collects past performance information pursuant to the submittal of responses to this Request for Proposals. The information will be used to assist City of Miami Beach in the evaluation of Proposals received in response to the RFP for providers of medical services. The company listed in the subject line has chosen to participate in this RFP. They have listed you as a past client for which they have provided services. Both the company and City of Miami Beach would greatly appreciate you taking a few minutes of your time to complete the accompanying questionnaire. Please review all items in the following document and answer the questions to the best of your knowledge. If you cannot answer a particular question, please leave it blank. Please return this questionnaire to Pamela Leja by August 25, 2010 via fax: 786-394-4006; or email: PamelaLeja @miamibeachfl.gov. • • Thank you for your time and effort. • • Gus Lopez, CPPO Procurement Director MIAMIBEACH RFP No.46-09/10 City of Miami Beach Page 38 of 39 Medical Services Provider 7/28/2010 City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov PROCUREMENT DIVISION Tel:305-673-7490, Fax:786-394-4006 PERFORMANCE EVALUATION SURVEY RFP 46-09/10 Company Name: Point of Contact: Phone and email: Please evaluate the performance of the company (10 means you are very satisfied and have no questions about hiring them again, and 1 is if you would never hire them again because of very poor performance). Please leave blank if you don't know. NO. CRITERIA UNIT 1 Ability to maintain courteous and professional service (1-10) Communication, resolution of discrepancies, responsiveness 2 of personnel servicing the account [to include availability of (1-10) designated contact person(s)] 3 Responsiveness to priorities for service (1-10) 4 Meeting number of required appointments and scheduling (1-10) requirements 5 Ability to provide requested services within the designated (1-10) timeframe 6 Cost of services provided (1-10) 7 . Experience level and credentials of assigned staff (1-10) 8 Overall customer satisfaction and hiring again based on performance (comfort level in hiring medical provider again) (1-10) Overall Comments: Company providing Referral: Contact Name: Contact Phone and e-mail: Date of Services: Dollar Amount for Services: Thank you for your time and effort. Please return this form via fax to 786-394-4006 Attn. Pamela Leja, or via e-mail: PamelaLeia(a7miamibeachfl.00v on or before August 25, 2010. RFP No.46-09/10 - City of Miami Beach Page 39 of 39 Medical Services Provider 7/28/2010 Exhibit 8 Final Negotiated Fee Schedule 10 CITY OF MB MEDICAL SERVICES SCHEDULE I PRE-EMPLOYMENT PHYSICAL PRICE LIST POLICE $180 FIRE $255 STD $80 FITNESS FOR DUTY(PE&DT) $90 FITNESS FOR DUTY(PE ONLY) $55 PPD $15 CHEST X-RAY $45 EKG $55 POST EXPOSURE EXAM $10 TETANUS $40 HEP B $180 HEP A/B(TWINRIX) $300 MMR $75 HIV EXP $150 DRUG TEST WITH MRO $35 BAT $20 SAP EVAL $50 MD/$125 DOT RESP QUESTIONNAIRE $10 RESPIRATOR CLEARANCE $50 PSYCH SERVICES $175 ON SITE SERVICE TECH **NO CHARGE" DURING BUSINESS HOURS MOBILE UNIT $200/day AFTER HOURS TECH $200/HR+SERVICE AFTER HOURS MED PERSONNEL $400/HR+SERVICE L I r ,._ , , M AAIAMIBEACH , City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfl.gov DEPARTMENT OF PROCUREMENT MANAGEMENT Tel: 305-673-7490 Fax: 786-394-4002 ADDENDUM NO. 1 REQUEST FOR PROPOSAL NO. 2014-144-LR FOR MEDICAL SERVICES FOR PRE AND POST EMPLOYMENT SERVICES(the RFP) March 7, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. 1. REVISION: SECTION 0200 — INSTRUCTIONS TO RESPONDENTS & GENERAL CONDITIONS, Number 5, PRE-PROPOSAL MEETING OR SITE VISIT(S), is hereby amended as follows. (Underlined denotes added language and strikethrough indicates deleted language.): 5. PRE-PROPOSAL MEETING OR SITE VISITS(S). Only if deemed necessary by the City, a pre-proposal meeting or site visit(s) may be scheduled. The details of pre submittal meeting or site visit(s), if necessary, will be noted in Appendix B, Minimum A Pre-Proposal conference will be held on March 20,2014 at 11 a.m.at the following address: City of Miami Beach City Hall-4th Floor City Manager's Large Conference Room 1700 Convention Center Drive Miami Beach, Florida 33139 Attendance(in person or via telephone)is encouraged and recommended as a source of information, but is not mandatory. Proposers interested in participating in the Pre-Proposal Submission Meeting via telephone must follow these steps: (1)Dial the TELEPHONE NUMBER: 1-888-270-9936(Toll-free North America) (2)Enter the MEETING NUMBER: 1142644 Proposers who are interested in participating via telephone should send an e-mail to the contact person listed in this RFP expressing their intent to participate via telephone. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado©m iam ibeachfl.gov Contact: Telephone: Email: Lourdes Rodriguez 305-673-7000 ext. 6652 LourdesRodriguez @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Bidders" questionnaire with the reason(s)for not submitting a proposal. Si t - . , P 01111p ent Director RFP No. 2014-127-LR Addendum#1 3/7/2014 REQUEST FOR PROPOSALS ( RFP TITLE: MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES SOLICITATION No. 2014-127-LR RFP ISSUANCE DATE: MARCH 6, 2014 PROPOSAL DUE DATE: APRIL 4, 2014 @ 3:00 PM ISSUED BY: LOURDES RODRIGUEZ rc .. AA I AAA I B EACH Lourdes Rodriguez, CPPB, Procurement Coordinator DEPARTMENT OF PROCUREMENT MANAGEMENT 1700 Convention Center Drive, Miami Beach, FL 33139 305.673.7000 x6263 I Fax: 786.373.4003 1 www.miamibeachfl.gov (, l • iVUAMIBEACH TABLE OF CONTENTS SOLICITATION SECTIONS: PAGE 0100 NOT UTILIZED N/A 0200 INSTRUCTIONS TO PROPOSERS & GENERAL CONDITIONS 3 0300 SUBMITTAL INSTRUCTIONS & FORMAT 7 0400 PROPOSAL EVALUATION 9 APPENDICES: APPENDIX A PROPOSAL CERTIFICATON, QUESTIONNAIRE AND AFFIDAVITS APPENDIX B "NO PROPOSAL" FORM APPENDIX C MINIMUM REQUIREMENTS & SPECIFICATIONS APPENDIX D SPECIAL CONDITIONS APPENDIX E COST PROPOSAL FORM APPENDIX F INSURANCE REQUIREMENTS RFP 2014-127-LR 2 AAI AAA BEACH SECTION 0200 INSTRUCTIONS TO RESPONDENTS& GENERAL CONDITIONS t GENERAL. This Request for Proposals (RFP) is issued by the City of Miami Beach, Florida (the "City"), as the means for prospective proposers to submit their qualifications, proposed scopes of work and cost proposals (the "proposal") to the City for the City's consideration as an option in achieving the required scope of services and requirements as noted herein, All documents released in connection with this solicitation, including all appendixes and addenda, whether included herein or released under separate cover, comprise the solicitation, and are complementary to one another and together establish the complete terms, conditions and obligations of the proposers and, subsequently, the successful proposer(s) (the"contractor[s]") if this RFP results in an award. The City utilizes PublicPurchase (www.publicpurchase.com) for automatic notification of competitive solicitation opportunities and document fulfillment, including the issuance of any addendum to this RFP. Any prospective proposer who has received this RFP by any means other than through PublicPurchase must register immediately with PublicPurchase to assure it receives any addendum issued to this RFP. Failure to receive an addendum may result in disqualification of proposal submitted. 2. PURPOSE. Through this Request for Proposals, the City of Miami Beach, Florida (the "City") seeks proposals from parties interested in providing the City with medical services as further detailed herein. The City has a need to establish an agreement with a medical services provider to perform pre-employment physical examinations, drug and alcohol testing, fitness for duty evaluations, and administer vaccines. The City seeks to retain the highest quality services available. The selected provider will provide a medical doctor licensed to practice in the State of Florida and with the credentials to serve not only as the City physician but also as the Medical Review Officer, as defined in the U.S. Department of Transportation (DOT), Title 40, Code of Federal Regulations (CFR), Part 40. The provider will deliver other medical services as required by the City and local, state and federal laws. The selected provider will also retain all related medical records. The City anticipates selecting one service provider to perform the requested services. However, the City reserves the right to select additional providers if it is deemed to be in the best interest of the City. 3. SOLICITATION TIMETABLE. The tentative schedule for this solicitation is as follows: Solicitation Issued March 6, 2014 Pre-Submittal Meeting March 20, 2014 Deadline for Receipt of Questions March 24, 2014 Responses Due April 4, 2014 Evaluation Committee Review TBD Respondent Presentations TBD Tentative Commission Approval Authorizing May 2014 Negotiations Contract Negotiations Following Commission Approval 4. PROCUREMENT CONTACT. Any questions or clarifications concerning this solicitation shall be submitted to the Procurement Contact named herein, in writing, with a copy to the City Clerk's Office, Rafael E. Granado via e-mail: RafaelGranado(amiamibeachfl.gov ; or facsimile: 786-394-4188. The Bid title/number shall be referenced on all correspondence. All questions or requests for clarification must be received no later than seven (7) calendar days RFP 2014-127-LR 3 P__. MIAMIBEACH prior to the date proposals are due as scheduled in Section 0200-3. All responses to questions/clarifications will be sent to all prospective-proposers in the form of an addendum. Procurement Contact: Telephone: Email: LOURDES RODRIGUEZ 305-673-7000, X 6652 LourdesRodriguez @miamibeachfl.gov 5. PRE-PROPOSAL MEETING OR SITE VISIT(S). Only if deemed necessary by the City, a pre-proposal meeting or site visit(s) may be scheduled. The details of pre-submittal meeting or site visit(s), if necessary, will be noted in Appendix B, Minimum Requirements and Specifications. 6. PRE-PROPOSAL INTERPRETATIONS. Oral information or responses to questions received by prospective proposers are not binding on the City and will be without legal effect, including any information received at pre- submittal meeting or site visit(s). Only questions answered by written addenda will be binding and may supersede terms noted in this solicitation. 7. CONE OF SILENCE. Pursuant to Section 2-486 of the City Code, all procurement solicitations once advertised and until an award recommendation has been forwarded to the City Commission by the City Manager are under the "Cone of Silence." The Cone of Silence ordinance is available at http://library.municode.com/index.aspx?clientlD=13097&statelD=9&statename=Florida. Any communication or inquiry in reference to this solicitation with any City employee or City official is strictly prohibited with the of exception of communications with the Procurement Director, or his/her administrative staff responsible for administering the procurement process for this solicitation providing said communication is limited to matters of process or procedure regarding the solicitation. Communications regarding this solicitation are to be submitted in writing to the Procurement Contact named herein with a copy to the City Clerk at RafaelGranado @miamibeachfl.gov. 8. SPECIAL NOTICES. You are hereby advised that this solicitation is subject to the following ordinances/resolutions, which may be found on the City Of Miami Beach website: http://web.miamibeachfl.gov/procurement/scroll.aspx?id=23510 • CONE OF SILENCE CITY CODE SECTION 2-486 • PROTEST PROCEDURES CITY CODE SECTION 2-371 • DEBARMENT PROCEEDINGS,..... CITY CODE SECTIONS 2-397 THROUGH 2-485.3 • LOBBYIST REGISTRATION AND DISCLOSURE OF FEES.......,. CITY CODE SECTIONS 2-481 THROUGH 2-406 • CAMPAIGN CONTRIBUTIONS BY VENDORS CITY CODE SECTION 2-487 • CAMPAIGN CONTRIBUTIONS BY LOBBYISTS ON PROCUREMENT ISSUES CITY CODE SECTION 2-488 • REQUIREMENT FOR CITY CONTRACTORS TO PROVIDE EQUAL BENEFITS FOR DOMESTIC PARTNERS ........................ CITY CODE SECTION 2-373 • LIVING WAGE REQUIREMENT ................................................ CITY CODE SECTIONS 2-407 THROUGH 2-410 • LOCAL PREFERENCE FOR MIAMI BEACH-BASED VENDORS......... CITY CODE SECTION 2-372 • PREFERENCE FOR FLORIDA SMALL BUSINESSES OWNED AND CONTROLLED BY VETERANS AND TO STATE-CERTIFIED SERVICE- DISABLED VETERAN BUSINESS ENTERPRISES......... CITY CODE SECTION 2-374 • FALSE CLAIMS ORDINANCE............. .................................,..... CITY CODE SECTION 70-300 • ACCEPTANCE OF GIFTS,FAVORS&SERVICES ... CITY CODE SECTION 2-449 9. POSTPONEMENT OF DUE DATE FOR.RECEIPT OF PROPOSALS. The City reserves the right to postpone the deadline for submittal of proposals and will make a reasonable effort to give at least three (3) calendar days written notice of any such postponement to all prospective proposers. 10. PROTESTS. Protests concerning the specifications, requirements, and/or terms; or protests after the proposal due date in accordance with City Code Section 2-371, which establishes procedures for protested bids and proposed RFP 2014-127 LR 4 I IAIV 1BEA �. awards. Protests not submitted in a timely manner pursuant to the requirements of City Code Section 2-371 shall be barred. 11. MIAMI BEACH-BASED VENDORS PREFERENCE. Pursuant to City of Miami Beach Ordinance No. 2011-3747, a five (5) point preference will be given to a responsive and responsible Miami Beach-based proposer. 12. VETERAN BUSINESS ENTERPRISES PREFERENCE. Pursuant to City of Miami Beach Ordinance No. 2011- 3748, the City shall give a five (5) point preference to a responsive and responsible proposer which is a small business concern owned and controlled by a veteran(s) or which is a service-disabled veteran business enterprise. 13. DETERMINATION OF AWARD. The final ranking results of Step 1 & 2 outlined in Section V, Evaluation of Proposals, will be considered by the City Manager who may recommend to the City Commission the proposer(s) he/she deems to be in the best interest of the City or may recommend rejection of all proposals. The City Manager's recommendation need not be consistent with the scoring results identified herein and takes into consideration Miami Beach City Code Section 2-369, including the following considerations: (1) The ability, capacity and skill of the proposer to perform the contract. (2) Whether the proposer can perform the contract within the time specified, without delay or interference. (3) The character, integrity, reputation,judgment, experience and efficiency of the proposer. (4) The quality of performance of previous contracts. (5) The previous and existing compliance by the proposer with laws and ordinances relating to the contract. The City Commission shall consider the City Manager's recommendation and may approve such recommendation. The City Commission may also, at its option, reject the City Manager's recommendation and select another Proposal or Proposals which it deems to be in the best interest of the City, or it may also reject all Proposals. Upon approval of selection by the City Commission, negotiations between the City and the selected Proposer(s) will take place to arrive at a mutually acceptable Agreement. 14. ACCEPTANCE OR REJECTION OF PROPOSALS. The City reserves the right to reject any or all proposals prior to award. Reasonable efforts will be made to either award the Contract or reject all proposals within one- hundred twenty (120) calendar days after proposals opening date. A proposer may not withdraw its proposals unilaterally before the expiration of one hundred and twenty (120) calendar days from the date of proposals opening. 15. PROPOSER'S RESPONSIBILITY. Before submitting a Proposal, each Proposer shall be solely responsible for making any and all investigations, evaluations, and examinations, as it deems necessary, to ascertain all conditions and requirements affecting the full performance of the contract. Ignorance of such conditions and requirements, and/or failure to make such evaluations, investigations, and examinations, will not relieve the Proposer from any obligation to comply with every detail and with all provisions and requirements of the contract, and will not be accepted as a basis for any subsequent claim whatsoever for any monetary consideration on the part of the Proposer. 16. COSTS INCURRED BY PROPOSERS. All expenses involved with the preparation and submission of Proposals, or any work performed in connection therewith, shall be the sole responsibility (and shall be at the sole cost and expense) of the Proposer, and shall not be reimbursed by the City. 17. RELATIONSHIP TO THE CITY. It is the intent of the City, and Proposers hereby acknowledge and agree, that the successful Proposer is considered to be an independent contractor, and that neither the Proposer, nor the Proposer's employees, agents, and/or contractors, shall, under any circumstances, be considered employees or RFP 2014-127-1R 5 l AM1BEACH AC agents of the City. 18. TAXES. The City of Miami Beach is exempt from all Federal Excise and State taxes. 19. MISTAKES. Proposers are expected to examine the terms, conditions, specifications, delivery schedules, proposed pricing, and all instructions pertaining to the goods and services relative to this RFP. Failure to do so will be at the Proposers risk and may result in the Proposal being non-responsive. 20. PAYMENT. Payment will be made by the City after the goods or services have been received, inspected, and found to comply with contract, specifications, free of damage or defect, and are properly invoiced. 21. PATENTS & ROYALTIES. Proposer shall indemnify and save harmless the City of Miami Beach, Florida, and its officers, employees, contractors, and/or agents, from liability of any nature or kind, including cost and expenses for, or on account of, any copyrighted, patented, or unpatented invention, process, or article manufactured or used in the performance of the contract, including its use by the City of Miami Beach, Florida. If the proposer uses any design, device or materials covered by letters, patent, or copyright, it is mutually understood and agreed, without exception, that the bid prices shall include all royalties or cost arising from the use of such design, device, or materials in any way involved in the work. 22. MANNER OF PERFORMANCE. Proposer agrees to perform its duties and obligations in a professional manner and in accordance with all applicable Local, State, County, and Federal laws, rules, regulations and codes. Lack of knowledge or ignorance by the proposer with/of applicable laws will in no way be a cause for relief from 9 9 Y p p pp Y responsibility. Proposer agrees that the services provided shall be provided by employees that are educated, trained, experienced, certified, and licensed in all areas encompassed within their designated duties. Proposer agrees to furnish to the City any and all documentation, certification, authorization, license, permit, or registration currently required by applicable laws, rules, and regulations. Proposer further certifies that it and its employees will keep all licenses, permits, registrations, authorizations, or certifications required by applicable laws or regulations in full force and effect during the term of this contract. Failure of proposer to comply with this paragraph shall constitute a material breach of this contract. Where contractor is required to enter or go on to City of Miami Beach property to deliver materials or perform work or services as a result of any contract resulting from this solicitation, the contractor will assume the full duty, obligation and expense of obtaining all necessary licenses, permits, and insurance, and assure all work complies with all applicable laws. The contractor shall be liable for any damages or loss to the City occasioned by negligence of the proposer, or its officers, employees, contractors, and/or agents, for failure to comply with applicable laws. 23. SPECIAL CONDITIONS. Any and all Special Conditions that may vary from these General Terms and Conditions shall have precedence. 24. ANTI-DISCRIMINATION. The proposer certifies that he/she is in compliance with the non-discrimination clause contained in Section 202, Executive Order 11.246, as amended by Executive Order 11375, relative to equal employment opportunity for all persons without regard to race, color, religion, sex or national origin. RFP 2014-127-LR 6 MIAMI BEACH 25. DEMONSTRATION OF COMPETENCY. A. Pre-award inspection of the proposer's facility may be made prior to the award of contract. B. Proposals will only be considered from firms which are regularly engaged in the business of providing the goods and/or services as described in this solicitation. C. Proposers must be able to demonstrate a good record of performance for a reasonable period of time, and have sufficient financial capacity, equipment, and organization to ensure that they can satisfactorily perform the services if awarded a contract under the terms and conditions of this solicitation. D. The terms "equipment and organization'', as used herein shall, be construed to mean a fully equipped and well established company in line with the best business practices in the industry, and as determined by the City of Miami Beach. E. The City may consider any evidence available regarding the financial, technical, and other qualifications and abilities of a proposer, including past performance (experience), in making an award that is in the best interest of the City. F. The City may require proposers to show proof that they have been designated as authorized representatives of a manufacturer or supplier, which is the actual source of supply. In these instances, the City may also require material information from the source of supply regarding the quality, packaging, and characteristics of the products to be supplied to the City. 26. ASSIGNMENT. The successful proposer shall not assign, transfer, convey, sublet or otherwise dispose of the contract, including any or all of its right, title or interest therein, or his/her or its power to execute such contract, to any person, company or corporation, without the prior written consent of the City. 27. LAWS, PERMITS AND REGULATIONS. The proposer shall obtain and pay for all licenses, permits, and inspection fees required to complete the work and shall comply with all applicable laws. 28. OPTIONAL CONTRACT USAGE. When the successful proposer (s) is in agreement, other units of government or non-profit agencies may participate in purchases pursuant to the award of this contract at the option of the unit of government or non-profit agency. 29. VOLUME OF WORK TO BE RECEIVED BY CONTRACTOR. It is the intent of the City to purchase the goods and services specifically listed in this solicitation from the contractor. However, the City reserves the right to purchase any goods or services awarded from state or other governmental contract, or on an as-needed basis through the City's spot market purchase provisions. 30. DISPUTES. In the event of a conflict between the documents, the order of priority of the documents shall be as follows: A. Any contract or agreement resulting from the award of this solicitation; then B. Addendum issued for this solicitation, with the latest Addendum taking precedence; then C. The solicitation; then D. The proposer's proposal in response to the solicitation. RFP 2014-127-LR 7 ISA MI ; M! BCH 31. INDEMNIFICATION. The contractor shall indemnify and hold harmless the City and its officers, employees, agents and instrumentalities from any and all liability, losses or damages, including attorney's fees and costs of defense, which the City or its officers, employees, agents or instrumentalities may incur as a result of claims, demands, suits,causes of actions or proceedings of any kind or nature arising out of, relating to or resulting from the performance of the agreement by the contractor or its employees, agents, servants, partners, principals or subcontractors. The contractor shall pay all claims and losses in connection therewith, and shall investigate and defend all claims, suits or actions of any kind or nature in the name of the City, where applicable, including appellate proceedings, and shall pay all costs,judgments, and attorney's fees which may be incurred thereon. The contractor expressly understands and agrees that any insurance protection required by this Agreement or otherwise provided by the contractor shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. The above indemnification provisions shall survive the expiration or termination of this Agreement. 32. CONTRACT EXTENSION. The City reserves the right to require the Contractor to extend contract past the stated termination date for a period of up to 120 calendar days in the event that a subsequent contract has not yet been awarded. Additional extensions past the 120 calendar days may occur as needed by the City and as mutually agreed upon by the City and the contractor. 33. FLORIDA PUBLIC RECORDS LAW. Proposers are hereby notified that all Proposals including, without limitation, any and all information and documentation submitted therewith, are exempt from public records requirements under Section 119.07(1), Florida Statutes, and s. 24(a), Art. 1 of the State Constitution until such time as the City provides notice of an intended decision or until thirty (30) calendar days after opening of the bids, whichever is earlier. Additionally, Contractor agrees to be in full compliance with Florida Statute 119.0701 including, but not limited to, agreement to (a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order to perform the services; (b) provide the public with access to public records on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law; (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law; (d) Meet all requirements for retaining public records and transfer, at no cost, to the public agency all public records in possession of the contractor upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the public agency in a format that is compatible with the information technology systems of the public agency. 34. MODIFICATION/WITHDRAWALS OF PROPOSALS. A Proposer may submit a modified Proposal to replace all or any portion of a previously submitted Proposal up until the Proposal due date and time. Modifications received after the Proposal due date and time will not be considered. Proposals shall be irrevocable until contract award unless withdrawn in writing prior to the Proposal due date, or after expiration of 120 calendar days from the opening of Proposals without a contract award. Letters of withdrawal received after the Proposal due date and before said expiration date, and letters of withdrawal received after contract award will not be considered. 35. EXCEPTIONS TO RFP. Proposers must clearly indicate any exceptions they wish to take to any of the terms in this RFP, and outline what, if any, alternative is being offered. All exceptions and alternatives shall be included and clearly delineated, in writing, in the Proposal. The City, at its sole and absolute discretion, may accept or reject any or all exceptions and alternatives. In cases in which exceptions and alternatives are rejected, the City shall require the Proposer to comply with the particular term and/or condition of the RFP to which Proposer took exception to (as said term and/or condition was originally set forth on the RFP). RFP 2014-127-LR 8 • MIAMI BEACH 36. ACCEPTANCE OF GIFTS, FAVORS, SERVICES. Proposers shall not offer any gratuities, favors, or anything of monetary value to any official, employee, or agent of the City, for the purpose of influencing consideration of this Proposal. Pursuant to Sec. 2-449 of the City Code, no officer or employee of the City shall accept any gift, favor or service that might reasonably tend to improperly influence him in the discharge of his official duties. Balance of Page Intentionally Left Blank RFP 2014-127-LR 9 //r' 1 MIAMI BE CH SECTION 0300 PROPOSAL SUBMITTAL INSTRUCTIONS AND FORMAT 1. SEALED RESPONSES. One original Proposal (preferably in 3-ring binder) must be submitted in an opaque, sealed envelope or container on or before the due date established for the receipt of bids. Additionally, ten (10) bound copies and one (1) electronic format (CD or USB format) are to be submitted. The following information should be clearly marked on the face of the envelope or container in which the bid is submitted: solicitation number, solicitation title, proposer name, proposer return address. Proposals received electronically, either through email or facsimile, are not acceptable and will be rejected. 2. LATE BIDS. Proposals are to be received on or before the due date established herein for the receipt of Proposals. Any Proposal received after the deadline established for receipt of proposals will be considered late and not be accepted or will be returned to proposer unopened. The City does not accept responsibility for any delays, natural or otherwise. 3._PROPOSAL FORMAT. In order to maintain comparability, facilitate the review process and assist the Evaluation Committee in review of proposals, it is strongly recommended that proposals be organized and tabbed in accordance with the sections and manner specified below. Hard copy submittal should be tabbed as enumerated below and contain a table of contents with page references. Electronic copies should also be tabbed and contain a table of contents with page references. Proposals that do not include the required information will be deemed non- responsive and will not be considered. TAB 1 Cover Letter& Minimum Qualifications Requirements 1.1 Cover Letter and Table of Contents.The cover letter must indicate Proposer and Proposer Primary Contact for the purposes of this solicitation. 1.2 Proposal Certification, Questionnaire & Requirements Affidavit (Appendix A). Attach Appendix A fully completed and executed. 1.3 Minimum Qualifications Requirements. Submit verifiable information documenting compliance with the minimum qualifications requirements established in Appendix C, Minimum Requirements and Specifications. TAB 2= ! Experience& Qualifications 2.1 Qualifications of Proposing Firm. Submit detailed information regarding the firm's history and relevant experience and proven track record of providing the scope of services similar as identified in this solicitation, including experience in providing similar scope of services to public sector agencies. For each project that the proposer submits as evidence of similar experience, the following is required: project description, agency name, agency contact, contact telephone & email, and year(s)and term of engagement. 2.2 Qualifications of Proposer Team. Provide an organizational chart of all personnel and consultants to be used for this project if awarded, the role that each team member will play in providing the services detailed herein and each team members' qualifications. A resume of each individual, including education, experience, and any other pertinent information, shall be included for each Proposal team member to be assigned to this contract. 2.3 Financial Capacity. Each proposer shall arrange for Dun & Bradstreet to submit a Supplier Qualification Report (SQR) directly to the Procurement Contact named herein. No proposal will be considered without receipt, by the City, of the SQR directly from Dun & Bradstreet. The cost of the preparation of the SQR shall be the responsibility of the Proposer. The Proposer shall request the SQR report from D&B at: https://supplierportal.dnb.com/webapp/wcsl stores lservlet/SupplierPortal?storeld=11696 Proposers are responsible for the accuracy of the information contained in its SQR. It is highly recommended that each proposer review the information contained in its SQR for accuracy prior to submittal to the City and as early as possible in the solicitation process. For assistance with any portion of the SQR submittal process, contact Dun & Bradstreet at 800-424-2495. RFP 2014-127-LR 10 (14 AA I AM I BEACH .TAB 3 = =! Scope of Services Proposed, Approach and Methodology Submit detailed information addressing how proposer will achieve each portion of the scope of services and technical requirements outlined in Appendix C, Minimum Requirements and Specifications. Responses shall be in sufficient detail and include supporting documentation, as applicable, which will allow the Evaluation Committee to complete a fully review and score the proposed scope of services. .TAB.4 _ ! Approach and Methodology Submit detailed information on how proposer plans to accomplish the required scope of services, including detailed information, as applicable, which addresses, but need not be limited to: implementation plan, project timeline, phasing options, testing and risk mitigation options for assuring project is implemented on time and within budget. TAB 5 Cost Proposal Submit a completed Cost Proposal Form (Appendix E). Note: After proposal submittal, the City reserves the right to require additional information from proposers (or proposer team members or sub-consultants) to determine: qualifications (including, but not limited to, litigation history, regulatory action, or additional references); and financial capability (including, but not limited to, annual reviewed/audited financial statements with the auditors notes for each of their last two complete fiscal years). RFP 2014-127-LR 1..,1..,. • ® MIAMI BEACH SECTION 0400 PROPOSAL EVALUATION 1. Evaluation Committee. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the requirements set forth in the solicitation. If further information is desired, Proposers may be requested to make additional written submissions of a clarifying nature or oral presentations to the Evaluation Committee. The evaluation of proposals will proceed in a two-step process as noted below. It is important to note that the Evaluation Committee will score the qualitative portions of the proposals only. The Evaluation Committee does not make an award recommendation to the City Manager. The results of Step 1 & Step 2 Evaluations will be forwarded to the City Manager who will utilize the results to make a recommendation to the City Commission. 2. Step 1 Evaluation. The first step will consist of the qualitative criteria listed below to be considered by the Evaluation Committee. The second step will consist of quantitative criteria established below to be added to the Evaluation Committee results by the Department of Procurement Management. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the qualifications criteria established below for Step 1, Qualitative Criteria. In doing so, the Evaluation Committee may: • review and score all proposals received, with or without conducting interview sessions; or • review all proposals received and short-list one or more proposers to be further considered during subsequent interview session(s) (using the same criteria). Step 1_=Qualitative Criteria =-:. — _ •Maximum Points • Proposer Experience and Qualifications,including Financial Capability 40 Scope of Services Proposed 20 Approach and Methodology 20 TOTALAVAILABLE STEP-1 POINTS. ____ _80 s-__:t. .r:- 3. Step 2 Evaluation. Following the results of Step 1 Evaluation of qualitative criteria, the proposers may receive additional quantitative criteria points to be added by the Department of Procurement Management to those points earned in Step 1, as follows. _ Step 2.-Quantitative Criteria ' �- _ . Cost Proposal 20 Miami Beach-Based Vendor Preference 5 Veterans Preference 5 r `t 'TOTAL AVAILABLE-STEP"2 POINTS - :11_30 - 4. Cost Proposal Evaluation. The cost proposal points shall be developed in accordance with the following formula: Sample Objective Formula for Cost Vendor Vendor Example Maximum Formula for Calculating Points Total Cost Allowable Points (lowest cost I cost of proposal Points Proposal (Points noted are for being evaluated X maximum Awarded illustrative purposes only. allowable points=awarded Actual points are noted above.) points) Round to Vendor A $100.00 20 $1001$100 X 20=20 20 Vendor B $150.00 20 $1001$150 X20=13 13 Vendor C $200.00 20 $1001$200 X 20=10 10 RFP 2014-127-LR 1 2 V\IA M 1 BEACH 5. Determination of Final Ranking. At the conclusion of the Evaluation Committee Step 1 scoring, Step 2 Points will be added to each evaluation committee member's scores by the Department of Procurement Management. Step 1 and 2 scores will be converted to rankings in accordance with the example below: Proposer A Proposer B Proposer C Step 1 Points 82 76 80 Step 2 Points 22 15 12 Committee Total 104 91 92 Member 1 Rank 1 3 2 Step 1 Points 79 85 72 Step 2 Points 22 15 12 Committee Total 101 100 84 Member 2 Rank 1 2 3 Step 1 Points 80 74 66 Step 2 Points 22 15 12 Committee Total 102 89 78 Member 2 Rank 1 2 3 Low Aggregate Score 3 7 8 Final Ranking* 1 2 3 * Final Ranking is presented to the City Manager for further due diligence and recommendation to the City Commission. Final Ranking does not constitute an award recommendation until such time as the City Manager has made his recommendation to the City Commission, which may be different than final ranking results. RFP 2014-127-1R 13 APPENDIX A 0:14 MIAMI II EACH Proposal Certification , Questionnaire & Requirements Affidavit RFP 201 4127-LR MEDICAL SERVICES DEPARTMENT OF PROCUREMENT MANAGEMENT 700 Convention Center Drive Miami Beach, Florida 33139 Solicitation No: Solicitation Title: RFP 2014-127-LR MEDICAL SERVICES Procurement Contact: Tel: Email: LOURDES RODRIGUEZ 305-673-7490, x6652 LourdesRodriguez @MiamiBeachFL.gov PROPOSAL CERTIFICATION, QUESTIONNAIRE & REQUIREMENTS AFFIDAVIT Purpose: The purpose of this Proposal Certification, Questionnaire and Requirements Affidavit Form is to inform prospective Proposers of certain solicitation and contractual requirements, and to collect necessary information from Proposers in order that certain portions of responsiveness, responsibility and other determining factors and compliance with requirements may be evaluated. This Proposal Certification, Questionnaire and Requirements Affidavit Form is a REQUIRED FORM that must be submitted fully completed and executed. 1. General Proposer Information. FIRM NAME: No of Years in Business: No of Years in Business Locally: OTHER NAME(S)PROPOSER HAS OPERATED UNDER IN THE LAST 10 YEARS: FIRM PRIMARY ADDRESS(HEADQUARTERS): CITY: STATE: ZIP CODE: TELEPHONE NO.: TOLL FREE NO.: FAX NO.: FIRM LOCAL ADDRESS: CITY: STATE: ZIP CODE: PRIMARY ACCOUNT REPRESENTATIVE FOR THIS ENGAGEMENT: ACCOUNT REP TELEPHONE NO.: ACCOUNT REP TOLL FREE NO.: ACCOUNT REP EMAIL: FEDERAL TAX IDENTIFICATION NO.: reserves the right to seek additional information from proposer or other source(s), including but not limited to: any firm or principal The City ese g p p ( ), g y p p information, applicable licensure, resumes of relevant individuals,client information, financial information, or any information the City deems necessary to evaluate the capacity of the proposer to perform in accordance with contract requirements. Miami Beach RFP 2014-127-LR Appendix A—Page 1 Ir 1. Miami Beach Based(Local)Vendor.Is proposer claiming Miami Beach based firm status? YES NO SUBMITTAL REQUIREMENT: Proposers claiming Miami Beach vendor status shall submit a Business Tax Receipt issued by the City of Miami Beach and the proof of residency requirement, as required pursuant to ordinance 2011-3747,to demonstrate that the Proposer is a Miami Beach Based Vendor. 2. Veteran Owned Business. Is proposer claiming a veteran owned business status? YES NO SUBMITTAL REQUIREMENT: Proposers claiming veteran owned business status shall submit a documentation proving that firm is certified as a veteran-owned business or a service-disabled veteran owned business by the State of Florida or United States federal government,as required pursuant to ordinance 2011-3748. 3. Conflict Of Interest.All Proposers must disclose,in their Proposal,the name(s)of any officer,director,agent,or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Further, all Proposers must disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates. SUBMITTAL REQUIREMENT: Proposers must disclose the name(s) of any officer, director, agent, or immediate family member (spouse, parent,sibling, and child)who is also an employee of the City of Miami Beach. Proposers must also disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates 4. References&Past Performance. Proposer shall submit at least three(3) references for whom the proposer has completed work similar in size and nature as the work referenced in solicitation. SUBMITTAL REQUIREMENT: For each reference submitted, the following information is required: 1) Firm Name, 2) Contact Individual Name&Title, 3)Address,4)Telephone, 5)Contact's Email and 6)Narrative on Scope of Services Provided. 5. Suspension, Debarment or Contract Cancellation.Has proposer ever been debarred,suspended or other legal violation,or had a contract cancelled due to non-performance by any public sector agency? YES NO SUBMITTAL REQUIREMENT: If answer to above is "YES," Proposer shall submit a statement detailing the reasons that led to action(s). 6. Vendor Campaign Contributions. Proposers are expected to be or become familiar with, the City's Campaign Finance Reform laws, as codified in Sections 2-487 through 2-490 of the City Code. Proposers shall be solely responsible for ensuring that all applicable provisions of the City's Campaign Finance Reform laws are complied with, and shall be subject to any and all sanctions, as prescribed therein,including disqualification of their Proposals,in the event of such non-compliance. SUBMITTAL REQUIREMENT: Submit the names of all individuals or entities (including your sub-consultants) with a controlling financial interest as defined in solicitation. For each individual or entity with a controlling financial interest indicate whether or not each individual or entity has contributed to the campaign either directly or indirectly, of a candidate who has been elected to the office of Mayor or City Commissioner for the City of Miami Beach. 7. Code of Business Ethics. Pursuant to City Resolution No.2000-23879, each person or entity that seeks to do business with the City shall adopt a Code of Business Ethics ("Code") and submit that Code to the DEPARTMENT OF PROCUREMENT MANAGEMENT with its bid/response or within five (5) days upon receipt of request. The Code shall, at a minimum, require the Proposer, to comply with all applicable governmental rules and regulations including, among others, the conflict of interest, lobbying and ethics provision of the City of Miami Beach and Miami Dade County. SUBMITTAL REQUIREMENT: Proposer shall submit firm's Code of Business Ethics. In lieu of submitting Code of Business Ethics, proposer may submit a statement indicating that it will adopt, as required in the ordinance,the City of Miami Beach Code of Ethics,available at www.miamibeachfl.gov/procurement/. Miami Beach RFP 2014-127-LR Appendix A—Page 2 ff r, 8. Living Wage. Pursuant to Section 2-408 of the Miami Beach City Code, as same may be amended from time to time, proposers shall be required to pay all employees who provide services pursuant to this Agreement,the hourly living wage rates listed below: • Commencing with City fiscal year 2012-13(October 1,2012),the hourly living rate will be$11.28/hr with health benefits,and$12.92/hr without benefits. The living wage rate and health care benefits rate may, by Resolution of the City Commission be indexed annually for inflation using the Consumer Price Index for all Urban Consumers(CPI-U) Miami/Ft. Lauderdale, issued by the U.S. Department of Labor's Bureau of Labor Statistics. Notwithstanding the preceding, no annual index shall exceed three percent(3%).The City may also,by resolution, elect not to index the living wage rate in any particular year, if it determines it would not be fiscally sound to implement same(in a particular year). Proposers' failure to comply with this provision shall be deemed a material breach under this bid, under which the City may, at its sole option, immediately deem said proposer as non-responsive, and may further subject proposer to additional penalties and fines, as provided in the City's Living Wage Ordinance, as amended. Further information on the Living Wage requirement is available at www.miamibeachfl.gov/procurement/. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document, Proposer agrees to the living wage requirement. 9. Equal Benefits for Employees with Spouses and Employees with Domestic Partners. When awarding competitively solicited contracts valued at over$100,000 whose contractors maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks, the Equal Benefits for Domestic Partners Ordinance 2005-3494 requires certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive bids, to provide "Equal Benefits" to their employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to all employees of a Contractor who work within the City limits of the City of Miami Beach, Florida;and the Contractor's employees located in the United States, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami Beach. A. Does your company provide or offer access to any benefits to employees with spouses or to spouses of employees? YES NO B. Does your company provide or offer access to any benefits to employees with(same or opposite sex)domestic partners*or to domestic partners of employees? YES NO C. Please check all benefits that apply to your answers above and list in the "other" section any additional benefits not already specified. Note: some benefits are provided to employees because they have a spouse or domestic partner, such as bereavement leave; other benefits are provided directly to the spouse or domestic partner,such as medical insurance. BENEFIT Firm Provides for Firm Provides for Firm does not Employees with Employees with Provide Benefit Spouses Domestic Partners Health Sick Leave Family Medical Leave Bereavement Leave If Proposer cannot offer a benefit to domestic partners because of reasons outside your control, (e.g., there are no insurance providers in your area willing to offer domestic partner coverage) you may be eligible for Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent and submit a completed Reasonable Measures Application (attached)with all necessary documentation.Your Reasonable Measures Application will be reviewed for consideration by the City Manager, or his designee. Approval is not guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement is available at www.miamibeachfl.qov/procurement/. Miami Beach RFP 2014-127-LR Appendix A—Page 3 • { 10. Public Entity Crimes. Section 287.133(2)(a), Florida Statutes, as currently enacted or as amended from time to time,states that a person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids,proposals,or replies on leases of real property to a public entity;may not be awarded or perform work as a contractor,supplier,subcontractor,or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in s.287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document, proposer agrees with the requirements of Section 287.133, Florida Statutes,and certifies it has not been placed on convicted vendor list. 11. Acknowledgement of Addendum. After issuance of solicitation, the City may release one or more addendum to the solicitation which may provide additional information to proposers or alter solicitation requirements.The City will strive to reach every Proposer having received solicitation through the City's e-procurement system, PublicPurchase.com. However, Proposers are solely responsible for assuring they have received any and all addendum issued pursuant to solicitation. This Acknowledgement of Addendum section certifies that the Proposer has received all addendum released by the City pursuant to this solicitation. Failure to obtain and acknowledge receipt of all addendum may result in proposal disqualification. Initial to Confirm Initial to Confirm Initial to Confirm Receipt Receipt Receipt Addendum 1 Addendum 6 Addendum 11 Addendum 2 Addendum 7 Addendum 12 Addendum 3 Addendum 8 Addendum 13 Addendum 4 Addendum 9 Addendum 14 Addendum 5 Addendum 10 Addendum 15 If additional confirmation of addendum is required,submit under separate cover. Miami Beach RFP 2014-127-LR Appendix A—Page 4 • ti DISCLOSURE AND DISCLAIMER.SECTION u - - The solicitation referenced herein is being furnished to the recipient by the City of Miami Beach (the"City") for the recipient's convenience. Any action taken by the City in response to Proposals made pursuant to this solicitation, or in making any award, or in failing or refusing to make any award pursuant to such Proposals, or in cancelling awards, or in withdrawing or cancelling this solicitation, either before or after issuance of an award,shall be without any liability or obligation on the part of the City. In its sole discretion, the City may withdraw the solicitation either before or after receiving proposals, may accept or reject proposals, and may accept proposals which deviate from the solicitation, as it deems appropriate and in its best interest. In its sole discretion, the City may determine the qualifications and acceptability of any party or parties submitting Proposals in response to this solicitation. Following submission of a Bid or Proposal, the applicant agrees to deliver such further details, information and assurances, including financial and disclosure data, relating to the Proposal and the applicant including, without limitation, the applicant's affiliates, officers, directors,shareholders, partners and employees,as requested by the City in its discretion. The information contained herein is provided solely for the convenience of prospective Proposers. It is the responsibility of the recipient to assure itself that information contained herein is accurate and complete.The City does not provide any assurances as to the accuracy of any information in this solicitation. Any reliance on these contents, or on any permitted communications with City officials,shall be at the recipient's own risk. Proposers should rely exclusively on their own investigations,interpretations, and analyses. The solicitation is being provided by the City without any warranty or representation, express or implied, as to its content, its accuracy, or its completeness. No warranty or representation is made by the City or its agents that any Proposal conforming to these requirements will be selected for consideration,negotiation,or approval. The City shall have no obligation or liability with respect to this solicitation,the selection and the award process,or whether any award will be made.Any recipient of this solicitation who responds hereto fully acknowledges all the provisions of this Disclosure and Disclaimer, is totally relying on this Disclosure and Disclaimer, and agrees to be bound by the terms hereof. Any Proposals submitted to the City pursuant to this solicitation are submitted at the sole risk and responsibility of the party submitting such Proposal. This solicitation is made subject to correction of errors, omissions, or withdrawal from the market without notice. Information is for guidance only, and does not constitute all or any part of an agreement. The City and all Proposers will be bound only as, if and when a Proposal (or Proposals), as same may be modified, and the applicable definitive agreements pertaining thereto, are approved and executed by the parties, and then only pursuant to the terms of the definitive agreements executed among the parties. Any response to this solicitation may be accepted or rejected by the City for any reason, or for no reason,without any resultant liability to the City. The City is governed by the Government-in-the-Sunshine Law, and all Proposals and supporting documents shall be subject to disclosure as required by such law. All Proposals shall be submitted in sealed bid form and shall remain confidential to the extent permitted by Florida Statutes, until the date and time selected for opening the responses. At that time, all documents received by the City shall become public records. Proposers are expected to make all disclosures and declarations as requested in this solicitation. By submission of a Proposal, the Proposer acknowledges and agrees that the City has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement information contained in the Proposal;and authorizes the release to the City of any and all information sought in such inquiry or investigation. Each Proposer certifies that the information contained in the Proposal is true, accurate and complete, to the best of its knowledge, information,and belief. Notwithstanding the foregoing or anything contained in the solicitation, all Proposers agree that in the event of a final unappealable judgment by a court of competent jurisdiction which imposes on the City any liability arising out of this solicitation, or any response thereto, or any action or inaction by the City with respect thereto, such liability shall be limited to$10,000.00 as agreed-upon and liquidated damages. The previous sentence, however, shall not be construed to circumvent any of the other provisions of this Disclosure and Disclaimer which imposes no liability on the City. In the event of any differences in language between this Disclosure and Disclaimer and the balance of the solicitation, it is understood that the provisions of this Disclosure and Disclaimer shall always govern. The solicitation and any disputes arising from the solicitation shall be governed by and construed in accordance with the laws of the State of Florida. Miami Beach RFP 2014-127-LR Appendix A—Page 5 t. PROPOSER CERTIFICATION- - • • - _ • I hereby certify that: I, as an authorized agent of the Proposer, am submitting the following information as my firm's proposal; Proposer agrees to complete and unconditional acceptance of the terms and conditions of this document, inclusive of this solicitation, all attachments, exhibits and appendices and the contents of any Addenda released hereto, and the Disclosure and Disclaimer Statement; proposer agrees to be bound to any and all specifications, terms and conditions contained in the solicitation, and any released Addenda and understand that the following are requirements of this solicitation and failure to comply will result in disqualification of proposal submitted; Proposer has not divulged, discussed, or compared the proposal with other Proposers and has not colluded with any other proposer or party to any other proposal; proposer acknowledges that all information contained herein is part of the public domain as defined by the State of Florida Sunshine and Public Records Laws; all responses, data and information contained in this proposal, inclusive of the Proposal Certification, Questionnaire and Requirements Affidavit are true and accurate. Name of Proposers Authorized Representative: Title of Proposers Authorized Representative: Signature of Proposers Authorized Representative: Date: State of FLORIDA ) On this day of ,20_,personally appeared before me who County of ) stated that (s)he is the of , a corporation, and that the instrument was signed in behalf of the said corporation by authority of its board of directors and acknowledged said instrument to be its voluntary act and deed. Before me: Nota ry Public for the State of My Commission Expires: Miami Beach RFP 2014-127-LR Appendix A—Page 6 APPENDIX B . , , i _ _ ._ ?. 1 . f\i/ I it, . ,,.., ID it\A IA , . , ® orm RFP 2014- 127-LR MEDICAL SERVICES DEPARTMENT OF PROCUREMENT MANAGEMENT 1700 Convention Center Drive Miami Beach, Florida 33139 atic�t® m ed� i rec -d u v e p o d �lkii s comt provr o n otBi r i s �ore :to oce�fot e r t e te �e e tato p tc c S hoc oife` l` t �9 . Th tti s ;Not _a o oBi pove�‘ e�� io to t i � i s t tom e O ra a :sol - o he t1 r r4 - d th ac � � o e g ® � e =r r= tat ue.e). raw F k . s��Q a__ • Statement of No Bid WE HAVE ELECTED NOT TO SUBMIT A PROPOSAL AT THIS TIME FOR REASON(S) CHECKED AND/OR INDICATED BELOW: Workload does not allow us to bid Insufficient time to respond Specifications unclear or too restrictive Unable to meet specifications Unable to meet service requirements Unable to meet insurance requirements Do not offer this product/service _OTHER. (Please specify) We do_ do not—want to be retained on your mailing list for future bids of this type product and/or service. Signature: Title: Legal Company Name: Note: Failure to respond, either by submitting a bid or this completed form, may result in your company being removed from our vendors list. PLEASE RETURN TO: CITY OF MIAMI BEACH DEPT. OF PROCUREMENT MANAGEMENT ATTN: Lourdes Rodriguez PROPOSAL #2014-127-LR 1700 Convention Center Drive MIAMI BEACH, FL 33139 Miami Beach RFP 2014-127-LR Appendix B—Page 1 APPENDIX C M AM I - Minimum Requirements & RFP 2014- 127-LR MEDICAL SERVICES DEPARTMENT OF PROCUREMENT MANAGEMENT 1700 Convention Center Drive Miami Beach, Florida 33139 l i Cl. Minimum Requirements. The Minimum Eligibility Requirements for this solicitation are listed below. Proposer shall submit detailed verifiable information affirmatively documenting compliance with each minimum requirement. Proposers that fail to comply with minimum requirements will be deemed non-responsive and will not be considered. A. Proposer shall document at least five (5) years providing services similar to those noted herein to at least one (1) public sector agency, state, county or municipal government. B. The provider shall have at least one facility within the City of Miami Beach. C. Services must be available 7 days a week, 24 hours a day, 365 days a year. C2. SCOPE OF SERVICES REQUIREMENTS. The City requires that the selected provider, at a minimum, provide the following services: A. GENERAL 1. The provider will order and review results of • laboratory tests, x-rays, and other diagnostic tests or reports from other health care providers; • make recommendations as needed, if any, based on the standard of care in the community and specific work related circumstances; • review and make recommendations to the patient or the City, as appropriate, regarding medical problems including, but not limited to: • contagious diseases, • clearances to return to work from sick leave, • on-duty injuries, • disability, and • other medical issues as required • provide reports and medical opinions when applicable; and • counsel City employees and job applicants about personal medical conditions and refer them for appropriate follow-up care when indicated. 2. The provider will supply the City with a primary contact or Project Manager who will be assigned to address all questions and concerns of the City. This contact will be available for pre-employment issues during normal .business hours, Monday through Friday, 8:00 AM through 5:00 PM. 3. A back-up contact will be designated in case the Project Manager is unavailable. The designated back-up will be fully informed of all issues in all areas. All other staff providing services under this contract will be properly informed and trained on procedures, forms, changes and requirements. Any special instructions will be communicated to all staff. 4. All medical evaluation results will be reported to the City of Miami Beach Human Resources Department within in forty-eight (48) hours from the time the applicant and/or employee is first seen, test results or additional information received by the provider. 5. All services will be available seven (7) days a week, twenty-four (24) hours a day. The actual service hours are subject to negotiation. 6. The City of Miami Beach will have the ability to schedule same day or next day appointments with the provider for all services, if necessary. Miami Beach RFP 2014-127-LR Appendix C—Page 1 • 7. The provider will offer convenient parking at no cost to applicants, employees, or the City for individuals referred to the facility. 8. The provider will set up and utilize an electronic mail system compatible with the City's. If requested by the City, all reports and other necessary communication will be through this system. 9. The provider will use City forms where required. The provider will review their own forms with the City and allow for changes, as needed. 10. The provider will assure that instruction, changes, and transfer of information and documents will be only with those individuals designated by the City of Miami Beach Human Resources Director. 11. Immediate notification will be made to designated City staff of"no-shows" or any problems with an individual's cooperation or compliance. 12. The provider will give applicants deadlines for follow-up as needed and as called for by City policy. 13. Individuals referred to the provider for reasonable suspicion or post-accident alcohol and/or drug testing must not have a waiting time that exceeds thirty (30) minutes. 14. The provider will assure confidentiality of all records, information and correspondence, verbal, electronic and written. 15. The provider will offer applicants and employees locked, secure boxes for private articles and police weapons. 16. The provider will submit a quarterly utilization summary report to the City. B. COMPREHENSIVE PHSICAL EXAMINATION AND DRUG TESTING FOR PRE- EMPLOYMENT AND PROMOTIONS Based on the physical requirements of the job descriptions provided by the City, the provider will conduct physical examinations and drug/alcohol pre-employment and promotional testing. Results of the applicants' physical examinations will be reported to the City of Miami Beach Human Resources Director's designee within forty-eight (48) hours after applicants are seen for results of their tuberculosis PPD test. The provider will permit at least ten (10) appointments per day and provide capacity for up to twenty (20) appointments per day with three (3) days advance notice from the City. The City will have the ability to schedule same day or next day appointments for pre- employment examinations. Tuberculosis PPD tests are to be read by the medical doctor. Positive test results will be J handled by the medical doctor and will not be referred to the Department of Health or other facility unless agreed to in writing by the City. In any case, there will be no additional charge to the applicant for this service. Police Officer and Firefighter applicant physical examinations must include tests for evidence of heart disease, evidence of AIDS or HIV, hepatitis, pulmonary tuberculosis, or meningococcal meningitis. Miami Beach RFP 2014-127-LR Appendix C—Page 2 C. MEDICAL RECORDS The provider will maintain medical records for all city employees and applicants. These files are to include medical records regarding injuries and accidents in accordance with all state and federal laws, as applicable. When requested by the City of Miami Beach Human Resources Director or her designee, the provider will make medical records available within twenty-four (24) hours of request. Medical records may only be released to the City of Miami Beach Human Resources Director, Risk Management Director, or their designees. All requests and designee assignments must be made and accepted in writing only (email is acceptable). The selected provider, if different from the current provider, will obtain all records from the current provider and will maintain such records. If and when this contract is awarded to another provider, all open medical and other records related to this contract will be delivered to the new provider within thirty (30) days of the expiration of the current provider's contract. The provider will give copies of closed records within twenty-four hours of the request. D. PSYCHIATRIC SERVICES The provider may be requested to attend staff conferences, conduct on-site training, observe new police officers and firefighters or evaluate employees referred by the City and provide expert opinion, recommendations and reports related to the employees' psychological or psychiatric evaluation. The provider may be requested to conduct stress-reduction meetings to police personnel spouses and other employees and their respective spouses or life partners, as referred by the City. E. IMMUNIZATION PROGRAM The P rovider will administer an intradermal test for Tuberculosis exposure on all applicants. A chest x-ray may be done in lieu of an intradermal test for Tuberculosis. The provider will administer a Tetanus Toxoid Booster immunization to Police Officers, Firefighters, Waste Collectors, and Parks personnel. This may include other occupations depending on the job description or specification and individual circumstances. The provider will administer Hepatitis B vaccine to those City employees with a potential risk exposure to infected blood or body fluids as determined by the City. The provider will administer other vaccines such as measles, mumps and rubella, and any additional vaccines as required by local, state or federal requirements or by industry recommendations, guidelines or best practices. Miami Beach RFP 2014-127-LR Appendix C—Page 3 The provider will administer and make available anti-viral medication against the AIDS virus for emergency responders according to current federal guidelines. These medications must be given within two hours of a significant exposure. Employees must have access to the administration of this anti-viral medication on a twenty-our(24) hour basis. The provider will test Fire and Police Department employees for the HIV/AIDS virus to establish a baseline and perform other tests as required by the City pursuant to the terms and conditions of employment agreed to between the City and any of the bargaining units representing employees. F. DRUG &ALCOHOL TESTING PROGRAM The provider will have the ability to conduct a Drug and Alcohol Testing Program as required by local, state, and federal laws and regulations. This includes having access to a certified Substance Abuse Professional, Breath Alcohol Technician, and Medical Review Officer as defined by the U.S. Department of Transportation (DOT), Title 49 Code of Federal Regulations (CFR), Part 40. The provider will conduct pre-employment drug and alcohol testing on all applicants as well as conduct promotional drug and alcohol testing as requested. Employment or promotion into a safety sensitive position requires testing before applicants actually perform any safety sensitive functions for the first time. The provider will test approximately 350 Fraternal Order of Police, Williams Nichols Lodge, No. 8 (FOP) bargaining unit employees, 60 Government Supervisors Association of Florida/OPEIU, Local 100 (GSA) bargaining unit employees, 440 American Federation of State, County and Municipal Employees, Local 1554 (AFSCME) and 190 International Association of Firefighters, Local 1510 (IAFF) bargaining unit employees on an annual basis and conduct other random, unannounced or reasonable suspicion drug and/or alcohol testing as may be specified by the City. The provider will test safety sensitive employees in positions that that require a commercial driver licenses in accordance with Title 49 CFR, Part 40. All alcohol and drug tests will be in compliance with procedures spelled out in 49 CFR, Part 40. The provider will also conduct random or unannounced drug and alcohol testing on all other City employees according to procedures set forth in Title 49 CFR, Part 40. The provider will conduct post-accident drug and alcohol testing as determined by the City. This requires provider availability twenty-four(24) hours a day, seven (7) days a week. The provider will test employees when the City observes behavior or appearance that results in a reasonable suspicion of drug use or abuse or alcohol use or misuse. Miami Beach RFP 2014-127-LR Appendix C—Page 4 S I The provider will conduct return-to-duty and follow-up drug and alcohol testing on employees who violate the City's drug free workplace standards, at intervals and frequency determined solely by the City. The provider will offer drug and alcohol testing services with licensed and certified personnel and laboratories as required by local, state and federal law. The provider's drug and alcohol testing services will be overseen by a Medical Review Officer(MRO). The provider will conduct annual training for designated City employees on the Drug Free Workplace Act, including training on signs and symptoms of drug and/or alcohol abuse, if requested by the City. The provider will ensure the proper and documented chain of custody during and after sample collection and testing. The provider will have private and appropriate facilities to conduct these tests. The provider will offer locked, secured boxes for employees' personal items and police weapons. G. FITNESS FOR DUTY EVALUATIONS The provider will evaluate an employee's ability to continue employment in his or her current capacity and assist in identifying what reasonable accommodation, if any, may make it possible for the employee to remain in his or her current job. These evaluations may include a physical examination, return-to-work evaluation, psychological and/or psychiatric evaluation, and result in reports as requested by the City. Evaluations are to be completed within two (2) working days of the request and on the same day in case of an emergency. Results of the examination will be forwarded to the City within twenty-four(24) hours of the appointment or receipt of test results, if any. The provider will assist the City in evaluating and verifying Family Medical Leave requests, as needed. H. PERFORMANCE CRITERIA AND EVALUATION Each month, the City will evaluate the provider's performance based on the scope of services and feedback from employees, applicants and customer satisfaction by the Human Resources Department. The criteria to be rated will include, but is not limited to, responsiveness to the City's needs for pre-employment drug and alcohol screening, fitness for duty determinations, communication on all required results and designated contact availability. The criteria to be rated will change based upon the needs of the City. If the City finds the provider to have less than 80% compliance with any one item within the scope of services over a thirty (30) day period, the City may utilize a fifteen (15) day notice to correct such default. Miami Beach RFP 2014-127-LR Appendix C—Page 5 I. COMMUNICATION The provider will set up and use an electronic email system compatible with the City's. All reports and other necessary communication will be through this system. Any and all associated costs with the set up will be absorbed by the provider. The provider will have qualified personnel available during normal business hours to provide all services including final physician sign-off for pre-employment examinations. All test results under the scope of services and the agreement will be communicated only to the Human Resources Director or his/her designee. J. STAFFING The provider's staffing level will be sufficient to deliver all services stated in the scope of services and the agreement.. The provider will increase staffing if unable to fully comply with what has been stated herein. K. FEES. Fee information must be submitted with the proposal. Notwithstanding any fee schedule submitted, the City reserves the right to further negotiate fees with the successful proposer. The proposers shall provide their fees for the following services: a. STANDARD PRE-EMPLOYMENT PHYSICAL including: 1. Review of medical history/physical examination and consultation 2. Breath Alcohol Test 3. Urine Drug Screen— 10 Panel 4. Hearing Screen/Whisper 5. Vision Screen 6. Tuberculin Skin Test b. POLICE , FIREFIGHTER PRE-EMPLOYMENT PHYSICAL including: 1. Review of medical history/physical examination and consultation 2. Breath Alcohol Test 3. Urine Drug Screen —Panel (test panels include Amphetamines, Barbituates, Benzodiazepines, Cannabinoid, Cocaine Metabolite, Methaqualone, Opiates, Phencyclidine, Methadone, and Propoxyphene.) 4. Comprehensive Blood Cell counts • 5. Comprehensive Blood Chemistries 6. Comprehensive Lipid Panel 7. Comprehensive HIV/AIDS 8. Comprehensive Hepatitis B and C titer 9. Comprehensive Urinalysis 10. Nasal Swab Culture Miami Beach RFP 2014-127-LR Appendix C—Page 6 11. Hem Cult (40 years and over) 12. Visual Exam, (acuity+depth+color+visual fields) 13. Glaucoma Screen (40 years and older) 14, Comprehensive Pulmonary Function Test 15, Tuberculin Skin Test 16. OSHA compliant PA and LAT (if medically indicated) 17. Chest X-ray with Cardiologic Interpretation c. IMMUNIZATION SERVICES to include: 1. Tetanus Toxoid Booster 2, Hepatitis B Vaccination (complete series of 3) 3. Hepatitis A&B Vaccination (complete series of 3) 4, Measles, Mumps and Rubella 5. Anti viral medication for HIV/AIDS exposure (3 day supply) d. EKG e. FITNESS FOR DUTY EVALUATIONS f. RANDOM, REASONABLE SUSPICION, RETURN TO WORK AND POST- ACCIDENT DRUG AND ALCOHOL TESTING INCLUDING CONSULTATION WITH THE MEDICAL REVIEW OFFICER AND EVALUATION BY THE SUBSTANCE ABUSE PROFESSIONAL PURSUANT TO DOT REQUIREMENTS g. RESPIRATOR REVIEW AND CLEARANCE h. MOBIL UNIT Miami Beach RFP 2014-127-LR Appendix C—Page 7 APPENDIX D AO. AA MAI ; - Special RFP 2 MEDICAL SERVICES DEPARTMENT OF PROCUREMENT MANAGEMENT 1700 Convention Center Drive Miami Beach, Florida 33139 1. TERM OF CONTRACT. The contract shall commence upon the date of notice of award and shall be effective for a period of two (2) years. 2. OPTIONS TO RENEW. The City, through its City Manager, will have the option to extend for three (3) additional one (1) year periods. 3. PRICES. All prices shall be negotiated with the selected proposer(s). Miami Beach RFP 2014-127-LR Appendix D—Page 1 • APPENDIX E 41.'"' AA AM I ;4- Cost RFP2O14- 127-LR MEDICAL SERVICES DEPARTMENT OF PROCUREMENT MANAGEMENT 1700 Convention Center Drive Miami Beach, Florida 33139 4 it APPENDIX A COST PROPOSAL FORM Failure to submit Appendix.A,Cos t Proposal Form;in its entirety and fully executed by the deadline established for the receipt of proposlals will result in proposal being deemed non-responsive and being rejected. Proposer affirms that the prices stated on the tender form below represents the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance. The Cost Proposal Form shall be completed mechanically or, if manually, in ink. Cost Proposal Form completed in pencil shall be deemed non-responsive.All corrections on the Cost Proposal Form shall be initialed. Refer to Section 0500 —Fees (paragraph K) for a complete description of the services included on each line item below. Annual ` t Total Item - . _Description... __-_ ;Quantity ��U'I M _ �_ Unit Cost _ _. _ (duantity_x_unit_cost) STANDARD PRE-EMPLOYMENT 1 PHYSICAL 237 Each $ $ POLICE,FIREFIGHTER PRE- 2 EMPLOYMENT PHYSICAL 80 Each $ $ 3 IMMUNIZATION SERVICES 350 Each $ $ 4 EKG 5 Each $ $ 5 FITNESS FOR DUTY EVALUATIONS 7 Each $ $ RANDOM, REASONABLE SUPICION, RETURN TO WORK AND POST-ACCIDENT 6 DRUG AND ALCOHOL TESTING 516 Each $ $ 7 RESPIRATOR REVIEW AND CLEARANCE 3 Each $ $ 8 MOBIL UNIT 4 da $ $ $ Company: Authorized Representative: Address: Telephone: Email: Authorized Representative's Signature: Miami Beach RFP 2014-127-LR Appendix E—Page 1 APPENDIX F -- • Insurance Requirements RFP2O14- 127-LR MEDICAL SERVICES DEPARTMENT OF PROCUREMENT MANAGEMENT 1700 Convention Center Drive Miami Beach, Florida 33139 IV\ A AVA :II.' :N1 INSURANCE REQUIREMENTS This document sets forth the minimum levels of insurance that the contractor is required to maintain throughout the term of the contract and any renewal periods. XXX 1. Workers' Compensation and Employer's Liability per the Statutory limits of the state of Florida. XXX 2. Comprehensive General Liability (occurrence form), limits of liability $ 1,000,000.00 per occurrence for bodily injury property damage to include Premises/ Operations; Products, Completed Operations and Contractual Liability. Contractual Liability and Contractual Indemnity (Hold harmless endorsement exactly as written in "insurance requirements"of specifications). XXX 3. Automobile Liability-$1,000,000 each occurrence-owned/non-owned/hired automobiles included. 4. Excess Liability- $ .00 per occurrence to follow the primary coverages. XXX 5, The City must be named as and additional insured on the liability policies; and it must be stated on the certificate. 6. Other Insurance as indicated: Builders Risk completed value $ .00 Liquor Liability $ .00 Fire Legal Liability $ .00 Protection and Indemnity $ .00 Employee Dishonesty Bond $ .00 Other: Professional Liability $ .00 XXX 7. Thirty (30) days written cancellation notice required. XXX 8. Best's guide rating B+:VI or better, latest edition. XXX 9. The certificate must state the bid number and title The City of Miami Beach is self-insured. Any and all claim payments made from self-insurance are subject to the limits and provisions of Florida Statute 768.28, the Florida Constitution, and any other applicable Statutes. Miami Beach RFP 2014-127-LR Appendix F—Page 1 PROPOSAL SUBMITTED BY MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC . . r ,` .-y , \.,,,, vi,o4the.7;1tikr.-..;,:,:";,'7.44141:1N*.10:::nWor.-81*,•.:.. .4,1p40.6404-4:.ligow„T,Iontlestv4,,,Aviketatmutos9..xtfoosso: ",•,,, ‘Iii!kt..'; N4:41. s c „ „ „ • • i • • • • • . 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The Proposer is appointing Ms. Linda Arama as the primary contact person for this RFP;she can be reached at(305)674-3910, and her e-mail address is LaramaAmsmc.com; Vicky Gonzalez is the secondary contact person for this RFP, she can be reached at (305)674-2085), and her email address is Vicky-go(c�msmc.com. Should you have any questions concerning the above, please do not hesitate to contact the undersigned. Sincerely, Linda Arama Director Occupational Health Center 1 Mount M E D I C A L C E N T E R Table of Contents TAB 1 —Cover Letter& Minimum Qualifications Requirements 1.1 Cover Letter......... Page 1 1.2 Proposal Certification, Questionnaire & Requirements Affidavit Page 2 Proposal Forms ...... Attachment A Local Business Tax Receipt...... ... .. ........ Attachment B Reference Letters............ Attachment C Code of Conduct...... ...... Attachment D 1.3 Minimum Qualifications Requirements............ ... ..........Page 3 TAB 2— Experience & Qualifications 2.1 Qualifications of Proposing Firm... ..........Page 4 Experience .................Page 5 Experience (Cont'd) ..................Page 6 Experience (cont'd).................... Page 7 Experience (cont'd).................... .................. ....... .....Page 8 2.2 Qualifications of Proposer Team Proposer Organization Chart..................... ..............Attachment E Management& Key Personnel............ ...... ............... ...Page 9 Management & Key Personnel (cont'd)........................... Page 10 Resume, Curriculum Vitae, Certificates, Licenses... ....Attachment F 2.3 Financial Capacity D&B Supplier Qualifier Report ... ..... . ....Attachment G TAB 3—Scope of Service, Proposed ..................... ... ...................Page 11 Scope of Service, Proposed (cont'd)... .......Page 12 Scope of Service, Proposed (cont'd)......... ......................Page 13 Scope of Service, Proposed (cont'd}.......................... ....... Page 14 Scope of Service, Proposed (cont'd).....................................Page 15 Scope of Service, Proposed (cont'd).....................................Page 16 Scope of Service, Proposed (cont'd}.....................................Page 17 TAB 4—Approach and Methodology... Page 18 TAB 5 -- Cost Proposal......... Page 19 Cost Proposal (cont'd)............... ............................Page 20 2 Mount Sinai M E D I C A L C E N T E R TAB 1 1.2 PROPOSAL CERTIFICATION QUESTIONAIRE & REQUIREMENT AFF1VADIT ATTACHMENT A PROPOSAL FORMS Solicitation No: Solicitation Title: RFP 2014-127-LR MEDICAL SERVICES Procurement Contact Tel: Email: .LOURDES RODRIGUEZ 305-673-7490,x6652 LourdesRodriguez @MiamiBeachFL.gov PROPOSAL CERTIFICATION,QUESTIONNAIRE&REQUIREMENTS AFFIDAVIT Purpose: The purpose of this Proposal Certification, Questionnaire and Requirements Affidavit Form is to inform prospective Proposers of certain solicitation and contractual requirements, and to collect necessary information from Proposers_ in order that certain portions of responsiveness, responsibility and other determining factors and • compliance with requirements may be evaluated. This Proposal Certification, Questionnaire and Requirements Affidavit Form is a REQUIRED FORM that must be submitted fully completed and executed. 1. General Proposer Information. FIRM NAME: mn 151 Ill_bIGAL Cana Or No of Years in Business: 53 No of Years in Business Locally: •53 • OTHER NAME(S)PROPOSER HAS OPERATED UNDER IN THE LAST 10 YEARS: • FIRM PRIMARY ADDRESS(HEADQUARTERS): 'x-300 i��-TOE �Q A-a CITY: n M t 0�.1'ln B.e.o--■ STATE: � Rae) .1)A- ZIP CODE: � 3 3 i go TELEPHONE NO.:. 3os- -3At O TOLL FREE NO.: lst f A FAX NO.:. gos - 535-19011 FIRM LOCAL ADDRESS: 4300 A L.-r/DA-) R oaA CITY: & _ t�i�rni STATE: F10 4.1M- ZIP CODE: 331 r¢o PRIMARY ACCOUNT REPRESENTATIVE FOR THIS ENGAGEMENT: Li f-ieAM4 ACCOUNT REP TELEPHONE NO:: 305— ty—7 4-341)0 ACCOUNT REP TOLL FREE NO.: NIA ACCOUNT REP EMAIL: Lcutzt„,ynaf m6rnc. FEDERAL TAX IDENTIFICATION NO.: 5q- a l_ Lj L The City.reserves the right to seek additional information from proposer or other source(s),including but not limited to:any firm or principal information,applicable Iicensure,resumes of relevant individuals,client information,financial information,or any information the City deems necessary to evaluate the capacity of the proposer to perform in accordance with contract requirements. Miami Beach RFP 2014-127-LR • AppendixA—Page 1 1. Miami Beach Based(Local Vendor.Is proposer claiming Miami Beach based firm status? YES NO SUBMITTAL REQUIREMENT:Proposers claiming Miami Beach vendor status shall submit a Business Tax Receipt issued by the City of Miami Beach and the proof of residency requirement,as required pursuant to ordinance 2011-3747,to demonstrate that the Proposer is a Miami Beach Based Vendor. 2. Veteran Owned Business.is ro oser claiming a veteran owned business status? YES E. NO SUBMITTAL REQUIREMENT:Proposers claiming veteran owned business status shall submit a documentation proving that firm is certified as a veteran-owned business or a service-disabled veteran owned business by the State of Florida or United States federal government,as required pursuant to ordinance 2011-3748. C.Re6e , To-&I Cqurta, ,,t,A- Local &Awed) "TexiG Reeve 3. Conflict Of Interest.All Proposers must disclose,in their Proposal,the name(s)of any officer,director,agent,or immediate family member(spouse, parent, sibling,and child)who is also an employee of the City of Miami Beach. Further,all Proposers must disclose the name of any City employee who owns, either directly or indirectly,an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates. ND}UL izie442:4- SUBMITTAL REQUIREMENT:Proposers must disclose the name(s)of any officer,director,agent, or immediate family member (spouse,parent,sibling,and child)who is also an employee of the City of Miami Beach. Proposers must also disclose the name of any City employee who owns,either directly or indirectly,an interest of ten(10%)percent or more in the Proposer entity or any of its affiliates 4. References&Past Performance.Proposer shall submit at least three(3)references for whom the proposer has completed Work similar in size and nature as the work referenced in solicitation. R.e Le,t_to tab- 7 trockno2Att r-Redeig a.( ) SUBMITTAL REQUIREMENT: For each reference submitted, the following information is required: 1) Firm Name, 2)Contact Individual Name&Title,3)Address,4)Telephone,5)Contact's Email and 6)Narrative on Scope of Services Provided. 5. Suspension,Debarment or Contract Cancellation.Has proposer ever been debarred,suspended or other legal violation,or had a contract cancelled due to non-performance by any ublic sector agency? YES J NO SUBMITTAL REQUIREMENT: If answer to above is"YES,'Proposer shall submit a statement detailing the reasons that led to action(s). 6. Vendor Campaign Contributions.Proposers are expected to be or become familiar with,the City's Campaign Finance Reform laws, as codified in Sections 2-487 through 2-490 of the City Code. Proposers shall be solely responsible for ensuring that all applicable provisions of the City's Campaign Finance Reform laws are complied with,and shall be subject to any and all sanctions, as prescribed therein,including disqualification of their Proposals,in the event of such non-compliance. SUBMITTAL REQUIREMENT: Submit the names of all individuals or entities(including your sub-consultants)with a controlling financial interest as defined in solicitation. For each individual or entity with a controlling financial interest indicate whether or not each individual or entity has contributed to the campaign either directly or indirectly,of a candidate who has been elected to the office of Mayor or City Commissioner for the City of Miami Beach. Norte 7. Code of Business Ethics.Pursuant to City Resolution No.2000-23879,each person or entity that seeks to do business with the City shall adopt a Code of Business Ethics (°Code') and submit that Code to the DEPARTMENT OF PROCUREMENT MANAGEMENT with its bid/response or within five(5) days upon receipt of request.The Code shall,at a minimum, require the Proposer, to comply with all applicable governmental rules and regulations including, among others, the conflict of interest, lobbying and ethics provision of the City of Miami Beach and Miami Dade County. - R ti to "ta—f C , t C Co ILL Cawiluel-) SUBMITTAL REQUIREMENT: Proposer shall submit firm's Code of Business Ethics. In lieu of submitting Code of Business Ethics,proposer may submit a statement indicating that it will adopt,as required in the ordinance,the City of Miami Beach Code of Ethics,available at www.miamibeachfl.gov/procurement/. Miami Beach RP 2014-127-LR ACpendiix A-Page 2 8. Living Wage.Pursuant to Section 2-408 of the Miami Beach City Code,as same may be amended from time to time,proposers shall be required to pay all employees who provide services pursuant to this Agreement,the hourly living wage rates listed below: • Commencing with City fiscal year 2012-13(October 1,2012),the hourly living rate will be$1 L.281hr with health benefits,and$12.92/hr without benefits. The living wage rate and health care.benefits rate may, by Resolution of the City Commission be indexed annually for inflation using the Consumer Price Index for all Urban Consumers(CPI-U)Miami/Ft.Lauderdale,issued by the U.S.Department of Labor's Bureau of Labor Statistics. Notwithstanding the preceding,no annual index shall exceed three percent(3%).The City may also,by resolution,elect not to index the living wage rate in any particular year,if it determines it would not be fiscally sound to implement same(in a particular year). Al) Proposers'failure to comply with this provision shall be deemed a material breach under this bid,under which the City may,at its sole option, immediately deem said proposer as non-responsive, and may further subject proposer to additional penalties and fines, as provided in the City's Living Wage Ordinance, as amended. Further information on the Living Wage requirement is available at www.miamibeachfl.govlprocurementl. SUBMITTAL REQUIREMENT:No additional submittal is required.By virtue of executing this affidavit document,Proposer agrees to the living wage requirement. 9. Equal Benefits for Employees with Spouses and Employees with Domestic Partners.When awarding competitively solicited contracts valued at over$100,000 whose contractors maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks,the Equal Benefits for Domestic Partners Ordinance 2005-3494 requires certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive bids, to provide "Equal Benefits' to their employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to all employees of a Contractor who work within the City limits of the City of Miami Beach,Florida;and the Contractor's employees located in the United States, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami Beach. A. Does your company provide or offer access to any benefits to employees with spouses or to spouses of employees? VA YES f NO • B. Does your company provide or offer access to any benefits to employees with(same or opposite sex)domestic partners'or to domestic partners of employees? X YES NO c. Please check all benefits that apply to your answers above and list in the "other" section any additional benefits not already specified. Note:some benefits are provided to employees because they have a spouse or domestic partner, such as bereavement leave; other benefits are provided directly to the spouse or domestic partner,such as medical insurance. BENEFIT Firm Provides for Firm Provides for Firm does not Employees with Employees with Provide Benefit Spouses Domestic Partners Health K Sick Leave X Family Medical Leave }� Bereavement Leave �( X If Proposer cannot offer a benefit to domestic partners because of reasons outside your control, (e.g., there are no insurance providers in your area willing to offer domestic partner coverage)you may be eligible for Reasonable Measures compliance.To comply on this basis, you must agree to pay a cash equivalent and submit a completed Reasonable Measures Application (attached)with all necessary documentation.Your Reasonable Measures Application will be reviewed for consideration by the City Manager,or his designee.Approval is not guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement is available at www.miamibeachft.govlprocurementl. Miami Beach RFP 2014-127-LR Appendix A—Page 3 10. Public Entity Crimes.Section 287.133(2)(a),Florida Statutes,as currently enacted or as amended from time to time,states that a person or affiliate who has been placed on the convicted vendor list following a conviction fora public entity crime may not submit a bid,proposal,or,reply.on a contract to provide any goods or services to a public entity;may not submit a bid,proposal,or reply on a contract with a public entity for the construction or repair of a public building or public work;may not submit bids,proposals,or replies on leases of real property to a public entity;may not be awarded or perform work as a contractor,supplier,subcontractor,or consultant under a contract with any public entity;and may not transact business with any public entity in excess of the threshold amount provided in s.287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list glk SUBMITTAL REQUIREMENT:No additional submittal is required.By virtue of executing this affidavit document,proposer agrees with the requirements of Section 287.133,Florida Statutes,and certifies it has not been placed on convicted vendor list. 11. Acknowledgement of Addendum. After issuance of solicitation,the City may release one or more addendum to the solicitation which may provide additional information to proposers or alter solicitation requirements.The City will strive to reach every Proposer having received solicitation through the City's e-procurement system, PublicPurchase.com. However, Proposers are solely responsible for assuring they have received any and all addendum issued pursuant to solicitation. This Acknowledgement of Addendum section certifies that the Proposer has received all addendum released by the City pursuant to this solicitation. Failure to obtain and acknowledge receipt of all addendum may result in proposal disqualification. Initial to Confirm Initial to Confirm Initial to Confirm Receipt Receipt Receipt f} ^Addendum 1 Addendum 6 Addendum 11 A- Addendum 2 Addendum 7 Addendum 12 pO/ri- Addendum 3 Addendum 8 Addendum 13 - Addendum 4 Addendum 9 Addendum 14 Addendum 5 Addendum 10 Addendum 15 If additional confirmation of addendum is required,submit under separate cover. • • • • • Miami Beach RFP 2014127-LR Appendix A—Page 4 • DISCLOSURE AND DISCLAIMER SECTION The solicitation referenced herein is being furnished to the recipient by the City of Miami Beach(the'City")for the recipient's convenience. Any action taken by the City in response to Proposals made pursuant to this solicitation,or in making any award,or in failing or refusing to make any award pursuant to such Proposals,or in cancelling awards,or in withdrawing or cancelling this solicitation,either before or after issuance of an award,shall be without any liability or obligation on the part of the City. In its sole discretion,the City may withdraw the solicitation either before or after receiving proposals,may accept or reject proposals,and may accept proposals which deviate from the solicitation,as it deems appropriate and in its best interest.in its sole discretion,the City may determine the qualifications and acceptability of any party or parties submitting Proposals in response to this solicitation. Following submission of a Bid or Proposal, the applicant agrees to deliver such further details, information and assurances, including financial and disclosure data, relating to the Proposal and the applicant including, without limitation, the applicants affiliates, officers, directors,shareholders,partners and employees,as requested by the City in its discretion. The information contained herein is provided solely for the convenience of prospective Proposers. It is the responsibility of the recipient to assure itself that information contained herein is accurate and complete.The City does not provide any assurances as to the accuracy of any information in this solicitation. Any reliance on these contents,or on any permitted communications with City officials,shall be at the recipient's own risk.Proposers should rely exclusively on their own investigations,interpretations,and analyses.The solicitation is being provided by the City without any warranty or representation, express or implied,as to its content,its accuracy,or its completeness.No warranty or P p p Y. p ty representation is made by the City ty or its agents that any Proposal conforming to these requirements will be selected for consideration,negotiation,or approval. The City shall have no obligation or liability with respect to this solicitation,the selection and the award process,or whether any award will be made.Any recipient of this solicitation who responds hereto fully acknowledges all the provisions of this Disclosure and Disclaimer,is totally relying on this Disclosure and Disclaimer,and agrees to be bound by the terms hereof.Any Proposals submitted to the City pursuant to this solicitation are submitted at the sole risk and responsibility of the party submitting such Proposal. This solicitation is made subject to correction of errors,omissions,or withdrawal from the market without notice.Information is for guidance only,and does not constitute all or any part of an agreement. The City and all Proposers will be bound only as, if and when a Proposal (or Proposals), as same may be modified, and the applicable definitive agreements pertaining thereto, are approved and executed by the parties, and then only pursuant to the terms of the definitive agreements executed among the parties.Any response to this solicitation may be accepted or rejected by the City for any reason,or for no reason,without any resultant liability to the City. The City is governed by the Government-in-the-Sunshine Law,and all Proposals and supporting documents shall be subject to disclosure as required by such law.All Proposals shall be submitted in sealed bid form and shall remain confidential to the extent permitted by Florida Statutes,until the date and time selected for opening the responses.At that time, all documents received by the City shall become public records. Proposers are expected to make all disclosures and declarations as requested in this solicitation.By submission of a Proposal,the Proposer acknowledges and agrees that the City has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement information contained in the Proposal,and authorizes the release to the City of any and all information sought in such inquiry or investigation. Each Proposer certifies that the information contained in the Proposal is true, accurate and complete, to the best of its knowledge, information,and belief. Notwithstanding the foregoing or anything contained in the solicitation,all Proposers agree that in the event of a final unappealable judgment by a court of competent jurisdiction which imposes on the City any liability arising out of this solicitation, or any response thereto, or any action or inaction by the City with respect thereto,such liability shall be limited to$10,000.00 as agreed-upon and liquidated damages.The previous sentence, however, shall not be construed to circumvent any of the other provisions of this Disclosure and Disclaimer which imposes no liability on the City. In the event of any differences in language between this Disclosure and Disclaimer and the balance of the solicitation,it is understood that the provisions of this Disclosure and Disclaimer shall always govern.The solicitation and any disputes arising from the solicitation shall be governed by and construed in accordance with the laws of the State of Florida. Miami Beach RFP 2014-127-IR Appendix A—Page 5 PROPOSER CERTIFICATION I hereby certify that I, as an authorized agent of the Proposer, am submitting the following information as my firm's proposal; Proposer agrees to complete and unconditional acceptance of the terms and conditions of this document, inclusive of this solicitation,all attachments,exhibits and appendices and the contents of any Addenda released hereto, and the Disclosure and Disclaimer Statement; proposer agrees to be bound to any and all specifications, terms and conditions contained in the solicitation,and any released Addenda and understand that the following are requirements of this solicitation and failure to comply will result in disqualification of proposal submitted; Proposer has not.divulged, discussed,or compared the proposal with other Proposers and has not colluded with any other proposer or party to any other proposal; proposer acknowledges that all information contained herein is part of the public domain as defined by the State of Florida Sunshine and Public Records Laws;all responses, data and information contained in this proposal, inclusive of the Proposal Certification,Questionnaire and Requirements Affidavit are true and accurate. Name of Proposer's Authorized Representative: Title of Proposer's Authorized Representative: Signatur of roposer's Authorized Representative:. Date: • State of FLORIDA or) On this '" day of C-E` 20 +/personally _ appeared before me I Las who Ccijapittgitn c:,44 I c stated that (s)he is the Vr of f4 A- 4 , a corporation, and that the instrument was signed in behalf o � p � g of the said corporation by authority of its board of directors and acknowledged said instrument to be its voluntary act and deed. Befor e: Dl6tary Public for the State of a My Commission Expires: A X23 acef7. Miami Beach RFP 2014-127-LR Appendix A—Page 6 Mount Sinai M E D I C A L C E N T E R TAB 1 1. 2 PROPOSAL CERTIFICATION QUESTIONAIRE & REQUIREMENT AFFIVADIT ATTACHMENT B LOCAL BUSINESS TAX RECEIPT • 000637 Local-,Business Tax Receipt. Miami—Dade County,State of Florida • THIS IS NOTA BILL-.DO:NOT PAY _ 1823476 -` , .BUSINESS°NAME/LOCATIOl1i - RECEIPT NO. EXPIRES: • MOUNT SINAI MEDICAL CIR OF FL INC 2014 -4300`ALTON.RD 1 823476 •MuSYbo.dIsplayed.at'plane of business ' 'MIAMI BEACH•FL 33140 ' ' Pursuant to County Code - Chapter 8A-Art:9-.&i:10 OWNER. J - SEC.TYPE OF BUSINESS_ PAYMENT RECEIVED -MOUNT SINAI MEDICAL CrR OF FL INC '173 NON-PROFIT CHAR!REL!EDUC. - BY TAX COLLECTOR $0.00 09/]9/2013 FPPU05-13-004306 This LcceI Business TO Receipeonly confirms payment of the Local Business Tax Tito Receipt is not a.license. „perarit;or a certifleation of the holder's qualifications,to do business.Holder must comply.wrth any governmental or , nongovernmental regulatory laws and requirements which apply to the business. - •- ' -The RECEIPT NU.above must be displayed on all commercial vehicles-Wliami-Dade Code Sac Sa-276. • ' -For more information,visit www.miemidede;gavltancollector . • • Mount Sinai M E D I C A L C ENT E R TAB 1 1.2 PROPOSAL CERTIFICATION QUESTIONAIRE & REQUIREMENT AFFIVADIT ATTACHMENT C REFERENCE LETTERS Human Resources • • , � _� . n Director's Office MIAMWADE 111 NW 1st Street•Suite 2100 COUNTY ? Miami,Florida 33128-1907 T 305-375-1589 F 305-375-2459 mlamldade.gov - ii • Y ' i t March 28,2014 • To whom it may concern: • Mount Sinai Medical Center performed Pre-Employment, Annual and HAZMAT Physical Examination, R andom Drug and Alcohol Testing, Fitness for Duty and Immunizations for 32 years to Miami Dade County. The County has been quite pleased with both the administration • and the work performed by the staff of Mount Sinai Occupational Health. Throughout the County's 32 years partnership, all requests were accommodated without hesitation including the availability of physicians as needed. I would recommend Mount Sinai Medical Center's Occupational health Facility to any employer considering a relationship with a medical services provider providing convenient, quality customer service and clear concise communication. I f you have any further questions regarding the services provided to Miami Dade County by Mount Sinai Medical Center Occupational Health, please feel free to contact me Michael Edwards,,Labor Relations Manager,Miami Dade County 111 N. N. 1st Street,Miami, Florida at 305-375-2479 with an e-mail address ofMXX @miamidade.gov. Sincerely, M hael dwards Labor Relations Manager • Human Resources • • { { !Ii±g of Aliami _....... 14, 73\ AMY!CLOSE • i ; DANIEL).ALFONSO Director of Human Resources • 1* uuu�vuu a City Manager •'",•4 0 1 1 0 1 March 26,2014 To Whom It May Concern: RE: Vender Reference--Mount Sinai This is in response to your request for a letter of recommendation for Mount Sinai which has been the City of Miami's vender since 2010 for Physical Examinations(i.e., pre-employment/promotional, Return to Duty and Fitness for Duty)and recently became our vender for Drug and Alcohol Screening Services(i.e., Pre-employment/Promotion, DOT/CDL follow-up, Random and suspicion and CBA Union Contracts' follow-up, Random and Suspicion). My name is Reveca Valiente-Ortiz, Human Resources Coordinator for the City of Miami Human Resources Department I am responsible for Physical examinations and Drug testing Services for all aforementioned services and have been working with the City in this capacity since 2004. Mount Sinai,as a City vender, has been one of the best venders that I have ever dealt with from the turnaround of pending drug screening results to accommodating the City with last minute scheduling of 50 firefighters applicants with timelines to meet while the staff at Mount Sinai was handling other services for the City and other customers. The staff has always provided high quality customer service and communication with the staff is excellent. Issues are rare;those only required some minor documentation,clarification and correction. As far as a vender to do business with, Mount Sinai is one of the best that I have ever dealt with based on my experience;any customer should be very pleased to be the one that selects them to do business with. If you would like further elaboration,feel free to call me at(305)416-2113. Sinc eiy, C Rev ca Vaii Ortiz, Human Resources Coordinator City of Miami-Human Resources Department Tel: (305)416-2113 Fax:(305)416-2115 RValiente-OrtizCa�miamigov.com DEPARTMENT OF HUMAN RESOURCES 444 S.W.2nd Avenue,76Floor Miami,FL 33130(305)416-2100 Fax:(305)416-2115 Mailing Address:P.O.I3ox 330708 Miami,Florida 33233-0708 Website:www.miamigov.com/Job Hotline(305)416-2050 • :`:$A OR==,= March 27,2014 Town Council Robert H.Yaffe Mayor To Whom It May Concern: Jordan W. Leonard vice Mayor Please accept this letter from the Town of Bay Harbor Islands based on the Stephanie Bruder professional association over the past several years with Mount Sinai Medical Council Member Center Occupational Health Department. Joshua D. Fuller Council Member The Town of Bay Harbor Islands is located in Miami-Dade County, Florida and our address is 9665 Bay Harbor Terrace, Bay Harbor Islands, FL 33154. My Kelly Reid Council Member name is Vicky Motola and I am the Human Resources Manager. My phone number is 305-866-6241. Solange M. Rousselot Council Member We have utilized the services of Mount Sinai Medical Center for a minimum of Isaac Salver the past nine years for the Town's medical and health needs. The scope of Council Member services include: pre-employment drug screening/physical exams, worker's compensation injury evaluation, and immunization needs. My experience with the staff has been of excellent standard and professionalism. Town Officials if I can be of further assistance, I can be reached at my office,305-866-6241. Ronald J. Wasson Town Manager Thank you. Marlene Maronte Sincerely, Town Clerk • Craig B. Sherman ` :;v% Town Anorney Vicky M ola Human Resources Manager MAYOR JOSEPH J. GARDNER GOVERNMENT CENTER 9665 Bay Harbor Terrace•Bay Harbor Islands,FL 33154•Tel:(305)8666241. •Fax:(305)866-4863•www.bayhorborislonds.org Mount Sinai M E D I C A L C E N T E R TAB 1 1 .2 PROPOSAL CERTIFICATION QUESTIONAIRE REQUIREMENT AFFIVADIT ATTACHMENT D CODE OF CONDUCT ...„;.,i. .+ -tee• z•---- _ _ i; 3:1s _ ^Qi r r " ' ...";:-.:,'...!.-.1-F, a'' •Y .C,r•e r'''' ';44 ;, .b! '!- • '•`. I:.Y: itJ..4, Y ,I: zM1!.?Al - '''' 4� , Z'7,.,. , � � B• : .;a=. , :' t - . -ti•`,: :.3:•. _�>c_- a °. 4w-rg i- �_r.ar 'T H .:T i'J Y ca n.,,a, _ v,.r' :a,^d ,, ` 4..x ^3Y A �T -,.. Sj 1 1,..,,,,.....-:.,..-i a,�,5,.....,S,.4.11:,-,,,r1"'" 4p °"',•".. ,.115- 1r•:1l i t , ,<7, o�t•�'• k 71:.._'''‘-;14,..7.......:'. "'er! iy.$.i +, 7:i 7s . J;/,,-SC;�.a 'O •� { 4..�.#.' b,, " ,'t .uo-�� 1.!:-�tom ,„ �r4f 4 `1 , A : TABLE'O F CONTENTS - . = Mission Statement 4 Ethics and Compliance Program 4 Department of Ethics and Compliance 4 Code of Conduct 5 Ethics and Compliance Training 6 Ethics and Compliance Committee 6 Compliance Hotline 6 What is the Compliance Hotline? 6 Who may utilize the Compliance Hotline'?.... 6 What should be reported to the Hotline? 7 Reporting Compliance Concerns 7 Investigation of Hotline Reports 7 Non-Relation 7 Confidentiality, Privacy and Security 8 Privacy of Patient Information 8 Medical Center information and Media 9 Social Media Usage 9 Quality Patient Care... 9 Patient Rights 10 Patient Safety Hotline 11 Fraud,Waste and Abuse 11 Ineligible Persons/Entities 12 Human Research 13 Record Keeping. 13 Safeguarding Medical Center and Patient Property 14 Workplace Health and Safety.. 14 Political Activity and Lobbying 14 Tobacco-Free Environment 15 Gifts 15 Conflict of Interest 16 Relationships with Vendors and Competitors 16 Dealing Honestly with Customers,Vendors,and Consultants 16 Respect and Dignity in the Workplace 17 Disruptive Behavior 18 Solicitation and Distribution 18 Drug-Free Workplace 18 Human Resources 19 1 Bioethics Committee... 19 Government Operations Management 20 Notes 21 Statement of Understanding and Compliance with Ethics and Compliance Program Back Cover .3 MISSICON+STATEMENT.rf The mission of Mount Sinai Medical Center is to provide high quality health care to our diverse community enhanced through teaching, research, charity care and financial responsibility. Our vision is to be a highly respected regional referral center providing high quality healthcare,teaching and research. ETHICS AND COMPLIANCE PROGRAM y. • ��f _ ...fie F, _. Y„ ' Mount Sinai Medical Center has developed an Ethics and Compliance program which affirms and formalizes our commitment to ethical business practices. The program includes: D Stating standards of compliance and ethical conduct through a Code of Conduct. Creating awareness of these standards among everyone in the Medical Center through Ethics and Compliance Training. Monitoring and auditing performance in areas'of compliance risk through an Ethics and Compliance Committee to ensure that established policies and procedures are being followed and are effective. f) Providing a means to confidentially report possible misconduct through the Compliance Hotline without fear of retaliation or retribution. DEPARTMENT.OF''.ETHICS,AND COMPLIANCE The Department is charged with supporting Medical Center departments by helping to develop policies, procedures and practices to ensure compliance with applicable laws and regulations; assisting in informing affected departments of changes and updates in regulations; performing reviews and evaluations of all compliance programs at the Medical Center; assisting in relations with regulatory bodies, and ensuring that - appropriate and timely information is provided to the Board of Trustees and senior leadership regarding all aspects of the compliance program.. 4 The Department coordinates multiple activities of the Compliance Program, including the preparation and distribution of this Code of Conduct, annual and special-purpose compliance training, the institutional Ethics and Compliance Committee, the Confidential Hotline program, monthly compliance updates, policy and procedure reviews, the patient privacy program and providing compliance information on the Medical Center intranet and elsewhere. The Department of Ethics and Compliance reports directly to the Chief Executive Officer and the Compliance Committee of the Board of Trustees. Please contact the Director of the Department of Ethics and Compliance at 305-674-2776 with any questions or concerns. CODE-:OF CONDUCT'. The Code of Conduct provides a reminder to all employees of how Mount Sinai conducts business in a proper manner, following state,federal and accreditation standards, as well as Medical Center policy. Mount Sinai expects all employees and associates to behave honestly, ethically, and in compliance with applicable laws. It is important for all of us to take time to review and become familiar with the Code of Conduct as well as Medical Center policies and procedures. The Medical Center requires that all officers, trustees, employees, physicians,allied health professionals,contractors, subcontractors, agents, and other persons who are associated with Mount Sinai promptly report any suspected violations of this Code of Conduct, Medical Center policies or applicable law. Violators of the Code will be subject to disciplinary action. Violations of the Code could result in any or all of the following: o oral warning o written warning • written reprimand • suspension, or • termination of employment or business relationship with the Medical Center. Violations of the Code may also result in a report to appropriate government agencies. 5 ETHiCS`AND,COMPLIANCE TRAINING h 'c• ; i• � c c .c x- a• is `L L. A kof a ..." •' - �. u Every employee receives two-hour "orientation" training on our Code of Conduct and policies within 30 days of the date of hire. During this training,each new employee will receive a copy of the Code of Conduct, participate in Code of Conduct training, and complete an acknowledgement card. Each year we conduct Code of Conduct "refresher" training for all of our employees. The required training is incorporated into the employee evaluation process. This training is conducted using slides or video clips and is facilitated by an instructor. The annual corporate compliance training provides continuing education and updates on topics related to ethics and compliance. The training is mandatory for all employees,vendors and associates,and is available in the English and Spanish languages. ;"'1 � L"ll , to i. .A • w T ` H r y..aic °- r '' y r f :: :.,, 'tit• r•, '�+ ��:. 7 E ;HICSANDDCOMPLiANCE.COM MI,TTEE °:• ` �m...b •�'- d.r ,, u{�, t.�-'`c,�..T'i4 "L:Wit.c','iZ. 3;"�4n rd�d99�r' (/r The Ethics and Compliance Program is supported and monitored by the Ethics and Compliance Committee. The Committee meets quarterly to review and discuss compliance information,including regulatory developments, departmental audits and reviews, compliance news, and reported incidents of non-compliance. COMPLIANCE HOTLINE 1-800-9544-6762-(English) 1-800-297-8592 (Spanish) What is the Compliance Hotline? The Compliance Hotline is a simple way for Mount Sinai employees and associates to confidentially report activities that may involve ethical violations or unlawful conduct at the Medical Center. The Compliance Hotline is managed and operated by an independent firm retained by Mount Sinai to ensure effective communication, integrity and confidential reporting. The Compliance Hotline is available toll-free, 24 hours a day, in.the English and Spanish languages. A trained operator takes each call, gathers the needed information, and ensures that the report is immediately sent to the Medical Center for investigation Y and appropriate action. Who May Utilize the Compliance Hotline? The Compliance Hotline is available for use by any employee or associate of the Medical Center. Everyone has a responsibility for reporting any activity that appears to violate applicable laws, rules, regulations, accreditation standards, Medical Center olic Y or this Code of Conduct. P 6, What should be reported to the Hotline? Users may call the Compliance Hotline to report suspected violations of the Code of Conduct, policies and regulations related to: • Fraud,Waste and Abuse • Conflicts of Interest • Confidentiality, Privacy and Security of Health Information • Identity Theft or Fraud • Environmental Health and Safety • Billing and Coding Integrity • Patient Rights • Business and Professional Ethics • ineligible Persons or Entities . • Research Concerns Reporting Compliance Concerns There are several options which an employee or associate may use to report a compliance concern. As a first step, an employee or associate has the choice to report any concerns to a supervisor, or to the Chief Compliance Officer at (305) 674-2916. Any person who feels uncomfortable reporting via these means is encouraged to call the confidential Compliance Hotline. Investigation of Hotline Reports Calls to the Compliance Hotline result in a written report that is transmitted to the Chief Compliance Officer for investigation. Each caller is given a case number for their use to provide additional information or to inquire about the status of the report. Every report is investigated, and the results of the investigation are provided to the caller via the Hotline. Investigation results are used to correct or prevent any improper behavior revealed by the report. Results of the investigations are shared with the Ethics and Compliance Committee and senior leadership of the Medical Center. Non-Retaliation There will be no retaliatory or disciplinary action taken against an employee for making a good-faith report to the Confidential Hotline. 7. I ' MOUNT SINAI MEDICAL CENTER r. a w •.,, • STANDARDS O�F�CO,NDUCT • '` ‘Confidentiality • ,P=rivacy •;Security. - Confidential information includes, but is not limited to: • Medical records("hard copy" or electronic); Individually Identifiable Patient Information • Personnel&Payroll records;and • Sensitive business and financial information of patients, vendors, and of the Medical Center,whether stored in electronic or"hard copy" format. Employees must dispose of confidential information in "hard copy" form in the special, locked consoles or shredders, and must dispose of electronically-stored confidential information according to procedures approved by the Information Security department. Employees must follow departmental records retention policies. Employees whose duties bring them into contact with electronically stored patient ' information are expected to observe all security rules regarding safeguarding confidential patient information in electronic form. Approval is required for the use of portable electronic storage devices which use, store or transmit patient records and other confidential information. Such devices must be secure at all times, and must utilize software and other controls(e.g.encryption)methods approved by the Medical Center's Information Security Officer. For additional information, please contact the Information Security Officer at(305)674-2947. Privacy of Patient Information Employees and associates of the Medical Center are privileged to have access to information that is personal and private. Our patients trust us to keep theii- information confidential. This means we should share records or patient information with authorized persons who are involved in the care of the patient or have a legitimate need to know. Inappropriate use or disclosure of patient information may be a violation of federal law and Mount Sinai policy and may subject the offender to significant penalties. All conversations which concern patient care must occur in a place that protects patient privacy and confidentiality. Employees may not leave private information where it may be seen or taken by unauthorized persons. Only the minimum confidential health information may be shared which is necessary for the purpose. a Employees are required to observe all security rules regarding electronic information. Employees may never share password or logon information. Users must sign off electronic systems when not in use, and at the end of each working day. Employees should ensure that all patient information is secured from access by unauthorized individuals, and notify supervisory staff of any suspicious individuals or behavior in their work areas. Identity theft has become an increasing concern. It is important for all employees who encounter or have a suspicion of identity theft to report the matter immediately to the Privacy Officer or Medical Center Security. Requests for information concerning our patients should be directed to the Health Information Management Department. For additional information, please contact the Privacy Officer at 305-674-2722. Medical Center Information and Media Only authorized employees may share or discuss Medical Center information with the news media. All calls must be referred to the Public Relations Department at 305-674-2600. Requests for information about an employee should be directed to the Human Resources Department, including requests for employment references and personal information. Social Media Usage Mount Sinai expects that all employees and associates who use social media (such as Facebook®, Twitter®, and similar services) will do so in accordance with applicable laws. Employees may not access personal social media accounts using the Mount Sinai network or e-mail system. Access to Social Media sites during work hours is only to take place during an authorized break period and outside of public areas of the Medical Center. Unauthorized employees may not make statements on social media sites which are (or which may reasonably be seen to be) made on behalf of the Medical Center. No patient information of any kind (including images), or confidential medical center information may be placed on social media sites for any reason. af1 QUALITY.RATIENT;'CAREJ "P.1 L ..Y..1 ,y. --..r� .v.. ..- .. �r --• .. . _... _ . _ .v.•.-�--.— 4 .7.....m Mount Sinai promotes health care quality, patient safety, and cost efficiency through focused initiatives. Furthering Mount Sinai's mission provides an opportunity for all employees to make a positive difference in the community. The Medical Center quality assessment and improvement processes are integrated into overall policies and operations. 9 The results of the evaluations are reviewed by the Quality and Patient Safety Committee and the Medical Staff Quality Performance Committee. Here are a few things we can do to improve the service we provide to our patients: • Follow the "SINAI Way"(Smile, Introduce, Narrate,Answer, Impact) • Report medication or treatment errors according to Medical Center policy. • Keep information about a patient private. • Be polite to patients and loved ones. • Maintain a safe patient care environment. • Report problems with medical equipment to Clinical Engineering. • Inform patients about their role in patient safety. PATIENT:RIGHTS The Medical Center believes that recognizing and respecting patient rights is an important aspect of care that encourages patients to become more involved in and informed about their care. Care, treatment and services should be provided in a.way that respects and fosters the patient's dignity, autonomy, positive self-regard, civil rights and involvement in his or her care. Further the Medical Center believes that care, treatment, and services should also be carefully planned and provided with due regard to the patient's personal values, beliefs, and preferences. Care at Mount Sinai Medical Center includes addressing processes and activities as they relate to patient rights by: • Informing patients of their rights and responsibilities • Helping patients understand and exercise their rights • Respecting patients'values, beliefs,and preferences • Informing patients of their responsibilities regarding their care,treatment,and services Some of the ways we meet standards of care related to patient rights include: a Respecting patients' right to receive visitors they designate including,but not limited to, a spouse,a domestic partner (including a same-sex domestic partner), another family member,or a friend, subject to reasonable or clinically necessary restrictions. • Honoring the patient's right to give or withhold informed consent. • Informing patients about advance directives. 10 • Complying with end of life decisions made by patients and surrogates. • Complying with decisions made by patients and families about organ donation. • Respecting the patient's right to receive information in a manner he or she understands. • Respecting the patient's rights during research, investigation and clinical trials. • Providing a process to have complaints reviewed by the Medical Center. PATIENT'SAFETYHO•i1Jl`!E F [r ti • • The Medical Center recognizes that Patient Safety is a priority for the organization and strives for continued improvement in the quality of care it provides to patients. While the Medical Center believes policies and procedures and compliance with state, federal and Joint Commission standards establishes a foundation for a.strong patient safety program it believes that feedback from stakeholders can only improve the program.As a, consequence, the organization has established a Patient Safety Hotline so that patients, family members, physicians, nurses and all employees are encouraged to express any safety concerns. Callers may remain anonymous. The telephone number is toll free and managed by a third party. The number is-888-234-2959. Any individual who provides care,treatment, and services may also report concerns about safety or the quality of care to The Joint Commission without retaliatory action from the Medical Center. 'FRAUD,;WASTE.AND ABUSE • Mount Sinai is committed to full compliance with all federal, state and local health care program requirements. "Fraud" involves the making of a false statement in order to receive some benefit to which one is not entitled. "Waste," and"Abuse"include practices which directly or indirectly result in unnecessary costs to a government health care p rogram or beneficiary. Examples of fraud and abuse include: • Billing for services or supplies which were not provided or furnished; • Altering claims forms or receipts in order to receive higher payments; • Duplicate billing to the government health care program and the patient or another insurer;and Offering, paying, soliciting, or receiving bribes, kickbacks or rebates, directly or indirectly, to induce referrals of patients or the purchase of goods or services paid for by government health care programs. Mount Sinai expects that all individuals associated with the Medical Center will avoid fraudulent, wasteful or abusive practices and promptly report these practices when they occur. Fraud and abuse may be prosecuted under state and federal law and can result in requirements for restitution, fines, and, in some cases,jail time. Such cases can also result in exclusion of individuals or institutions from participation in government health care programs. Fraud and abuse guidelines state that we must: • Provide only those services that are documented as being medically necessary. • Document accurately and completely the services that we provide. • Perform complete,accurate and consistent coding of medical records in accordance with regulatory requirements and guidelines. • Report all costs according to generally accepted accounting practices and according to Medical Center policy. • Maintain internal accounting controls. • Maintain accurate billing to government payers, commercial insurance payers,and patients,as well as conform to pertinent Federal and state laws and regulations. Al!of these measures improve our level of service,while helping to assure that we remain on firm legal and ethical grounds. For additional guidance or information regarding fraud, waste and abuse, you are encouraged to consult Mount Sinai's written policies on these topics, or to contact the Department of Ethics and Compliance. 7ti + t °aW 11V E;LlGI BtE°.PE:R$ NSIENTIT.IES,:d _-* Mount Sinai will not contract with, employ, or bill for services rendered by a person or organization which has been excluded from or is ineligible to participate in government healthcare programs, or who has been convicted of a crime related to the provision of healthcare items or services. Employees,contractors,vendors and individuals holding clinical privileges at Mount Sinai must report if they become excluded or otherwise ineligible for participation in a government health- care program, or if they have been charged with or convicted of a crime involving the provision of healthcare items or services. 12 1 HUMAN 'RESEARCH Mount Sinai strives to protect all individuals involved in research by assuring that their safety, welfare and rights are .} respected. Thus, Mount Sinai requires our physicians and professional staff conducting research to comply with all federal, state and local regulations regarding research. All prospective and retrospective research involving human subjects, including research on materials (that have been collected from human subjects must be submitted to the Mount Sinai Medical Center institutional Review Board (IRB). The IRB will then determine the type of review required and the conditions of carrying out the investigation based on the submitted material. This requirement is waived for non-employed physicians whose research project is conducted entirely within their office and seeks to recruit only their own Y Y private practice patients. ' Mount Sinai works to ensure that patients or third party payers are not billed for the cost of research-related tests,procedures, and supplies which are paid for by a study sponsor or which are otherwise not appropriate to be charged to the patient or the ,patient's insurance or government health care programs. For assistance with billing issues related to research,please contact the office of Research Administration at 305-674-2790. :RECORD'KEEPING Mount Sinai maintains many types of records. These include medical records, documents, and information that is received via electronic methods, including e-mail. State and federal regulations impose specific requirements for keeping and destroying specific types of records. Because departments maintain various types of records, please take the time to become familiar with the rules that apply to the documents which your department uses, manages or creates. There are a number of rules that commonly apply to everyone. Please keep the following in mind: • Do not falsify facts or make false record entries. • Do not remove any Medical Center files or documents from the premises. • Keep records confidential. • Maintain and destroy records according to the applicable departmental document retention'policy. • Give records only to those people who are authorized by policy and regulatory requirements to have access. 13 SAFEGUARDING 'MEDiCAL;: , I CENTER. i AND PATIENT PROPERTY' All employees and associates are expected to use Medical Center property and resources responsibly and only for an appropriate purpose. In addition, employees are expected to use facilities and equipment correctly to avoid injury. Medical • Center property may not be used for non-Medical Center purposes without written permission. Medical Center time, facilities, or equipment may not be used for unapproved purposes. Ask your supervisor if you have any questions about proper use of Medical Center property and resources. - Patients have the opportunity to place patient valuables in a safe at the time of registration. Patients should be encouraged to leave all valuables at home and should keep with them only the necessities such as eyeglasses. Employees are encouraged to take an inventory of patient belongings at the time of admission and transfer to ensure patient belongings are not lost. Employees should ensure that patients sign the Patient Belongings List to ensure accountability with patient valuables. ID WORKPLACE HEATH :AND°SAFETY The Medical Center strives to maintain a working environment free from hazards or unsafe condition's. All of us must follow safety standards and regulations. Please take extra care to: • Dispose of medical waste,environmentally sensitive and other hazardous material correctly. • Use personal protective equipment to protect you and others from exposure to dangerous substances. • Prepare and react timely to internal and external disasters, such as fires and hurricanes. • Be familiar with Mount Sinai's Emergency Operations Plan and your role in the plan. Immediately report all incidents and accidents involving equipment and property to Risk Management at 305-674-2555. POLITICAL ACTIVITY AND LOBBYING - ( Jf Mount Sinai advocates for legislative issues that affect the • Medical Center. However,Mount Sinai is a not-for-profit Medical Center and does not contribute funds to support political parties, individuals running for office,or for the advancement of controversial political issues. 14 Medical Center employees and associates are free to support political campaigns or issues outside of their duties at Mount Sinai. However, employees are expected to ensure that private political activities are not carried on in such a way as to suggest an endorsement by the Medical Center. TOBACCO FREE ENVIRONMENT It is the policy of the Medical Center to educate staff and the public at large about the hazards of smoking and tobacco use and to provide smoking cessation assistance. As a health care provider and as an employer the Medical Center is committed to providing patients, visitors, staff and volunteers with an environment that promotes healthy behaviors. For this reason, . all Mount Sinai Medical Center campuses are Tobacco Free. All individuals on the Medical Center property are prohibited from using any tobacco products while on any campus. 9 r r GIFTS ° • r+E It is inappropriate for employees to give or receive, directly or indirectly, any gifts (including cash, services, favors, entertainment, offers of employment or other things of value) that may improperly influence, or appear to influence, business relationships. Small perishable items may be allowed. However, you must notify your supervisor before accepting a gift of any kind. Never request or accept gifts from a patient in exchange for services. If someone offers you cash,do not take it. If they insist, notify your supervisor or manager. The giving of gifts to, or receiving gifts from, individuals or businesses who are doing business with (or who are seeking to do business with) the Medical Center, or who may represent a possible source of referrals for patients or other business may be contrary to law. Please check with your Supervisor or the Department of Ethics and.Compliance with any questions about such gifts. 15 CONFLICTS"OF INTEREST ti•vr.w w ,.a.r +.•..-r'•.+e.. �'..+�rl�v+•,. �w.-.-+per....`�:��•''Sa •.�... 1-��r..�^.�s .`..o� .1�.+.'��`�'� Employees and associates of the Medical Center sometimes have personal or financial interests which make it inappropriate for those persons to be involved in. certain activities and transactions of the Medical Center. These situations are called "conflicts of interest." Here are two examples of what may be considered a conflict of interest: • A situation in which an employee or associate(or a member of that employee or associate's family)is employed by or has a financial interest in a company that does business with Mount Sinai. A situation in which a Mount Sinai employee or associate also works part-time for a Mount Sinai vendor,competitor, supplier or patient It is extremely important that any employee or associate of the Medical Center promptly disclose any conflict of interest to a supervisor, even if the conflict is just a possibility. Questions concerning conflicts of interest may also be directed to the Chief Compliance Officer at(305)674-2916. R ELATION S,H I P-S WITH TH.VENDOR S ANDtOM;PET-ITOR:S . �v Information that is used by the Medical Center is private. This includes business strategies, costs, financial data, and other economic information. Business information about the Medical Center may not be disclosed to anyone outside our organization;such disclosure may also violate federal law. Only Administration may enter into contracts with another business entity. DEALING+1ONESTLY W ;N CUSTOMERS VENDORS AN`DCON'SULTANTS ten... Respect for our patients, guests and business associates requires that we only make statements that we know are honest and accurate. Written documents should be prepared in a timely manner and all business information,records and reports . should be complete and truthful. Likewise, it is important that we abide by trademark and copyright laws and licensing requirements. .16 We support ethical business behavior by properly representing ourselves to the public. In order to effectively control both internal and external printed materials, all proposed printed material to be used by any Medical Center department with any outside audience must be presented to the Director of Marketing at(305)674-2388 for consultation and approval prior to production. a r .RESPECT A .� THE WORKPLACE. . , . r • emu"--"....r..--.-_.-.:.�-r ...,._',..-_�.� -... .�.,.:o,..:;•`..:.:.�"..'-'��_ - ...." ..-.-':,.Y..:....-.e -�-....n....1 It is the policy of the Medical Center to maintain a work environment free from all forms of unlawful harassment. Comments or conduct relating to a person's race, ethnic background, gender, religion, age, handicap, or sexual orientation, or which fail to respect the dignity and feelings of the individual are unacceptable. Employees, patients, volunteers and visitors are to be treated with dignity, respect, and courtesy. Sexual harassment is a violation of the law and will not be tolerated or condoned. This behavior is defined as unwanted sexual advances, requests for sexual favors and all other verbal or physical conduct of a sexual nature, especially where it: • Becomes a term or condition of employment. • Is used to make decisions affecting someone's job. • Creates an intimidating, hostile,or offensive work environment. Sexual harassment also includes comments,jokes,suggestions, sexually oriented statements or.other remarks or actions that are offensive. The Medical Center will do everything possible to prevent discrimination and harassment of any kind. All of us have the right to work in an environment of mutual respect and professionalism. Please report any activities involving discrimination or harassment to your supervisor, manager, the Human Resources department at 305-674-2500, or the Compliance Hotline. 17 BEHAVIOR WHICH: UNDERMINES '- A: CULTURE'O F SAFETY ,Y } rrf �zrs; Behavior which undermines a culture of safety affects morale or . staff turnover and can be harmful to patient care.Behavior such i as intimidation,verbal or physical abuse,sexual misconduct,or the creation of a hostile or offensive work environment will,not be tolerated. Individuals working at all levels of the Medical Center, including management, clinical and administrative staff, licensed independent practitioners, and governing body members are expected to conduct themselves in a professional manner so that the workplace is free from behaviors that could have a negative impact-on patient safety. SOLICIAION'ANDSTRIBUION , 4 .. ;. 'tea;. _ Af It is our purpose to provide undivided attention to our responsibility of caring for patients. It is the policy of Mount Sinai to prohibit any solicitation of employees, patients, or visitors to the Medical Center. This policy includes, but is not limited to, handing out, dispensing, selling, or requesting another person to take,acknowledge or . buy materials, literature, goods or items. Employees may not solicit patients or visitors for any cause or for private employment arrangements. Personal items or notices from any source other than Administration may not be posted on Medical Center bulletin boards. Items that promote any organization or commercial entity, political ideology, religious, or other cause, or which include messages or slogans that may disturb patients or otherwise interfere with patient care services may not be displayed. . `D`RUG FREE`WORKPLA€ E' . • The Medical Center is committed to a drug-free work place. It is the policy of the Medical Center to foster an environment of zero tolerance for the unlawful manufacture, 'distribution, dispensing, possession, or use of alcohol, controlled substances or illegal drugs in the work place. 18 MOUNT SINAI MEDICAL CENTER DEPARTMENTS/RESOURCES • • HUMAN RESOURCES The.objective of the Human Resources department is to ensure that: • The Medical Center establishes and maintains sound organizational structure and desirable working conditions among all members of the organization. • The Medical Center utilizes and motivates its workforce to accomplish the organization's mission and goals. • The Medical Center is compliant with standards and regulations set forth by entities governing all operations. Please contact the Director of Human Resources at 305-674-2500 with any questions or concerns. THE S.I.N.A.I.WAY... All employees are expected to follow the S.I.N.A.I. way when interacting with our patients. The S.I.N.A.I. way includes the following steps: Smile Introduce Narrate/Need to Know Answer Impact By observing the SINAI way, we can improve patient care and help patients and families better understand what we are doing —and most importantly,why. ` IOETH'ICS CO B MMITTEE4 -0 -Patients, families, and healthcare providers may be faced with difficult and/or confusing ethical issues related to medical care. The Bioethics Committee functions in an advisory capacity to provide case consultation, policy recommendations, and education to assist with difficult clinical decision-making and the ethical aspects of those decisions. Please contact Risk Management at 305-674-2555 with any questions or concerns concerning the Bioethics Committee. 19. GOVERNMENT OPERATIONS MA NAG.E:ME`NT Government Operations Management serves as a resource for the management of Medicare/government regulation issues. Government Operations Management can assist departments in interpreting technical Medicare, Medicaid or governmental regulations and updates and in implementing necessary changes. Keep in mind, however, that each department is primarily responsible for keeping up-to-date with regulatory updates/changes and incorporating them into their operations. Please contact the Director of Government Operations Management with any questions or concerns at 305-695-7609. • 20' Mount Sinai M E D I C A L C E N T E R TAB 1 1. 3 MINIMUM QUALIFICATIONS REQUIREMENTS Mount Sinai M E D I C A L CENTER MINIMUM QUALIFICATIONS REQUIREMENTS • • Mount Sinai Medical Center is South Florida's largest not-for-profit organization. We are an equal opportunity employer and do not discriminate on the basis of race, creed, color, national origin, sex, religion, veteran status, disability or any other characteristic prohibited by law. The Medical Center's facilities include acute care, diagnostic, treatment, teaching and research facilities with approximately a 672-licensed bed capability. Mount Sinai Medical Center has over 60 years of professional experience in providing acute care, diagnostic and treatment services within the facility. Our facility is within the City of Miami Beach. The Occupational Health Department at Mount Sinai Medical Center is located in the Lowenstein Building, first Floor and has been providing services to numerous accounts and municipalities for over 32 years. Mount Sinai is especially proud of the occupational health services it provides to the City of Miami, provided to Miami Dade County and City of Miami Beach. We look forward again to providing the City of Miami Beach with quality health services. The Scope of services provided by this department includes: Pre- employment Physicals, Return to Work Physical Examinations, Vaccinations and any additional services requested. 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I .: ,,...:,„..„:,.::..:::,,, ',.-',r,1:',. n Sou• Ill .L A n k Tyr r 1 I 1.9 ,.T,,,,,,li' '' 4'.. -;-"''...1'.'S,,'-,•,,,:'1,-; `w. j3 Vry,. Y 1 f `€ •., 45';::;yMr • . Mount Sinai M E D I C A L C E N T E R TAB 2 2. 1. QUALIFICATION OF PROPOSER FIRM QUALIFICATIONS EXPERIENCE Mount Sinai M E D I C A L C E N T E R EXPERIENCE & QUALIFICATIONS The Occupational Health Center at Mount Sinai Medical Center opened its doors in 1981 and has been providing services to numerous accounts and municipalities for over 32 years. The Occupational Health Department employs the following dedicated and qualified personnel to perform the services outlined in this proposal: Program Manager, Secondary contact person, two Medical Review Officers (MROs), Medical Director, Internal Medicine Physicians (one female), licensed to practice in the State of Florida, Cardiologists, Psychiatrists, Radiologists (all licensed to practice in the State of Florida), an LPN (Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician BAT), three Medical Assistants (Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician BAT), two Patient R epresentatives/Reception/Medical Records personnel. All employees are required to undergo a criminal investigation background check and they are drug tested before their employment with Mount Sinai Medical Center. • 4 Mount Sinai M E D I C A L C E N T E R EXPERIENCE City of Miami Contact Person:Reveca Valiente-Ortiz Telephone No.305-416-2113 E-Mail:Rvaliente-Ortiz@miamigov.com Work Performed:Pre-employment Physicals Examinations, OSHA, Exposures,Drug and Alcohol Screening, including DOT, Fitness for Duty and Immunizations Years: 4 City of Miami Contact Person: Adrian Plasencia Telephone No.305-416-5450 E-Mail:Aplasencia@miamigov.com miamigov.com Work Performed: Fire Fighters,Physicals Examinations, OSHA, Exposures, Drug and Alcohol Screening, including DOT, Fitness for Duty and Immunizations Years: 4 City of Miami - Contact Person:Nilzeth Martinez Telephone No.305-603-6189 E-Mail:4405@miami-Police.org Work Performed: Fire Fighters,Physicals Examinations, OSHA, Exposures, Drug and Alcohol Screening, including DOT,Fitness for Duty and Immunizations Years: 4 City of Miami Beach Contact Person:Kristin Tiger Telephone No.305-673-7524 • E-Mail: Yarilysam@rniamibeachfl.gov miamibeachfl.gov_ Work Performed: Pre-Employment Physicals Examinations, OSHA, Exposures, Drug and Alcohol Screening, including DOT,Fitness for Duty and Immunizations Years: 5 Miami Dade County Contact Person:Michael Edwards Telephone No.305-375-2643 E-Mail: mxx@rniamidade.gov Work Performed: Pre-Employment and Annual Physicals Examinations, OSHA,Exposures,Drug and Alcohol Screening, including DOT, Immunizations,Fitness for Duty/Return to Work and Executive Physicals Years: 29 years 5 Mount Sinai M E D I C A L C E N T E R EXPERIENCE City of Hialeah Contact Person: Capt. Clifford Charlock Telephone No.305-824-5717 E-Mail:Cchafrlock@a hialeahfl.gov Work Performed: Fire Fighters Hazmat Physicals and Immunizations Years: 10 City of North Bay Village Contact Person: Janice Rosado,Human Resources Telephone No.305-756-7171 E-Mail: Jrosado@NBVillage.com Work Performed: Pre-Employment and Annual Physicals for Police and Drug and Alcohol Screening Years: 10 City of Sunrise Fire Department Contact Person: Chief James Dixon Telephone No.954-746-3400 E-Mail: idixon@cityofsunrise.com Work Performed: Hazmat Physicals Years: 18 City of Sunny Isles Beach Contact Person: Yael Londono Telephone No.305-947-0606 E-Mail: Ylondon@sibfl.net Work Performed: Pre-employment and Annual Physicals for Police, and Drug and Alcohol Screening Years: 7 Miami Dade County Public Schools-Police Department Contact Person: Joey Diaz Telephone No.305-757-7708 E-Mail: jadiaz@dadeschools.net Work Performed: Pre-employment and Annual Police Physicals and Drug and Alcohol Screening Years: 20 6 • Mount M E D I C A L C E N T E R EXPERIENCE Miami Parking Systems Contact Person: Socorro Perez Telephone No.305-373-6789 E-Mail: Sperez @miamiparking.com Work Performed: Pre-employment.and Alcohol Screening Years: 15 Town of Bay Harbor Islands Police Department Contact Person: Vicky Motola Telephone No.305-866-6241 E-Mail: Vmotola @Bayharborislands.net Work Performed: Pre-employment and Annual Physicals and Drug and Alcohol Screening and Immunizations Years: 10 Village of Pinecrest Police Department Contact Person: Mayra Sauleda Telephone No.305-234-2121 E-Mail: Sauleda @pinecrest-fl.gov Work Performed: Pre-employment Physicals for City employees,Police,Drug and Alcohol Screening, and Immunizations Years: 7 Village of Key Biscayne Fire Department Contact Person: Chief Lang Telephone No.305-365-8989 E-Mail: elang@keybiscayne.fl.gov keybiscayne.fl.gov Work Performed: Pre-employment and Annual Physicals and Drug and Alcohol Screening Years: 7 Ecology&Environment,Inc. Contract Person: Paul Jonmaire Telephone No. 716-684-8060 E-Mail: PJonmaire @ene.com Work Performed:Pre-employment and Annual Physicals Years: 10 7 • Mount Sinai M E D I C A L C E N T E R EXPERIENCE Intercredit Bank Contract Person: Nadia Avelar Telephone No. 716-684-8060 E-Mail: PJonmaire a ene_com Work Performed: Drug and Alcohol Screening Years: 10 Lloyds Bank Contact Person: Carol Ann Loo Telephone No. 305-579-8905 , Work Performed: Drug and Alcohol Screening Years: 7 8 Mount Sinai M E D I C A L C E N T E R TAB 2 2 . 2 QUALIFICATION OF PROPOSER TEAM ORGANIZATIONAL CHART MANAGEMENT TEAM AND KEY PERSONNEL CURRICULUM VITATE / RESUME Mount Sinai M E D I C A L C E N T E R TAB 2 2 . 2 QUALIFICATION OF PROPOSER TEAM ATTACHMENT E ORGANIZATIONAL CHART MANAGEMENT TEAM AND • KEY PERSONNEL 3 1 OO LL i C �` ac?• . w2v �L p a. 4 x Q i W *+ o H 1 0-0 sn `o - >. o. 2.2 eo co e'o.O ) C }r C •c �C CO 'i• y Z C L C p 3 • N c V; if1 (t �, (� f0 oc Q, ae a al i 2, z - Q . O C 'V < cc m O ev Z a ;tu0 a1 ._ ao Ftrsit cd � E0 FR • ai n 0 s N H •.; al Q o � m m U O m . m a i 3 L • 0 W it - .a • • t 0.1 ell - t V a v - u -0 ai s.CJ' a C 1_ ,> .V ® 0. CD OO. �. co _ 2,u C L. CU F 0 4.. o 5 — 0' a • ® ® ,� 4 ® Vf a ? t0 O co ' '3 c OC U a C N ( a,— w �C C grr o co v E. a � • U V a 0 G C C co H .0 as _ • im r U. u °?� i °� p ▪ C co q ..c a. W d y C -0'CU ID C' as N d 47 tr. I : s- 0 c .a ".7 min" as' X :4= t E t / 2 c V c. .... u a c' z Oo J + • " i a : m c c o 1- .co a:I in . , 0. O *Cr u I G ; c o �, , � � . vim L V v1 C d 'C O O c U m 0 Iv �a C ( . Ei in) V al os .� 1 • 2 o o _ _ Mount Sinai M E D I C A L C E N T E R MANAGEMENT TEAM AND KEY PERSONNEL The Occupational Health Center will staff sufficiently to provide all services stated in the Scope of Services and the Agreement and will increase staffing when necessary to fully comply with what has been outlined in the Scope of Services. Linda Arama,Director,Project Manager Over 29 years with Miami Dade County,City of Miami Beach and City of Miami as Director of Occupational Health. Vicky Gonzalez,Secondary Contact Person Program/Billing Coordinator Gerardo Jose Minsal-Ballester,M.D. Medical Director of Occupational Health Department, Medical Review Officer, Board Certified in Internal Medicine,SAP,Certified Workers Compensation Berta Pita, M.D. Board Certified in Internal Medicine, Medical Review Officer Orlando Santana, M.D. Board Certified Cardiologist Alfonso Tolentino,M.D. Board Certified Cardiologist Chetan Rajadhyaksha,M.D. Board Certified Radiologist Amy Chu,ARNP Board Certified Advance Registered Nurse Practitioner Ashley Pages,MSN,FNP-BC,CPN Board Certified Family Nurse Practitioner Patricia Wilson,LPN Clinical Supervisor,Certified DOT Drug Screening Technician,Certified Breath Alcohol Technician(BAT)/ (DOT) 9 Mount Sinai M E D I C A L C E N T E R • MANAGEMENT TEAM AND KEY PERSONNEL Lourdes Campos Medical Assistant Certified DOT Drug Screening Technician,Certified Breath Alcohol Technician(BAT)/(DOT),Pulmonary Testing, Hearing/Vision Testing,EKG and Phlebotomist Linda Diejuste Certified DOT Drug Screening Technician,Certified Breath Alcohol Technician(BAT)/(DOT), Pulmonary Testing, Hearing/Vision Testing,EKG and Phlebotomist Bonnie Lawson Certified DOT Drug Screening Technician,Certified Breath Alcohol Technician(BAT)/(DOT),Pulmonary Testing,Hearing/Vision Testing,EKG and Phlebotomist Meredith R. Portee Patient Representative/Receptionist/Billing and Medical Records Clerk Registration,Certified DOT Drug Screening Technician,Certified Breath Alcohol Technician(BAT), Pulmonary Testing,Hearing/Vision Testing, Billing and Medical Records Clerk. Linda Ivory Patient Representative Registration/Reception/Medical Records Clerk • 10 Mount Sinai M E D I C A L C E N T E R TAB 2 2. 2 QUALIFICATION OF PROPOSER TEAM ATTACHMENT F CURRICULUM VITATE / RESUME Linda Arama 1900 Sunset Harbour Dr. Apt. 1806 Miami Beach, Florida 33139 Phone:305-673-0731 Work:305-674-3910 PROFESSIONAL EXPERIENCE: 1984—Present Director, Occupational Health-Mount Sinai Medical Center, Miami Beach, Florida Responsible for the day-to-day supervision, coordination, and evaluation of personnel,policies, and operational objectives for the Occupational Health Center located at Mount Sinai Medical Center, Mount Sinai Aventura and additional sites. Project Manager to Miami Dade County Project Manager to City of Miami Beach Project Manager to City of Miami Additional responsibilities include: • Executing pre-employment physicals, annual physicals, executive physicals, fitness for duty assessments, drug and alcohol testing, Employee Health assessments,Health promotion, and Wellness service. • Executing out-of-country physicals,including Premier Physical services. • Prepare and present contract bids,including pricing models and services offered to over 65-private and government organization. • Analyze financial statements to forecast profitability and long-term opportunities for Occupational Health,Center. • Responsible for on-call personnel for drug/alcohol program. • Available 24 hours, 7 days a week for emergencies for all areas of responsibility. • Work closely with all contract personnel to provide excellent service. • Public Relations in promoting department to the public. 1984—Present Director of Patient Access, Occupational and Employee Health, Outpatient Departments—Mount Sinai Medical Center, Miami Beach, FL/Mount Sinai/Aventura Responsible for providing leadership and direction for staffing in accordance with the organization goals and objectives and meets changing needs in areas of responsibility. • Manages daily operation of the assigned departments for Mount Sinai Medical center including remote or satellite locations to ensure qualitative/timely registration and front-end collection of fees. • Responsible for ongoing effective operation of the Quality Assurance Program is monitored and properly performed for Federal and State programs. • Demonstrates initiative and creativity to identify opportunities, list potential courses of action, evaluate alternatives, and implement workable solutions • Develops department capital and operative budget, and maintain department operations within budgetary guidelines. • Develops departmental and employee productivity targets,sets appropriate measurement tools, and monitors methods designed to assist the department in exceeding budgetary and performance goals. • Demonstrates proficiency in hiring, training,motivating,retaining, organizing and leading a productive and cooperative team. • Responsible for ongoing effective operation of all registration areas for Mount Sinai Medical Center. 1 986-Present Manager, Private Central Outpatient Registration/Scheduling-Mount Sinai Medical Center,Miami Beach,FL—Mount Sinai/Aventura Responsible for the day-to-day supervision, coordination, and evaluation of personnel,policies, and operational objectives for Outpatient Registration and Scheduling. Additional responsibilities include: • Tracking and monitoring employee's compliance for accounting accuracy. • Tracking and monitoring employee's compliance with standards and guidelines as they relate to hospital and government policies including Medicare and Medicaid compliance programs. • Monitor and evaluate employee's performance in ensuring patient rights and responsibilities. • Tracking and monitoring employee's performance in assuring that patient care services are available to physician offices upon request. • Develop, track and monitor employee's training,performance - improvement and educational programs for registration/scheduling requirements. 1991 -2003 Supervisor, Clerical Staff-Mount Sinai Medical Center, Miami Beach, Florida Responsibilities included the day-to-day supervision, coordination,and evaluation of personnel,policies, and operational objectives for the clerical and film library staff in the following departments:Nuclear Medicine,Ultrasound, Radiology, Aventura Diagnostic Center,Non- invasive Cardiology,and MRI. Additional responsibilities include working closely with the Systems department for the building of billing and registration software programs for HBOC implementation.Additional responsibilities include: • Monitor and evaluate operations of patient care in all managed areas. • Analyze and report the effectiveness of employee performance. • Maintain personnel staffing patterns within budgetary guidelines. • Cross-train personnel across departments for future adequate coverage for all departments of responsibilities. • Monitoring and tracking accuracy of data entry by patient registration and scheduling personnel. • Monitor and evaluate patient satisfaction survey,personnel statistics, budget reports(variances), etc.to meet compliance requirements. • List of Serve Memberships,Newsletter,Education In-Service: Hospital Access Management—strategies for Health Care Compliance The Advisory Board- Financial Leadership Council Conference/Seminars- Customer Service,Health Care Compliance,including HIPPA and EMTALA MSMC Annual Ethics& Compliance Training Compliance Alert Compliance Update Florida Hospital Association News Clips Finance Watch Healthcare Compliance Forum Quarterly Insights Medicare Reform Advisor Alert PROFESSIONAL OBJECTIVE: To contribute and continue to be an integral part of Mount Sinai Medical Center. To provide effective administrative and technical management. Dedicated to provide exceptional health care services to all patients,doctors and staff REFERENCES: Available upon request. 2580 SW 189TH Ave Home#(305)-407-8177 Miramar,Florida 33029 Cell#(786)-587-7684 Vicky Gonzalez Objective Individual with organizational skills seeks position with challenges as well as advancement. Experience 2006-Present Mount Sinai Medical Center Miami Beach,Florida Occupational and Employee Health Department Program Coordinator • Assist as a back-up to Program Manager when needed • Assist in implementing of new contracts for Occupational Health • Send out monthly invoices for all Occupational Health accounts. • Receive checks and post payments from contracts for Occupational Health into STAR. • Check figures,posting of payments,and document for accuracy of Occupational Health contracts before entering into Excel spreadsheet. • Review payments of Occupational Health contracts for all 30 days past due not received. • Place calls for collection for payment to all Occupational Health contract accounts past due. • Verify that Occupational Health is in Complaint with federal,state,and company policies/ procedures,and regulations. 2006-Present Mount Sinai Medical Center Miami Beach,Florida Patient Access Department Coordinator • • Typed statistical reports via using Microsoft Excel Spreadsheet. • Typed assignments via using Microsoft Word. • Prepared personnel reports such as(Performance Evaluations,Notice of Separation,Terminal Clearance,Personnel Change Request and submit to Human Resources. • Operate office machines,such as photocopiers and scanners,facsimile machines,voice mail systems,and personal computers. • Answer telephones, direct calls,and take messages. • Maintain and update filing,inventory,mailing,and database systems,either manually or using a computer. • Communicate with customers,employees,and other individuals to answer questions, disseminate or explain information,take orders,and address complaints. • Open,sort,and route incoming mail,answer correspondence,and prepare outgoing mail. • Compile,copy,sort,and file records of office activities,business transactions,and other activities. • Compute,record,and proofread data and other information,such as records or reports. • Type,format,proofread,and edit correspondence and other documents,from notes or dictating machines,using computers or typewriters. • Complete work schedules,manage calendars,and arrange appointments. • Review files,records,and other documents to obtain information to respond to requests. 1999-2006 Mount Sinai Medical Center Miami Beach,Florida Emergency Department Coordinator/Office Manager • Supervise Ancillary Staff on reviews,counseling/attendance and payroll. • Responsible for Time/Keeper(Kronos)for 85 employees. • Served as a resource person for administrative issues during the administrative director's absence. • Type schedules for Nursing,Techs and ancillary staff. • Submit LUR on a daily basis • Prepare Statistics for MOR reports. • Schedule appointments for administrative director. • Assisted administrative director in budget preparation. • Assisted in finding coverage for emergency department personnel sick calls. • Transcribed data using dictaphone machine. • Tooked and transcribed minutes. • Typed statistical reports via using Microsoft Excel Spreadsheet. • Typed assignments via using Microsoft Word. • Prepared personnel reports such as(Performance Evaluations,Notice of Separation,Terminal Clearance,Personnel Change Request and submit to Human Resources. • Ambassador for the Emergency Department. 1988-1999 Mount Sinai Medical Center Miami Beach,Fl Telecommunications Department Secretary I • Answer phones,Filing,Typing using Microsoft Word • Reconcile'digital beeper invoice by charging back hospital departments using Microsoft Exce program submitting to the accounting department. • Reconcile phone bill by charging back hospital departments using Microsoft Excel program a submitting to the accounting department. • Paying invoices by submitting a check request to accounts payable. • Preparing Purchase Request when obtaining new telephone contract. • Coordinating and making appointment to meet with vendors. • Preparing a yearly in-house telephone directory. • Keep inventory of all in-house and digital pagers and assigning beepers to new staff to the institution. • • Answer the switchboard by using the Nortel system. 1984-1988 Mount Sinai Medical Center Miami Beach,Fl Foundation/Development Clerk/Typist • Answer phones • Filing • Type letter for donor via computer • Various other clerical duties - - 1979-1984 Mount Sinai Medical Center Miami Beach,Fl Emergency Department Unit Secretary • Patient Registration • Answer phones for the department. • Process doctors orders. • Various other duties. Education 1968--1972 Miami Senior High School Miami,Florida • Attended 9th through 12th grade. • Graduated from the 12'h grade. Skills Computer: Microsoft Windows,Microsoft Word,Microsoft Excel,Power Point,E-Mail, Internet knowledge. Languages: Spanish and English References Upon Request. • • CURRICULUM VITAE Gerardo Minsal, M.D., rACP • nRSONAL INFORMATION - 'LACE OF BIRTH: Puerto Rico :ITIZENS-tIP: USA WDDRESS: 16720 Sapphire Spgs Weston, Fl 33331 Ph: (305) 308-0231 'ROFESSIONAL ADRESS: Mount Sinai Medical Center 4300 Alton Rd. Miami Beach, Fl 33141 Ph: (305) 674-2430 i-MIL• ADRESS: gminsal@hotrail.com EDUCATION/POST GRADUATE TRAINING X973 Graduated - La Piedad High School Puerto Rico. L979 University of,_Puerto Rico, Rio Piedras Campus, Puerto Rico. Pre-med. 11963 Doctor of Medicine, Un i'rersidad Central del Este, School of Medicine, San Pedro de Maccris, Dominican Republic. +.997 - 19EE Transitional Internship, Caguas Regional .Hospital, Caguas, Puerto Rico. ,96E - 1591 Internal. Medicine, Caguas Regional Hospital, Caguas, Puerto Rico. +.991-1993 Geriatric Medicine, University of Hawaii at Manna, Kuakini Medical Center, Honolulu, Hawaii C + tP•RDO MXNSA1,, M.0. , FACP • . iE TWO Nl;:)ICAL. LICENSURE F )RZOA: ME64508 F 7jARD CERTIFICATION • F :rican Board of Internal Medicine: August 21, 1996 C :tification in Geriatric Medicine: November 4, 1998 F i+I:;SENT POSITION C 1998 - present: Faculty Geriatrician and Medical Director of the House Call Program, Division of Geriatrics, Dept of Medicine. Mount Sinai Medical. Center of Greater Miami, 4300 Alton Rd., Miami Beach, Florida. 33140 P i , 2012 - present: Medical Director Occupational Medicine and Employee Health., Mount Sinai Medical Center, 4300 Alton Ad, Miami Beach-, Fl 33140. PY;EVIOUS PROFESSIONAL POSITIONS in. 1995 - Nov. 1998: Associate Director, Life Care Nursing Home, Crossing Blvd, Orange Park, Fl. till. 1995 - Nov. 1996: Medical Director, Medwise Center at two locatons: 5500 Bland.an 9 Blvd.Blvd # 1, Jacksonville, FL and 3199 US Hwy 17, Green Cove Springs, FL. iv. 1996 - July 1998: medical Director, Oak Terrace Nursing Home, Green Cove Springs, FL. ,v. 1996 -- Nov_ 1998: ACLS Medical Course Director, Heart Start, Orange Park, Florida. pt.1p95 -- Oct. 1995: Medical Director, La Fosada Nursing Home, Miami, FL. il.y 1993 - May 1995: Director of Geriatric and Family Consultation Services, Division cf Geriatrics, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii. g. 1993 - Jun. 1995: Assistant Professor of Medicine, • Division of Geriatrics, Department of Medicine, John A. Burns. School of Medicine, University of Hawaii, Honolulu, Hawaii. :ERARDO MINSAL, M.D., FSCP 'AGE THREE • F , !. 1993 - Jun 1995: Director of Medical Students, Division of Geriatrics, Department of Medicine, John A. Burns School of Medicine, university of Hawaii , Honolulu, Hawaii. J 32 - 1995: Advance Cardiac Life Support Instructor, Queen's Medical Center, Honolulu, Hawaii 1*i.1,ITARY SERVICE: I :11 2005 - Dec 2012: Air Force Inactive Reserve, Lt Col, Denver, Colorado. ouary 2005 - March 2005: Air Force Reserve, It Col., Homestead Reserve Base, Homestead, Florida. !il 1997 - Dec 2004 : Director of Medical Section, Lt. Col. , 202 RHS, Florida Air National Guard, Camp Blanding, Starke, Florida. • } )1 - May 1995: Hawaii Army National Guard, Captain. , Officer in Charge of the Cardio-Vascular Screening Program. Honolulu, Hawaii. 38 - 1991: Puerto Rice Army National Guard, Captain. Juana Diaz, Puerto Rico. 1I CHING ACTIVITIES-HOSPITAL :. 1998 - present- Faculty Geriatrician. Division of Geriatrics, Dept of Internal Medicine. Mount Sinai Medical Center, Miami Beach, Fl. I 1998 - May 2000- Medical Faculty. Physician Assistant Program, Barry University, Miami, Fl. j 1993 - Jun. 1995: Assistant professor of Medicine, Division of Geriatrics, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii- , RARDO MINSAL, M.D., FACP .GE FOUR • ipSPITAL COMMITTEE APPOINTMENTS 1 c. 1998 - June 2000: Utilization Committee, Mt Sinai Medical Center, Miami Beach, Fl. • ' - 96 - 1998: Utilization Committee, Member. Orange Park Medical Center, Orange Park, Fl. : - 33 - 1995 Member, Immunization Task Force, Department of Health, Honolulu, Hawaii. • F t'TORS AND AWARDS :te Active Duty, Florida National Guard, 2004. Hurricane Relief Mission C Ixo Travel Grant. Suicide: -The Honolulu Study. AGS Poster Presentationj. .19.93 . ty Commendation Medal, Puerto Rico Army National Guard, 1990 Lte Active Duty, 'Hawaii Army National Guard, 1993. Relief 993. Hurriczne Iniki Re_ic_ P . ;sion. F-:.'FESSIONAL AND SOCIETY MEMBERSHIP A !ricar_ College of Physician. 1988 present. A-! -rican Geriatrics Society. 1993 -- present. L: :TUBES/PRESENTATIONS D ubitus Ulcers Care. ACP Florida Chapter Meeting. 1999. P noipal Investigator, Suicide: The Honolulu Study. Poster Presentation. Al rican Geriatric Society. 1993. C• UNITY ACTIVITIES H se Call Program. Florida State Grant. 1998-present. Provides house calls to t . needed patients in the community. • C 1 RAIDO MINSAL, M.D. , FACP t ' ;E FIVE 1? ACTIVITIES r' Dual Session 2006. 01/06/2006 - 04/06/2006. 'I a Core of Internal Medicine: A Recertification Freparaticn Course. C1 '04/2006 - 04/05/2006. C'D TINUXNG MEDICAL EDUCATION Interna). Medicine Examination. May J., 2007. N • : Orleans Internal Medicine Board Review. July 15 - 20, 2007 F -Med. Current Clinical. Issues in Primary Care. Feb. 21 - 25, 2007. P -Med. Pre-Conference Day Symposia Track 1. Feb. 22 - 23, 2007. P -Med. Current Clinical Issues in Primary Care. Feb, 24 -26, 2006. F -Med. Current Clinical Issues in Primary Care. Feb. 25 -27, 2005. ,1`,.a• t...: i 1 lJ ,IC t !• . ., J .;�:°" v '.-7.' `'•1g }f.. --;;ice J"+.4?.T- ',..1.-,... •ice' ,fit..: •�i }+�7f ,` -.18- ••1 'T ,:'IV, , '• ;-.'•., ...sr r...v.::V.Z.,24,.-'i:.,,,i_ity,€2.:,:,:::-....p....;c3,...,...,:_..,-.,:.,-- .�:?t Iq.�ii •G '� ,rte �•...E;.* •.`,:;, • g.5..... .g <5 _�!5 "yl-'x,,,,..: • • • • • M 0 A A IVI R 0 P. J cif o f at aj 4_3.6_ 0 N.,.\S-T°' . y . ,:,. -,, .s,1 11,70 ...; IC9 "eq‘ 0 r6_ 1, THIS IS TO CERTIFY THAT ► Grardo Min6ai M.D . ) .... ...... haying presented to the Executive Board of the American Association of Medical Review Officers satisfactory evidence of prescribed qualifications and P having passed an approved examination before the . nwric n zz riati d 'I' i.bi.ca1 thZU Ufficer i. ' in accordance with national standards of competency anti expertise established for Medical Review Officers, is hereby accredited and designated as a Gertifix?i 'j' bica1 Rthied . and by order of the AAMRO Board has been entered as such in the . AAMRO Registry of Certified Medical Review Officers Given and dated this 27th day of �'Qbruarg. 2011 fat 000' �'y�uA y x h �� " ...I�� yy,�.�o•L� chairman °� g r�,� �',�`F'{rte. 8 " • tinurh•rsi9,wd oral scrota with the Sea!of the American.tccucicilcun of Medical Review i (lflic•eir.+ltce day o+td dale above tort?ten 110227106 . CL Corporate Secretary CerticateNuuiber k • • • • } {: •i Y a .'4 1 a• 71 -f o O V) U N C p F. = p o ..0 r `° Q 0 ca .-� a 0 LU 0. ..-1 .., ,.,, . ., 4", Va O o yAo�i a a ■ __OF z ct Z .0 Q_, uX.s .E itz„. 0 •ir cc F' a ? vl c a E Z av r..1 6 pin a Oa . o H c • = a LP a. H V '^ E n 1 N, H lElft) 114.■ ' C JO N J .A Q C)j 4..) CC � w n. > o ; 8 `Q t~ .. a C > Q F xi;N w 0 2 N •T.,a, Cr .1...") cn < LU IZI p4 ILI I.L. CLI :Ln Um it.,. ,. 0 O O V1 W a s U , ".To. O DC `o c ° .� m o •1. m = Hllhiil W O o 8 p 4 Q u 4 . r'L; I— O •a ` ° - c C , • A c ro a u 2 c O y G u a�O_ �•• .� O ,c ti to C •N ... a Q ~ n N;VI U � 3 '� a i a� =nro '• M� CL f0 1.; o m " 8 a o .. U U ° =wow Q '� a•n C s N Q N 7 .. 1reio Q t7 � = '= 'I 3 zc d ° E t p W cc O v u m ilnII fv c = f-' W O o' <-.. J 6 N O Q W o c 0 .-E.-uQ ,p p ^ O cc -0 u N V O b N H o _ ` Z m 3 c c � z� wy I Cif . ` LNO QLiJ o .a 13 w u m F= 8i u c' { m 41 ° O al m u pc uy 8 p J. u A i', 1 r. 49 y Curriculum Vitae BERTA PITS., m.-D. • 6439 SW 56 ST. MIAMI,FL 33155- p: (305).606 4474.-bertapira@hotmail.com I !•ucaiioil American Board of Internal Medicine (ABM) STATUS ELEGIBLE CERTIFICATION EXAM Augusr,2013 Medical Review Officer Certified July, 2012 Educational Commission for Foreign Medical Graduates (ECFMG) Certificate Number 0-670-745-9 February 2,2S l- University of Chile Santiago, Chi - Doctor ofModicine January,2002 High Honors. University of-Chile Santiago, Ch Bachelor ofMedicthe August, 2000 rcrnship and Residency Mount Sinai Medical Center Miami Beac' Fl !nrerxnaIMedicine Resident July,2010—.I 4e,2012 Mount Sinai Medical Center Miami Beach Fl Irrrernaf lifcdicirie Internship June, 2009-- ' e,2010 San Borja Arriaran Hospital Santiago,C i Dermatology training fellowship April,2005— e,2006 Including Sexually Transmitted Disease Clinic Catholic University of Leuven Leuven,Belg m Dermatology training fellowship February-Sept per;2003 cdica! Experience Mount Sinai Medical Center Miami Bead ;Fl Staff Physician and core faculty member August,2012. .resent Outpatient Department.Internal Medicine Occupational Health. Medical Review Officer Mount Sinai Medical Center Miami Beach,' 1 Internal Medicine Residency June,2009-4 c,.2012 • San J3 orja Axxiaran Hospital Santiago, Chk c Dermatology and STD Department April,2005--J he,2006 Staff Physician Dialysis Centers (Chacabuco,Terranova,Vita Dial) Santiago, Ch." Staff Physician January,2002—Oct i•rr,2002 Hemodialysis procedure and related co-morbidities October,2003— he,2006 Community Health Center Dr.Agustin Cruz Melo Santiago, Ch 6 Staff Physician April—August 2002 In charge of the Hypertension Program 1 .qcarch,Publications AND PRESENTATIONS ACP. 2012 Associates Meeting. Oral Presentation. Clinical Vignette: "S ; et-Ring Labyrinth". Doubletree by Hilton Orlando Downtown, Orlando, Florida. Ma,.i 24-25, 2012. Thyroid incidentalornas. poster for the XII Chilea ongress MuruLa F, Pita B, et al, y , p g on Endocrinology and Metabolism,November 23k,246,and 25th,2002,Hote •e1 Lago, Pu.con,Chile. Wajnet J,Pita B,Ncurosarcoidosis,Bol Hosp "S J de Dios",2001;48(1);8-15,1: Wajncr j,Pita B,Sarcoidosis and Kidney,13o1 Hosp "S J de Dios",2000;47(4); .29-236.. Wainer.J, Pita.B,Sarcoidosis,Bol Hosp "S J de Dios",2000; 47(3); 154-163. Wajner J,Pita 13, Leptospixosis and Panercatitis, Bol Hosp "S J de Dios", 19 9; 46(5); 326-330. _ • ACHING EXPERIENCE Course of Dermatology. Medical School. Faculty Sa.n..I3orja Arriaran. University of Chile. 2006. Student Preceptor in Internal Medicine,University of Chile,San Borja Arriara ospital, Santiago,Chile, 1997-2001. Student Preceptor in Physiology and Biophysics,University of Chile,Sandago, I.hile, 1996. Student Preceptor in Internal Medicine,ISCM-H,La Habana,Cuba, 1994-199' i:! .FERENCES Available upon request • � •' ^ ._.-�¢ �•J , 'h�1 F�W Y.yri.i•s (A 1y 1 .-..tLq- u 4 6 T�' . n � ., . -.-/:Y ."v yi .7t . i C M t, tt1'•t �t I• 'g .:4-RZ, 1 1. r sir. .,6 � a 1*. •Z•473:,.'._ Y;0,'_( 1; 4 'gt.e rr.d..X� 1�j' l. ).1:1:S; yy .10't r•C r: I:t•,py conga/St;lo the dtsdosUrtt,Impaction eat copying of Infarrnalfon end documents relating fo my eredonllalo and quotlrcntlons and performance Cc o•ronttaling lnformatlon-1 by end bpbveen'nits Healthcare Orgnnlzetibn'and other Haalthyoro Orgunc=ations(o•g,,hospital medfeel star.!,medical on rrr•:r;Indopendoril practice 13%90e03Uorie(iPA),health care'service plans.hoeith maintenance organtr-atiena(WMOG).prefened providerorgsnl,cotiona !i (P1't:!:),°ther•het3lth deI'vory-systems or entilfos.medico)adcfeliea,profasafonet associations.modlcat school faculty posILIOna,training programs, par :atonal Ilabulty 1nsuranco compaelas.(wllh revpeotlo certification or aoveraga and clnitiis.hIstory).licensing avfhurities,and bustnosses and In loafs acting a:UMW ageAta-cotlectivery'lloallhcaro Organizations:)for the purpose of evaluating this appllealion and•any rocrudonllairng ail -'.+Sion regarding my profcastohai earning,wreath:1mA.character,conduct and Judgment.chile;.and ability to work with ethers.In this regard,the utn.;. .care shall be 1eket 10 earoguard the privacy of patients and ilia confidentiality of peer records,and to protect peer revfsV&Information from being fur.'z'disclosed. 1 vi.r••rormed and acknawtedgo that fader)!Pnd•atnle Imes provide bnrnunily prolectians Iacerialn individuals end 9ntiUe9 for their nets oedfor • cos:r 1.nlcatlon6In connection with evaluating the qualifeatrons of heOl&lcare provtdera.!'hereby release elf persons prid•entiiiot;Including t is Itc;irlf•;aro Organization,engaged In qualify assesrme/II,pear review and credenlralrnp on babel.Of this He;+llhicaro•Orpanrzolron,and all percoris arid Oni.rc'r providing credenGaIing inroimatlen to such roproaenlo[lces of this lieat0+eor°Orgcrntzation,from any liability they mlght'lncur for their acts endror con,,...nicalions In Canneclbn with°valuation of my qualIRcallons for participation In this Hoarlhcarn Organization,to the extent that Lhasa ac19 ondror con f,:,n1c.atfons are protected by state or federal 13w. •• I un i,:•stand that I eha[I bo•afforded ouch fair procedures with respect to my perrclpotton•ln•th13 Hoene-ore Organization as moy be required by state and ,prat laewond rogvlatlon,including,but not IrmIled to,[S•nde Business and Prolosslons Codo If applicable. 1 un•.•:.:land end agree that I,as an applicant.hove lhtilburdt7'n'ei producing adequate information for proper°valuation of my.profecstonai compatonc.o, .6 cunt r.I;r,cthlc9 and other qualiticellont+nd for resoNtrig'#rrY totibl about-such quAI 1e.at;ori;. furl Onto on 11116 application Is barnp processed,.!aRreQ to updates the application should More be any change In Iho Information provided. in or•1f:ion to any notice required by any conlraet with a Kaolih:are Organlzellon,i agree to notify this Healthcare Organs'atron imrriediateiy inwfifng of the r.:'.rrrence of anyof the following:(I)fhb-un,tnyod susponsion,revocation or nonrenewal of my Roane to eractico medicine In Florida;(Ii)any suep•r,Ion.revocation or nonrenewal of my DEA or other controlled t yes lances reglalrellon;or(lit)any cancellation or ncnrcnowel of my proraeSlDnal tfablr y n•lteranenooverage. I rbrt.t-•agree tonality this Healthcare Oreanizatlon in ti:•ri{Ing,within fourteen(14)day;from the occurrence or any of iho'fo'lowing:(1)receipt of wrlllen nolic •.'ony adverse action against me.by the Medical Uoard of Florida lake or pending,Including,but not limited le,any accusation reed, tomp:r•ry restraining oidor of Impostlion of any interim suspanelon,probation or limitations affecilnp my Ilcerteo to praclrce medicine;or(11)any adverse octro lainsi me by any Hcarihcaro Organtzallan,which has resuitod In the iding of a Stollen 8OG report(or any sub;acllens)tvitb the Medical t3oartt of Florrr.r. 1pploprtate!kerning boaffJ or g report 1'rrth IhP'Nallbria!Practitioner-gala Bank;or(III)(ho dental.revocation.suspension.reduction tirnlle'r nonrenewai orvofuntary retincuflatlment b'restpnatian of my medical alarm mornbarstrip or clinical privileges nt any Herollhcero Organization:or (iv)C.r.estate!reduction In my professional IlobIlityInsurence OOvorogo:or(v)my!ocelot of wrihlOn rsollee of any Iogel action egalnsl mo,holm:116g, %vitho r miiatian,any Mad end served mafproctieo null or arbitration action:or(vi)my coiwicilon or ony crime(eaccluding any minor traffic vforct;ons):or (vii)r•r'ocetpt ofwmien nonle°of any adverse action against me under the Medicare or Medicaid-programs.including.but net itmllcd to.fraud and abus. :rocoedinge or CenvlttI4ns. • • t plait; o provtdo continuous care for my potion's. • t hare •y >,U1rnt that fhe information submitted in thte opaUcaUon and any addenda tlrerato•(tnctudtng my curriculum Vilna If attached)fa(rUO,. currer • erred,end comptele to the best of myknowledgo ond•bellof and Is furnished In good faith.I Ufdoroland[hat material omissions or Infirm r••,eniatlons may result in dental airily application or lerrnfnollon or my privileges.employment or phyniclen punk/potion agreement. ' A plie • spy of this document shell be as affective es the oigrnal• r. t-dt APPL •;NISI-NA RE(Sin pIs Not Acceptabrol ANTED NAME / p 'E This sap:le ion anti Addendu Amid 0 Ware created and. Addor r..St/braitling: are endorsed by •CA AseocielIon Health PIans(9t6)552491O rl c•lendurr fl:Professional LIabllity Action Explanation -CA Association of Physician Groves(010)443.227+1 The PPPA hrr,ben,molded. N/enn be,vi,s:prf bark sired ilk/rift two pages f a er 15 arid 16)1iffanr�r�b�afftfrou. Florida licIpating Prectti0n0CApplication 16 Vprgion 1.2052 Theodore F Shu)ts,M.S,Td -' � ` ' ' O ..nh airman ;.` • (919)489-5407 ,I! �� American Association of Medic al Review Officers ugust 14, 2012 Verification of Certification for: Berta Pita, M.D. Mount Sinai Mcdidal. Center 4800 Alton Road Ascher Blvd 2nd Floor Miami Beach FL 33 l 40 .Certification Number: 120725216 Current Certification Date: July 25, 2012 Certification Expiration Date: July 25, 2017 ibis notice serves as verification that the.above-referenced physician has been certified IS a Medical Review Officer(MIRO) through the American Association of Medical review Officers (AAMR0). !=or all physicians certified or recertified by AAMRO after October l., 2010 will have to• tttext.d an MRO training program and take the exam. Recertification is required every five years to remain in good standing. 11 e referenced physician is listed in the AAMRO registry of Certified Medical Review Officers (www_aamro.com). Theodore F. Shults, J.D., M.S. chairman • P.O.Box 12873 • REscarch Miangle Park,NC 27709 (919)489-5407 Fax:(919)490-1010 I .1.ic.r- '' 'het,;.•:t '-47_i • ,••i ' , Q DEPART EMIT:QF>. EALTH ,•:•: . . .. , t- d . ��. F ICA ALL Y•ASSi1.RANCE .. a.N OF N� L Ql.�' _ • �. d .. .. .. _• ri TC: :1-1 CENSE NO, .- :-CONTROL WO. 1 •i9 1125l2Q12 ,ME 1'13909 390912 =x m • _ `-MEDICALZ0gT.O11 - '` I Diet all''rti uirefnents of ned"telo+iv hay Q 4 w;§ar�dtruLe ;iL a state of Florida. • 74'..t a;t� ,° : 3,ir;at1dr.D21te: .JAN.UARY 3.1 r 2015 .., 'o; �. s; • vI1.13A0r1=T1 3310" o z.,a, . :14 . a, :d . El''''' '• r . ,•,:yi,d.••• . •-. •'. . • ' • ••a, 4,0 _ .r...._ r FVi c'.S.cbti •.: • . J.John H.Arms tsan g; • •. i - . STATE SURGEON GENERAL, • DISLAY(F EQI 'BY LAW ' -•• EXPIRATION DATE: JANUARY 31,20 E. ur ticcnac. nuinbet C IC 113909, ploosc use lI in all correspondence with your boortllcounell.Each licensee in solely responsible Tot notl rtt the department in writing the Ilccnhre'!CUrI .. :mailing nctdreso nrtcl practice location oddreao• tf you have not received your rnncwat notice 90 days prior to the expirati in date nhown on thin cnac.plenoc can( '11488-0595. ,r.this acc.tioi to r t.•rt.name chwigc.Nome chRngen require Legal dorame:ntntion showing the(tame change.Piennc make sure that q photococ&jif one of the following corr_panlc+this fol I. q renfringc tinearlc.rt divorce decree or n court order.A drivorn itr a or�oolnl aoettlty Gard I..cot oonotdared lca.1 onroentation. ;dicRI Quality Aoz.: •nee offers you the cnnve-rdencc of*enrol oniinc services.Therm 3rrvie:rtl give you the mobility to renew your license.upda your mailitip and practice :Rttnn ndciresses n. update ynur profile information, I. UA top...a 'lhealthierciteu.cQro 2.click(- I.icenseeprovnel'er . 3.Click 1.0 ''rnedtinnrr Login 4.Select •.et'prricapion S.Enter 1 • oreotittttf and password that$Qa provided to you on your initial license:rod click on'Login••. , 0.1f you•• ant know your account ID and nnmtvord.cluck nn^Get Login itlottl'or evil our Customer Contact Center at(85tt1 488-p. for assistance. AIL TO:DEPAR fNIENT OF HEALTH DIVIS!C it OF MEDICAL QUALITY ASSURANCE LICENSING AND AUMTING SERVICES UNIT P.O.BE) 832Q TALLAI t,tSSEE,FLORIDA 32314-6320 I NAME CHAI,Ir=E(ATTACH LEGAL DOCUMENTATION) ROM: __.__.,...�____.._ _r_ LAST FIRST MIDDLE 0: LnSi'—_-- —------------- 14-51- ------------ MIDDLE tl-I 2103.5(98 Orlando Santana:.M.D. • 6770 Indian Creek.Drive. 8-Dl Miami.Beach, Fl. .3 s X41 > ; ' .�� _ 12111/61 Married to Roxanna Gam, M.D. no children U.S.citizen S.S.# 560-17-5461 University of Miami School of Medicine. Coral'Gables,Florida(1983-1987) Degree: M.D. University of Miami, Coral Gables,.Florida(1980-1983) Degree: B.S. University of Loyola at Chicago(1979-1980) studied Augusta=College,Summer School in Spain-1978 Sph Civilization and Culture. CI AQUALF IR Thfl G: Cardiology Fellowship,Mount Sinai Medical Center. Miami Beeh. Florida(1900-1993). Residency. internal.Medicine,Mount Sinai Medical Center. Miami Beach, Florida(1987-1990). Medical License: State of Florida.November 1989 4'55387 DEA: :4i3S 1933589 • ELO_ARD criwr n(7A O T. Internal Medicine, September 12, 1 990 Cardiology, November. 1993 1 , Pain Research -University of Miami 1985 Research.on Suicide-University of Miami 1 986 Named "Outstanding Fellow of the Year" by the resident and the Department of Internal Medicine, 1991-1992. Outstanding Fellow of the Year-Department of Medicine 1992-1993 ° "'A. � "Thrombocropenia associated with Lepto irosis". Outstanding Presentation, Mount Sinai Medical Center, Miami Beach-Florida-March I9S8_ "T't rnbocytopcnia associated with Leptospirosi? Outstanding pmsentation at Regional ACP Meeting-Tampa, Florida-Oct. 1985. Medical Jeopardy Contestant-ACP Meeting, March 1989-Winner. Medical Jeopardy Contestant-ACP Meeting.November 1954- Second Place in State.of Florida. ' Medical Jeopardy Contestant-ACP Meeting,March 1990-Winner. Medical Jeopardy Cor.tcstant-ACS'Mee'ti.ng,October 1990- Second Place in State of Florida. Resident Lecture Series_ Mount Sinai Medical Center. Miami Beach, Florida. nTratarniento del Infzrrto Agudo del.Miocar iio`t (Treatment of Ac Myocardial Infarction)-Latin American Conference. Nov. 199.1-Mount Sims..Medical Center, Miami Beach. Florida. "Muerte Subita" (Sudden Death),Latin American Confemice Nov. 1992-Mount Sinai Medical Center,Nitiami Beach,Florida. "Uso alnico del Eco Transesofagi.L?" (Clinical:use of TEE)- Latin American Conference-Mt-.Sinai Med. Ctr.-Nov. 199:. ERE. 'T'AT Oi:S. "Tratamiento.del Infamy Agudo del.Miocardio en las primers 24 horns"(Treatment of acute MI in the first 24 hours). Latin, Ameriam Conference.Nov. 199 4--Mt.'Sinai Medical Centter, .lir► i Be I,.Florida. St. Francis Hospital, Miami Beach. Florida-Flouse.Physici nn 2/91-2/9?. South Miami Hospital-Miari.i, Florida--Critical Care Physician. -7/93. Mt.Sinai Hospital. Miami Beach.. Florida-Cardiology Attending_ 7,93---4X94. Private Practice Cardiology-Miami,Florida. 4/94-prcsent. Chief of Cardiology-Pasteur Clinic. 2/94-present. azal,l S; Critical Ca e Pathway way for Acute MI.L\ cal Resident Search Committee. ilB£)TCAL SQctt TIFS; American College of Physicians American College of.Cardiology Florida Society of Internal Medicine National Society of Medical Residents National Society of Internal Medicine Dade County Medical Association. PERSPN'AL r.P''►.r'[`ERE$ : Traveling,reading. cycling,tennis. • • PUBLICATIONS; 1. Slatatrn 0;SafrStein S, Williams D,Machado H. Agatston AS.Noninvasive documentation of rupture of the interventricular septum due to subacute bacterial endocarditis. Video Journal of Echocardiography Vol 2:No 1;26-23,Jan 1992. ?. Agats`tvin AS,� In ea. : Doppler Echocardiography. Current Opinion in Radiology. August 1992,4:1V, 1 5-22. 3 Santana 0,Vivas P.Ramos A. Safi tein S.Agatston AS.Multiple myeloma involving the pericardium associated with cardiac tamponade and constrictive pericarditis. Amer Heart J 1993:Vol 126: 737-740. 4. Guerra OR,a.uLituas2,Starstein S.Agatston AS. Diagnosis of localized cardiac. tamponade following cardiac surgery:The role of trarsesophaeeal echocardiography. Video Journal of Ech rdiogzapby,Vol 2;145-148;Oct. 1992. 5. a , Guerra OR, Vivas P.Ramos A, Agatston AS. Multiple myeloma involving the pericardium associated with cardiac tamponade and constrictive pericarditis. Video Journal of Echocardiography=. '10 be published. 6. Sagtatii Q. Vivas P. Tratamiento del Infarto Agudo eel Miocardio (Treatment of Acute Myocardial Infarction). Medico Interamericano. Feb. 1993.49-8. 7. nfl.n CO,Vivas P.Tratamiento del harm Agudo del Miocardia (Treatment of Acute Myocardial infa}ctiom). Medico tnteratneriicano, Mar. 1993.4?-50 8, Fandino-Sehde F, Vivas P. Muerte Subita(Sudden.Death). Medico Inter-americium,May 1993,45-52. 9, agataaa.D, Campo O,Vivas P. .Agatston AS. Large Ventricular thrombus i.n an asymptomatic man-A case report.To be submitted_ 10. Santana 0, Franco M„Vivas P.Guerra OR. Agatston.AS. Spindle cell sarcoma presenting venting as right ventricular outflow tract obstruction. Video Journal of Echocardiography. 199.E Vol. 3; 67-70. 1 i. Guerra OR, t.t na ,Vivas P1I.Vignola PA. r ttatston AS. Transesophageal Echo- cardiography in percutaneous mitral balloon vtaivulopiasty. Video Journal of Echocar- diogntphy. 1993; Vol.3,No 2.41-45. 12: WilienS H, . .r ...0„Vttoto'1 Guerra.OR,A a r ton AS. € iag►osis of intran.ortic Debris by tratsesophageal ethocardiOgrapby in a patient with digital ischernia. Video Journal of Echocardiozrophy,.Apt 1993,Vol 3,No 2.46-49. FM11C0 M,Geara It. 43 t=_ a f0. Vivas P. lndicaciones para marcapasos en adultos(Indi= • rations for pacernakeis in adults). Medico.,nter,uncricano,June 1 993.59-66. 14. Franco NI,Gezira R. tana,.,,Q. Vivas P. lndicaciores para et itplante de Cardiodeft- briladores Atxtornat.cos del Corazon (Indications for AJCD).Medico I.nteramcricano. • Nov, 1993.. 15-1.8. 15. Jara i AR. . ..Q,Fanclino-Sencle F.Agatston AS, Asymptomatic Sinus of Valsalva aneurysm compressing the left.main coronary artery. Video Journal of I chocardiozmphy: 1993:Vol:.3: 71-72. 16. earn foil; a : El uso clinic()del Eco Transesofagico(Clinical use ofTFE). Medico Internmericano,Aug. 1 993: 17-24. 17. Ceara R.M, .„ t :La Ecocardifl `rn Transesofagica(Transesophageal.Echo- cardiography).Cardiologia 1ntercorrt.nenra1, Vol 3, No 1:Jan-April 1994,58:61. IS. Agatston AS J'anrrwitz ,Ge.ara RN1 �n ; Tomogra&a compurarimda ultra- rapidn para visual:imr las arterias cororiarias. (Ultra-fast Ct to visualize the coronaries;) • Cardiologia intercontinental Vol.2,#2. May-August 1993.56-59. 19. Agatston AS Jancrwitz WL,Geara RN!.SIntam •. Visualization de.his coronaries r medid del Imatmn(Visualization of the coronaries by the brat on). Medico° Fnternnricano.July 1993.Vol, 7. 35-38. • :o. Sa irstein S.�ulaatt.Q, Agatston AS. Thvrnntoxknsis a' ociuted with a reversible Dilated Cardiomvapath.. Amer.tHe.ari J. Sept. 1994. 616-617. :21. Urena P,Taverns III 'M. to a Q,Crespo F. Coronary Artery Dissection. To he published-Resident 8 St 'Physician. 22. Tat. <z.111 TM,fsntima,Urena P.Crespo F.Manejo modern°del paciente con cardio- rniopatia hipertroitca(Management of patients with Hyperirophic,Cardionmyopathv). Medico Interamerica.no,Feb. 1994, 71.-72 • 23. Stine JM.F.Santana RM. as P. Sende FF: Dias nostico di ferencial de lka tquiardias de coniplejo QRS amplio !Differential Dia-gnosis of Wide Complex Tachycardia).Me o interarnencano, Sept, 19Q3.,33-37. 24. Gear R,$anzn ka Q,: > .?vision de los estudios de rnortalided en fall°cardiac?congestivo. (Review of Mortality Studies on Congestive Heart Failure).Medico i.nteramericano. April 1994,. 22 1.-223. 25. G a a ;,Revision cle ios estudios de mar naortalideod en fa bo cardiaco congestivo. (Review of Mortality in CHF). To be published-Cardiologia intercontinental. 1,994. 26:. a an :El use de Best-bloqueadores en pacientes con in uficiencia cardiaca. (Use of beta-Mockers in Congestive Hear!..Failure.). To be published-Medico Inleramericano. Nov. 1994. 27. Via,, ..Q: El use de Beta.-bloqueadores en pacientes con instificiencia cardinca. (Beta- blockers in CHF)..To be p blished-Cardiologia Intercontinental, 1994. T-521 rot: 3021 p- 11-04-p 23 10:01 EFOil- Azov .: • • . . , ,..,.. . ,,,..?...... • . ... f,iA --;_ A C73. — 6 41•9:-' . , •-`-',-,1-,..r.i. ..,, -...,.. :-.:' •— '..7.-I• ',--" ."'''. ' .,f.7: 'STATt.,;vri r LORIDA, . - . ..... A ..,...-- ,-4,-..-•:--,-. • ..,,-- ........,..• ...-. , .. .1,.. . .-.. -.4-,.. . :: •,_-.„ •,„ ., ,,,..„,.....-... 2...,• t f! ;; Ka 4,-.. , ...: a ••• '....■ •+4•...-• :7..4". -•••••..,i.1., ...„,..7,;• .,"; . ..,. "-,,,. ' ." .,..". ,., ...: c'.• .-. ..I. '' '' .... : -..e L.,. '"'"': ,...`,..;; :.' .. ,.., v,.,-....-c- ..T 7. •,..,,,., ,.... li, 2 .... =7,..•-1 ,P U.... ..iy,:l.::.' . DEPARTIVIENT OF HEALTH ,,,,,- .....: ,..-.:%- ,..- "-;.....— r.-7.. A....:„ ... er •,•••••••^".",4••••:-. ";.....: ..• •..-,n . ,•• •-....,- -.4"..''''" ''.:...' ''', ,.. •".. 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' 4`..•;..: .q- Z) '-. ,- ','-;...:-.:•- `..'i,-4;;;ffii:;-::,' 22...,... .I.... :' .....:4„. ...a...-;',...,,-" ;i: ,.it . :11:-;•.--'1'-•,:•••#•i .-,e,•.,•$,,,,..--..---.,-••••.:4_11,P..: , ,. ., ',7 V.-!'"-,.'-'-'-',..;:',::!',/. ,,,,•-..-tz z-'7-:.•.1 4",:-.7'..,-!-?:;... '* ; ". .'.-:.-..':iir, '-' _ .;,-.1 •.:;.".....-,..."..t;.y...:.. ii, :....:7-...•, -• • -', -:- .,-.•.7::7,;;;;.:::4?:•.,' --,1.-1..:::7::...1Z.k...• 1.4..,-....•-._. - .-- 7' 7:.......'• •-'- • , - ..ir, . . .:•-• .,,.7-.. ,.--,----,-,.,- ;•.. Rick,-Sbit-,,.-'•.__'- '-'__,t;,--1,. • -,---•.,..-..-..'1.:7,. ,..77-`4 , John H.-Armsiroi-O"-k1.1);SA• - • --',., Ar' .f* .-; ---, •-,,' ,:••• •• •s''' - - :7'74; '1'..;:::*.--)3 ,...; '5. -..;.-,7_1 GOVERNOR ., ,. ;'_'.-4. g .4'.:''`,:•,. ,' ..-•--c"..z..:•-S..'. P,-A T.,E,SU-R..G.....,,E.-.-O.,..i.: .c.-.G.,-,E,_ E...-R A,L.7.,.: -j--.,„....-.-, .. 4.,' ;... --;,'-1-:. 7.:. A.. --.-.' -3:-...., - • •. •..."..;In ...i,..t 2;:.7'7"......,•-..I.P.:.. ..,•.:i.r.-.:,_:,:-....,'- '- ..,.: 1-; .'-.." -,,- .-, -....-..7,....:c •. DISPLAYiPAEQ-0IECr-...13YLAW =.,.- t.;--,'-",;'4-..'..-: ..--,trs;*-a::.7:,:je•'--.7:•.,'-' .1 , .. -',air.:•- -..,:..: ...---,...- • '•• ‘.•.7.a-,-,...f,••-'''''''';;,,. -;.1: -,....; .- --;...,. •.:" , - • , ,.•,, .„.. ..,„ ?•...:.,...:•• ,.. • . , . •. . ." ' • •' - • • 1 • . ' • • •• . . . ... , . ; . ,:■..,.. .. .__,3 )1 SA-'\, t- iii(( ...........-T . ' 1 • • . -.... • • . . • Page 1 Personal Data: Name: Alfonso O. Tolentino Birthdate: October 30, 1942 Birthplace: Lucban, Quezon , Philippines Citizenship: U.S. • Education: 1962: Associate in Arts University of the East, Manila, Philippines 1967: Doctor of Medicine UERMMMC, Quezon City, Philippines Postdoctoral Training: 1967-1971: Medicine Residency UERMMMC, Quezon City, Philippines 1971-1974: Medicine Residency Mercy Catholic Medical Center, Philadelphia, PA 1974-1976: Cardiology Fellowship Mount Sinai.Medical Center, Miami Beach, FL Licensure: ME0027147 Florida Board Certified, Internal Medicine 2005 Board Certified, Cardiovascular Diseases 2007 Professional Organizations: Fellow, American College of Cardiology Fellow, American College'of Physician Member, American Heart Association, Council for Thrombosis Member, Heart Rhythm Society Member, Cardiac Electrophysiology Society Member, American Medical Association • Academic Appointments: Vice Chairman of Medicine Assistant Professor of Medicine Columbia University Division of Cardiology Mount Sinai Medical Center Miami Beach, Florida Hospital Appointments: Attending, Invasive Cardiology Mount Sinai Medical Center Division of Cardiology Miami Beach, Florida July 1976—June 1991 Attending, Non Invasive Cardiology Mount Sinai Medical Center Division of Cardiology Miami Beach, Florida July 1991 —present Page 2 Co-Director, Electrocardiography Laboratory Columbia University Division of Cardiology Mount Sinai Medical Center Miami Beach, Florida January 2012- December 2012 Director, Electrocardiography Laboratory Columbia University Division of Cardiology Mount Sinai Medical Center Miami Beach, Florida January 2013.to present Vice Chair Department of Medicine Mount Sinai Medical Center Miami Beach, Florida September 2013 to present Honors: Residents Teacher of the Year Award 1998-1999 Cardiology Fellows Attending of the Year Award 2004-2005 2007-2008 2009-2010 Departmental Committee: Mount Sinai Medical Center • Miami Beach, FL Pharmacy Committee Chairman January 2012 to present . Mount Sinai Medical C enter Miami Beach, FL Cardiovascular Services Committee 2000 to present Mount Sinai Medical Center Miami Beach, FL Medical Services Committee January 2012 to present Teaching Experience: Key Faculty Cardiology Fellowship Training Program from 1976 to present Weekly ECG seminar for. Cardiology Fellows from 2000 to present Annual ECG seminar for Medical Residents and Interns from 2005 to present . Annual ECG seminar for Emergency Department Residents from 2010 to present Publications: 1) Echocardiographic Assessment of LV Function in Coronary Artery Disease; Chandraratna PAN, Tolentino AO. British Heart Journal; 1977 Feb. 2) Echocardiographic Observations Between Mitral Valve Prolapse and Asymmetric Septa! Hypertrophy; Chandraratna PAN, Tolentino AO. Circulation; 1977 April • Page 3 3). Ten Year Prospective Observations on HV Intervals in Patients with RBBB and LAD;,Narula OS, Tolentino AO. Circulation; 1978 Nov. 4) Sinus Bradycardia in the Elderly; Gann D., Tolentino AO., Samet P., Annals of Int Medicine; 1979 Dec. 5) *Pacer Induced Tachycardia Associated with ASVIP Pulse Generator;Tolentino AO, Javier RP, Samet P. Pacing &Clinical Electrophysiology; 1982 Mar. Page 3 . .6) Pseudocomplications of Cardiac Catheterization;Hildner FJ, Javier RP, Tolentino AO. Catheterization & Cardiovascular Diagnosis; 1982 Aug. 7) *Electrocardiographic Patterns of Normally Functioning Dual Chamber Pacemakers; Tolentino AO, Javier RP, Samet P. Mount Sinai Medical Journal of Medicine; 1985 Feb. 8) New Principles for Optimum Left Ventriculography; Hildner FJ, Furst A,Javier RP, Tolentino AO, Samet P. Catheterization &Cardiovascular Diagnosis; 1986 Feb. Book Chapter *Indications for Pacing in Bradyantiythmias Tolentino AO,.Javier RP, Samet P. Cardiac Pacing and Electrophysiology, Chapter 37, 1991 EI-Sherif N, Samet.P, authors. • • Healthcare Practitioner License Display Page 1 of 1 1 L/Zt r Handal cl Medical Quality Assurance (MQA) Services HEALTH �" •� License Verification Data As of 1/232014 ALFONSO 0 TOLENTTNO Mb LICENSE NUMBER:81E27147 1"trrd+Fr.•r.11'veer.a • Oo'tro ,Sb erdpry slefortc, Sttrii&ede. r10-mib.i Fromm FleCeir_ners:. PfCINUIDO MEDICAL DOCTOR G1m1sc/ACtivfl/�tyy Status Controlled Substance Pres rAber n rna,ar-nvF li._ UCenaa Expiration Daft Uterus 4ilgLul Issue Date 1/31/016 09120/1976 l Dlfciptlne on File Public Complalot NO tiO Address of Record mourn S1NA1 MEDICAL CENTER 430D ALTON ROAD.SUITE 82070 HTAMI UEACH. Ft. 33140 UNITED STATES The Ittorreataonon this page is a Secure.primary saute tar Ranee Ventl0at= pmvlded by The Florida Depaireer+t of Moan,Owision or Mrdirat Quality Assurance.This nebsae Is mauda,ned by Dryad=start and to updated intrrMOately upon a change to our O[BMutp and enforcement database Privaer Statement'p,aclarmer Feressib,t Iv In/nMlAtlnn•E la..Uvn 1 pownfo:1 Deal • https://wrw2.dolh.state.fl.us/IRM00PRAES/PRASINDI.ASP?LicId=20012&amp:ProINBR._. 1/23/2014 Chetan D. Rajadhyaksha M.D. (`Dr. Raj') 4515 N Jefferson Ave Miami Beach,Fl,33140 Email:chetanr @chetanr.com 305-982-7252 Current Position: Attending radiologist at Mt.Sinai Medical Center,Miami Beach,Fl.Since 7/08 -Chairman Dept of Radiology -Section Chief Nuclear Medicine Residency/Post Graduation Training: MRI—University of Miami,.Mlanii,FL.7/07—6/08 -Combined position of junior faculty/instructor and fellowship in MRI(MSK,Body,Neuro). Radiology Residency-St.Vincent Hospital at Worcester Medical Center,Worcester,Ma.7/1/04-- 6/30/0.7 Chief Resident Nuclear Medicine Residency-7/02-6/04-Joint Program in Nuclear Medicine-Harvard Medical School Chief Resident Internship-7/01-6/02-Internal Medicine,Lenox Hill Hospital,New York,NY. Certification and Licensure: Board Certification— 1.American Board of Nuclear Medicine— Active-Recertified till 2014 2.American Board of Radiology-Active Florida:State Medical Licence—Active,unrestricted,in good standing DEA Certification-Active Education: 2000 M.D. DY Patil Medical College,Bombay University,Bombay,India 1994 BA Biology Brandeis-University,Waltham,MA Active Medical Societies/Memberships: Radiological Society of North.America American Roentgen Ray Society American College of Radiology Society of Nuclear Medicine • American Medical Association Professional Interests: 1. Functional Imaging—P.E.T./CT,MRI 2. Image Fusion 3. 3D Image reconstruction 4. Radiotherapy 5. Applications of Computers and Internet in Medical 6. Mobile Radiology Academic Activities/Presentations/Research/Publications:, 2013 November RSNA 2013—Scientific exhibit,`Spectrum of SPECT C7'findings in head and neck Iymphoscintigrriphy' 2013 May ARRS 2013—Invited.Speaker—Nuclear Medicine Book Chapter: Approach to Diagnosis:A Case Based Imaging Review,NuclearMedicine Neurology' ISBN 978-1-890705-20-6 2011 May ARRS 2011—Invited Speaker—Nuclear Medicine Book Chapter: 'Approach to Diagnosis:A Case Based Imaging Review,Imaging of Infection and Inflammation', ISBN 978-1-890705-17-6 2011 April ASNR 2011-Exhibit-"Use of MIM Cloud on the iPad for On Call Stroke Protocols."Bhatia,Aashim;Bhatia, Vinay,Rajadhyaksha,Chetan;Plitnikas,Mike;Burke,William;Pizarro,Jose(2011,April). 2010 May ARRS 2010—Invited Speaker—Nuclear Medicine Book Chapter: 'Approach to Diagnosis:A Case Based Imaging Review,NuclearMedicine-Skeletal Scintigraphy', ISBN 978-1-890705-15-2 2009 May ARRS 2009—Invited Speaker—Nuclear Medicine/PET-CT *Awarded best new speaker award Book Chapter: 'Approach to Diagnosis:A Case Based Imaging Review,NuclearMedicine-PET-CT', ISBN 978-1-890705-13-8 2008 April ARRS 2008-Exhibits 1.Budd-Chiari Syndrome:Spectrum of Imaging Findings.ARRS 2008 2.Renovascular Hypertension:an organized approach to diagnosis;ARRS 2008 3.Imaging of Abdominal AIDS Related Lymphoma;ARRS 2008 4.Imaging with pathologic.correlation of unusual adrenal masses;ARRS 2008 2006 September Society of Nuclear Medicine Technology Massachusetts Chapter—'Basics ofPET/CT Including Normal and Benign Variants and Artifacts'—Invited Speaker 2006 April Society of Nuclear Medicine Technology New England Chapter—'Basics ofPET/CT Including Normal and Benign Variants and Artifacts'—Invited Speaker 2006 January All India Congress of Obstetrics and Gynecology 2006 Annual Meeting `Utility ofPET/CT in Ovarian Cancer'—Invited Speaker 2005 May ARRS 2005-Exhibit-18 FDG PET/CT in Non-Small Cell Lung Cancer 2004 May ARRS 2004-Exhibit—Normal and Benign Pathologic Findings in 18-FDG-PET and PET/CT—*Rewarded Certificate of Merit 2003 December RSNA 2003-Oral Presentation Prospective Comparison of FDG-PET and Ga-67-Citrate in patients with Hodgkin's disease treated with ABVD. 2003 Aneurysmal bone cyst of the sacrum:value of three-phase imaging.Rajadhyaksha C,Connolly LP,Connolly SA, Treves ST.,Clinical Nuclear Medicine.2003 Nov;28(11):933-5 2003 December All Lung—An Integrated Digital Educational Tool;RSNA 2003 2002 December All Brain-An Integrated Digital Educational Tool;RSNA 2002 2001 May 1.All Adrenal-An Integrated Digital Educational Tool; ARRS 2001 -*Rewarded Certificate of Merit 2.All About Vein-ARRS 2001 -*Rewarded Certificate of Merit 3.Radiology ER"-A Web Site Focusing On Imaging In The ER.- ARRS 2001 4.Left Ventricle Radiologic Pathologic Correlation.-ARRS 2001 2001 December All Spleen-An Integrated Digital Educational Tool;RSNA 2001 2000 April All Pancreas:An Integrated Learning Tool;AIM Annual Meeting 2000 r -Aug,..;._.... i•.:.-- ._.:..,:. - • �•. '- b ipa °>ur i..vluluf , . , . ,-r,•;;,,-„ •”-'->< �. ,. L' . t , • = Z° . - :,, - ' - DEPARTMENTOF MEALTN - -� ; ::Y ��`<:::=-:. �� .,_ .f?� ) o ,-. • ' -DIVISION-OFMEDICA L Q UAL TY.ASSURANCE: Smita Bhandari, M • General Adult Psychiatrist (Board Certified) Phone:305-775-5239 &mail; bhandariminnie(gmail.com Education and Training . 07/1995- 12/1999 M.B.B.S. GSVM Medical College • Kanpur,India 12/1999- 12/2000 Rotational Internship • Shri Maharana Pratap District Hospital Bareilly,India 07/2004 -06/2008 House Officer Department of Behavioral Health Services Henry Ford Health System . . Detroit,MI 05/2007-06/2008 Chief Resident ( Department of3ehavioral Health Services • Henry Ford Health System Detroit,MI • Faculty Appointment 07/2008-09/2011 Staff Psychiatrist Division of Consultation-Liaison Psychiatry Department of Behavioral Health Services Henry Ford Health System,Detroit,MI 03/2009-09/2011 Clinical Assistant Professor Wayne State University School of Medicine,Detroit,MI - • 07/2009-09/2011 Adjunct Clinical Instructor University of Michigan Medical School,Ann Arbor,MI 03/2010.-06/2010 Interim Chief of Service • Division of Consultation-Liaison Psychiatry Department of Behavioral Health Services Henry Ford Health System,Detroit,MI • • • Licensure and Certifications 0912009 Board Certification,American Board of Psychiatry and • Neurology 07/2004-present Michigan Physician License Michigan Controlled Substance License Research Experience r ' 06/2001-02/2004 Research Assistant Department of Consultation Liaison Psychiatry Henry Ford Health System,Detroit,MI Supervisory and Teaching Experience 06/2007-0612008 Teaching and Supervision-Inpatient,Consult Liaison and Emergency Psychiatry Junior Residents/Medical Students Henry Ford Health System,Detroit,MI 06/2006-.06/2007 Teaching and Supervision-Outpatient Psychiatry Rotating Family Practice Residents Henry Ford Health System,Detroit,MI 06/2006 Teaching-In-service training for Mental Health Security Personnel Henry Ford Health System,Detroit,MI 11/2006 Teaching-Anxiety Disorders Social Work Interns Lecture Henry Ford Health System,Detroit,MI 12/2006 Teaching-Substance Use Disorders •• • Social Work Interns Lecture Henry Ford Health System,Detroit,MI 0712007-09/2011 Teaching-Personality Disorders Monthly Medical Student/Rotating Residents Lecture - Henry Ford Health System,Detroit,MI 07/2008-09/2011 Teaching-Drug-Drug Interactions Senior Resident Lecture Henry Ford Health System,Detroit,MI 04/2009-0912011 Teaching-Gender Identity Disorders and Transsexualism Senior Resident Lecture Henry Ford Health System,Detroit,MI 05/2009 . Mock Oral Board Examiner Wayne State University Psychiatry Residents Henry Ford Health System,Detroit,MI • • • • 06/2009-09/2011 Teaching-Psychopharmacology during Pregnancy • Senior Resident Lecture Henry Ford Health System,Detroit,Ml Other Educational/Leadership Experience 06/2006 Participant:Bnprenorphine and Office-based • Treatment of Opioid Dependence Sponsored by AM,Troy,MI • 07/2006-08/2006 Participant:"Love and Logic" 7 week Parent Training Workshop • Conducted by Dr.0.Osoba(Senior StaffPsychiatrist) Henry Ford Health System,Detroit,MI 09/2006 Participant:2006 NEI Psychopharmacology Academy Conducted by Dr.Stephen Stahl,NEI,Chicago,IL 02/2007 Program Team Representative Mind Games,National Online Qualifying Competition Sponsored by APA r 1 03/2007 Participant:Team Centered Leadership Workshop Henry Ford Health System,Detroit,MI 05/2007 Participant SEMCME Chief and Senior Resident Workshop Providence Hospital,Southfield,MI • 06/2007-06/2008 Quality Improvement Project Department of Behavioral Health Services Henry Ford Health System,Detroit,MI 08/2007 Participant Crucial Conversations Workshop Henry Ford Health System,Detroit,MI - 10/2007-06/2008 Representative:Quality Improvement Team(QIT) Henry Ford Health System,Detroit,MI 12/2007 Participant:Team Centered Leadership Workshop Henry Ford Health System,Detroit,Ml 02/2008 Program Team Representative Mind Games,National Online Qualifying Competition Sponsored by APA 0612007-06/2008 Simulation Technology Applications in Residency Training • Project Department of Behavioral Health Services 3 • • • lQ/20l]-present ' Florida Psychiatric 8m.. . ��' /°_� � � References Available on request . . . . . . . . ' . • . . � . . • . ' � . � . . ! ' . . . . . . . . - | ' � • ` . . . � 6 � . . . • . . . . . . • — '------ ----' ,..,I.,i r c. L[- I-L.t.J rt!U/k DE, ARTMENT OF HEALTH ' .DIV?SiON OF MEDICAL QUALITY ASSURANCE f5 ; '° ! z DATE LICENSE NO. 'CONTROL NO. I L) . •11/27/2013 ME 113610 .. I� 436175 ¢. do a t`9, w!° °u� The MEDICAL DOCTOR a ¢ = o„ mecl below has met all requirements of W the laws and rules of the state of Florida. x n z Expiration Date: JANUARY 31, 2016 Q ti iY SMJTA BHANDARI o6 o Ti a t�?_5 V4147TH CT FE 0 Lai i °4, a' z° z I a r. ai Q . ItAmt BEACH,.FL 33140 uT o a 0 a o = Or!z aim w, m.c CO wry° it r `t2•°- Q t/) Q a is .t2 ~ tit F-tilt} l R c '_ `? • toQ�.__ -. i- r. EW U) , cre..r. ..c........ Ak....suoo0. ■ ti Rick Scott John H..Armstrong,MD,FA S GOVERNOR STATE SURGEON GENERAL DISPLAY iF'REQUIRED BY LAW ■ EXPIRATION-DATE: JANUARY 31,2016 'our-license counter is BIE 113610, please use it in:all correspondence with-your board/council.Hach licensee is solely responsible for notifying the department in writing o iic licensees curlew mailing address and practice location address. lfyou have not received your renewal notice 90 days print to the expiration now shown on this license, +lease call 18501 98R 05 95. se this section to-report narur.change.!fame changes require.legal documentation shoKing the name change.Please make sure that a-photocopy alone of the following e companies this form:a marriage license..u divorce decree ora court order. .Medical Quality Assurance oflcrs.}-ou the convenience of several online services.These services give you the ability to rernnvyour license,update your mailing and practice ucc,UUn addresses and update your profile information. 1.Co to www•nheolthsourcc.com 2.Click on.licenset•/Provider- 3.Click ou 1'r.r,tiuoncr login .I.Select your profession S linter the account ID and password that was provident to you on your initial license and click on.Logic". 6.If you do not know'your account ID anri password;click on^Get Login Help or call our Customer Contact C-enter et 18501 48x3.0595 for[assistance. iAlL T(:X DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE IMPORTANT ANNOUNCEMENT LICENSURE SUPPORT SERVICES UNIT THE DEPARTMENT OF HEALTH WILL NOW REVIEW P.O.f3OX 6320 YOUR CONTINUING EDUCATION RECORDS AT TALLAHASSEE,FLORIDA 323.14-6320 THE TIME OF LICENSE RENEWAL. l NAME CHANGE(ATTACH LEGAL DOCUMENTATION) TO LEARN-MORE,PLEASE VISIT W,WW.CEatRENEWAL.COM ROM _ LAST -�FIRST---.._. 1Vt1aDLE 0: LAST --•- --- •--- - --- -Flf?S' .-_ --_.---- 'MIDDLE� I-I 2103,.5198 4 AMY CHU, RN, MSN, ARNP, ANP-C 13401 SW 82 Court, Pinecrest, FL 33156 Home: 305.255.6951 Cell: 305.205.7569 achu1209©gmail.com PROFESSIONAL SUMMARY Registered Nurse,Emergency Department • Vastly skilled professional with 5 years experience in hospital, outpatient and home health setting. • Established in emergency nursing including assessment, technical skills, communication and education regarding medications and treatment, critical thinking, interpersonal skills, planning, intervention, evaluation, flexibility, professional accountability, and leadership. • Provide comprehensive, Immediate, and stabilizing care in an emergency situation, independent of the location of the emergency. • Manage patients of all age groups with acute and urgent Illness and injury who present with a full spectrum of episodic undifferentiated physical and behavioral symptoms and/or disorders. • Be competent in coordinating and overseeing the management of multiple patients simultaneously, including mass-casualty Incidents. • Act as the patient's advocate, advisor, and guide within the acute phase of his or her illness or injury • Experience with increasing responsibility as department team leader, leadership role as a nurse preceptor, mentor, and debriefer for the Versant program for new nurses. • Computer skilled and proficient in all documentation and paperwork to ensure accuracy, privacy and patient confidentiality, Proficient in typing. • Proficient in prioritizing clinical decision making based on patient specific acuity. • Bilingual, proficiently read, write, and speak both English and Chinese. CREDENTIALS Florida ARNP Certification(Adult Nurse Practitioner), License #: ARNP 9280682 EXP: 4/2014 Registered Nurse, State of Florida, License#: RN 9280682 EXP: 4/2014 Trauma Nursing Core Course Certified EXP: 3/2015 Basic Life Support for Healthcare Providers Certification CPR/AED EXP: 3/2013 Advanced Cardiac Life Support Certification EXP: 7/2014 Pediatric Advanced Life Support Certification EXP: 2/2013 Moderate Sedation Certified 2012 WORK EXPERIENCE Advanced Registered Nurse Practitioner, Occupational/Employee Health Dept. 2013-Current Mount Sinai Medical Center, Miami Beach, Florida Advanced Registered Nurse Practitioner,Wilfred McKenzie MD, Internal Medicine 2013-2013 Broward Health Medical Center, Ft. Lauderdale, Florida Advanced Registered Nurse Practitioner,Wilfred McKenzie MD,Internal Medicine 2013-2013 Wilton Manors Nursing Home and Rehab Center, Ft. Lauderdale, Florida M&O Clinical Research,Wilfred McKenzie MD&Khadra Osman MD 2013-2013 Sub Investigator Clinical Trials, Ft. Lauderdale, Florida Clinical Proficient Staff Nurse, Emergency Department 2008-Current Baptist Hospital of South Florida, Miami, Florida Clinical Staff Nurse,Emergency Department 2010-2012 Mercy Hospital, Miami, Florida Clinical Staff Nurse, Emergency Department 2008 Miami Children's Hospital, Miami, Florida Patient Care Technician,Respiratory Unit 8 Carroll 2006-2006 Mercy Hospital, Miami, Florida Certified Nursing Assistant,Alzheimer's Unit 2004-2005 Gainesville Health Care Center, Gainesville, Florida EDUCATION Master of Science, Nursing Adult/Geriatric Health Nurse Practitioner 2012 Florida International University, Miami, Florida Bachelor of Science, Nursing 2008 University of Florida,Gainesville,Florida High School Diploma, Nursing Program 2003 Coral Reef Senior High School, Miami, Florida AFFILIATIONS/HONORS/VOLUNTEER American Academy of Nurse Practitioners, Member #: 1205624 South Florida Council of Advanced Practice Nurses Florida Nurse Practitioner Network Gerontological Advanced Practice Nurses Association Emergency Nurses Association, Member #: 672493 Florida Nurses Association,Member#: 079405606 South Florida Council of Advanced Practice Nurses Gerontology Society of America Dermatology Nurses'Association, Member #: 27749 Wound Ostomy and Continence Nurses Society, Member #: 18103399 Golden Key International Honour Society Phi Kappa Phi Honor Society, Member #: 12376140 Shining Star Award, Baptist Health of South Florida • Pineapple Award,Baptist Health of South Florida Christ Fellowship Church, Palmetto Bay, Florida ADVANCED CLINICAL TRAINING EXPERIENCE Nurse Practitioner Student, Florida International University Miami cardiology Group, Miami, FL 2011 • Contact reference: Sandra Valencia, MSN, ARNP 305.301.7788 • 150 clinical hours completed Baptist Health of South Florida,5 Main Pulmonary/Med/Surgical Unit, Miami, FL 2011 • Contact reference: Patricia Anastaclo, MSN, ARNP 786.280.5774 • 210 clinical hours completed Baptist Health of South Florida, Internal Medicine 2 Tower Med/Surg Unit, Miami, FL 2011-2012 • Contact reference: Theresa Nguyen, MSN,ARNP 305.898.1121 • 440 clinical hours completed Baptist Health of South Florida, Nursing Administration,Code Rescue Responder, Miami, FL 2011 • Contact reference: Maria Cordero, MSN, ARNP 305.281.6456 • Contact reference: Opal Reid, MSN,ARNP 305.761.6032 • Contact reference: Gerri Galloway-Rouette, MSN,ARNP 786.596.1960 • 75 clinical hours completed REFERENCES Baptist Health of South Florida, Emergency Department,Nurse Manager • Contact reference: Suzanne Balbosa-Saunders, MSN, MsHSA, RN 786.596.3258 Mount Sinai Medical Center,Comprehensive Cancer Center,Advanced Registered Nurse Practitioner • Contact reference: Barbara Gomez, MSN, ARNP 786.286.5800 West Kendall Baptist Hospital, Nursing Administration, House Supervisor • Contact reference:.7ean Augustin, RN 305.335.3545 L s -- - .`-•r r_'�T�w� r rti. ..r ��_. • ar•M+�.w. -. ..— .r r... . 1• .'. ■ s • .r. ......�....nom ...ti. ... ..ti,......•............ •.• 1.• STATE OF FLORIDA AC# DEPARTMENTO.F HEALTH l. DIVISION OF MEDICAL QUALITY ASSURANCE . DATE. . .. ' LICENSE NO. -CONTROL NO: 9280682 'I 61�OU6 it i).;17/2012 ARNP 1 .The•••••ADV REG. NURSE PRACTITIONER :•named below has,met..all requirements of . the Laws and rules:.of the state of Florida. Expiration Date:- . APRIL 30, 2014 AMY CHU: L b j'( )VIV. VV YY+ LICEIN8EE SIGNATURE f N l. a 3 ASHLEY L. PAGES, MSN, FNP-BC, CPN ip›.4.4.-, leeteki 1286 SW 146th Court,Miami,FL, 33184 (305) 213-0600 • apage002 @gmail.com EDUCATION 2009-08/2012 Florida International University Masters of Science in Nursing Family Nurse Practitioner Specialty 2004-12/2008 Florida International University Bachelor of Science in Nursing 2000-06/2004 Coral Gables Senior High School High School Diploma International Baccalaureate Certificate WORK EXPERIENCE Family Nurse Practitioner Take Care Health Systems 03/2013-present • Responsible for assessments, diagnosis and treatment of common disease processes such . as; urinary tract infections, sinus infections, ear infections, skin infections, conjunctivitis, minor injuries, staple/suture removal, corneal abrasions,minor burns, animal bites and foreign body removals. gi Treatment of skin conditions such as; acne,varicella zoster, eczema, impetigo, ringworm, scabies,wart removal, skin tag removal and dermatitis • Completion of school and sports physicals and administration of vaccines and specialty injections to children and adults • Managing chronic conditions such as hypertension, diabetes, and hyperlipidemia Clinical Nurse Level III Miami Children's Hospital Miami, FL 04/09-preset 3/r • Using the nursing process to provide individual pediatric patient care in the intensive care department for patients experiencing life-threatening problems such as respiratory failure, trauma,neurological,neurosurgical problems, and hematological and oncological problems. • Managing airways via the use of mechanical ventilators;providing care for intubated patients requiring extracorporeal membrane oxygenation, managing intravenous therapy, caring for patients in induced pentobarbital comas and managing continuous/conscious sedation and vasoactive medications. • Developing a plan of care that is individualized for the patient;providing patient and family education; documenting patient assessment findings,physical and psychosocial responses to treatments and reporting these findings to appropriate personnel. r • Participation in developing safety checklist and life wings protocol for staff to ensure quality of care of patient with diabetic ketoacidosis • Preceptor/Mentor for students and new employees Patient Access Registrar Miami Children's Hospital Miami,FL 03/05-04/09 ▪ Organized patient charts,registered urgent care and emergency room patients,verified insurance information GRADUATE CLINICAL EXPERIENCE Take Care Health • Completed sports physicals,well person exams, administered vaccines • Responsible for assessments, formulation of diagnosis and prescription of medications • Treatment of common diseases such as; otitis media,urinary tract infections, streptococcal pharyngitis, otitis media and sinusitis Department of Health - Women's Health Clinic • Performed clinical breast exams,pap smears and health screenings • Provided patient education regarding birth control and safe sexual practices Same Day Surgery/Minor Procedures • Completed thorough history and physical examinations to establish surgical clearance • Communication of pertinent assessment findings to anesthesia team that may impact patient care Valerio Toyos,MD Internal Medicine • Administered primary care to patients • Responsible for physical exams and health screenings • Promoted healthy lifestyle through patient education embracing weight loss and exercise PROFESSIONAL LICENSURE, CERTIFICATION Board Certified Family Nurse Practitioner-American Nurses Credentialing Center (ARNP 9288922) Florida Licensed Registered Nurse Certified Pediatric Nurse American Heart Association: PALS American Heart Association: BLS for Health Care Providers CPRIAED Sedation Certified Trauma Certified OTHER SKILLS Computer skills:Proficient in Microsoft applications(Word,Excel, and PowerPoint) 2 Languages: Fluent in both English and Spanish(Written and Spoken) PROFESSIONAL MEMBERSHIP American Academy of Critical Care Nurses 2010-2012 HONORS and AWARDS PICU Beacon Award 2011-2012 References available upon request 3 • • • • • i�C � ~:�= ,:, STATE FLORID • ... of :'• �'� ;AR � .�-CEALTH ..` ��<. ,DIVISION OF MEDICAL QUALITY ASSURANCE • v >DATE <'.} r •:.k LICENSE No::`- A4 e. ,�`` %CONTROL NO. , 11/301201:2`: ,'�'.yARN P. 9288922.• ::'' '1615638 • The AD•V REG NURSE PRACTITIONER ,w ,-: fit- ham-ed•below<hasine 5---a requirements of } » •the laws,•and rules:ofitl estate of Florida, >: }< Expiration D`..te= QIJAL"IFICATION(Sya;„;. gib.':;J:U L�f 31 �2U 14.. '-. �� T.3‘..„,,• �.;. ..:'°:: P ' .NURSE PRACTITI0NE ' +• - `{. „. z; ASHLEY°L UREN::PAGES. : R; ' ir>n.,4 f 3100 SW 62ND AVENUE • . ' • s '�: •"�:, % ::';`, . .• _ i v s�T'•• i.lF ,`Cry �• c , ". : .,,::.,,'.'::: .(i vi.,..*_,,,,, .1,4 . .. . - .. ---- --• ---- K-•. •:V: 4'<:•John H.Armstr ng,M D; •.EACS ":::, ^ •:�.:, .�Rick� cott � ; .r '.STATE SURGEOU'GENRAL }`- GOVERNOR AW "" �"•_. {' • DISPLAY IFREOU.IREDygY L �,: ',,, y ,,,,,,:c b. • • • Patricia Wilson 18125 NW 49th Ave,Miami, FL 33055 Cell:(305)467-8701 Home: (305)624-9210 Pwilson @rnsmc.com Professional Summary Licensed Practical Nurse with over 30 + years experience in clinical hospital settings in providing nursing care. Core Qualifications • Licensed Practical Nurse in Florida • Strong clinical judgment • Analyzing information and evaluating results • Assisting and Caring for Others e Documenting/Recording medical information • Strong communication skills with Supervisors, Peers,or Subordinates ® Collect/Train DOT drug testing collections for over 10 years • Knowledge of relevant equipment,policies,procedures,and strategies Experience July 2000-Present Mount Sinai Medical Center, Miami Beach,FL LPN—Occupational Health Department • Administer prescribed medications and vaccinations • Measure and record patients' vital signs, such as height, weight, temperature,blood pressure, pulse and respiration. • Prepare patients for examinations, tests or treatments and explain procedures • Supervise medical assistants with daily clinical activities • Train on DOT collections and procedures • Train and performs EKG,Vision, Hearing,Glaucoma,and Collect Labs • Analyzing information and evaluating results to choose the best solution and solve problems. September 1971-July 2000 Mount Sinai Medical Center,Miami Beach,FL LPN-Telemetry • Evaluate nursing intervention outcomes, conferring with other health care team members as necessary. • Provide medical treatment and personal care to patients • collect specimens from patients • prepare patients for tests,therapy,or treatments Certification/Licensed • CPR • State of Florida Licensed Practical Nurse • Administration of Medication and vaccination • IV Certification • Certified DOT • eo v c 3 M m w . d ? 3 . C c Q C u r a ai . g 3 u eo c c i G L 7 u v o E o� C? L, u C C o .°. .0 •y∎ U to• ›, 4 O ° 0 G 0 Lc)2 C o 00 00 . .1 C o r G in . -- ^ O O cc U ul co . M.zi t g t u J G d v - . G t, ,' v v c�> � c U L ' o • 1 U o . o t. � Q n v • ¢ � �i � D W f u c .0 o Z- • " �• s W .Tt , W- u o U •. N• A. ° u L V I-• • < p --. 'ti . ' : 7.4A7.4A.7. W^ �, Et Z v . �� J W U . u V a O c V ▪ Q 0.) v - J � {. �QQ .'" <.t. '%.,•.: ' ' - ,' o 5 ., . 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Campos 5400 S.W. 77 Ct.Apt. 1L Miami, Fl. 33155 Telephone: (786)444-5796 Email: Danilu68 aol.com OBJECTIVE: Seeking a key position in Medical Field where my achievements, Experience and communication skills will enhance the opportunities of growth and advancement. HIGHLIGHTS: Certified Medical Assistant. Trained and Licensed in CPR,EKG And Phlebotomy. OSHA Certified Certified in DOT Drug/Alcohol collection QUALIFICATIONS: Administrative Scheduling Appointments and obtaining patient data. Medical Records and efficiently routing calls and taking messages Clinical Receiving patients, preparing charts, obtaining vital signs and medical history, assisting doctor with examinations and treatment of special procedures, performs routine lab tests,EKG,Pulmonary Testing, Vision, Hearing, Administration of PPD • EXPERIENCE: Mount Sinai Medical Center February 2005 to Present Occupational Health Miami Beach, Fl. 33140 University of Miami January 2003 to Ma y 2004 Patient Clinical Asst. Miami, Fl. 33136 Dr. Lawrence Wheatman August 2002 to January 2003 Internal Medicine Miami,Fl. 33129 INTERNSHIP: CAC Medical Center August 1995 to August 1996 Miami, Fl. 33155 LANGUAGES: English/Spanish Read, Write and Translate \.� ,•f�.• -.. I '♦ . 7-_-;::::"-----..': •�• I r.• •�/�rr.I. 3 �. •� '.•�I•..•.-�i11•i.t'.I•I ••.. 5, • rr/‘t. .‘'\7.`■ .4■%•••`.0:./........"." ■■--.--•• ''rej...,-1•7 i':=. '.. .• In• "'""natt■■•••• 1.••■•.■ '.(..•'' I Zg=•:•W'n i'■•;:-7 .%•■■ N.•••el I::•...;:-.400=r4.-1.- ../Z.C: f,....'.1 4. �+ ` /•n �• •I ! j •!H� � , �-. I .. �rr.••. . �` )/i • .r.. •1rL%11lr '+•�• -1'•%� • ••, --.. 1 �� er r r: • ley il '1) eV yeti - i•. ......tt 1..... .. ie.':',%,\ ) ...... . :,-4?� • ,;;. =s`'ti N/.f,4%‘ ,.\ �.,Vii,,, -4:11014::...// • `�� ;J i�� ti •�4 ll q U ��;+1==fir •1 . 0411.0 >1 t: ;::: cip) c,..) to■.,di ; r ...ff eit••R �qt; , J J i t r H td. 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C -i CI p LI c°) k-Z1 4 o.1 co Z...t V."...1 �;illa .1. ji4.11 a) 4 0 _ liaW 0 .(:) °itta 1113 °V...% t°5 CD ,4 ~ , r ry • 'C CO w as . :�.:� m•® El- - - •``' � O 4 14ga) I Q / \: 1 i A A A A A A A A Linda Dieujuste 18105 NW 25th Court Miami, FL 33056 Phone:305-625-9492 Cell 786-246-6670 Professional Summary Experience medical assistant in fast past hospital clinical setting Qualifications • Bilingual English-Creole • Certified DOT drug and alcohol technician • Provide great customer service to patients. • Work in fast.past environment • Medical records • Perform EKG,labs,vision,pulmonary testing,glaucoma,hearing, administer PPD • Willing to take on responsibilities and challenges. Experiences Mount Sinai Medical Center,Miami Beach,FL 2007-present Occupational Health,Medical Assistant II • Record patients'medical history,vital statistics and information such as test results in medical records. • Show patients to examination rooms and prepare them for the physician. • Collect blood, tissue or other laboratory specimens,log the specimens,and prepare them for testing. • Collect urine drug test for DOT and NON-DOT patients Williams Pediatric,Miami,FL 2006-2007 Medical Assistant Precision Response Corporation,Miami, FL 2002-2007 Customer Service Representative Certificates • CPR/BLS • OSHA • EKG • HIV/AIDS • Certified DOT Drug/Alcohol Collection \ %., '1.,%■„. .......... r:I ....loi,"."1_,....;:....,,,_ :1:, . 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R '4 t ... • -. _ • .... __ Bonnie Lawson 18950 NE 2nd Avenue, North Miami Beach,Fl 33179 Phone 786-515-8442 Objective: Seeking a position as Medical Assistant, Phlebotomist and or EKG Technician Qualifications: • Performs calmly and effectively with high stress situations • Careful with details when completing work tasks • Reliable,responsible,and dependable,and fulfilling obligations • ,Pleasant with others on the job and displaying a good-natured, cooperative attitude Experience: Mount Sinai Medical Center,Miami Beach,FL 2008-Present Occupational Health,Medical Assistant II o Prepare treatment rooms for patient examinations,keeping the rooms neat and clean. • Interview patients to obtain medical information and measure their vital signs, weight,and height. • Performs EKG,Labs,Vision,Pulmonary, Glaucoma, Drug test collections on both DOT and Non-DOT patients,Hearing,Administration of PPD • File medical records and input medical information in data base Mount Sinai Medical Center,Miami Beach FL 2005-2008 Lab Administration,Phlebotomy • Collect blood or tissue samples from patients,observing principles of asepsis to obtain blood sample. • Conduct chemical analyses of body fluids,such as blood and urine,using microscope or automatic analyzer to detect abnormalities or diseases,and enter findings into computer. • Set up,maintain,calibrate,clean,and test sterility of medical laboratory equipment. National School of Technology Inc,Miami,FL 2001-2005 Lab Assistant!Substitute Education National School of Technology, Inc 2001 Specialized Associates Degree:Advanced Medical Assistant Certifications o CPR o EKG o HIV/AIDS o OSHA e Certified DOT technician tom'Op f Of tilt, Ottt� ‘�tttt, �lIfe*'P � � �I Aowils, \ koeg . �4° sf fob.4_ ,4°i f s \ r� ��l��1iilj/®ir ��\\.zeiv ®�.„- \k\�m ; •- \0► ff,b- -4-t.\��:1 .I:4� .,�a, pr//,/� A 1�Eif�/�® i/ 1 �• ��.�®l a1\+aaalr/��®Si•� 4`\\\�a•"�r��/� � �\a�a.,!r%/r � , ..'. ' , „� � e. �• s``a CP¢+.er_ '0974 po:ipt Pg 1 4001 rn 2♦ ~_ `-est- P r Pte ` � En tu • rim��=�a`� � � .. li . � Qi c 4; i'� LiellaNZA ‘1111.14 CI) ;14 1 rte► tt CZ1 a C--:._. -L- •+ _�:, U :per; ` 3 • •,, v`�■s11 rho/�y 14 \i " • J aiJi r "IN, ) • %�s� t V _r 4 t// N1 . evit• 00•4404 Wit C3\ .. --. liArli •te.`®NA` -_.. 0 v-4 lsr�t ...........z.z.,71: 124M114 Q c) 1 44„.......,:. d ` �''� Ve • . kitigiV Il (7). c dr 90. =1-1 -) ("44121, , _sotaw . 141. 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W. 176th Terrace,Miami,Florida 33056 Home: (305) 626-0168 Cell(786)285-2611 Email:Mportee@msmc.com - Professional Summary Patient Access Representative with over 23 +years experience in hospital settings Core Qualifications o Strong communication skills • Ability to work in fast past environment • Collect!Train DOT Drug and Alcohol testing for over 10 years • Knowledgeable of hospital policies procedures and HIPPA regulations • Develops and monitors front desk registration processes • The ability to communicate information and ideas with all levels of management Experience Mount Sinai Medical Center,Miami Beach,FL 1987 to Present Occupational Health,Patient Access Representative • Collect!Train DOT drug and alcohol testing based on the standards as set forth by the DOT regulations 49 CFR Part 40. • Responsible for radiology registration, scheduling and registration of outpatient procedures, answering phones, and insurance verification. • Provide information to supervisors, co-workers, and subordinates by telephone, in written form,e-mail,or in person. • Analyze billing information and evaluate results to choose the best solution and solve problems. • Explain policies, procedures, or services to patients using medical or administrative knowledge, • Investigate and direct patient inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution. o Collect and report data on topics such as patient encounters and inter-institutional problems,making recommendations for change when appropriate for billing/charges. Mount Sinai Medical Center,Miami Beach,FL 1987- 1989 Radiology,Patient Access Registration Education Ashford University 2008-2010 Pursued Bachelor of Arts degree in Criminal Justice Kaplan University 2007-2008 General Education Miami Dade Community College 1984 Associates of Arts Degree in Criminal Justice \\;••\ t..t...... """_,....Z1..... ..0" 12 7.1,44%., . ...:"'`..............__ . ;174.-% . .n".1,..••■...4-.. • .•°..,...'"i •••*"...."*•••••■ 1, t',/...-1 ,��. �+ �`. �• ,r. :-.tea.. �: .�• : •�1• .?;,: �i•..�r.. ��.`:i ,i i,•`�.. .'•'%•p?tr�1..,,p1.• ∎•'Z..... \`• �' •�':'��I:"14-- 1'+:•` • j �:'�•.�ii•t1.i:~•. +•' • •' .I .--...,,,,,,,I••-......."f • `• 1, •■••�fi �'' `_s �� Iir �il�r.7— -''tit — 1 =— 'Nita ii_, :��i . 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I 18119 NW 90th Avenue Home#(305)-407-8177 Hialeah,Florida 33018 Cell#(786)-587-7684 Vicky Gonzalez Objective Individual with organizational skills seeks position with challenges as well as advancement. Experience 2006-Present Mount Sinai Medical Center Miami Beach,Florida Occupational Health Department Billing Coordinator • Assist in implementing of new contracts for Occupational Health • Send out monthly invoices for all Occupational Health accounts. e Receive checks and post payments from contracts for Occupational Health into STAR. d Check figures,posting of payments,and document for accuracy of Occupational Health contracts • before entering into Excel spreadsheet. • Review payments of Occupational Health contracts for all 30 days past due not received. • Place calls for collection for payment to all Occupational Health contract accounts • past due, • Verify that Occupational Health is in Complaint with federal,state,and company policies, a procedures,and regulations. 2006-Present Mount Sinai Medical Center Miami Beach,Florida Patient Access Department Coordinator • Typed statistical reports via using Microsoft Excel Spreadsheet. • Typed assignments via using Microsoft Word. • Prepared personnel reports such as(Performance Evaluations,Notice of Separation,Terminal Clearance,Personnel Change Request and submit to Human Resources. • Operate office machines,such as photocopiers and scanners,facsimile machines,voice mail systems,and personal computers. • Answer telephones,direct calls,and take messages. o Maintain and update filing,inventory,mailing,and database systems,either manually or using a computer. • Communicate with customers,employees,and other individuals to answer questions, disseminate or explain information,take orders,and address complaints. • Open,sort,and route incoming mail,answer correspondence,and prepare outgoing mail. o Compile,copy,sort,and file records of office activities,business transactions,and other activities. o Compute,record,and proofread data and other information,such as records or reports. • Type,format,proofread,and edit correspondence and other documents,from notes or dictating machines,using computers or typewriters. • Complete work schedules,manage calendars,and arrange appointments. • Review files,records,and other documents to obtain information to respond to requests. 1999-2006 Mount Sinai Medical Center Miami Beach,Florida Emergency Department Coordinator/mice Manager • Supervise Ancillary Staff on reviews,counseling/attendance and payroll. • Responsible for Time/Keeper(Kranos)for 85 employees. • Served as a resource person for administrative issues during the administrative director's absence. • Type schedules for Nursing,Techs and ancillary staff. • Submit LUR on a daily basis • Prepare Statistics for MOM reports. • Schedule appointments for administrative director. • Assisted administrative director in budget preparation. • Assisted in finding coverage for emergency department personnel sick calls. • Transcribed data using dictaphone machine. • Tooked and transcribed minutes. • Typed statistical reports via using Microsoft Excel Spreadsheet. • Typed assignments via using Microsoft Word. • Prepared personnel reports such as(Performance Evaluations,Notice of Separation,Terminal Clearance,Personnel Change Request and submit to Human Resources. • Ambassador for the Emergency Department 1988-1999 Mount Sinai Medical Center Miami Beach,Fl Telecommunications Department Secretary I • Answer phones,Filing,Typing using Microsoft Word • Reconcile digital beeper invoice by charging back hospital departments using Microsoft Exce program submitting to the accounting department • Reconcile phone bill by charging back hospital departments using Microsoft.Excel program a submitting to the accounting department. • Paying invoices by submitting a check.request to accounts payable. • Preparing Purchase Request when obtaining new telephone contract. • Coordinating and making appointment to meet with vendors. • Preparing a yearly in-house telephone directory. • Keep inventory of all in-house and digital pagers and assigning beepers to new staff to the institution_ • Answer the switchboard by using the Norte!system. 1984-1988 Mount Sinai Medical Center Miami Beach,Fl Foundation/Development Clerkfl`ypist • Answer phones • Filing • Type letter for donor via computer • Various other clerical duties • 1979-1984 Mount Sinai Medical Center Miami Beach,Fl Emergency Department Unit Secretary • Patient Registration a Answer phones for the department. • Process doctors orders. • Various other duties. Education 1968-1972 Miami Senior High School Miami,Florida • Attended 9th through 12th grade. • Graduated from the 12th grade. Sl��s Computer: Microsoft Windows,Microsoft Word,Microsoft Excel,Power Point,E-Mail,Internet knowledge. Languages: Spanish and English References Upon Request. Linda Ivory 7619 Embassy Blvd. • Miramar, Fl. 33023 Cell (786)586-1178 Home(954) 964-0984 Email: overflow0115 a aol.com OBJECTIVE To secure a position where my experience can be utilized in a position offering new and challenging responsibilities. SUMMARY OF QUALIFICATIONS • Handle all Occupational Health electronically medical records • Capable of handling multiple tasks in fast paced environment • Recognized for exceptional customer service and interpersonal skills • Knowledge of front desk Receptionist and Insurance Billing • Knowledge of computer(CDL,Burroughs, Medic Med Star, Vision and envoy machines • Recognized for organizing Special Events and Activities EDUCATION High School Diploma 1975 WORK EXPERIENCE Medical Records Clerk 3 February 2004-Present Mount Sinai Medical Center, Miami Beach FL • Prepares folders and maintains records of newly admitted patients • Review and prep electronic medical records for completeness, assembles records into standard order • Locates, sign out,and delivers medical records requested by hospital departments • -Assist other workers with charging, coding and ordering of records Patient Access Representative August 2000-February 2004 Mount Sinai Medical Center,Miami Beach, FL • Front desk registration • Verify benefits, eligibility, certification and authorization for hospital • Serve as a liaison between Physician practices, Departments, Administration Clinical Management and Hospital services • Provides financial counseling, informs patients of general hospital policies regarding payments Medical Records I May 1992-August 2000 Mount Sinai Medical Center, Miami Beach,FL Appointment Clerk, March 1980-January 1992 Family Health Center,Miami,FL Teachers Aide August 1977-June 1979 Miami Park Elementary,Miami, FL SKILLS:Proficient in Office 2000 and Excel Mount Sinai M E D I C A L C E N T E R TAB 2 2 . 2 QUALIFICATION OF PROPOSER TEAM . SUBCONTRACTOR ORGANIZATIONAL CHART RESUME / LICENSES Soltas Laboratory, Inc. (Doctors Laboratory, Inc. ) • a ski'^.r, ,01:.:'..a.'14:3 '' .9 l '1 I A l a • .p,'.' y .r' II 6:5 s. ry J sy • "*o�', 1 • ., .. _� : r i, ..j:i. V1 }- as .lid• Iv i i e ,~. ' O L I ;'err r .y-•` '� �r.'.% ` , , cia.• i -P.. I L . [ , t-:-. • -. ' , _ C 4-° 1 i - psi - . , _I= k.) U rts t..J. . N ..[ , , 1 -r4 ,.. ci, . ...._ a) c 1 cl L ga .. .... . i Si I C3 th 1 : . - . 1 _ i _ IR 7t7s ..c) 01 01 2 o.al ai Q. " • .: . . , .,..... .... LEM 03 . . 1)-s-IN ::-.1.. • , . . _g I ,.,,, , .. .. a / Pd., ,. � � x-•11, y._'r _ t�•a ,,4'+f~ - 'r —I . . - I „, :.L....„,i...„.. „,,,,..,„,.,,,,.,......,„,„,,,,,,,,,,t.,... . D Q C j.;:;,... fir' .•.,..- : #-” , ,i, }:rr" ' • o Sf� r a lA,-'�: P�j,: 3._ r 7 .o` .��J;•d C r' � ;: .r "+ ,;. 44 r � r " ti2y.._,;. 1r ' '+r11j � c 'a?f vY r. y j ...j .d,, . . - ...<:-.-.T1 n f r a > ` : CENTERS FOR MEDICARE&MEDICAID SERVICES CLINICAL LABORATORY IMPROVEMENT AMENDMENTS 1 ,A CERTIFICATE O REGIS TR-A ION. 0 /'`�� LABOR.�i1URY NAML•AIVD ADDItE55 CLIA ID NUMBER -o�;; 1100646134 _r .• riv DOCTORS LABORATORY INC/SOLSTAS LAB PAR - 2906 JULIA DRIVE EFFECTIVE DATE VALDOSTA, GA 31602-1435 11/11/2013 9 A.LABORATORY DIRECTOR EXPIRATION DATE V 3: GARLAND E PENDERGRAPH M.D. 11/10/2015 • Pursuant to Section 353 of the Public Health Services Act(42 US.C.263a)as revised by the Clint Laboratory Improvciaent Amendments(CLIA), the abort named laboratory located at the address shown hereon(and otter approved locations)may accept human specimens for the purposes°I-performing laboratory t."s-�minations or procedures. This certificate sh:dl he valid until the expiration date above,but is subject to revocation,suspension,limitation,or other sanctions e for violation ad=Act or the regulations promulgated thereunder. 9(4, _4/ige " .V: ..:' I CS Judith A.lost,Director Division of Laboratory Services ancvr�erFrv � osu�rn�r Survey and Ccrtifcation Croup Center for Medicaid and Stare Operations , -`t .\t'.- :... • 4i/C% o w .• o a <.>. o as • o •'- < 599 Certs1 010714 • If this'is a Certificate of Registration,it represents only the enrollment of the laboratory in the CLIA program and does not indicate a Federal certification of compliance with other CLIA requirements.The laboratory is permitted to begin testing upon receipt of this certificate,but is not determined to be in compliance until a survey is successfully completed. • If this is a Certificate for Provider-Performed Microsco•,py Procedures,it certifies the laboratory to perform only those laboratory procedures that have been specified as provider-performed microscopy procedures and,if applicable, esmminations or procedures that have been approved as waived tests by the Department of Health and Human Services. • If this is a Certificate of Waiver,it certifies the laboratory to perform only examinations or proredures that have been, approved as waived tests by the Department of Health and Human Services. - FOR MORE INFORMATION ABOUT CLIA,VISIT OUR WEBSITE AT VVWW CMS.HHS.GOV/CLIA OR CONTACT YOUR LOCAL STATE AGENCY.PLEASE SEE THE REVERSE FOR YOUR STATE AGENCY'S ADDRESS AND PHONE NUMBER. 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Tom`J i�r ( �- 'I`'T�•`yf�'Sa.3),-, '��Yi. `: .,. � '' '. `Y�al� :4�i(ty.,i.4,.r.) �,y' ,:t. ,f C4,:h «' •r#-.r�. ft9cr,.�'�°. i; ..�f.rr'rj. i;1::� ;'� ; . =\'lk-, -.g4A _ . _ k., 1SJt f,;.,;4(. 04. J:w 4t,r4.4 �j1� /�-M1••t .6 J J \I . i4/ . _ •/} � 555�M1f Y6' ! + J f itit r}��► /,�..�.��l ,mil+ -�i- _ti_^.f _ `7 +� '�='r` h•i } -r �'- .-- �.- O '- �}•Jf `C /!�'tii of %'`i, �,Lr `�..r �r1 A f J..•- ' c�jr" ''` +4'.� �U `. '� `. ''e ?d+ Q r `„-C, iL. ‹. �J 0 0 o O a ti � .:.: .... %..�ih q.�J4'.:..:y:a ..::..•..'.•. .._�,�, vMy).arJ•.:�,.,N'-�1._6'/tr oi•.-V]IC]LL!?!Y\...'.•Pi4w'%I:F.I�IiAGY2'uJFIi.ARlii�:AL�.f 14,�..11h).GC�:Y-W'. '-•C TM1f:Mi a...� �`�ti il I CENTERS FOR MEDICARE&MEDICAID SERVICES 1:i �,y CLINICAL`LABORATORY IMPROVEMENT AMENDMENTS - . CERTIFICATE OF ACCREDITATION I s >Je•ti LABORATORY NAME AND ADDRESS CLIA ID NUMBER # J 0` ' - 1000281231 t•�Ai,\ MOUNT SINAI MEDICAL CENTER CLINICAL LA i ' 4300 ALTON RD - EFFECTIVE DATE r Je, MIAMI BEACH, FL •33140-2849• ,0 `�.�, 04/28/2013 / 41 C. Li/0;i\ LABORATORY DIRECTOR EXPIRATION DATE p,�� NP' . 1 '\V.i It , § ROBERT J POPPITI M.D. 04/27/2015 I :•,l Vii' " Pursuant to Section 353 of the Public Hdth Services Act(42 U.S.0 263a)as revised by the Clinical Laboratory.lrnprov�ement Amendments(CLIA), V"', the above named laboratory located at the address shown hereon(and other approved locations)may accept human specimens 3 •�. .. / for the purpasns of performing laboratory eactminattons or procedures. t 4 ' This certificate shall be valid until the expiration data above,but is subject to revocation,suspension,limitation,or other sanctions . ;, 0,k for violation of the Actor the regulations promulgated thereunder. y 0. � �u .. , . t, . 'r.. 8, CMS Judith A.Yost,Director Z, `{ Division of Laboratory-Services V ■ +�+? / aN,rxsr�saaeeRr,u�ucs�rExsr�s Survey and Certification Group Center for Medicaid and State Operations •� /• - - � ��/: �.�"�s��`.-+ f:F' ��•,�/,''f�°`.t .�-'�.:4�,a•- ;'1'�lr,' �' .�'�‹• �ti,�-,`a� ..` s �,1 off.�' ,,`•kv.� �, Cr a -o o. 0 4 o O o o� �� }�` • 1'-moo� �� 1�:�'''N�'� ti,�...� �•� � '`�.y�{��,��`� �� + 4.1.��i�y-m�:•�'�Cb 113 Certs2 033013 If you currently hold a Certificate of Compliance or Certificate of Accreditation,below is a list of the laboratory specialties/subspecialties you are certified to perform and their effective date: JB CERTIFICATION(CODEZ EFFECTIVE DATE LAV GERT1FICArION(CODE) EFFECTIVE DATE BACTERIOLOGY(110) 07/26/1995 ANTIBODY TRANSFUSION(520) 07/26/1995 MYCOBACTERIOLOGY(115) 07/2611995 ANTIBODY NON-TRANSFUSION(530) 07/26/1995 MYCOLOGY(120) 07/26/1995 ANTIBODY IDENTIFICATION(540) 07)26/1995 PARASITOLOGY(130) 07/26/1995 COMPATIBILI7Y TESTING(550). 07/26/1995 • VIROLOGY(140) 08/12/1998 HISTOPATHOLOGY(610) 07/26/1995 SYPHILIS SEROLOGY(210) 07/26/1995 CYTOLOGY(630) 07/26/1995 GENERAL IMMUNOLOGY(220) 07/26/1995 ROUTINE CHEMISTRY(310) 07/26/1995 URINALYSIS(320) 07/26/1995 ENDOCRINOLOGY(330) 07/26/1995 TOXICOLOGY(340). 07/26/1995 HEMATOLOGY(400) 07/26/1995 ASO&•RH GROUP(510) 07/26/1995 FOR MORE INFORMATION ABOUT CLIA,VISIT OUR WEBSITE AT WWW.CMS.HHS.GOV/CLIA OR CONTACT YOUR LOCAL STATE AGENCY.PLEASE SEE THE REVERSE FOR YOUR SPATE AGENCY'S ADDRESS AND PHONE NUMBER. PLEASE CONTACT YOUR STATE AGENCY FOR ANY CHANGES TO YOUR CURRENT CERTIFICATE. ______ _ . � ;!- � TZ+�� 'INC. DOCTORS^�'��^ ^�r»��/-a�`.v��a , ��` ^~ � .: ''Ji'� 0.4 i\I%1%/1"^`')u)\ /`'o � vu /~o`u'o��w� ./ ��'��'^ '`~.�' `^x'z'^ u^ ^,`� `"'0,`^``u^,*.'n` r. ^ Ili . . . 1! ' '- _ ---_ . - � � - --' IT uca� n CnL-_-_ - --' ----�------ �-------- � --—'' - i � RP(s) / RiChe[d E. Struenpknr ; Director BG, MS, MA MT� SCp).NRCC l - _ , /> . . Alt-RP(s) Jacques Wilson | Tech-Supv. BS � & ' -- �T �� Richard~ ~'- E. - r— -- -- ---'- --! Will Collie ---~ - certifying .,Na' ��h|ioht � Scientist(s) -' - - '-____ � John ' '~ ' -__-' .--_=R & D Spec___._______ -----''---~ --- ' ci' -- ---' / Richard Srruenp l e r _Director BS, MS, MA � � 2 �" ti Will Collie Night S BS. ,[1, Certifying -'' - - ti ^ ~ Technician(s) - -- --- 1 Richard � o( Director B� � � [ A �� P\NR��_______ . I Jacques Wilson • | Supervisor(s) n/ til '_J . ' C & C •__- ---- --' Custod --- � ti Other Key Roark ' Record _ ��o _____ _ _ ./ ' 1-- ��' ( \ � ' | / �; � ' �_' •__--_ . — '. . — _�.�' — --_—__—. ^ i , `| ` ` .,: ` ;l• t. ` , • . il . it .I, . • ` tI... .., i.: [., ti; '` n . ;I! ' r; / F. . 1: 1; . 1;. . I.' . I.- I ..-"..."it;.").' Federal Register/Vol_ 78, No. 84/Wednesday, May 1, 2013/Notices 25461 Place:National Institutes of Health, past month,it will be listed at the end Aegis Analytical Laboratories,345 Hill Neuroscience Center,GOOi Executive and will be omitted from the monthly Ave.,Nashville,TN 37210,615-255- Boulevard,Rockville,MD 20852,(Telephone listing thereafter. 2400.(Formerly:Aegis Sciences Conference Call), This notice is also available on the Corporation.Aegis Analytical Contact Person:Scott A.Chen,Ph.D., Internet at http:// Laboratories,Inc.) Scientific Review Officer,Office of Extramural Affairs,National Institute on �vsysv.svorkplcrce.samhsa.gov and h[tp:// Mere Toxicology Services,1111 Newton Drug Abuse,NMI,DIIIIS,Room 4234,MSC ivwsv.druJreesvorkplace.gov. St..Gretna,LA 70053,504-361-8980/ 0550,6001 Executive Blvd.,Bethesda,MD • FOR FURTHER INFORMATION CONTACT:Mrs. 800-433-3823.(Formerly:Kroll 20592-9550.301-443-9511. Giselle Hersh,Division of Workplace Laboratory Specialists,Inc., 1 cherrsctLrrrai/.rrrh,gov. Programs,SAMHSA/CSAP,Room 2- Laboratory Specialists,Inc.) • • (Catalogue of Foderel Domestic Assistance 1042.One Choke Cherry Road, Alere Toxicology Services,450 Program Nos.:x3.270,Drug Abuse and Rockville,Maryland 20857;240-276- Southiuke Blvd.,Richmond,VA Addiction Research Programs,National 2600(voice).240-276-2610(fax). 23236,804-378-9130.(Formerly: Institutes of Health,HHS) SUPPLEMENTARY INFORMATION:The Kroll Laboratory Specialists,Inc., Dated:April 25.2013. Mandatory Guidelines were initially Scientific Testing Laboratories,Inc.; . Michelle Trout, developed in accordance with Executive Kroll Scientific Testing Laboratories, Proorvnr Analyst.O/fico of Pectoral Advisory Order 12564 and section 503 of Public Inc.) Corrrnriticc Policy. Law 100-71.The"Mandatory Baptist Medical Center-Toxicology Guidelines for Federal Workplace Drug Laboratory,11401 1-30,Little Rock, {FR Dec.2013-10203 Filed 4-30-13:0:45 um] AR 72209-7056,501-202-2783. t3ituec CODE 4140-01-P Testing Programs",as amended in the revisions listed above,requires strict (Formerly:Forensic Toxicology standards that Laboratories and Laboratory Baptist Medical Center,) DEPARTMENT OE.EfEALTHAND, Instrumented Initial Testing Facilities Clinical Reference Lab,8433 Quivira HUMAN SERVICES ' (IITF)must meet in order to conduct Road,Lenexa,KS 60215-2802,800- drug and specimen validity tests on 445917. tSubstance Abuneand.Mental.Tlealth urine specimens for Federal agencies. Doctors Laboratory.Inc.,2906 Julia Services Administration To become certified,an applicant Drive,Valdosta.GA 31002,229-671- " Laboratory/I1TF must undergo three 2281. Current Llst.ot Laboratories.and: rounds of performance tasting plus an DrugScan,Inc..200 Precision Road, Instrumented tnittaLTestinggFacillties on-site inspection.To maintain that Suite 200,Horsham,PA 19044,800- Whitb.Meet.Mlnlmum.Standards To certification,a Laboratory/IITF must 235-4890' tErigageInUrinalatwg Testinglor participate in a quarterly performance E1Sohly Laboratories,Inc..5 Industrial delral Park Drive,Oxford,MS 38655,602- Agencies testing program plus undergo periodic, 236-2608. AGENCY:Substance Abuse and Mental °n' to inspections.rtes Fortes Laboratories,Inc.,25740 SW Health Services Administration,HHS. Laboratories and Instrumented Initial Testing Facilities(IITF)in the applicant Canyon Creek Road,Suite 600, ACt ON:Notice. stage of certification are not to be Wilsonville.OR 97070,503-486- considered as meeting the minimum 1023• SUMMARY:The Department of Health and Gamma-Dynacare Medical re uits described in the HHS Hainan remen escr Human Services(HI-15)notifies Federal Mandatory Guidelines.A Laboratory/ Laboratories",A Division of the agencies of the Laboratories and 1[TF must have its letter of certification Gamma-Dynacare Laboratory Instrumented Initial Testing Facilities TF) from HHSISAMHSA(formerly:HHS/ Partnership,245 Pall Mall Street. (II currently certified to meet the N1DA)which attests that it has met London,ONT,Canada NBA 1P4,519- standards of the Mandatory Guidelines 679-1630 for Federal Workplace Drug Testing minimum standards. p 8 g In accordance with the Mandatory Laboratory Corporation of America Programs(Mandatory Guidelines).The Guidelines dated November 25,2008 Holdings,7207 N.Cessna Road, Mandatory Guidelines were first (73 FR 71858),the following . Houston,TX 77040,713-856-8288/ published in the Federal Register on Laboratories and Instrumented Initial 800-800-2387. April 11.1988(53 FR 11970),and Laboratory Corporation of America subsequently revised in the Federal Testing Facilities(I1TF) and the 50 First Ave.,Raritan,N q y minimum standards to conduct drug Holdings, R NJ Register on June 9,1994(59 FR 29908); and specimen validity tests on urine 08869.908-526-2400/800-437-4986. September 30.1997(62 FR 51118); specimens: (Formerly:Roche Biomedical April 13,2004(69 FR 19644);November Laboratories,Inc.) 25,2008(73 FR 71858);December 10, Instrumented Initial Testing Facilities Laboratory Corporation of America 2008(73 FR 75122);and on April 30, (11TT) Holdings,1904 Alexander Drive, 2010(75 FR 22800).) None. Research Triangle Yark,NC 27709, A notice listing all currently certified 919-572-6900/800-833-3984. Laboratories and Instrumented Initial Laboratories (Formerly:LabCorp Occupational Testing Facilities(1ITF)is published in ACL Laboratories,8901 W.Lincoln Testing Services,Inc.,CompuChem the Federal Register during the first Ave.,West Allis,WI 53227,414-328- Laboratories,inc.;CompuChem 1 week of each month.If any Laboratory/ 7840/800-877-7016,(Formerly: Laboratories,Inc.,A Subsidiary of IUTF's certification is suspended or Ba shore Clinical Laboratory.) Roche Biomedical Laboratory;Roche C revoked,the Laboratoryll[TF will be AMyMedical Laboratory,Inc.,160 CompuChem Laboratories,Inc.,A omitted from subsequent lists until such Elmgrove Park,Rochester,NY 14624, Member of the Roche Group.) lime as it is restored to full certification 585-429-2264. Laboratory Corporation of America under the Mandatory Guidelines. •• Advanced Toxicology Network,3560 Holdings.1120 Main Street, If any Laboratory/IITF has withdrawn Air Center Cove,Suite 101,Memphis, Southaven,MS 38071,866-027-8042/ from the HHS National Laboratory TN 38118,901-794-5770/888-290- 800-233-6339(Formerly:LabCorp Certification Program(NLCP)during the 1150. Occupational Testing Services.Inc.; • • • _e r Curriculum Vita Garland Edward Pendergraph Date of Birth: 28 January 1936 Education: B.S., 1958, Georgetown College, Georgetown, KY, Major.biology,Minor: chemistry • • M.S.P.H., 1959, Dept. of Public Health University of Kentucky, Lexington • Ph.D, 1968, School of Public Health, University of North Carolina, Chapel Hill, Major:medical parasitology, Minors:mycology and bacteriology • JD, 2008, Concord Law School of Kaplan University, Davenport, Iowa, Concentration in Health Law. • • Fellow in Tropical Medicine, 1969, Louisiana State University, New Orleans and Central America Certificate, Health Care Risk Management Program, 2008, • University of South Florida,Tampa, FL • Professional Instructor, biology and chemistry, Furman University, Experience: Greenville, S.C., 1960 r, Assistant Director, Public Health Laboratories, Dept. of Health and Hospitals,St.Louis, MO 1968 Chairman and Associate Professor, Dept. of Medical Technology, East Carolina University, Greenville, NC 1970-72 Chairman and Associate Professor, Dept. of Medical p decal Technology, Western Carolina University, Cullowhee, NC, 1973-75 Director, School of medical Technology, Methodist Hospital, Pikeville, KY, Adjunct Professor, Pikeville College,and Eastern Kentucky University, Richmond,KY, 1976-77 Laboratory Director, Sumter Memorial Hospital, Livingston, AL, Visiting Professor, Livingston University, 1977-78 Laboratory Director, Berrien County Hospital, Nashville, GA 1979 Laboratory Director and Technical Supervisor for satellite laboratories, Privacy Officer, Safety Officer Doctors Laboratory, Inc.! Solstas Lab Partners 1980-present. • ® Publications: PENDERGRAPH, G. E., EVERT, L.D., MORRELL, M.J. and JONSSON,V. 1969 The Dog Heartworm:A Possible Problem in Man. Mo. Med. 66:731. PENDERGRAPH, G. E. 1971 First Report of the Acanthocephaian, Bolbosoma vasculosum(Rudolphi,1819), From the Pigmy Sperrn Whale, Kogia breviceps. Jour.Parasii.S7:1109. } PENDERGRAPH, G. E. 1972 A Serological Study of Toxoplasmosis in Wild Pigeons and Their Possible Role in its Dissemination. Jour. Eli Mitchell Sci. Soc, 88:72. PENDERGRAPH, G. E. and MAEHARA, K.T. 1974 Specialist vs. Generalist:Why not both? Med. Lab. 8:22. PENDERGRAPH, G. E. 1985 One of several contributors in the area of "laboratory practice"in NCA Review for the Clinical Laboratory Sciences, 2nd Ed., J. L. Bender, Editor, Little, Brown, and Co. Boston. PENDERGRAPH, G. E, CORNELIUS,G.M. and CROWLEY,J. R. 1991 New Tests for Infectious Disease,Part I:Sexually Transmitted • Diseases.The Learning Laboratorian Series,Academic Publishing Services, Medical College of Georgia,Augusta, GA. PENDERGRAPH, G. E., 1996"Anglicanly"Speaking,2nd Edition, Order of Saint Augustine of Canterbury, Pensacola, FL. PENDERGRAPH, G. E. 1998 Handbook of Phlebotomy and Patient Service Techniques,4th Edition.Williams and Wilkins, Baltimore. PENDERGRAPH, G. E.2003'Department of Transportation (DOT) Regulated Urine Specimen Collection Training.www. Medialabinc.net. PENDERGRAPH, G. E.2004"HIV:Structure and Replication", www.Medialabinc.net PENDERGRAPH,G. E.2005 "Nursing Home Etiquette for Phlebotomists", Phlebotomy Today. 6(3):2. PENDERGRAPH, G.E. 2006 "Introduction to Bioterrorism", www.Medialabinc.net PENDERGRAPH, G.E. 2010 "Risk Management in the Clinical Laboratory",www.Medialabinc.net. i • Licensure and Laboratory Director, State of Georgia, License No. 80520. Certifications: Laboratory Director, State of Florida, License No. D119193. Specialist in Microbiology,American Society of Clinical Pathologists, SM(ASCP),,Cert. No. 583. • Medical Laboratory Scientist,American Society of Clinical Pathologists MLS`m(ASCP);Cert. No.231302. • High Complexity Clinical Laboratory Director,American Board of Bioanalyst, HCLD (ABB), Cert No.4945. I`'• Clinical Consultant,American Board of Bioanalyst, CC(ABB),Cert. No. 4945. f 2 • 1 Certified Phlebotomy Technician,American Society of Phlebotomy • Technicians, CPT(ASPT), Cert. No. 62110994465. • Certified Professional Collector Trainer, Drug and Alcohol Testing Industry, Washington, DC. • • Certified Breath Alcohol Technician and Calibration Technician Trainer, 1 Intoximeters, Inc., St. Loris, MO 2002. i.1 Professional American Society of Clinical Pathologists ! Memberships: American Society for Microbiology American Society for Clinical Laboratory Scientists 1 Southeastern Association of Clinical Microbiologists American Association of Bioanalysts American Society of Phlebotomy Technicians 1 American College of Legal Medicine �t iy American Association of Clinical Chemists {. American Society for Healthcare Risk Management r • Florida Association of Healthcare Risk Management and Patient Safety ;. Georgia Society of Healthcare Risk Management t► • Medical Mycology Society of the Americas d Honors: 1, Delta Kappa Award for outstanding achievement in the field of r,: Omicron D Public health, 1959. 1: it Lambda Tau Honorary Medical Technology Society, 1970. it, r: i;: Who's Who in the South and Southwest, 1978, if St. George Award for outstanding service to the Anglican Church and the 11 Scouting movement, 1990. ;; William H. Spurgion, Ill Award,Alapaha Council, BSA,March, 1996. i4 Silver Beaver Award,Alapaha Council, BSA, March 1997. District Award of Merit,Alapaha Council, BSA, 1990. Distinguished Council Commissioner's Award,Alapaha Council, BSA 1988. , I. .. United States Coast Guard Commendation Award, Dec. 11,2001. , s# t^ii Southern Region (BSA)'Venturing Leadership Award, 2003 1 • rt: • cif,. i..t: !f • 3 I ir . +i3. �`',• _ r . -_� .�. --�m�-- --- _ is m C . C •. 0 V/ L a, a VAtt o q>16/... tS e o ...../ O .G cn i- .0• 1 til \� a U A f%.1.C. lig) (3) . C:4‘11: co P_ CT) el o m ii7Cor ,r, le 0 = 49 CL IQ �� di°j z z°CU • t I R . 1114k «C .. {� sIi 6i o „CG en �+ W 7 G 33 1* O. tile itt 47, . E tu C;:l 4i4. 7'ma�tie VI® 0 "/ Q `� , ▪ 1. 6'1' .o a,< 1-411) a- MI L. > a) mitit Id '0 4... I :c2,'-,P-2 w g 42-a i; ELI ,...\% '004,, A a) § a) .... z , m..._ ,,.... .2.,, 15 .*M C. 0 LL az Q O Z C 0 z�Q•..0 u= >1 NA W C 1:1 CL 2 a} O rnaa f-` c=W 'C9 1 0 ,� .� .P 0,r �� c , 1:1111V111:40r.ii CU 15) IcomP %-i) W. 4. .r "Z) N tr- L L U if J . • 1 I -- Curriculum Vitae Bo Hong • Doctors Laboratory of Lake City 163 SW Stonegate Terrace, Suite 109 Lake City,FL 32024 Phone: (386)755-0605 Fax: (386)961-9474 Cell phone: (229)560-0024 Bo.Hong@solstas.com PRACTICE/EXPERIENCE May 12,2010—Present Medical Director,Doctors Laboratory,Inc Valdosta,Georgia July 2006—Present Pathologist,Doctors Laboratory,Inc Valdosta,Georgia EDUCATION 08/92-08/97 Ph.D.of Cell Biology, University of Florida,Gainesville,Florida. 09/85-08/88 Master of Medicine, Shanghai Second Medical University, Shanghai,China. 09/78-08/83 Bachelor of Medicine,Zhejiang Medical University,Hangzhou,Zhejiang, China. CLINICAL AND RESEARCH EXPERIENCE 1 07/05-06/06 Fellow,Department of Pathology,College of Medicine,University of Florida, Gainesville,Florida. 07/01-06/05 Resident,Department of Pathology,College of Medicine,University of Florida, Gainesville,Florida. 09/97-06/01 Postdoctoral Associate,University of Florida,College of Medicine,Gainesville, Florida. 06/90-07/92 Attending Physician,Department of Medicine,The Second Hospital,Zhejiang Medical University, China. 09/88-05/90 Resident,Department of Medicine,The Second Hospital,Zhejiang Medical University, China. 09183-08/85 Resident,Department of Surgery,the Second Hospital,Zhejiang Medical University, China. Bo Hong,MD,PhD • L+C l S /EXAM.LNATIO1 1 --' 08/05 Certified in combined Anatomic Pathology and Clinical Pathology by The — , American Board of Pathology. 11/97 Certified by ECFMG. Current State Licensure: Florida(#ME96743) Georgia(#057989) Alabama(#MD.27504) PUBLICATIONS --, Peter A.Drew,Bo Hong,Nicole A.Massoll,Daylene L.Ripley. 2005. Characterization of papillary r , squamotransitional cell carcinoma of the cervix. Journal of Lower Genital Tract Disease,9(3):1497153. Brooks WH, Satoh M,Hong B,Reeves W11,Yang TP. 2002. Autoantibodies from.an SLE patient immunostain the Barr body. Cj togenetic and Cenome Research,97:28-31. Scarpace PJ,Matheny M,Zhang Y,Tamer N,Frase CD, Shek EW,Hong B,Prima V,Zolotuldtin S. 2002. Central leptin gene delivery evokes persistent leptin signal transduction in young and aged-obese rats but physiological responses become attenuated over time in aged-obese rats. Neuropharmacology,42(4):548- ,. 561. Hong,B.,P.Reeves,B.Panning,M. S. Swanson,and T.P.Yang. 2001.Identification of an autoimmune serum containing antibodies against the Barr body. Proceedings of the National Academy of Sciences of the USA,98(15):8703-8708. Hong,B.,K.Wu,J.S.Brockenbrough,P.Wu and J.P.Ms. 2001. Temperature sensitive nop2 alleles defective in synthesis of 25S rRNA and large ribosomal subunits in Saccharomyces cerevisiae. Nucleic Acids Research,29(14):2927-2937. Hong,B.,J. S.Brockenbrough,P.Wu and J.P.Ms. 1997. Nop2p is required for pre-rRNA processing and 60S ribosome subunit synthesis in Yeast. Molecular and Cellular Biology,17(1):378-388. de Beus,E.,J. S.Brockenbrough,B.Hong,and J.P.Aris. 1994. Yeast Nop2 encodes an essential nucleolar protein with homology to a human proliferation marker. J. Cell Biology,127(6):1799-1813. Hong,B.,G.S.Zhao,D.Y.Li and Q.Peng. 1989. A study on the uptake of 5-hydroxytryptophane by - platelets in hypertensive patients and their children. Chinese J. Cardiology,17(6):324-326. Zhao,G.S.,M.D. Cai,B.Hong,J.Ong,Q.Peng and J.Wang. 1988.The platelet ATP release response of patients with essential hypertension and their normotensive children Chinese J. of Cardiology,16(4):217. 1119 • •.y 2 NY 0 0 0 } CONFERENCE PRESENTATIONS } Bo Hong,Peter A.Drew,Nicole A.Massoll,Daylene L.Ripley.2004. Characterization of papillary squnmotransitional cell carcinoma of the cervix. Abstract published in Archives of Patholov& Laboratory Medicine, 129(4). Presented at CAP'04 Meeting. Bo Hong,MD PhD Bong,B.,M.S.Swanson,and T.P.Yang. 1999.Identification of an autoimmune serum containing antibodies against the Barr body. Presented at Chromosome Research Conference,Pacific Grove, California. Hong,B.,P.Wu,J.S.Brockenbrough and J.P.Aris. 1996. Temperature sensitive alleles of Nop2. The abstract published in Molecular Biology of the Cell,7(suppl):99a. Presented at 6th International Congress On Cell Biology and 36th The American Society For Cell Biology Annual Meeting., I. Hong,B.,J.S.Brockenbrough,P.Wu and 3.P.Aris. 1995, Nop2 gene is required for pre-rRNA processing and 60S ribosome subunit synthesis in Yeast. The abstract published in Molecular Biology of the Cell,6(suppl):198a. Presented at 35th The American Society For Cell Biology Annual Meeting. MEMBERSHIP Fellow,College of American Pathologists • AWARDS 1995 The American Society for Cell Biology Travel Award 1996 First Prize for a Poster in Medical Sciences I,The Graduate Student Forum at University of Florida • 1996 Overall First Prize for,Presentation,The Graduate Student Forum at University of Florida t, • • • • I. Bo Hong,MD,PhD 3 1 .j Page 1 of I :Ack 2224.38 STATE OF FLORIDA DEPARTMENT.OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE DATE LICENSE NO. CONTROL NO. 1210212008 ME 96743 264605 The MEDICA?'DOCTOR . named below has me.t all requirements of the laws and rules of the state of Florida,, Expiration Date: JANUARY 31, 2011 BO HONG ATTN:DOCTORS LABORATORY,INC. 2906 JULIA Dk. VALDOSTA,GA. 31.602 riage4 - t, irtta4401/4 'Charlie Grist Ma M.Viamonle Ros,M.D., M.P.H. GOVERNOR 'STATE SURGEON GENERAL DISPLAY IF REQULREO 6Y LAW ' • • • • • • 1, t ......._/_.,7C/T -vo ravf;finafPCI1 r0/„')(1T-Inno O/3fl*'l WM. %WFx 12./1 RPM n Healthcare Practitioner License Display Page 1 al F ". .•" ...��.'., License Verification Data As Of 5/6/2013 T,�;,��;tk:sase'�/eiJlid�t[o`�►; �_4'<(' a1,: 1 POP c-ice" BO HONG LICENSE NUtlfiet:,ME96743 1'r+nisrFn:no:yVorson turd S •.7rc1;ry ,,r:_liiv(i Kr infcrrnalion Lccatims PIofili;-. ,• Profession MEDICAL DOCTOR License/Activity Status Controlled Substance Prescriber CI FAR/ACT[VE® License Expiration Date License Original Issue Date 1/31/2015 08/17/2006 Discipline on File Public Complaint- NO NO Address of Record 163 SW STONEGATE TERRACE SUITE 109 LAKE CITY, FL 32024 UNITED STATES ATTN:SOLSTAS LAO PARTNERS/DOCTORS LAB • . i The Information on this page is a secure,primary source for license verification provided by The Florida Department of Health,Division of Medical Quality Assurance.This viebsite Is maintained by Division stall and is updated immediately upon a change to our licensing and enforcement database. • • • ti 1 II { • • • • • http://Nvw2.doh.state.1.us/1RM04PRAES/PRASINDLASP?Licic1-9,1472&ProlN13R=1501 5/6/2013 CURRICULUM VITAE Richard E. Struempler BS, MT (ASCP), MS, MA, NRCC Director of Operations and Toxicology/Responsible Person (NLCP-DHHS) Doctors Laboratory, Inc, 2906 Julia Drive Valdosta, GA 31602 Telephone: 229 671-2225 Fax: 229 245-4820 E-mail: rstruempler @doctorslabinc.com DEGREES 1976 Master of Arts, Human Relations, Webster College 1976 Master of Arts, Health Facilities Management,Webster.College 1972 Master of Science, Clinical Chemistry, Louisiana Tech University 1970 Bachelor of Science, Biology, University of Houston EDUCATION 1980 San Diego County Regional Police Academy, San Diego, CA r. 1975-1976 Webster College, St. Louis, Missouri, Great Lakes, Illinois Campus 1970-1972 Louisiana Tech University, Ruston, Louisiana 1968-1969 Hermann Hospital School of Medical Technology, Houston, Texas r: 19664970 University of Houston, Houston, Texas 1965 S.F. Austin High School, Houston, Texas i REGISTRATIONS �i 2008 College of American Pathologist Comprehensive Online Team Member training for CAP :' Accreditation Inspector (October 10, 2008) 2008 Permanent variance granted from Rule 59A-24.006(1)(A)(2), Florida Administrative Code (requiring PhD or MD) and permitted to serve within the State of Florida as Director of hi Doctors Laboratory, Inc.'s Forensic Urine Drug Testing Laboratory for Florida Drug Free 1:1 Workplace Program. 2002 ISO 9001:2000 Internal Auditor Training, i-long Kong 2000 College of American Pathologists (CAP), Basic Laboratory Accreditation Inspector 1996 CAP, Forensic Urine Drug Testing Laboratory Accreditation Inspector ; 1980 P.O.S.T. Certified Level II Police Officer, State of California 1979 Clinical Chemist- National Registry of Certified Chemistry ` 1969 Medical Technologist-American Society of Clinical Pathologists I HONORS AND ASSOCIA`T`IONS 2004 FBI Laboratory Symposium on Forensic Toxicolo , Washington, DC i I 9Y 9 2003 Member, Association for Professionals in Infection Control and Epidemiology i � i • Richard E.Struempler 1/5/11 I 1 1999 Member- American Society for Quality, Biomedical Division, Healthcare Division 1 1991 Navy Achievement Medal for Professional Achievement, Second Award, } Department of the Navy k 1990 Member, the Society of Forensic Toxicologists I i 1989 Meritorious Unit Commendation, U.S. Naval Hospital, Yokosuka, Japan 1988 Member, the Society of Armed Forces Medical Laboratory Scientists 1987 Nominated for the Arthur S. Flemming Award for Outstanding Young' Men and i; Women in Federal Government, Washington, D.C. ,1 1986 Member, Association of Military Surgeons or the United States +� 1984 Navy Achievement Medal for Professional Achievement, Department of the Navy 1980 Clinical Chemist's Recognition Award, American Association for Clinical Chemistry is 1979 Clinical Chemist, National Registry of Clinical Chemistry 1975 Member, American Association for Clinical Chemistry ',�z. 1969 Medical Technologist, American Society of Clinical Pathologists ^,. WORK EXPERIENCE 'f• f;. March 2006 — Present ;,, ,i. Director of Operations, Doctors Laboratory, Inc., Valdosta, Georgia. Responsible ►�` for the overall management of operations of the clinical laboratory ,t 9 p ry processes including, ;,., r! . toxicology, logistics, facilities, specimen processing, clinical chemistry, hematology, and i - microbiology, plus the day-to-day operations of toxicology as indicated below. ;H November 2003—Present • Director of Toxicology, Doctors Laboratory, Inc., Valdosta, Georgia. Responsible s i Person (NLCP-DHHS) for the day-to-day operations of the forensic urine drug testing and 'i!1 clinical toxicology laboratory. Duties include custodian of documents and records, `I preparation of litigation packages, providing expert testimony, and providing client ''f training in the area of employment urine drug testing. October 2002-Present • :''' President, Total Quality Management Services, Inc. Originally formed as Forensic i' Toxicology Services, (FTS) in 1983, TQM Services,-.Inc has a twelve-year history of ,> providing training programs.in a variety of healthcare related areas, starting initially in the area of forensic urine drug testing and g g personnel issues associated with substance abuse, and currently providing programs for accreditation and certification ' of clinical laboratories, and detailed training programs for infection control in healthcare ' 1:.; facilities. . - ., Ilj rl May 2001 -- October 2002 ,' Executive Director and Corporate Officer Integrated ' tai P g d Iviledical Advancement, t� Ltd. (TMA). and Colby Group International, Inc, (CGI). Responsibilities include 4 i, oversight of all technical content for both IMA and CGI including the creation of the IMA f t:' Laboratory Academy..for training laboratory managers and directors regarding accreditation and certification requirements for both CAP and the emerging ISO 15189 `' international standard for clinical laboratories. Numerous corporate related activities F,; include Secretary to the Board of Directors of Colby Group International. ,.. ii•; 2 '. 1 .J'. _t. Richard E.Struempler 1/5/I1 January 2000—August 2003 In January 2000 after working as an associate of Colby Group International For 8 years. ". relocated to Tokyo, Japan and accepted the position of Managing Director, Colby Group International, Inc., and Integrated Medical Advancement, Ltd. CGI/IMA is a Japan based medical consulting company working within the Japanese medical system to provide assistance in improving the standard of care in the health-care industry. Consulting projects include preparation of Facilities for accreditation by the College of American Pathologist, establishing standards of practice for infection control, medical risk management, continuing medical education; support of U.S. based medical products inn the Japanese market, and support for urine drug testing for Japanese employees. Responsibilities include providing technical support for these projects as well as general management of consulting projects. June 1993 - Present Independent consultant in forensic toxicology and forensic urine drug testing (Forensic Toxicology Services, Riverton, Utah), providing technical review and evaluation of scientific data and application of that data in specific situations, for both individual and corporate clients. Have been recognized as an expert witness in the field of forensic toxicology and forensic urine drug testing over 250 times in Federal, state, and local legal forums throughout the United States, and in military courts overseas. January 1994 -January 2000 Forensic Toxicology Supervisor, Responsible Person, Substance Analysis and Management, Associated Regional and University Pathologists, Inc., Salt Lake City, Utah. Responsible for the day to day operations of a NIDA (DHHS/SAMHSA) certified urine drug testing laboratory, processing approximately 35,000 samples per month, including personnel management, budgeting and budget execution, and strategic planning. Additional duties include preparation of litigation packages, providing expert testimony, and providing client training in the area of employment urine drug testing. July 1993 - December 1993 Fa Director of Forensic Toxicology and Responsible Person for NIDA accredited forensic 1110 toxicology laboratory, IHC Laboratory Service Forensic Toxicology, Provo, Utah. Duties include acting as a Certifying Officials and providing expert testimony • July 1992 - June 1993 Executive Officer, • Navy Drug Screening Laboratory, Great Lakes, Illinois; responsibilities included day-to-day operation of a Department of Defense and NIDA certified urine drug testing laboratory. Duties included acting as a Certifying Official, and providing expert testimony support of testing results in federal courts. O. 1992 - 1999 Director of Accreditation Programs, Colby Group International, Tokyo, Japan, based in the United States. Provide consulting services in the area of laboratory accreditation issues for Japanese laboratory facilities, with organizations such as College of American Pathologists, American Association for Blood Banking, and the Joint Commission International, Served p 1 3 1 Richard E.Struernpler 1/5/11 • as a liaison with the College of American Pathologists and 5 large clinical reference laboratories in Japan including one laboratory processing approximately 75,000 clinical specimens per day. 1988 - 1992 • Senior Laboratory Officer, Head of the Chemistry Department, and Administrative Assistant to the Head, Laboratory Division, U.S. Naval Hospital, Yokosuka, Japan. Responsibilities IMO included the general administration of the clinical laboratory for the Naval Hospital, MOO administration of a reference laboratory for military facilities located in the western Pacific region. Additional duties included providing expert testimony in the field of drug Fri abuse testing, for military courts, and providing briefings to local commands on the »� Navy drug-testing program in general. Fib 1984 - 1988 Technical Director and Executive Officer for the Navy Drug Screening NO:. Laboratory, Great Lakes, Illinois. Duties included maintaining Department of Defense accreditation standards and certification. 1982 - 1984 Head, Navy Drug Screening Laboratory, Naval Hospital, Oakland, California, - responsible for setting up a new drug-screening laboratory, including the implementation of new analytical methods and procedures. Served as a member of the committee that established the Standard Operating Procedure that was implemented in all Navy drug- ! screening laboratories. This procedure served as the basis for the current Federal drug- testing program. 1979 - 1932 Biochemistry Project Manager, Naval Health Research Center, San Diego, California. Projects included the development of a portable laboratory system for use in the field, a modular laboratory system for shipboard use, and investigating hair analysis for trace elements, as a predictor for disruptive behavior in military recruits. 1975- 1979 Officer-in-Charge of the Toxicology and Drug Screening Laboratory, Naval Regional Medical Center, Great Lakes, Illinois; responsibilities included all technical aspects of the laboratory. Served as an instructor in chemistry for the Navy School of Medical Technology, an American Society of Clinical Pathologists accredited school. 1972 - 1975 Head, Clinical Chemistry Section, Laboratory Service, Naval Regional Medical Center, Philadelphia, Pennsylvania PUBLICATIONS/PRESENTATIONS 1. Richard E. Struempler, Drug Testing for Dummies, Valdosta-Lowndes County Chamber of Commerce, Valdosta, GA, October 27, 2009 4 1 Richard E.Struempler 1/5/11 2. Richard E. Struempler, Drug Screen Collections: Hitting a Moving Target, American Society of Phlebotomy Technicians, Regional Conference, Lake Buena Vista, FL, October 17, 2009 3. Richard E. Struempler, Evaluation of a Claim of Moonshine Mixed with Methamphetarnine, DATIA Focus, Winter 2009. 4. Richard E. Struempler, On-Site Testing: Pot Holes and Pit Falls or Taking the High Road, Drug & Alcohol Testing Industry Association, 12th Annual Conference and Exposition, Grapevine,Texas, April 29--May 3, 2008. 5. Richard E. Struempler, Interpreting Positive Screening Results, US Probation and Pre-Trial Conference, Albuquerque, NM, June 19-20, 2007. 6. Richard E. Struempler, Jacques Wilson, and John Giddens, A Claim of Moonshine Mixed with Methamphetamine, ToxTalk Case Notes, Society of Forensic Toxicologists,Inc., Vol. 32, Issue 2, June 2007 7. Richard E. Struempler, ISO 15189, Quality and Competence in the Clinical Laboratory, A New Certification Program, Medica 2003, Dusseldorf, Germany, November 20, 2003. 8. Richard E. Struempler, College of American Pathologists - Laboratory Accreditation Program and ISO 15189: Medical Laboratories - Particular requirements for quality and competence, Quality Progress, American Society for Quality, submitted for publication, July 2003. . 9. Richard E. Struempler, WHAT DO YOU DO WITH HOSPITAL WASTES? Health & Lifestyle, Manila, Philippines, March 2003. 10. Richard E. Struempler, INFECTION CONTROL WORKSHOP, Air & Waste Management Association Philippines Section, Manila, Philippines, March 27th & 28th, 2003. 11. Richard E. Struempler, •infection Control in the 21st Century, Philippine Hospital Association Regional Conference Series 2003, Cebu City, Philippines, March 23`d, 2003. 12. Richard E. Struempler, HEALTHCARE QUALITY MANAGEMENT Infection Control: Principle and Methods-for the 21st Century, TUV Product Services Asia Pacific PTE Ltd., Philippine Branch Customer Training Program, Quezon City, Philippines, March 13th, 2003. 13. Richard E. Struempler, HOME HEALTHCARE AND INFECTION CONTROL, East Avenue Medical Center, Tumor Board Presentation, Quezon City, Philippines, March 12th, 2003. 14. Richard E. Struempler, TRENDS IN ACCREDITATION: Total Quality Management, Philippine Hospital Association 51" Annual National Convention, November 28-29,2002, Manila, Philippines. • 5 I -- J Richard E.Struempler 1/5/11 15. Richard E. Struempler, BASIC MICROBIOLOGY, NOSOCOMIAL INFECTIONS AND INFECTION CONTROL PROCEDURES, TLIV Product Services Notified Body Training, September 10, 2002, Shanghai, China and September 13,2002,Tokyo, Japan. 16. Richard E. Struempler, INFECTION CONTROL AND CLINICAL PROCESSES: How to Comply to Clinical Laboratory Standards, Hospital Management Asia 2002, September 4-6, 2002, Bangkok, Thailand. 17. Richard E. Struempler, BASIC MICROBIOLOGY, NOSOCOMIAL INFECTIONS AND INFECTION CONTROL PROCEDURES, TOV Product Services Notified Body Training, September 10,2001, Tokyo,Japan. 18. Richard E. Struempler, THE STATUS OF CYTOPATHOLOGY LITIGATION IN THE UNITED STATES AND QUALITY/RISK MANAGEMENT PROCEDURES, Keynote Address: 4.P Cytopatho/ogists Educational Seminar Programme, August 25-26, 2001 Tokyo, Japan; September 1-2, 2001 Osaka, Japan 19. Richard E. Struempler, THAT CAN'T BE RIGHT! INFORMATION ON FALSE POSITIVES AND ADULTERATED TESTS, Drug Testing in the New Millennium, Intermountain Health Care, Salt Lake City, Utah September 30, 1999. 20. Richard E. Struempler, DRUG TESTING ISSUES INTO THE 215`, CENTURY, Critical Issues in Children and Adolescents. An Intervention Update,The Children's Mental Health Institute, Salt Lake City, Utah, September 2-3, 1999. • 21. Richard E. Struempler, BASIC DRUG TESTING: TOXICOLOGY AND CHAIN OF CUSTODY, Guidelines for a Drug-Free Workplace, Utah Council for Crime Prevention, Salt Lake City, Utah January 15, 1999. 22. Richard E. Struempler, FIGHTING THE ADULTERATION BATTLE: WHO'S WINNING. Drug-Free Workplace Update, National Safety Alliance, Portland, Oregon, October 28, 1998. 23. F.M. Urry, G. Komaromy-Hiller, B. Staley, D. K. Crockett, M. Kushnir, G. Nelson, and R. E. Struempler, NITRITE ADULTERATION OF WORKPLACE URINE DRUG TESTING SPECIMENS II. SPECTROPHOTOMETRIC DETECTION AND QUANTITATATION OF NITRITE ANION WITH AN AUTOMATED ANALYZER, AND FREQUENCY OF NITIRITE ADULTERATION, Journal of Analytical Toxicology, Submitted for publication 15 May 1998. 24. F.M. Urry, G. Komaromy-Hiller, B. Staley, D. K. Crockett, M. Kushnir, G. Nelson, and R. E. Struempler, NITRITE ADULTERATION OF WORKPLACE URINE DRUG TESTING SPECIMENS I: SOURCES AND ASSOCIATED CONCENTRATIONS OF NITRITE IN URINE, AND DISTINCTION BETWEEN NATURAL SOURCES AND ADULTERATION, Journal of Analytical Toxicology, Vol. 22, No. 2, March/April 1998. 6 9. 0 Richard E.Struempler 1/5111 p 25. F.M. Urry, G. Komaromy-Hiller, B. Staley, D.K. Crockett, M.M. Kushnir, G. Nelson, R.E. Struempler. Abstract - Nitrite Adulteration of Workplace Drug Testing Specimens; Concentrations of Nitrite in Urine and Distinction between 0 Natural Sources and Adulteration. Presented at the 27th Annual Meeting of the Society of Forensic Toxicologists, Salt Lake City, UT: Abstracts of the conference, pg. 81, 1997. 26. R. Struempler, G. Nelson, and F. Urry, A POSITIVE WORK PLACE DRUG TEST FOLLOWING THE INGESTION OF COMMERCIALLY AVAILABLE HEMP SEED OIL, Journal of Analytical Toxicology, Vol. 21, No. 4, July/August 1997. 1 27. Richard E. Struempler, DRUG TESTING ADULTERATION AND SAFETY SENSITIVE ISSUES, Occupational Health Management, Wyoming Medical Center, Casper Wyoming, January 16, 1997. • /; 28. M. Kushnir, C. Jones, R. Struempler, F.M. Urry (ARUP Inc., Salt Lake City, UT 84108), ELIMINATING INTERFERENCE OF RELATED COMPOUNDS IN OPIATES GC/M5 ANALYSIS, [Abstract] presented at the 48th National AACC Meeting, Chicago, IL 1996. 1 Clinical Chemistry, Vol. 42, No. 6, 1996 1 29. Richard E. Struempler, TECHNOLOGICAL ASPECTS OF SCREENS/ • CONFIRMATIONS AND ADULTERATION/SUBSTITUTES, SAPAA Seminar and } Membership Meeting, Salt Lake City Utah, April 5-8. 1995. 30. R. Struempler, C. Vaughn, E. Wozniak, and F.M. Urry (ARUP Inc., Salt Lake City, UT 84108), ACTIVITY OF SYVA EMIT IITM MONOCLONAL AMPHETAMINE /METHAMPHETAMINE ASSAY TO d-AMPHETAMINE AND d- METHAMPHETAMINE ON THE TECHNICON CHEM 1+TM CHEMISTRY ANALYZER, [Abstract] presented at the 46th National AACC Meeting, New Orleans, LA 1994. Clinical Chemistry, Vol. 40, No. 6, 1994 31. Struempler, Richard E., EXCRETION OF MORPHINE IN URINE FOLLOWING THE INGESTION OF POPPY SEEDS, Milita ry Medicine, vol. 153, September 1988. 32. Struempler, Richard E., EXCRETION OF CODEINE AND MORPHINE FOLLOWING THE INGESTION OF POPPY SEEDS, Journal of Analytical Toxicology, vol. 11, May/June 1987. • 33. Struempler, Richard E., Larson, G. E., and Rimland, B., HAIR MINERAL ANALYSIS AND DISRUPTIVE BEHAVIOR IN CLINICALLY NORMAL YOUNG MEN, Journal of Learning Disabilities, vol. 18, 569-632, 1985. 34. Naval Ocean Systems Center Technical Report, MODULAB: DEPLOYMENT AND ENVIRONMENTAL TEST REPORT, Department of the Navy, 1984. 35. Struempler, Richard E., A QUALITATIVE ANALYSIS OF A PLASMA CEREBROSIDE FOUND IN NORMAL CHILDREN AND DEFICIENT IN MENTALLY RETARDED CHILDREN, MS Thesis, Louisiana Tech University. 1972. Richard iE+.Struempler 1/5/11 RESEARCH EXPERIENCE 1979-1982 Naval Health Research Center, P.O. Box 85122, San Diego, California 92138, Dr. Eugene Lang, Captain, Medical Corps, U.S. Navy, Commanding Officer 1970-1972 Louisiana Tech University, Department of Chemistry, Dr. S. S. Patton, Ph.D., Advisor for Master's Program and Research TEACHING EXPERIENCE 1977-1979 Clinical Instructor in Chemistry, College of Lake County, Grayslake, Illinois 1976-1979 Clinical Instructor in Pathology, The George Washington University, School of Medicine and Health Science, Washington, D.C.; U.S. Navy School of Medical Technology MILITARY SERVICE 1972-1993 Lieutenant Commander, Medical Service Corps, United States Navy (Retired) • 8 Doctors Laboratory, Inc. PHONE (229) 671-2280, E-MAIL:Aiddens @doctorslabinc.com JOHN F. G1DDENS SUMMARY • Chemistry degree; Advanced knowledge of drug testing instrumentation, methodology and application; Knowledge of Forensic Toxicology; Advanced knowledge. of computer hardware, software, and networking; Ability to identify and solve problems; Experience in marketing and sales; Client recruitment and retention; Eagle Scout EDUCATION • Graduated from Valdosta High School in 1997. • Graduated from Valdosta State University in 2002 with a Bachelor of Science degree with a major in Chemistry ADVANCED • COURSES • 3 Semesters of Calculus • Set Theory • 2 Semesters of Calculus Based Physics • An Advanced Physics course in Electronics • 2 Semesters of Physical Chemistry • 2 Semesters of Organic Chemistry • 2 Semesters of Inorganic Chemistry • 2 Semesters of Biochemistry • Quantitative Analysis • Instrumental Analysis • Research course on Nanotechnology STUDENT RESEARCH • • Received a National Science Foundation Grant and conducted research under the supervision of Dr. Francis Flaerty and Dr. Betty Derrick • Worked extensively under the National instruments lab view environment and attended workshops on the usage and implementation of Lab View • Setup a Laser Laboratory overseeing several experiments, such as Adsorption vs. Wavelength vs. Dye Wavelength, using Helium Neon Dye Laser and a Monochromator. • Technician for the Laser Laboratory for 1 Year at Valdosta State University • Compiled a student workbook companion for Dr Eric Drexier's book Nanosystems. WORK EXPERIENCE ▪ 2003-Present Doctors Laboratory, Inc. Current Position of Research and Development with a focus on the optimization of current methods and the development of new methods fox drugs of abuse testing; prior positions include; Negative Certifying Scientist, Non-Negative Certifying Scientist, and Extraction Technologist • 1997-Present Indianola Records LLC: Co-founder of a record label which in 2007 • Partnered with Koch Entertainment and Entertainment One; London (AIM: ETO.UN) for Global Distribution • 1999-2000 Valdosta State University Chemistry Department; Laser Laboratory Technologist 1 r • 1946_1999 Rural Cable Inc.; Performed commercial (Georgia Lottery) and residential satellite installations Work Specific to Forensic `oxicology GC/MS Methods • 1, THC-000H hene 2. Methadone/Norpropoxyp }ieXObar>vital, 3. Barbiturates (Butaibital, Amobarbital, Pentobarbital, Secobarbital, Phencbar+':t ! 4. Federal Opiates 2000ng/mL (Codeine, Morphine w separation from Hyorco e ne) 5 g. Healthcare Opiates 300ng/rnL (Codeine, Morphine, Hy Oxycodone, Oxymorphone) 6. Ethylglucuronide 500nglmL • 7. Benzoylegonine Fluid Amphetamine 50nglmL on Shimadzu QP2010 Plus with no deans switch 8. Oral Ft P 9. Oral Cocaine 6nglmL on Shimadzu Qpo P10 Pw�th noh�e deans s switch 10. Oral THC Ong'/ma on sinhiNIST and AMIDS 1 11. Full Scan Method using Temaze am, Lorazepam and Nordiaze P � 12. Benzodiazepines ( am, Oxazepam,p Alphahydroxyalprazolam). I 13. 6-mam (with separation from all healthcare opiates) 14. PCP 1 15. Methaqualone I 16. Amphetamine, metharnp hetamine, MDA and MDMA am and many others that are 17. Have set up SIM for Mepri further development is pursued awaiting client demand I immunoassay methods ! Developed General Oxidant (Nitrite Equivalent) Bayer Advia 1650 Chemistry 1. Parameters Using Axiom Diagnostic Bayer is 1650 2. Set up Ethylglucuronide Testing up 3. Set u all standard Drugs of abuse test and SVT test On Bayer Advia 1650 i Lead AA vetoed a Filter Paper Lead Testing Method For a Perkin Elmer 4100z AA w } 1• De P } Graphite Furnace GC-FID f 1. Set Up Blood Alcohol Assay using Headspace and GC Chemstation 0 GC-MS Maintenance 1. Clean and Change Agilent and Shimadzu Ion Sources, lens stacks, horns and filaments. 2. Change GC Columns Maintenance 3. Perform Gc inlet and Rough Pump 4. install and set up new instruments methods and reports templates D Development Projects s 11 diagnostics with Axiom diagnostics in the development of a linear General Oxidants(nitrite equivalent) immunoassay procedure 1. Work for the Bayer Advia 1650 i 4 , - - __ 2. Worked with Shimadzu QP2010-Plus for development of a Drugs of abuse package and oral fluid testing using Dual tuTurbo d for pumps achieve eve h hher sensitivity needed for oral fluids without 3. Worked with Phenomenex on a new drugs of abuse column that would achieve excellent separation with minimal runtime 4. Lead Filter paper method using Whatman 904-Miter paper 5. Developed Healthcare Opiate GC-MS method and SPE extraction method • • • } rep. - � ._.,.._.r..- .__ . ........ ._. .. ... •--- -- - -- _ ._. _._- 0 0 Jtarv11 1•:. llfir•:l:t rr111•ti it1� �ir•ir•11Ii�1 )r100r•.:4 l,:rl>Irlr;11t1ri lllt•. \•:llc11,tir-:1. G.\ 31602 (229)671-2280 ) I I�,rE1lr�li:ic,l, • 1997-2001 1•aitlast„ •�1:,I1. 1:11iv(r•SiI.ti• 13.S. i,l 13ic,Icw-v-:11ti►tlst 20()I I'r,•-ti'rtrrin:,ry f:nllrA0,4 inI•)1,tII�r) (111,1 mil 111)61111 Iii): 1:r•n1•tiI ti, llulrl Itl�+t' t;1�11rti1�. (r•I1I Il1-r1lr1gV. IC0 111'!r:111ir l'111-111.1S11'10.4. I\t t1 gr•,11'r:1I -'III 1111�I!'!t•s. I,it)I•I,I•,1l is!r\•. llir•rI111ir,Irlr\ arid 1 ir•11I4-g.\ Work Fxpurictiet• -1120{)I- Doctor's I,aI,I,r:llnrti• Inr• 1'rl•srl1l `il1I11•r\'i:ur: IiirI1:1rdI 1•:. 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Valdosta, GA 31602 229-506-1063 EDUCATION: r 2010-present University of Florida r Working towards M.S. in Forensic Science 1998-2002 Valdosta State University B.S. in Biology—December 2002 Pre-reed major with focus in genetics i Courses included: • Genetics(4 hrs w/lab) • Molecular Biology of DNA(4 hrs w/tab) • Molecular Fish Genetics (4 hrs w/lab) • Vertebrate Physiology (4 hrs w/lab) • • Biochemistry (3 hrs) • Organic Chemistry I & II (4 hrs each w/labs) • Chemistry I & 11(4 hrs each w/labs) • Calculus (4 hrs). • 44 credit hours of upper level Biology classes. • 20 hours of Math and Physics • 19 hours of major level chemistry classes. Scholarships awarded: • John Odum Scholarship • • Governor's Honors Scholarship • Robert Patten Scholarship • National.Merit Scholarship (c/o Roadway Express, Inc.) • Beta Scholarship WORK EXPERIENCE: 8/2004 - Doctors Laboratory, Inc. Present Valdosta, GA 31602 Positions Held: Toxicology Night Supervisor/Certifying Scientist(7/2005—present) • Supervise 10-15 technicians, analysts, and scientists in a SAMHSA certified forensic drug testing facility 1 ® Direct department workflow for maximum efficiency, schedule employee paid time off, consult with director and other key staff weekly to absolve issues and improve laboratory performance • Ensure all specimen handling, processing, testing, data review and reporting is handled utilizing forensic methods according to SAMHSA, FL-DFW, and CAAP requirements ® Review confirmatory testing data for all non-negative specimens and report results to clients by specified deadlines • Review QC data for all instrumentation and testing to validate defensibility of individual results • • Resolve technical, mechanical, and personnel issues including repair and conflict resolution • Perform all duties of Negative Certifying Scientist, analyst, and technician Toxicology Negative Certifying Scientist(2/2005—present) • Perform initial testing of specimens on immunoanalyzer, refractometer, and pH meter • Review data and ensure accuracy of information • Certify and release all negative results, forwarding non-negative results to appropriate confirmatory testing • Troubleshoot instrumentation • Perform all duties of analyst and technician Toxicology Laboratory Analyst--GC/MS Technician (8/ 004—present) • Initiate GC/MS testing of prepared samples • Ensure proper operation of instruments through routine maintenance and troubleshooting • Perform initial review of confirmation data (chromatography checks, re-injects, etc.) • • Carry out extractions, operate immunoanaiyzer, and handle client calls when necessary 11/2003- Viagen, Inc. 8/2004 Athens, GA (main office: Austin,Texas) Research Technician • Successfully cloned (by nuclear transfer) porcine embryos resulting.in live, healthy piglets • Performed cell and embryo culture • Assisted in surgical implantation and caesarean delivery of cloned swine • Performed DNA extractions, PCR, RE digestion, gel electrophoresis, blotting, probing, and various other molecular techniques • • Collaborated on targeted transfection of cell line to improve disease resistance in cows (targeted BSE i.e. "mad cow") • Maintained detailed lab journal, reported data, results, and conclusions to principal scientist 2 •n • l.• f Prepared media, solutions and buffers; maintained glassware and equipment 2/2001 - Valdosta State University 11/2003 (c/o John F. Elder PhD) Valdosta, GA Genetics Laboratory Assistant(Non-paying position) 2 Performed grant research involving fish species • Performed DNA extractions, RE digestions, electrophoresis, Southern blotting, antibody labeling, DNA banding analysis ("fingerprints"), PCR, and other molecular'techniques • Routinely prepared solutions.and laboratory materials for use and maintained instruments and equipment a • a a 3 Mount Sinai M E D I C A L C E N T E R TAB 2 2.3 FINANCIAL CAPACITY ATTACHMENT G Dun & Bradstreet Qualification Report Decide with Confidence Supplier Qualifier Report To save report(s)to your PC, click here for instructions. D Print this Report Copyright 2014 Dun &Bradstreet- Provided under contract for the exclusive use of subscriber 100150009 ATM: MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. Report Printed: MAR 13 2014 In Date BUSINESS INFORMATION MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. 4300 Alton Rd Miami Beach, FL 33140 Rating Change This is a headquarters location. D-U-N-S® Number: 04-602-5144 Branch(es) or division(s) exist. Telephone: 305 674-2121 D&B Rating: 1R3 Formerly Fax: 305 674-2769 1R2 Number of employees: IR Is 10 or more Chief executive: STEVEN SONENREICH, PRES-CEO employees. Composite credit Year started: 1946 appraisal: 3 is fair. D&B Supplier Risk: 2 Employs: 3,225 (Undetermined here) SUPPLIER EVALUATION RISK (SER) RATING FOR History: CLEAR THIS FIRM : 2 Financing: SECURED 9 8 7 6 5 4 3 2 9 High Medium Low D&B PAYDEXO D&B PAYDEX: 73 1 When weighted by dollar amount, payments to 1 suppliers average 11 days beyond terms. -J • i20 days stow 30 days slow Prompt Anticipates Based on up to 24 months of trade. SUMMARY ANALYSIS https://supplierportal.dnb.com/webapp/wcs/stores/servlet/S QRReportDisplay?reportForma... 3/1 3/20 14 D&B Rating: 1R3 Number of employees: 1R indicates 10 or more employees. Composite credit appraisal:3 is fair. The Rating was changed on September 25, 2013 because D&B's file shows a change in the company's suit(s), lfen(s), and/or judgment(s) activity. The 1R and 2R ratings categories reflect company size based on the total number of employees for the business.They are assigned to business files that do not contain a current financial statement. In 1R and 2R Ratings, the 2, 3, or 4 credit worthiness indicator is based on analysis by D&B of public filings, trade payments, business age and other important factors. 2 is the highest Composite Credit Appraisal a company not supplying D&B with current financial information can receive. For more information, see the D&B Rating Key. Below is an overview of the company's rating history since 10/25/01: D&B Rating Date Applied 1R3 09/25/13 1R2 08/14/12 1R3 10/17/11 SA3 02/15/11 1R2 12/18/07 1R3 10/15/07 5A3 05/12/03 5A4 06/03/02 5A3 11/30/01 1R4 10/25/01 The Summary Analysis section reflects information in D&B's file as of March 10, 2014. RISK SCORE ANALYSIS SER COMMENTARY: - Proportion of past due balances to total amount owing. - Higher risk industry based on inactive rate for this industry. - Proportion of slow payment experiences to total number of payment experiences reported. - Evidence of open suits. PROBABILITY OF CEASED OPERATIONS/BECOMING INACTIVE SUPPLIER EVALUATION RISK RATING: 2 The probability of ceased operations/becoming inactive indicates what percent of U.S. businesses is expected to cease operations or become inactive over next 12 months. Probability of Supplier Ceased 2.1% (210 PER 10,000) Operations/Becoming Inactive : Percentage of US business with same SER 15% (1,500 PER I0,000) score : Average Probability of Supplier Ceased o Operations/Becoming Inactive : 5.60/o (560 PER 10,000) -Average of Businesses in D&B's Supplier Database CREDIT DELINQUENCY SCORE: 512 DIVERSITY Minority-Owned Business: N/A Historically Underutilized Business: N/A Women-Owned Business: N/A Veteran-Owned Business: N/A https://supplierportal.dnb.com/webapp/wcs/stores/servlet/S QRReportDisplay?reportForma... 3/13/2014 • Disadvantaged Business Enterprise: N/A Vietnam Veteran Business: N/A Small Disadvantaged Business: N/A Disabled-Owned Business: N/A HUB-Zoned Certified Business: N/A Historical College Classification: N/A SBA 8(a) Certified: N/A Labor surplus area: YES (2014) Small Business: N/A CUSTOMER SERVICE If you have questions about this report, please call our Customer Resource Center at 1.800.234.3867 from anywhere within the U.S. If you are outside the U.S. contact your local D&B office. *** Additional Decision Support Available *** Additional D&B products, monitoring services and specialized investigations are available to help you evaluate this company or its industry. Call Dun &Bradstreet's Customer Resource Center at 1.800.234.3867 from anywhere within the U.S. or visit our website at www.dnb.com. HISTORY The following information was reported 09/25/2013: Officer(s): STEVEN SONENREICH, PRES-CEO . WAYNE CHAPLAIN, CHB ALEX MENDEZ, EXEC VP OF OPER-CFO ANGEL PALLIN,S V PRES - OPER DIRECTOR(S): THE OFFICER(S) The Florida Secretary of State's business registrations file showed that Mount Sinai Medical Center Of Florida, nc. was rY 9 , registered as a Non-Profit Corporation on May 23, 1966. Business started 1946 by other directors and community members. STEVEN SONENREICH. Antecedents are unknown. WAYNE CHAPLAIN. Antecedents are unknown. ALEX MENDEZ. Served as the hospital's Senior Vice President and Chief Financial Officer. ANGEL PALLIN.Antecedents not available. BUSINESS REGISTRATION CORPORATE AND BUSINESS REGISTRATIONS REPORTED BY THE SECRETARY OF STATE OR OTHER OFFICIAL SOURCE AS OF MAR 05 2014: Registered Name: MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. Business type: DOMESTIC CORPORATION Corporation type: NON-PROFIT Date incorporated: MAY 23 1966 State of incorporation: FLORIDA Filing date: MAY 23 1966 Registration ID: 710931 Federal ID: 590624424 https://supplierportal.dnb.com/webapp/wcs/stores/servlet/SQRReportDisplay?reportForma... 3/13/2014 fLIxLJ tJuyyiil..i uci11 t. IvIvLIN I 011V1"11.1V11..i.lJIV1-11, \iLitN ll.il\ Vl' 1'L1J1\11JC1.,I... relgc `t VI IV Status: ACTIVE Where filed: STATE DEPARTMENT/CORPORATION DIVISION,TALLAHASSEE, FL Registered agent: PRISCILLA FRIEDLAND, 4300 ALTON ROAD, MIAMI BCH, FL, 331400000 Principals: STEVEN D SONENREICH, PCEO, 4300 ALTON ROAD, MIAMI BEACH, FL, 331400000 ARNOLD JAFFEE, SENI, 4300 ALTON RD, MIAMI BEACH, FL, 331400000 ALEX MENDEZ, EXEC, 4300 ALTON RD., MIAMI BEACH, FL, 331400000 WAYNE CHAPLIN, CHAI, 4300 ALTON RD., MIAMI BEACH, FL, 331400000 OPERATIONS 09/25/2013 Description: Operates as a general medical or surgical hospital. Provides management services. Terms are cash, direct patient billings and reimbursements from third party payors. Sells to general public.Territory : Local. Nonseasonal. Employees: 3,225 which includes officer(s) and 425 part-time. Undetermined employed here. Facilities: Owns 1,510,000 sq. ft. in a multi story building. Location: Suburban business section on main street. Branches: This business has multiple branches, detailed branch/division information is available in Dun & Bradstreets linkage or family tree products. Subsidiaries: This business has one subsidiary listed below. Right Choice Management Inc(100%) chartered 1997. Operates as a management services organization. FAMILY LINKAGE This business is at the head of its corporate family tree. It is not a subsidiary of any other business. UNSPSC UNSPSC(United Nations Standard Product and Services Code) is a globally accepted commodity (Product and Services) classification system. MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. offers the following product(s) and service(s): 80000000 Management and Business Professionals and Administrative Services 85101500 Healthcare centers NAICS Beginning in 1997, the Standard Industrial Classification (SIC) was replaced by the North American Industry Classification System (NAICS).This six digit code is a major revision that not only provides for newer industries, but also reorganizes the categories on a production/process-oriented basis. This new, uniform, industry-wide classification system has been designed as the index for statistical reporting of all economic activities of the U.S., Canada, and Mexico. 622110 General Medical and Surgical Hospitals 561110 Office Administrative Services SIC https://supplierpo rtal.dnb.comlwebapp/wcs/stores/sery let/S QRReportD i sp lay?reportForm a... 3/13/2014 I _ v Based on information in our file, D&B has assigned this company an extended 8-digit SIC. D&B's use of 8-digit SICs enables us to be more specific to a company's operations than if we use the standard 4-digit code. 80620000 General medical and surgical hospitals 87410000 Management services D&B PAYDEX The D&B PAYDEX is a unique, dollar weighted indicator of payment performance based on up to 129 payment experiences as reported to D&B by trade references. l 3-Month D&B PAYDEX: 73 1D&B PAYDEX: 73 I When weighted by dollar amount, payments to I I When weighted by dollar amount, payments to Lsuppliers average 11 days beyond terms. 1 I suppliers average 11 days beyond terms. 0 ' 100 0 V 100 120 days slow 30 days slow Prompt. Anticipates 120 days slow 30 days slow prompt Anticipates Based on trade collected over last 3 months. Based on up to 24 months of trade. When dollar amounts are not considered, then approximately 84% of the company's payments are within terms. PAYMENT SUMMARY The Payment Summary section reflects payment information in D&B's file as of the date of this report. Below is an overview of the company's dollar-weighted payments, segmented by its suppliers' primary industries: Total Total Dollar J Largest High Within Days Slow IRcv'd Amts Credit . Terms ' <31 31-60 61-90 90> --—_—_—_ __— f (#) ; ($) ! ($) i (%) (%) Top industries: Mfg medical instrmnt 7 1,062,500 700,000 99 l - f - 1 11 - Whol medical equip i 6 611,000 400,000 100 ; - - l - - Telephone communictns 5 320,000 } 200,000 100 - - : - - Electric services 5 ' 225,000 I 100,000 97 3 E - - - Whol groceries ; 5 ; 235,000 100,000 ' 99 i 1 i - 1 - - Mfg electromedcl prdt i 4 2,205,000 2,000,000 55 45 I - : - - Newspaper-print/publ } 3 ' 86,000 I 60,000 50 1 35 - 1 - I 15 Mfg computers { 2 210,000 200,000 52 I 48 - ' - I - : 1 Mfg surgical supplies i 2 ; 102,500 100,000 f 50 I 50 E - - I - Mfg environment cntrl I 1 60,000 60,000 ! 100 i - - , - . - OTHER INDUSTRIES . 65 284,800 40,000 88 F 1 ` 1 . 1 9 Other payment categories: Cash experiences 23 6,850 i 750 Payment record unknown 0 . 0 ; 0 Unfavorable comments i 1 250 250 Placed for collections: With D&B J 0 ! 0 f Other , 0 I N/A i Total in D&B's file 129 5,408,900 2,000,000 https://supplierportal.dnb.com/webapp/wcs/stores/servletlSQRReportDisplay?reportForma... 3/13/2014 - -- .---•. -•.....y vA.•• vy_,t.y,t.i1\vi. 1 LVl\1LC1, 1... rage o OI 1U The highest Now Owes on file is$2,000,000 The highest Past Due on file is$70,000 Dun & Bradstreet has 129 payment experiences In Its file for this company. For your convenience, we have displayed 80 representative experiences in the PAYMENTS section. PAYMENT DETAILS Detailed payment history Date Reported I Paying Record___High Credit Now Owes Past Due!-Selling Terms , -Last Sale-1 ( ) (s) ($) I 1 Within 1 I__._ -- 1 _ _1____.__..__. 1 (months) I 02/14 Ppt 400,000 200,000 1 40,000 : 1 mo i Ppt I 200,000 200,000 1 0 1 1 mo l Ppt I 40,000 i 35,000.1 50 N30 f 1 mo Ppt I 25,000 I 15,000 • 0 I 1. 1 mo ? Ppt 20,000 15,000 0 i 1 1 mo Ppt 20,000 15,000 0 I N15 1 1 mo Ppt 15,000 10,000 0 I 1 mo f Ppt 10,000 500 0 x I 1 mo 1 Ppt f 10,000. 1,000! 0 E = t 1 m ' Ppt 10,000 • 5,000 i 100 ' N30 I 1 mo i Ppt 7,500' 5,000 1 500 i 1 1 mo Ppt 7,500 7,500 0 1 1 mo Ppt 7,500 0 0 j 2-3 mos Ppt 5,000 5,000 0 ; 1 1 mo I PPt 2,500 0 0 I 2-3 mos Ppt I 750 1 0 ; 0 ' N30 • 2-3 mos Ppt .= 750 t 0' 0 • ` 6-12 mos Ppt 750 i 750= 0 . I 1 mo Ppt 500 500 I 0 1 t 1 ma 1 1 Ppt 250 0 1 0 E N30 ' 1 mo Ppt 100 0 0 f 4-5 mos Ppt 100 0 : 0 i N30 1 6-12 mos Ppt 100 • 0 0 . N30 1 mo Ppt I 50 , 0 ; 0 N30 4-5 mos Ppt 50 0 ; 0 3 6-12 mos 1 j Ppt-Slow 30 I 200,000' 0 I 0: ; 2-3 mos 1 Ppt-Slow 30 2,500 2,500 0 1 mo Ppt-Slow 60 5,000 2,500 1,000 I i 1 mo f Ppt-Slow 90 20,000 500 500 � 1 mo Ppt-Slow.120 7,500 5,000 5,000 ! N30 I 1 mo Ppt-Slow 150 i 250.1 0 ' I 1 mo Slow 90+ 100 1001 100 = N30. i 1 mo (033) 0 1 0 1 0 : Cash account f 6-12 mos 01/14 / Ppt 700,000 k 250,000 I 0 1 mo Ppt 300,000 200,000 0 i 1 1 mo Ppt ' 200,000 25,000 1 0 . 4-5 mos i Ppt 1 100,000 100,000, 1 1 mo https://supplierportaLdnb.com/webapp/wcs/stores/serviet/SQRReportDisplay?reportForma... 3/13/2014 Ppt 80,000 I 80,000 I 0 1 1 mo Ppt- 70,000 , 7,500 7 0 = 4-5 mos Ppt 60,000 ! 60,000 1 mo Ppt 50,000 t- 50,000 . • t 1 mo Ppt i 10,000 0A 0 i ', 4-5 mos Ppt 5,000 2,500 1,000 ! 1 mo i Ppt 2,500 . 0 0 i N45 1 mo Ppt 2,500 1,0001 0 ± 1 mo Ppt 2,500 I 0 0 ; N30 f 4-5 mos Ppt 1,000 : 0 0 2-3 mos Ppt 1,000 ' 0; 0 1 mo Ppt 250 I 2501 0 1 mo Ppt-Slow 10,000 I 10,000 1 mo i ;.Ppt-Slow 5,000 5,000 1 mo Ppt-Slow 30 2,500 1,000 , 1,000 1 j 1 mo Ppt-Slow 30 I 250 250 0 i 1 mo i (054) t i ! Sales COD 1 mo (055) i Sales COD 1 mo (056) 2501 i 250 250 AAA, .„.Unsatisfactory. 12/13 i Ppt-Slow 30 1,000 ' 1,000 100 I. 1.mo Ppt-Slow 90 2;500 0 0 2-3 mos 11/13 Ppt-Slow 120 40,000 I 20,000 ! 10,000 N30 1 mo 10/13 . Ppt 5,000 I 1 1 mo• . Ppt i 2,500 I 0 i 0 . N30 6-12 mos Ppt 2,500 i. mo Ppt 250 0! 0 I N30 6-12 mos ' Ppt-SIow:30 1 100 , 0 1 0 ! 6-12 mos 08/13 Ppt 1 50 1 • 1 mo 07/13 Ppt 100 I 0 ' 1 mo Ppt •. 50 , ; 1 mo Ppt 1 SO f 1 I ; 1 mo 06/13 1 Ppt 1,000 0 0 ; N30 6-12 mos 04/13 I Ppt 2,500 1 1 1 mo ; Ppt 2,500 4 i 1 mo Ppt 2,500 , 7 1 mo • Ppt 1,000 i 1 mo s 'Ppt 250E 0 f 0 N30 6-12 mos 02/13 , Ppt . 100 i 0 0 ' � 6-12 mos 12/12 Ppt 250 I 01 0 N30 6-12 mos 10/12 ;Ppt 100 I 0 1 0 ! 6-12 mos 07/12 i Ppt I 1,000 , 0 i 0 , 4-5 mos Ppt , 2501 0 0_. 6-12 mos 06/12 ; Ppt-Slow 30 60,000 10,000.1 10,000 1 mo Payment experiences reflect how bills are met in relation to the terms granted. In some instances payment beyond terms can be the result of disputes over merchandise,skipped invoices etc. I Each experience shown is from a.separate supplier, Updated trade experiences replace those previously reported. PAYMENT TRENDS https://supplierportal.dnb.cornlwebapp/wcs/stores/servlet/SQRReportDisplay?reportForrna... 3/13/2014 a a A • SUPPLIER VERSUS INDUSTRY PAYDEX -> PRIOR 4 QTRS CURRENT 12 MONTH TREND 2012 --- --- 20 Z3 --- —� --- .—_`- 7--- --- —' t 2014 i f 1 F 1 i I 4 I JUN SEP DEC j MAR l APR MAY:JUN;JUL AUG SEPI OCT! NOV' DEC JAN j FEB : MAR Supplier; 66 167 •• 68 168 f 68 I` 68 # 68 68 69 69 1 69 71 j 71 73 173 . 73 PAYDEX i i € , • Industry PAYDEX(Based on 40 establishments in SIC 8062) UP QRT• 75 75 : 74 . 75 l } 75 ; 1 '' 75 { : 75 MEDIAN 70 70 70 70 i 70 i i i 70 E ! 70 I I LO QRT 64 64 64 64 , 64 { ' 64 ; 65 PAYDEX scores are updated daily and are based on upto 13 months of trade experiences from the Dun& Bradstreet trade file. All amounts displayed within this report are in local currency. FINANCE 09/25/2013 Accountant: DELOITTE TAX LLP, TAMPA, FL. I On SEP 25 2013 Alicia Padron, Exec Sec, declined financial statement. PUBLIC FILINGS The following Public Filing data is for information purposes only and is not the official record. Certified copies can only be obtained from the official source. SUITS Suit amount: $42,573 Status: Pending DOCKET NO.: A1304828 Plaintiff: NORTH SIDE BANK AND TRUST CO Defendant: MOUNT SINAI MEDICAL CENTER OF FLORIDA INC Where filed: HAMILTON COUNTY COMMON PLEAS COURT, CINCINNATI, OH Date status attained: 07/10/2013 Date filed: 07/10/2013 Latest Info Received: 07/17/2013 If it is Indicated that there are defendants other than the report subject, the lawsuit may be an action to clear title to property and does not necessarily imply a claim for money against the subject. UCC FILINGS Collateral: Inventory including proceeds and products -Account(s) including proceeds and products - Machinery including proceeds and products - Contract rights including proceeds and products - and OTHERS Type: Original Sec. party: FLORIDA HOUSING FINANCE CORPORATION,TALLAHASSEE, FL Debtor: MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. Filing number: 200901599555 Filed with: SECRETARY OF STATE/UCC DIVISION, TALLAHASSEE, FL https://supplierportal.dnb.com/webapp/wcs/stores/servlet/S QRReportDisplay?reportForma... 3/13/2014 w wJ.I v.—r✓aa�•a y+.wYa.a va �.\V�J Va�. a•�y Va• Vaa.J a.A a.Ai/AIAV•�L \/IJ►+aLi� VA 1 1J VJSLJI♦��♦... 1 tAL/ / Vi Z V Date filed: 11/30/2009 Latest Info Received: 12/10/2009 Collateral: Leased Inventory and proceeds-Account(s) and proceeds- Leased Assets and proceeds -General intangibles(s) and proceeds- and OTHERS Type: Original Sec. party: CORPORATION SERVICE COMPANY, AS REPRESENTATIVE, SPRINGFIELD, IL Debtor: MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. Filing number: 201308205692 Filed with: SECRETARY OF STATE/UCC DIVISION, TALLAHASSEE, FL Date filed: 01/07/2013 Latest Info Received: 01/17/2013 Type: Termination Sec.party: CORPORATION SERVICE COMPANY, AS REPRESENTATIVE, SPRINGFIELD, IL Debtor: MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. Filing number: 201308631888 Filed with: SECRETARY OF STATE/UCC DIVISION,TALLAHASSEE, FL Date filed: 03/13/2013 • Latest Info Received: 03/15/2013 Original UCC filed date: 01/07/2013 Original filing no.: 201308205692 Collateral: Leased Inventory and proceeds Type: Original Sec. party: CISCO SYSTEMS CAPITAL CORPORATION, SAN JOSE, CA Debtor: MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. Filing number: 201206991486 Filed with: SECRETARY OF STATE/UCC DIVISION, TALLAHASSEE, FL Date filed: 06/22/2012 Latest Info Received: 07/03/2012 Collateral: Leased Inventory and proceeds - Chattel paper and proceeds Type: Original Sec. party: CISCO SYSTEMS CAPITAL CORPORATION, SAN JOSE, CO Debtor: MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. Filing number: 201104848269 Filed with: SECRETARY OF STATE/UCC DIVISION,TALLAHASSEE, FL Date filed: 06/27/2011 Latest Info Received: 07/06/2011 There are additional UCC's in D&B's file on this company available by contacting 1-800-234-3867. The public record Items contained in this report may have been paid, terminated, vacated or released prior to the date this report was printed. GOVERNMENT ACTIVITY Activity summary Borrower(Dir/Guar): NO Administrative debt: NO Contractor: NO Grantee: YES Party excluded from federal program(s): NO Congressional District: 24 The details provided in the Government Activity section are as reported to Dun & Bradstreet by the federal government and other sources. https://supplierportal.dnb.comlwebapp/wcs/stores/servlet/SQRReportDisplay?reportForma... 3/13/2014 A l t 1 - V Copyright 2014 Dun & Bradstreet-Provided under contract for the exclusive use of subscriber 100150009 1 https://supplierportal.dnb.com/webapp/wcs/stores/servl et/SQRReportDi spl ay?reportForma... 3/13/2014 Help j Home .:a i �`'f? Dun & Bradstreet Government Solutions Contractor Management Portal Step 3 of 3 View Registration Status 1 Find Your Company D&B Supplier Certification Receipt 2 Provide Payment 1 Date Time Company D-U-N-S Product Cost Information _ 03- 09:36:54 MOUNT 046025144 Supplier Sub $91.95 13- SINAI Portal Total 3 View Registration Status 2014 MEDICAL Registration CENTER Product- OF Yearly FLORIDA, INC. Tax $0.00 Total Cost S91.95 For further information or clarification Please contact our Customer Resource Group by clicking on the Customer Support link at the bottom of the page. Print Back To progress through the portal, Powered By Support Privacy Policy Help use the available navigation y buttons.Do not use the back or forward buttons on your browser window • https://suppli erp ortai.dnb.com/webapp/wcs/stores/s ervlet/SpRegistrati onReceiptV iew?1 ang... 3/13/2014 its .:. w-. <► (f"� }^ r • 24 !! r 3' ak5r •o`+ .�- 3 .� 1 • °ro-0 ''* : .: :Y fir, .. 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Y,�F'C? °r k Y4�f^ _ Js xa`"gva�1� . „ s s� o f '—" st 2 2; $ee °o f k litiii� 41g...''ry � t^v~_1 c F1z a �szl^�'�`' s y L).; k�r 110` -,,, ::44, f s 1; s r Eye f;Sh' � .q -al�At G`S'w.. �4' 4 �` k p jam.k5 '_ Y. �'�aVF 1¢j <X � A 6£FR F .J f1 5 k 1y. J 3 ' N�3�FS,K}iY } nc � ,,;;55 Y mow 5' Y zF�?CF�m y ;'s :. k _ , tf 3�' n (. � ,aey�' Y I y � �F_. '�;of � --F :F'3'?,YdY�'GV., ! y y`f 'S G FYy """ i ij5 rs 0 o7 ui rri • 0 -n V., !Pt 0 0 • • • • • •° eat. Mount Sinai M E D I C A L C E N T E R SCOPE OF SERVICE A. GENERAL The Occupational Health Center will perform and review laboratory tests, x-rays, and other diagnostic tests as well as evaluate medical reports from other healthcare providers making appropriate recommendations as needed. Additionally, the Occupational Health Center will review special medical problems such as but not limited to contagious disease cases, return from sick leave evaluations, on-duty injuries, disability, and other medical issues as required and will provide reports and medical opinions when applicable. Other services will include counseling City employees and job applicants about personal medical conditions and providing referrals for appropriate follow-up care when necessary. The Occupational Health Center will supply the City with a Project Manager/primary contact, who will be assigned to address all questions and concerns of the City. The Project Manager will be available for pre-employment issues during business hours, Monday through Friday, 8:00 A.M. through 5:00 P.M. Additionally, the Program Coordinator, will act as the secondary contact person in case the Project Manager is unavailable. All staff providing services under this contract will be properly informed and trained on procedures, forms, changes, and requirements. Any special instructions will be communicated to all staff. The Occupational Health Center will evaluate all results and will report it to the City of Miami Beach, Human Resources Department within forty-eight (48) hours from the time the applicant or employee is first seen. All services will be available (7) days a week, twenty-four (24) hours a day. Actual service hours are open to negotiation. The Occupational Health Center will ensure the City of Miami Beach has the ability to schedule same day or next day appointments for all necessary services. 11 The Occupational Health Center will provide convenient parking adjacent to the Lowenstein Building at no cost to applicants, employees, and the City for individuals receiving services. The Occupational Health Center with the assistance of the City's Information Technology Department will develop up and utilize an electronic mail system compatible with the City. If requested by the City, all reports and other necessary communication will be distributed through this system. The Occupational Health Center will utilize City forms where required. We will review our own forms with the City, and allow for changes as needed. The Occupational Health Center will ensure that instructions, changes, and transfers of information and documents will be limited to those individuals designated by the City of Miami Beach Human Resources Director. The Occupational Health Center will provide immediate notification of"no-shows" or any problems with an individual's cooperation or compliance to designated City staff. The Occupational Health Center will give applicants deadlines for follow-up as determined by the City's policy. Individuals referred to the Occupational Health Center for reasonable suspicion or post- accident alcohol and/or drug testing will not have a waiting time that exceeds thirty (30) minutes. The Occupational Health Center will ensure the confidentiality of all records, information, and correspondence; verbal, electronic and written. The Occupational Health Center will offer applicants and employees locked, secure boxes for private articles and police weapons. The Occupational Health Center will submit a quarterly utilization summary report to the City. B. COMPREHENSIVE PHYSICAL EXAMINATIONS AND DRUG TESTING FOR PRE- EMPLOYMENT AND PROMOTIONS The Occupational Health Center based on the physical requirements of the job description provided by the City, will conduct physical examinations and drug/alcohol testing, as required for pre-employment applicants and promotional employees. The Occupational Health Center will report results of the applicant's physical examination to the Human Resources Director's designee within forty-eight (48) hours from the time the applicants are first seen for results of their tuberculosis PPD test. 12 The Occupational Health Center will permit at least ten (10) appointments per day and provide capacity for up to twenty (20) appointments per day with three (3) days advance notice from the City. Occupational Health Center is flexible of all scheduling that is required by the City of Miami Beach. The Occupational Health Center will provide the City of Miami Beach with the ability to schedule same day or next day appointments for pre-employment examinations. The Occupational Health Center Medical Doctor will read Tuberculosis tests. Positive results will be read by a Medical Doctor and will not be referred to the Department of Health or other facility unless agreed to in writing by the City. In any case, there will be no additional charge to the applicant for this service. The Occupational Health Center will provide Police Officer and Firefighter applicant physical examinations which will include tests for evidence of heart disease, AIDS or HIV, Hepatitis, Pulmonary Tuberculosis, or Meningococcal Meningitis. C. MEDICAL RECORDS - The Occupational Health Center will maintain health files for all City employees and applicants seen at its facilities. These files will include medical records related to City employees regarding injuries and accidents in accordance with all state and federal laws. Upon request by the City of Miami Beach Human Resources Director or their designee, we will provide medical records within twenty-four (24) hours of request. Medical records may only be released to the City of Miami Beach Human Resources Director, Risk Management Director, or their designees. All requests and designee assignments must be made and accepted in writing only (e-mail is acceptable). Upon awarding of the contract we will obtain all records from the current provider and will maintain those records provided. If this contract is awarded to another provider, all open medical and other records related to this contract will be delivered to the new provider within thirty (30) days of the expiration of the current provider's contract. The selected provider, if different from the current provider, will give copies of closed records within twenty-four hours of the request. D. PSYCHIATRIC SERVICES The Occupational Health Center upon request will be available to attend staff conferences, conduct on-site training, observe new police officers and firefighters or evaluate employees referred by the City and provide expert opinions, recommendations and reports related to the employee's psychological evaluations. 13 The Occupational Health Center, upon request, will be available to review and research psychological factors relating to personnel especially public safety. The Occupational Health Center, upon request, will be available to conduct stress- reduction meetings with spouses of Police personnel and other employees referred by the City. E. IMMUNIZATION PROGRAM The Occupational Health Center will administer an intradermal test for Tuberculosis exposure on all applicants. A chest x-ray may be done in lieu of an intradermal test for Tuberculosis. The Occupational Health Center will administer a Tetanus Toxoid Booster Immunization for Police Officers, Firefighters, Waste Collectors and Parks personnel. This may include other occupations depending on the job description or speculation and individual circumstances. The Occupational Health Center will administer Hepatitis B vaccine for those City employees with a potential risk exposure to infected blood or body fluids, as determined by the City. The Occupational Health Center will administer other vaccines that may be required such as measles, mumps and rubella vaccine, and any and additional vaccines, as required by local, state, or federal requirements, or by industry recommendations or guidelines or best practices. The Occupational Health Center will administer and make available, anti-viral medication against the AIDS virus for emergency responders according to current federal guidelines. These medications will be given within two hours of a significant exposure. The City's employees will have access to the administration of anti-viral medication on a twenty-four(24) hour basis. The Occupational Health Center will administer HIV/AIDS baseline tests to sworn Fire Department employees and perform other tests requested by the City to comply with future union contracts. 14 F. DRUG &ALCOHOL TEST PROGRAM The Occupational Health Center will conduct a Drug and Alcohol Test Program as required by local, state and federal law and regulations. The Occupational Health Center will staff a certified Substance Abuse Professional (SAP), Breath Alcohol Technician (BAT), Drug Screening Technician and Medical Review Officer (MRO) as defined by the U.S. Department of Transportation (DOT), Title 49 Code of Federal Regulations (CFR), and Part 40. The Occupational Health Center will conduct pre-employment drug and alcohol testing on all applicants, as well as conduct promotional drug and alcohol testing to all safety sensitive applicants before they actually perform safety sensitive functions for the first time. The Occupational Health Center will test annually approximately 350 Fraternal Order of Police, Williams Nichols Lodge, No.8 (FOP) employees, 60 Government Supervisors Association of Florida/OPEIU, Local 100 (GSA) employees, 440 American Federation of State, County and Municipal Employees, Local 1554 (AFSCME), and 190 International Association of Firefighters, Local 1510 (IAFF) bargaining unit employees, on an annual basis as well as conduct other random, unannounced or reasonable suspicion drug and/or alcohol testing as may be specified by the City. The Occupational Health Center will also test safety sensitive employees who drive vehicles that require Commercial Driver Licenses in accordance with Title 49 CFR, Part 40. The Occupational Health Center will conduct all alcohol and drug tests in compliance with procedures outlined out in 49 CFR, Part 40. The Occupational Health Center will also conduct random or unannounced drug and alcohol drug testing for all other City employees according to, the procedures set forth in Title 49 CFR, Part 40. The Occupational Health Center will conduct post-accident drug and alcohol drug testing as determined by the City. Mount Sinai Medical Center Emergency Department will be available twenty-four (24) hours a day, seven (7) days a week to conduct these tests. The Occupational Health Center will conduct testing on employees when the City observes behavior or appearance that is characteristic of drug use or abuse or alcohol use or misuse. The Occupational Health Center will conduct return-to-duty and follow-up drug and alcohol testing for employees who violate the City's drug free workplace standards at intervals determined solely by the City. 15 The Occupational Health Center will provide drug and alcohol testing services with licensed and certified personnel and laboratories as required by local, state, and federal law. Drug and Alcohol testing services will be overseen by the Medical Review Officer (MRO). The Occupational Health Center will conduct annual training for designated City employees on the Drug Free Workplace Act, including training on signs and symptoms of drug and/or alcohol abuse, if requested by the City. The Occupational Health Center will ensure proper and documented chain of custody during and after sample collection and testing. The Occupational Health Center will provide appropriately private facilities to conduct these tests, including locked, secured boxes for private articles and police weapons. G. FITNESS FOR DUTY EVALUATIONS Occup ational Health Center will evaluate employees' ability to continue employment in their current capacity and to assess and recommend reasonable accommodation for which they may be qualified. This may include a physical examination, return to work evaluation, psychological and/or psychiatric evaluation, and/or any reports to be completed as requested by the City for fitness for duty. The Occupational Health Center will complete evaluations within two (2) working days of the request and on the same day in case of an emergency. A status report and recommendations will be forwarded to the City within twenty-four (24) hours of the appointment or receipt of test results. The Occupational Health Center shall assist the City in the evaluation and verification of Family Medical Leave requests as needed. H. PERFORMANCE CRITERIA AND EVALUATION, The Occupational Health will meet with the City periodically each month to evaluate our performance based on the scope of services and feedback from employees, applicants and customer satisfaction by the Human Resources Department. The criteria to be rated will include, but is not limited to, responsiveness to the Cit4y's needs for pre- employment, drug and alcohol screening, fitness for duty determinations, communication on all required results, and designated contact availability. The criteria to be rated may change based upon the needs of the City. The Occupational Health Center will make all efforts to remediate any services the City finds to have less than 80% compliance with any one item within the scope of services 16 • over a thirty (30) day period. The City may utilize a fifteen (15.) day notice to correct such default. I. COMMUNICATION The Occupational Health Center will set up and utilize an electronic mail system compatible with the City's. All reports and other necessary communication will be utilized through this system. Any and all costs associated with the set up will be borne by Occupational Health Center. The Occupational Health Center will have qualified personnel available during all business hours to provide all services as outlined, including final physician sign-off for pre-employment examinations. All test results under the Scope of Services and the agreement will be communicated only to the Human Resources Director, or his/her designees. 17 •.;._.:.,.i.g <.l, »:.<<� c�.:.a<laY?_��:�.Y'��X s��F, aaa:;?r;.>.-.::;",.�:.r>..�:a a,s`�.4a,>-a�.".,.a."�.-.:_.<,....u.e-y��a°?y�r�,>.a�s.:-..,,.---:.:b:,'3q.•=.,,u"t!R.." .r:.-•r,,..n'-,�.:+_:-... e g rx • .,z "~x ��: ° `,`"�,t.: , <s,m:�x � :. - - ,': � ,«xr i >'.z .- '� ? � ,i - ^ .„ , may c ' _�4, ”.� ' _ a k��ss.a:. ; ` ^> • , .�° F".»�,s,...x".. a 3"'.•,i-x,,,k.,ss"'�'4. k 4-ys..a. xl,# .. > °* :� , ?�a n_ a R _•€�`e .<-._w x, : x c>&�; /�P''b.Y,i c'»� ?r-..<?k; z1...- �z>,.a sv\ \ a* aS` _7 r o . F: a Y.. Yr i mss_n __a� s.w'b h�f ^\ �nt ? .naHv ' u reas 4 \ '1_� °iZ „ *.m : ♦1\ , •• • S, v�F. F`z<�7>r�s�:ee :C•:.t :^'G $53 �”».:s ,�,xa < te .y. .t s a x s �� o,F dR7�„ . ,i ?v.<...-- -�r.-s e ' . 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'.c.,>� -. . .s- ._`` �a ri-:>:.�c � --». � &� -.,�! w :aa•.,-5 •tr x.�r” :>. «za a. ,: y F: fi. �F4a.. � s. .„. , fe£�i f ,�\ � @ � �3 .M ? . kM F 3g A t tR N • rya to e ��a k�efr >F a al>. »\ pw"5 `'f'�,pYYm�ga �o � am s s �a . � `h�'▪ s ,a ': '\x <ilr .ms Z a,- sr Z .£ b/ ps g k •• s a : M 3t�z z�s te t .� 4, 'iu Y// k-i3 x �Y /aY V • :a� { \: 6 � T R I r � \" • :.,,,,,,...?„:„.„:_,,,,,,,,,,,.:,,. •.......„:„.„..„,,„:„,,,,...,t,-,..t.,,,,,e.,,,,c,F.iii,,,,,,,,„,,,,.:,,., .......4„..„,sur„,,,,,,,,..,,,,..„..a,.i. -' '. is 1J- °R Y 3 R :y i y METHIDOLOGY. c.H. .. ‘,41,,,,‘ „.... _...,s , , _.,;,,,,..,,,,„.,,,,„..„4„,„:..,.,....... ..„,,,,..„:„....,:\:,,,,..,....„,::-'44:401.elal .1:4:N:...latiki*A%V-47— :,,' ,'''..:7.01,4:',',',,,...--.'''"'t,-WfaltRek.itS.A.A:':::::,...3. .... .,..,„„.„,:,,,,,,*„.„:_„:„,„.„., :,. ,,......,: _ .----ettatax'..,:,:akgmbeaszil ..:,,,,,a;m4, 'NeNti*-.11.4,1414'11:*I• till=e111:01.11e11111 m E I 11 .. .., .. • ' ea i f t nE £;, S S 3 �a y. • l': k 5', sn:s \ f ...All Y F3" y� { 4f . . i'.,..--.,-..-...."''...''''•-•: ntY 3 F.y' �. i�x� ¢Y l a t >: _ _ 4 { F } z i R�C F 3 �/ F -▪� F La z 7 A 1 15114451.so t 4� » a • r k F�2 `s<'i S S cat t l A> >z 4 ^F 1', r 1 §k\« � \ C 3«\ • • • • • | \ \ \ \ \ \ : � . , . . .. > • « 0 ©°e\ \\ ^ z • \ } . • , - • \/ \ 0 • 0 • %}»\ • • • • • • • • • \� f} } \ • . 2yS ,s z§ Mount Sinai M E D I C A L C E N T E R Approach and Methodology Mount Sinai Medical Center is located at 4300 Alton Road Miami Beach, Florida 33140.The Occupational Health Department at Mount Sinai is located on the first floor of the Lowenstein Building with adjacent free parking spaces for the City of Miami employees. The Occupational Health Department has approximately 8,000 sq. ft. dedicated to the waiting area that is designed to hold a maximum capacity of 60 persons at one given time. Hours of operation are Monday through Friday, 7:00 am to 5:00 p.m. (Hours are flexible). The designated area is comprised of • 4 Diagnostic exam rooms: Vision, Pulmonary, Hearing and EKG testing • 3 Physical Examination rooms • 1 Laboratory • 1 Drug And Alcohol Testing area The following equipment is used to perform services: • Audiology testing booths that meet OSHA standards with testing capabilities from 500 to 8000 Hz • Visual Screening instruments for visual acuity, muscle balance(horizontal and vertical phoria),depth perception,color perception,and binocular vision • 14 and 24 plate Ishihara and 15D-Farnsworth tests for color deficiency • Diagnostic Spirometry Testing using a Fleisch-Type Pneumotachometer with computer graphics and interpretation. • Handheld non-contact tonometer for glaucoma measurements • 12 Lead EKG machines electronically connected to Board Certified Cardiologists for interpretation. • Complete phlebotomy and comprehensive radiology services on site. • US DOT approved ALCOMonitor for breath alcohol testing The Occupational Health Department has back-up equipment on premises. 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Proposer affirms that the prices stated on the tender form below represents the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, delivery delays,taxes, insurance,cost Indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance. The Cost Proposal Form shall be completed mechanically or, if manually, in ink. Cost Proposal Form completed in pencil shall be deemed non-responsive.All corrections on the Cost Proposal Form shall be initialed. f r to=Se ttgn j,160--FdengtAgropbSaft coi i tc description;p,.the seciri s•includeor cti I1f1' ritern below. 1 Pro-Employment Physicals Each $ $ )011'.o C' a.Police end Fire 80 Each ,4 ct.3s•90 J/' 00! b.General Employees 237 Each 7a-00 .J /z 06 -DO ► 2 Immunization Services 350 Each $ $ ! a.Tetanus Toxoid Booster It 0 Each 41 3 9.0 O b.Hepatitis B Vaccination(complete series of three). 54 Each 130•d1 0 f`t`D20 .00 c.Hepatitis A&s Vaccination(complete series of three). yr Each t• 3X).0 0 � — Q — d.Measles,Mumps and Rubella 0 Each 4 70,00 , —Q — Anti-viral medication for HIV/Aids exposure 3 (minimum 3 day supply). i Each 02 c0.0 o A .290•00 4 Chest X-ray 4 O ae1t. ,$ BID, O O _ 5 PPD Test 560 eaeA $ /0• 0 O 4 5,6 JO•©o 6 EKG 5 Each $ 35.00 $ l 75'• 0 0 7 Fitness for Duty Evaluations Each $ $ goo.60 a.Physical and Drug/Alcohol Screens 7 Each /'5.0© 875.00 b,Psychological/Psychiatric 3 Each MC-0 0 ,5,5,0 0 Random,Reasonable Suspicion,Return to Work,and 8 Post-Accident Drug and Alcohol Screening' 516 Each $ 35•.00 $ I$,O b0.00 9 , Respirator Review and Clearance 3 Each $ loo.oo $ I&O.o0 10 Mobil Unit — V Om CAtQLAG 4 day $ is 75,oo $ 3,5o0•oo 11 Cardiac Stress Test ' 0 & $ c-50.oo 4- D — 12 On-Site Service Tech(Nurse or Physician Assistant) $.0 &A is 6e0.v o —0 t l 13 After Hours Dn g Alcohol Testing Technician 460 4-5.®a , — D 14 After Hours Medical Personnel ® Hour $/50. 00 % 7500.00 TOTAL $ •7 R Sac(.Q o Nam}Esach ¢( 0 RFP 2014127-LR Appandlx E-Page l • Bidder's Affirmation `Company: Nip 14.n - n .fil W j`r X4114,1P Authorized Representative: • Address: 4300 e.. 3.t LtA e 1, eeacl t, Fl 3-/ Telephone: foS 7 Entaih- t-r, in'tit 6) PriS M Authorized Representative's Signatu • Miami Reach RF'2014-1274.R Appendix E—page 2