HomeMy WebLinkAboutExhibit C Price Proposal
Exhibit C
Price Proposal
Mount Sinai
MEDICAL CENTER
PRICE PROPOSAL
Pre-Employment Physical:
Police, Promotional, Lifeguard and other classifications $106.70
Urine Drug Screen
Breathe Alcohol Test
Comprehensive Blood Cell Counts
Comprehensive Blood Chemistries
Comprehensive Lipid (Cholesterol) Panel
Comprehensive Urinalysis
Syphilis Screen (RPR)
Hem cult (40y/o & over)
Visual Exam (Acuity + depth + color + visual fields)
Glaucoma Screen (40y/o & over)
Comprehensive Pulmonary Function Testing
PPD (Tuberculin Skin Test for TB)
OSHA-Compliant Audiometry Screening
Chest X-Ray PA & LAT (if medically indicated)
EKG with Cardiologic Interpretation
Review of Medical History/Physical Examination and Consultation
Firefighter Pre-Employment Physical: $271.20
Urine Drug Screen
Breathe Alcohol Test
Comprehensive Blood Cell Counts
Comprehensive Blood Chemistries
Comprehensive Lipid (Cholesterol) Panel
Comprehensive HIV
Comprehensive Hepatitis B Titer
Comprehensive Hepatitis C Titer
Comprehensive Urinalysis
Syphilis Screen (RPR)
Nasal Swab Culture
Hem cult (40y/o & over)
Visual Exam (Acuity + depth + color + visual fields)
Glaucoma Screen (40y/o & over)
Comprehensive Pulmonary Function Testing
PPD (Tuberculin Skin Test for TB)
OSHA-Compliant Audiometry Screening
Chest X-Ray PA & LAT (if medically indicated)
EKG with Cardiologic Interpretation
Review of Medical History/Physical Examination and Consultation
Page 14
Standard Applicant and other classification Package: $62.00
Urine Drug Screen
Visual Acuity
Hearing Screen/whisper
Review of Medical History/Physical Examination and Consultation
Psychiatric Services:
$175.00
Per Visit
Immunization Services:
Tuberculosis Exposure
Interadermal Test
Chest X-ray
Post Exposure Exam
Tetanus Toxoid Booster Immunization
Hepatits B Vaccine (series of 3)
Measles, Mumps and Rubella Vaccine
Anti Viral Medication (3 day supply)
$ 5.00
$ 25.00
$ 30.00
$ 20.00
$150.00
$ 40.00
$130.00
Drug and Alcohol Test Program
Drug and Alcohol Testing including MRO fee
Substance Abuse Professional Evaluation
$ 35.00
$ 50.00
Fitness for Duty Evaluation
Physician Exam and Drug Screening
$ 90.00
Executive Physical: $ 83.70
Comprehensive Blood Cell Counts
Comprehensive Blood Chemistries
Comprehensive Lipid (Cholesterol) Panel
Comprehensive Urinalysis
Syphilis Screen (RPR)
Hemocult (40y/o & over)
Visual Exam (Acuity + depth + color + visual fields)
Glaucoma Screen (40y/o & over)
Comprehensive Pulmonary Function Testing
PPD (Tuberculin Skin Test for TB)
OSHA-Compliant Audiometry Screening
Chest X-Ray P A & LA T (if medically indicated)
EKG with Cardiologic Interpretation
Review of Medical History/Physical Examination and Consultation
Employee Assistance Program (EAP):
Services Provided by
, $36,720.00
Per Year
Page 15
ADDITIONAL OPTIONAL SERVICES Executive Physical
Stress Test
Mammogram
PSA
CT Coronary Artery Calcification
Colonoscopy
$250.00
$160.00
$ 30.00
$440.00
$980.00
Preferred pricing is available to you for any additional services you may request.
Cap of $250.000.00 (two hundred fifty thousand dollars)
Additional Charges:
On-sight
Protection Outfitting
Page 16
Mount Sinai
MEDICAL CENTER
PROPOSAL DOCUMENTS
Proposer Information
Acknowledgemer,t of Addenda
Declaration
Questionnaire
. Members of Board of Directors (Attachment)
Page 17
. .
PROPOSER INFORMATION
Submitted by:
Linda Arama
Proposer (Entity):
Mount Sinai Medical Center
~
~~
~
Signature:
Name (Typed):
Linda Arama
Address:
4300 Alton Road
City/State:
Miami Beach, Florida 33140
Telephone:
(305) 674-3910
Fax:
(305) 535-7904
It is understood and agreed by Proposer that the City reserves the right to reject
any and all Proposals, to make awards on aU Items or any items according to the
best interest of the Clty~ 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 point during the aforesaid evaluation/selection process until and
unless a contract has been agreed to and signed by both parties.
/If .IIINF. 72. 70m
(Authorized I gnato re) (Date)
Steven D. Sonenreich
(Printed Name)
RFP NO. 24-04/05
DATE: 5/20105
28
CITY OF MIAMI BEACH
ACKNOWLEDGMENT OF ADDENDA
REQUEST FOR PROPOSALS NO. 24-04/05
Directions: Complete Part I or Part II, whichever applies.
Part I: Listed below are the dates of issue for each Addendum received in connection
with this RFP:
Addendum No. 11 Dated JUNE 13 I 2005
Addendum No. 21 Dated
Addendum No.3, Dated
Addendum No.4, Dated
Addendum No. 51 Dated
Part II:
No addendum was received in connection with this RFP.
Verified with Procurement staff
Linda Arama
Name of Staff Member
June 22, 2005
Date
Mount Sinai Medical Center
Proposer - Name
June 22, 2005
Date
~~
Signature
RFP NO. 24-04/05
DATE: 5/20105
29
CITY OF MIAMI BEACH
DeCLARA TION
TO: Jorge M. Gonzalez
City Manager
City of Miami Beach, Florida
day of
JUNE
.2005.
Submitted this 23
The undersigned, as Proposer. dedares that the only persons interested in this
proposal are named herein; that no other person has any interest in this proposal or in
the contract to which this proposal pertains; that this proposal is made without
connection or arrangement with any other person; and that this proposal is in every
respect fair and made in good faith, without collusion or fraud.
The Proposer agrees if this proposal 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 of Miami Beach. Florida, for the performance of all
requirements to which the proposal pertains.
The Proposer states that this proposal is based upon the documents identified by the
following number: RFP No. 24-04/05
~'--~~
SIGNA TURE
Wayne Chutkan
PRINTED NAME
Vice President, Finance
TITLE (IF CORPORATION)
RFP NO. 24-04/05
DATE: 5/20/05
30
CITY OF MIAMI BEACH
QUESTIONNAIRE
Proposer's Name:
Linda Arama
Principal Office Address:
4300 Alton Road
Lowenstein Building, 1st Floor
Miami Beach, FL 33140
Official Representative:
Wayne Chutkan, Vice President of Finance
If a Corporation. answer this:
When Incorporated:
1948
In what State:
Florida
If a Forelan Corporation:
Date of Registration with
Florida Secretary of State:
Name of Resident Agent:
Address of Resident Agent:
President's Name:
Steven D. Sonenreich, President & CEO
Vice-President's Name:
Amy Perry, Vice President & COO
Treasurer's Name:
Alex Mendez, Senior Vice President & CFO
31
CITY OF MIAMI BEACH
RFP NO. 24-04/0S
DA TE: 5120/05
Members of Board of
Directors: See At tached List
If a Partnership:
Date of organization:
General or Limited Partners:
Name and Address of Each Partner:
NAME
ADDRESS
* Designate general partners in a Limited Partnership
I. Number of years of relevant experience in operating similar
business: 1981
2. Have any similar agreements held by Proposer ever been canceled?
Yes III No ( )
If yes, give details on a separate sheet.
Cancelled City of Miami Beach Contract
RFP NO. 24-04/05
DATE: 5/20/05
32
CITY OF MIAMI BEACH
MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC.
BOARD OF TRUSTEES
April 1, 2004 - March 31, 2005
BOARD MEMBER BOARD MEMBER Honorary Physician Trustee
Abess, Leonard L. Jr. Kern, Andrew E. Furlong, James MD
Adler, Bernyce Kline, Arthur J. Kohen, Roland, J. MD
Adler, Michael M. Korman, Bernard J. Nash, Seymour MD
Arkin, L. Jules Kulvin, Stephen M., MD
Barash, A. Jeffrey Lampert, Ira
Bergmann, George Levy, Harry (Hap)
Bergmann, Marla May, Isabel
Bien, Lettie Mendelson, Laurans
Blank, Jerry Multack, William E.
Braman, Norman Muss, Stephen
Broad, Morris Nestor, Brenda
Burstein, Jack Orovitz, Michael D.
Candib, Murray A. Orovitz, W. James
Chaplin, Paul MD Pertnoy, Earl
Chaplin, Wayne Pincus, Rosalie Emeritus:
Cohen, Stanley Poliakoff, Jackie Davidson, Joseph
Cooperman, Sidney Randolph, Carl Giller, Norman M.
Cypen, Irving Richard, Dennis
Robinson, Morton MD
Deutch, David O. Rosenberg, Marshal E. (PhD)
Dickens, Jacoby D. Jr. Rosenbloom, Frederick (MD) Honorary Trustees:
Elias, Richard MD Ruskin, Candace Fletcher, Jackie
Feldman, Robert S. Ruskin, Lloyd L. Olin, Jerry
Fine, Ted Samet, Philip MD
Frehling, Robert Sandler, Martin
Friedland, Joel Scheck, Michael Auxiliary
Frost, Phillip MD Segall, Peter MD Helene Owen
Gelb, Martin J. Shane, Ronald W.(MD) Gloria Martin
Gerson, Gary R. Shapiro, Edward
Gidney, Jeffrey A. Silverman, Barry M.D.
Glottmann, Saul Simon, George
Goldberg, Barton Simon, Sherman
Goldin, Barry Sivina, Manuel MD
Goodman, Jerrold F. Sonenreich, Steven
Gorson, Matthew B. Sparber, Bvron
Gumenick, Randy Steele, Morton
Hildebrandt, Mark H. Stone, Robert A.
Hirschi, Andrew DDS Tate, Stanley
Hollo, Sheila Wien, Leonard, Jr.
Holtz, Abel Williams, Donald MD
Jacobson, Samuel Wittels, S. Howard MD
Kanter, Joseph Wolfson, Louis E.
Kelner, Milton Zelcer I Isaac
Zinn, David
Questionnaire (continued)
3. Has the Proposer or any principals of the applicant organization failed to
qualify as a responsible Bidder, 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:
NO
4. Has the Proposer or any of Its principals ever been declared bankrupt or
reorganized under Chapter 11 or put into receivership? Yes ( ) No <<t
If yes, give date, court Jurisdiction, action taken, and any other explanation
deemed necessary on a separate sheet.
5.
Person or ~rsons Interested In this bid and Qualltlcatlon Form have ( )
have not (111 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 (100/0). (Strike out inappropriate words)
Explain any convictions:
6. Lawsuits (any) pending or completed involving the corporation, partnership
or individuals with more than ten percent (100/0) interest:
A. List all pending lawsuits:
YES
RFP NO. 24-04/05
DATE: 5/20/05
33
CITY OF MIAMI BEACH
B. 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 entitles 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. (Use additional sheet if needed)
Linda Ararna. Director of OccuDational Health Center
Wayne Chutkan, Vice President. Finance
Steven D. Sonenreich, President & CEO
RFP NO. 24-04/05
DATE: 5/20/05
34
CITY OF MIAMI BEACH
The Proposer understands that information contained in this Questionnaire will
be relied upon by the City in awarding the proposed Agreement and such
information is warranted by the Proposer to be true. The undersigned Proposer
agrees to furnish such additional information, prior to acceptance of any
proposal relating to the qualifications of the Proposer, as may be required 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 Miami Beach Police Department. By submitting this
questionnaire the Proposer agrees to cooperate with this investigation, Including
but not necessarily limited to fingerprinting and providing Information for credit
check.
WITNESS:
IF INDIVIDUAL:
Signature
Signature
Print Name
Print Name
WITNESS:
IF PARTNERSHIP:
Print Name of Firm
Signature
Address
Print Name
By:
General Partner
Print Name
Print Name
IF CORPORATION:
MOl(~,r S".l'Ili f rV\-eJ'(f;..V (e,;&.iLfL~.L., ~~.
Print Name of CO?Oration
11<"51-1) flL T~ f,-~~a t'. L 3 ? IV C
'tt )n I 19 -f a. c.. ..>
Address
President
UiJJ
Signature ~ II
'.yr' K.e I., I A
F"l~
By:
(CORPORATE SEAL)
. Attest:
Secretar}
RFP NO. 24-04/05
DATE: 5/20/05
35
CITY OF MIAMI BEACH
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