(SEE ATTACHED FOR CONDITIONS AND INSTRUCTIONS)

Transcription

1 BID FORM MISSOURI DEPARTMENT OF TRANSPORTATION GENERAL SERVICES 830 MoDOT DRIVE P.O. BOX 270 JEFFERSON CITY, MO SEALED BIDS, SUBJECT TO THE ATTACHED CONDITIONS WILL BE RECEIVED AT THIS OFFICE UNTIL REQUEST NO. IFB DATE January 24, 2005 PAGE NO. 1 NO. OF PAGES 20 QUOTATIONS TO BE BASED ON THE RATES AS NOTED ON THE ATTACHED DOCUMENTS 3:00 P.M. Local Time, February 14, 2005 Various Locations Around the State AND THEN PUBLICLY OPENED AND READ FOR FURNISHING THE FOLLOWING SUPPLIES OR SERVICES. SIGN AND RETURN BEFORE TIME SET FOR OPENING. BUYER: FRANKIE J. RYAN BUYER TELEPHONE: SUPPLIES OR SERVICES Missouri Department of Transportation s Pre Employment/Post Offer Physicals See attached Specifications, Pricing Page, Attachment A Seasonal Maintenance Worker/ Maintenance Crew Worker Job Specific Protocols, Attachment B Certificate of Examination, Attachment C MoDOT Health History, Attachment D MoDOT Physical Examination Form, Attachment E Range of Motion Form, and the Standard and Special Terms and conditions. NOTE TO VENDOR The Offeror must be in compliance with the laws regarding conducting business in the Sate of Missouri. The Offeror should review the insurance requirements listed in the attached Terms and Conditions. The Offeror should submit a copy of the insurance certificate issued to the vendor by the insurance provider along with all other documentation required to be submitted as part of this solicitation. No contract work will be requested of a vendor until all documentation, and insurance certificates, have been submitted, verified, and approved by the MHTC or its designee. (SEE ATTACHED FOR CONDITIONS AND INSTRUCTIONS) In compliance with the above invitation for bids, and subject to all conditions thereof, the undersigned Offeror agrees to furnish and deliver any or all the items on which prices were quoted within the time frame specified by MoDOT s designee and agreed to by the Offeror. Date: Telephone No.: Fax No.: Federal I.D. No. Form E 103 (Rev ) Firm Name: Address: By (Signature): Type/Print Name Title:

2 PREFERENCE IN PURCHASING PRODUCTS DATE: The Offerors attention is directed to Section RSMo 2000 which gives preference to Missouri corporations, firms, and individuals when letting contracts or purchasing products. Bids received will be evaluated on the basis of this legislation. All vendors submitting a bid must furnish ALL information requested below. FOR CORPORATIONS: State in which incorporated: FOR OTHERS: State of domicile: FOR ALL VENDORS: List address of Missouri offices or places of business: THIS SECTION MUST BE COMPLETED AND SIGNED: FIRM NAME: ADDRESS: CITY: STATE: ZIP: BY (signature required): Federal Tax I.D. #: if no Federal Tax I.D. # list Social Security #: NOTE: For bid/quotation to be considered, the Preference in Purchasing Products form must be on file in the General Services (Procurement) Division and must be dated in the current calendar year. IFB Page 2 of 20

3 MISSOURI DEPARTMENT OF TRANSPORTATION SPECIFICATIONS Pre Employment / Post Offer Physicals IFB GENERAL The Missouri Highways and Transportation Commission (hereinafter referred to as MHTC) intends to secure contracts with multiple service vendors for Pre Employment / Post Offer Physicals for MHTC job applicants. The original and three (3) copies of your sealed written offer must be received on or before 3:00 p.m., Local Time, February 14, 2005, at the office of: Frankie Ryan Missouri Department of Transportation General Services Procurement 830 MoDOT Drive; P.O. Box 270 Jefferson City, MO All documents must be sealed and should be clearly marked "Offer for Pre Employment/Post Offer Medical Examination Services. MoDOT intends to enter into one (1) year contracts with multiple vendors located throughout the state for preemployment/post offer physical examination services. PRE EMPLOYMENT/POST OFFER PHYSICAL EXAMINATION HISTORY In 1992, the Commission authorized the development of physical standards for nineteen (19) physically demanding job titles. The resulting job specific physical standards were incorporated into nineteen (19) different pre employment/post offer medical examinations. Since then, that number has increased to forty five (45) different job specific physical standards. Applicants are given a conditional offer of employment pending the passing of their job specific medical examination. GENERAL REQUIREMENTS The contractor shall provide all health care professionals, services, equipment and supplies for the purpose of providing pre employment/post offer medical evaluations based on MoDOT job specific protocols. Please refer to Attachment A Seasonal Maintenance Worker/Maintenance Crew Worker Job Specific Protocols as an example of MoDOT s job specific protocols. The contractor shall coordinate its services with MoDOT's Office of Risk Management. The contractor must cooperate in periodic and/or random audits which may be required and authorized by MoDOT, the State Auditor's Office, or any other party authorized by MoDOT. The contractor will be given reasonable notification (at least one week before the audit). The contractor shall participate in audits at no additional charge to MoDOT. The contractor shall agree and understand that MoDOT intends to utilize the contractor s services for preemployment/post offer physical examinations based on the geographic location of the job applicant s home address. Please see the section below titled Contract Award and Use of Contracted Services for additional information. IFB Page 3 of 20

4 The contractor must monitor the quality of service provided through the contractor s location(s) and must take necessary steps to ensure that only MoDOT approved services are being performed by the contractor. All contractors must agree to follow established guidelines and procedures and use customized forms, as developed by MoDOT. Such guidelines and procedures shall include, but not be limited to: o o o o Offer specified hours of availability for physical exams and medical evaluations. Provide services within three (3) working days of MoDOT s request. Provide uniform reporting of pre employment/post offer results. These include, but may not be limited to, Attachment B "Certificate of Examination"; Attachment C "MoDOT Health History", Attachment D "MoDOT Physical Examination", Attachment E Range of Motion Form and all other medical documentation associated with the physical examination, e.g.: lab tests, hearing tests, pulmonary function, etc. Provide any other form of communication as deemed beneficial by MoDOT in order to perform services outlined in this solicitation. All providers should be either board certified/board eligible or have at least 3 years of experience in occupational medicine. The contractor shall not use or disclose, at any time during or after the termination of this contract, any information discovered or developed without the express written consent of MoDOT. Any and all reports related to this contract shall be submitted to MoDOT through the Central Office Risk Management Division and the District Human Resources Managers. In addition, Attachment B "Certificate of Examination" shall be faxed to the appropriate District or the Central Office Human Resources Division. SPECIAL REQUIREMENTS The contractor must provide pre employment/post offer physical examinations to MoDOT applicant s on an as needed basis. See Attachment D MoDOT Physical Examination for an example of the document to be used to record the examination. All contractors must also be able to provide drug collection in accordance with Department of Health and Human Services (DHHS) guidelines for Federal Department of Transportation (DOT) required pre employment/post offer testing. The contractor shall provide the physical examination services for MoDOT s job applicants who are located in various regional areas of the State of Missouri. Please refer to Attachment A Seasonal Maintenance Worker/Maintenance Crew Worker Job Specific Protocols, Attachment B "Certificate of Examination" and Attachment C "MoDOT Health History, for information regarding the services to be provided by the contractor. CONFIDENTIALITY The Contractor shall not disclose to third parties confidential factual matters provided by MHTC s representative except as may be required by statute, ordinance, or order of court, or as authorized by MHTC s representative. The Contractor shall notify MHTC immediately of any request for such information. PAYMENTS Payment will be made on the basis of the firm, fixed, discounted prices submitted by the vendor for the services performed. CONTRACT PERIOD The contract period is anticipated to begin after February 14, 2005 and end November 30, MoDOT shall have the right, at its sole option, to renew the contract for one (1) additional one year period, or any portion thereof. In the event MoDOT exercises such right, all terms and conditions, requirements and specifications of the contract shall remain the same and apply during the renewal period. CONTRACT PRICE & INVOICES All prices shall be firm and fixed. The Department shall not pay nor be liable for any other additional costs including but not limited to insurance, interest, penalties, termination payments, attorney fees, etc. IFB Page 4 of 20

5 The contractor shall not invoice federal excise tax unless otherwise required under federal law or regulation. The contractor will invoice no more than two (2) times monthly for those services provided to MoDOT. Payment for all supplies and/or services required herein shall be made in arrears. DOCUMENT SUBMITTALS In addition to pricing, the offeror shall supply the following information: 1. Experience. The bid must clearly identify the Offeror s experience in offering the services requested in this IFB during the past twelve (12) months. The description should include a list of the agencies (not individual patients) which your company has served or currently serves. 2. Personnel and Service Hours: a. Please indicate the name, location, telephone number, fax number and address of the primary contact person for the Offeror. b. Please indicate the name(s) of all personnel who will deliver contracted physical examination services. i. Offeror should include copies of current certifications for Federal DOT specimen collection, Breath Alcohol Technician Certification, Missouri Medical Licensure, Audiometric Technician Certification of the use of an audiogram for hearing tests, etc., for all employees who will conduct contracted physical examination services. ii. Offeror should include copies of board certified/eligible certification documents or submit documents that indicate that your firm has at least three (3) years of experience in occupational medicine. iii. Offeror should submit documentation outlining specified hours of availability for physical exams and medical evaluations. iv. Offeror should provide documentation outlining Offeror s ability to do drug collection in accordance with Department of Health and Human Services (DHHS) guidelines for Federal Department of Transportation (DOT) required pre employment/post offer testing. 3. References. Offerors should indicate the name, title and telephone number of at least two (2) business clients (not patients) within the past twelve (12) months. CONTRACT AWARD AND USE OF CONTRACTED SERVICES Contract awards will be based on the vendor meeting the business and licensing criteria published as a part of this solicitation. However, the right is reserved to reject any and all pricing submittals or award the contracts based on the best interest of the Department. Any award of this bid does not constitute final acceptance of all submitted documents by the MHTC. The MHTC reserves the right to reissue this solicitation at any time throughout the contract period in order to obtain the services of additional pre employment/post offer service vendors located around the state. The MHTC does not guarantee that award of a contract to the vendor will result in MHTC using the services provided by the vendor. Use of vendor services will be determined by the geographical proximity of the job applicant s home address to the vendor s business location, as follows: 1. The vendor with a business site closest to the applicant s home address will receive the purchase order to provide the contracted services. If the vendor cannot provide the listed services within the time period specified by the MHTC, the vendor with the next closest geographic proximity to the applicant s home address will receive the purchase order. This selection process will continue until an available service vendor is located. 2. If there are two (2) or more vendors within a 10 mile radius of the applicant s home address, the decision on which vendor will be chosen to provide the contracted services will reside with the MHTC s program designee. IFB Page 5 of 20

6 PRICING PAGE IFB Page 1 of 1 The offeror shall provide firm, fixed, discounted *prices in the table below for the original contract in accordance with the provisions and requirements stated elsewhere herein. * Please indicate the Current Procedural Terminology (CPT) code you will be using to bill for each component of the physical. Component CPT Code* Firm, Fixed, Discounted Price Health History Physical Snellen Vision Test including testing for color blindness. Audiometric Testing Sense of Smell Test Blood Lead Testing with Zinc Protoporphyrin Chest x ray EKG Pulmonary Function Urinalysis (dip test) Range of Motion Testing Work Simulation (based on 1 hour time requirement) Total Cholesterol/ HDL Stress EKG DOT drug specimen collection (urine) Non DOT drug specimen collection (urine) Respirator Fit Test NOTE ON POSSIBLE EXTENSION OF CONTRACT PRICING: Should the annual issuance of the CPT schedule be delayed, in either publishing or distribution, the prices stated herein shall be used for any extensions of contracted services until such time the annual CPT schedule becomes available for use. At that time, the contractor will be notified to submit pricing for services for the next contract period, as well as any other documentation requested by MoDOT. Depending on circumstances, MoDOT will attempt to limit the contract extension to no more than two (2) months. THIS SECTION SHOULD BE COMPLETED AND SIGNED: FIRM NAME: ADDRESS: CITY: STATE: ZIP: BY (printed name): (signature): IFB Page 6 of 20

7 Missouri Highways and Transportation Commission Standard Bid Provisions, General Terms and Conditions and Special Terms and Conditions Accepted: 9/29/03; Updated: 11/05/04 IFB Page 7 of 20 STANDARD SOLICITATION PROVISIONS a. The Missouri Department of Transportation (MoDOT) reserves the right to reject any or all bids/quotes/proposals, and to accept or reject any items thereon, and to waive technicalities. In case of error in the extension of prices in the bid/quote/proposal, unit prices will govern. b. All bids/quotes/proposals must be signed with the firm name and by a responsible officer or employee. Obligations assumed by such signature must be fulfilled. c. By virtue of statutory authority, a preference will be given to materials, products, supplies, provisions and all other articles produced, manufactured, made or grown, within the State of Missouri. d. Time of delivery is a part of the consideration and, if not otherwise stated in the solicitation documents, must be stated in definite terms by the Bidder/Offeror and must be adhered to. If time varies on different items, the Bidder/Offeror shall so state. e. If providing bids/quotes/proposals for commodities, the Bidder/Offeror will state brand or make on each item. If bidding or proposing other than the make, model or brand specified, the manufacturer's name, model number or catalog number must be given. f. For bids/proposals of $25,000 or more, no bids/proposals by telephone, telegram or telefax will be accepted. If provided, these bids/proposals should be returned in the MoDOT solicitation return envelope. g. If a solicitation return envelope is provided by MoDOT, the bid/quote/proposal should be returned in the envelope provided with the Bid/RFQ/RFP Request Number plainly indicated thereon. h. The date specified for the returning of bids/quotes/proposals is a firm deadline and all bids/quotes/proposals must be received at the designated office by that time. The Department does not recognize the U.S. Mail, Railway Express Agency, Air Express, or any other organization, as its agent for purposes of accepting proposals. All proposals arriving at the designated office after the deadline specified will be rejected. General Performance Deliveries GENERAL TERMS AND CONDITIONS a. This work is to be performed under the general supervision and direction of the Missouri Department of Transportation (MoDOT) and, if awarded any portion of the work, the Contractor agrees to furnish at his own expense all labor and equipment required to complete the work, it being expressly understood that this solicitation is for completed work based upon the price(s) specified and is not a solicitation for rental of equipment or employment of labor by MoDOT, and MoDOT is to have no direction or control over the employees used by the Contractor in performance of the work. a. Unless otherwise specified on the solicitation documents or purchase order, suppliers shall give at least 24 hours advance notice of each delivery,. Delivery will only be received between the hours of 8:00 a.m. to 3:00 p.m., Monday through Friday. Material arriving after 3:00 p.m. will not be unloaded until the following workday. No material will be received on Saturday, Sunday or state holidays. b. If the prices bid herein include the delivery cost of the material, the Contractor agrees to pay all transportation charges on the material as FOB Destination. Freight costs must be included in the unit price bid and not listed as a separate line item. c. Any demurrage is to be paid by the Contractor direct to the railroad or carrier. Nondiscrimination a. The Bidder/Offeror understands that this project involves state funds and the Bidder/Offeror awarded the contract will be required to comply with the Executive Order of the Governor of the State of Missouri dated January 14, This order stipulates that there shall be no discriminatory employment practices by the Contractor or his subcontractors, if any, based on race, sex, religion, national origin, age, color, disability, or veteran status. The undersigned Contractor or his subcontractors, if any, shall give written notice of their commitments under this clause to any labor union with which they have bargaining or other agreements. b. The Contractor shall comply with the Regulations relative to nondiscrimination in federally assisted programs of the Department of Transportation, Title 49, Code of Federal Regulations, Part 21, as they may be amended from time to time, (hereinafter referred to as the Regulations), which are herein incorporated by reference and made a part of this contract. c. All solicitations either by competitive bidding or negotiation made by the Contractor for work to be performed under a subcontract, including procurements of materials or leases of the Contractor's obligations under this contract and the Regulations, will be relative to nondiscrimination on the grounds of race, color, or national origin. Contract/Purchase Order 1) Sanctions for Noncompliance: In the event of the Contractor's noncompliance with the nondiscrimination provisions of this contract, MoDOT shall impose such contract sanctions as it or the Federal Highway Administration may determine to be appropriate, including, but not limited to: i. withholding of payments to the Contractor under the contract until the Contractor complies, and/or, ii. cancellation, termination or suspension of the contract, in whole or in part. a. By submitting a bid/quote/proposal, the Bidder/Offeror agrees to furnish any and all equipment, supplies and/or services specified in the solicitation documents, at the prices quoted, pursuant to all requirements and specifications contained therein. b. A binding contract shall consist of: (1) the solicitation documents, amendments thereto, and/or Best and Final Offer (BAFO) request(s) with any changes/additions, (2) the Contractor's proposal and/or submitted pricing, and (3) the MHTC s acceptance of the proposal and/or bid by purchase order. c. A notice of award does not constitute an authorization for shipment of equipment or supplies or a directive to proceed with services. Before providing equipment, supplies and/or services, the

8 Contractor must receive a properly authorized purchase order and/or notice to proceed. d. The contract expresses the complete agreement of the parties and performance shall be governed solely by the specifications and requirements contained therein. Any change, whether by modification and/or supplementation, must be accomplished by a formal contract amendment signed and approved by and between the duly authorized representative of the Contractor and the duly authorized representative of the MHTC, by a modified purchase order prior to the effective date of such modification. The Contractor expressly and explicitly understands and agrees that no other method and/or no other document, including correspondence, acts, and oral communications by or from any person, shall be used or construed as an amendment or modification. Subcontracting a. It is specifically understood that no portion of the material or any interest in the contract, shall be subcontracted, transferred, assigned or otherwise disposed of, except with the written consent of MoDOT. Request for permission to subcontract or otherwise dispose of any part of the work shall be in writing to MoDOT and accompanied by documentation showing that the organization which will perform the work is particularly experienced and equipped for such work. b. Consent to subcontract or otherwise dispose of any portion of the work shall not be construed to relieve the Contractor of any responsibility for the production and delivery of the contracted work and the completion of the work within the specified time. c. All payments for work performed by a subcontractor shall be made to the Contractor to whom the contract was awarded and the purchase order issued. Invoicing and Payment a. MoDOT is exempt from paying Missouri Sales Tax, Missouri Use Tax and Federal Excise Tax. However, the Contractor may themselves be responsible for the payment of taxes on materials they purchase to fulfill the contract. A Federal Excise Tax Exemption Certificate will be furnished to the successful Bidder/Offeror upon request. b. Each invoice should be itemized in accordance with items listed on the purchase order and/or contract. The statewide financial management system has been designed to capture certain receipt and payment information. Therefore, each invoice submitted must reference the purchase order number and must be itemized in accordance with items listed on the purchase order. Failure to comply with this requirement may delay processing of invoices for payment. c. Unless otherwise provided for in the solicitation documents, payment for all equipment, supplies, and/or services required herein shall be made in arrears. The Missouri Highways and Transportation Commission (MHTC) shall not make any advance deposits. d. The MHTC assumes no obligation for equipment, supplies, and/or services shipped or provided in excess of the quantity ordered. Any authorized quantity is subject to the MHTC s rejection and shall be returned at the Contractor's expense. Applicable Laws and Regulations a. The contract shall be construed according to the laws of the State of Missouri. The Contractor shall comply with all local, state, and federal laws and regulations related to the performance of the contract. b. The Contractor must be registered and maintain good standing with the Secretary of State of the State of Missouri and other regulatory agencies, as may be required by law or regulations. Prior to the IFB Page 8 of 20 issuance of a purchase order and/or notice to proceed, the Contractor may be required to submit to MoDOT a copy of their current Authority Certificate from the Secretary of State of the State of Missouri. 1) Prior to the issuance of a purchase order and/or notice to proceed, all out of state Contractors providing services within the state of Missouri must submit to MoDOT a copy of their current Transient Employer Certificate from the Department of Revenue, in addition to a copy of their current Authority Certificate from the Secretary of State of the State of Missouri. c. The exclusive venue for any legal proceeding relating to or arising, out of the contract shall be in the Circuit Court of Cole County, Missouri. Preferences a. In the evaluation of bids/quotes/proposals, preferences shall be applied in accordance with Chapter 34 RSMo. Contractors should apply the same preferences in selecting subcontractors. b. By virtue of statutory authority, RSMo and to , a preference will be given to materials, products, supplies, provisions and all other articles produced, manufactured, made or grown within the State of Missouri. Such preference shall be given when quality is equal or better and delivered price is the same or less. 1) If attached, the document entitled PREFERENCE IN PURCHASING PRODUCTS should be completed and returned with the solicitation documents. c. In the event of a tie of low bids, the MHTC reserves the right to establish the method to be used in determining the award. Remedies and Rights a. No provision in the contract shall be construed, expressly or implied, as a waiver by the MHTC of any existing or future right and/or remedy available by law in the event of any claim by the MHTC of the Contractor's default or breach of contract. b. The Contractor agrees and understands that the contract shall constitute an assignment by the Contractor to the MHTC of all rights, title and interest in and to all causes of action that the Contractor may have under the antitrust laws of the United States or State of Missouri for which causes of action have accrued or will accrue as the result of or in relation to the particular equipment, supplies, and/or services purchased or produced by the Contractor in the fulfillment of the contract with the MHTC. c. In the event a Contractor becomes involved in, or is threatened with, litigation with a subcontractor or supplier as a result of such direction, the Contractor may request MoDOT to enter into such litigation to protect the interests of the MHTC, and, in addition, the Contractor may request the United States to enter into such litigation to protect the interests of the United States. Cancellation of Contract a. If the MHTC cancels the contract for breach, the MHTC reserves the right to obtain the equipment, supplies, and/or services to be provided pursuant to the contract from other sources and upon such terms and in such manner as the MHTC deems appropriate and charge the Contractor for any additional costs incurred thereby. Bankruptcy or Insolvency a. Upon filing for any bankruptcy or insolvency proceeding by or against the Contractor, whether voluntary or involuntary, or upon the appointment of a receiver, trustee, or assigned the benefit or

9 creditors, the Contractor must notify MoDOT immediately. Upon learning of any such actions, the MHTC reserves the right, at its sole discretion, to either cancel the contract or affirm the contract and hold the Contractor responsible for damages. Inventions, Patents, and Copyrights a. The Contractor shall defend, protect, and hold harmless the MHTC, its officers, agents, and employees against all suits of law or in equity resulting from patent and copyright infringement concerning the Contractor's performance or products produced under the terms of the contract. Inspection and Acceptance Warranty a. No equipment, supplies, and/or services received by MoDOT pursuant to a contract shall be deemed accepted until MoDOT has had reasonable opportunity to inspect said equipment, supplies, and/or services. b. All equipment, supplies, and/or services which do not comply with the specifications and/or requirements or which are otherwise unacceptable or defective may be rejected. c. The MHTC reserves the right to return any such rejected materials/reports at the Contractor's expense for full credit or replacement and to specify a reasonable date by which replacements must be received. d. The MHTC s right to reject any unacceptable equipment, supplies, and/or services shall not exclude any other legal, equitable or contractual remedies the MHTC may have. a. The Contractor expressly warrants that all equipment, supplies, and/or services provided shall: (1) conform to each and every specification, drawing, sample or other description which was furnished to or adopted by MoDOT, (2) be fit and sufficient for the purpose expressed in the solicitation documents, (3) be merchantable, (4) be of good materials and workmanship, and (5) be free from defect. Insurance IFB Page 9 of 20 SPECIAL TERMS AND CONDITIONS a. The Contractor shall purchase and maintain such insurance as will protect him from claims under workmen's compensation acts and other employee benefit acts, from claims for damages because of bodily injury, including death, and from claims for damages to property which may arise out of or result from the Contractor's operations under this Contract, whether such operations be by himself or by any Subcontractor or anyone directly or indirectly employed by any of them. b. This insurance shall be written for not less than any limits of liability specified as part of this contract, or required by law, whichever is the greater, and shall include contractual liability insurance as applicable to the Contractor's obligations under this contract. Unless otherwise specified, insurance limits shall be as follows: 1) Workmen's Compensation: Workers Compensation Insurance, including "Occupational Disease Act" requirements, must be maintained if required by law. b. Such warranty shall survive delivery and shall not be deemed waived either by reason of the MHTC s acceptance of or payment for said equipment, supplies, and/or services. Status of Independent Contractor a. The Contractor represents itself to be an independent Contractor offering such services to the general public and shall not represent itself or its employees to be an employee of the MHTC. Therefore, the Contractor shall assume all legal and financial responsibility for taxes, FICA, employee fringe benefits, workers compensation, employee insurance, minimum wage requirements, overtime, etc., and agrees to indemnify, save and hold the MHTC, its officers, agents and employees harmless from and against any and all losses (including attorney fees) and damage of any kind related to such matters. Indemnification a. The Contractor shall be responsible for injury or damages as a result of any services and/or goods rendered under the terms and conditions of this Agreement. b. In addition to the liability imposed upon the Contractor on the account of personal injury, bodily injury, including death, or property damage, suffered as a result of the Contractor's performance under this Agreement, the Contractor assumes the obligation to save harmless the Commission, including its agents, employees and assigns, and to indemnify the Commission, including its agents, employees and assigns, from every expense, liability or payment arising out of such wrongful or negligent act or omission, including legal fees. c. The Contractor also agrees to hold harmless the Commission, including its agents, employees and assigns, from any wrongful or negligent act or omission committed by any subcontractor or other person employed by or under the supervision of the Contractor for any purpose under this Agreement, and to indemnify the Commission, including its agents, employees and assigns, from every expense, liability or payment arising out of such wrongful or negligent act or omission. Required Specifications 2) Public Liability (includes property damage and personal injury): i. Not less than $400,000 for any one person in a single accident or occurrence. ii. Not less than $2,500,000 for all claims arising out of a single occurrence. 3) Special Hazard Insurance: As required. a. All services, equipment and/or supplies bid upon must comply with the attached MoDOT Specification and any other provisions outlined in the solicitation documents. Information and Reports a. The Contractor shall provide all information and reports required by the Regulations, or Directives issued pursuant thereto, and shall permit access to its books, records, accounts, other sources of information, and its facilities as may be determined by the Missouri Department of Transportation or the Federal Highway Administration to be pertinent to ascertain compliance with such Regulations or Directives. Where any information required of a Contractor is in the exclusive possession of another

10 who fails or refuses to furnish this information the Contractor shall so certify to the Missouri Department of Transportation, or the Federal Highway Administration as appropriate, and shall set forth what efforts it has made to obtain the information. Permits, Licenses and Certifications a. The contract price shall include any necessary permits, certifications and licenses required by law incidental to the work. Failure to Execute Contract a. Failure to execute the contract within 15 days after the contract has been mailed to the bidder shall be just cause for the cancellation of the award. Award may then be made to the next lowest responsible bidder, or the work may be readvertised and performed under contract or otherwise, as the Commission may decide. No contract shall be considered effective until it has been executed by all parties thereto. Notice to Proceed a. Within 30 days after the execution of the contract, a "Notice to Proceed" will be issued by the Department. A purchase order may be attached to the "Notice to Proceed," which would specify the date or dates that the Contractor can start delivery and will also include the completion dates. These dates will be in accordance with the dates shown in the proposal. Cancellation of Contract a. If the Contractor/supplier fails to carry out the performance of the work with sufficient personnel and equipment/supplies to insure the completion of the delivery of services within the time specified or becomes insolvent or is adjudicated a bankrupt or commits any act of bankruptcy or insolvency or allows any final judgment to stand against him for a period of ten (10) days, the Missouri Department of Transportation may give notice in writing by registered mail to the Contractor/supplier and the surety of such delay, neglect or default. b. If, within ten (10) days after such notice the Contractor/supplier does not proceed to remedy to the satisfaction of the Department's representatives the faults specified in said notice, the Department shall have full power and authority, without impairing the obligation of the Contractor/supplier under the contract, arrange for the services/materials necessary to complete the work and the Contractor/supplier will be responsible for any additional costs incurred by the Department in obtaining the completion of the services. IFB Page 10 of 20

11 IFB Attachment A Page 1 of 3 Missouri Department of Transportation Seasonal Maintenance Worker/ Maintenance Crew Worker Job Specific Protocols Category: General: Vision: Hearing: Cardiovascular Condition: Respiratory System: Endocrine System: Medication use must not be sedating or affect concentration. No fear of heights or confined spaces. If allergic to insect bites, must have Epipen closely available. NOT QUALIFIED IF PRIOR ANAPHYLAXIX TO INSECT BITES. 20/40 (Snellen) with or without correction in each eye, color vision adequate to determine signal light red, green and amber. Distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lenses, field of vision of at least 70 degrees in the horizontal meridian in each eye, First perceives forced air whispered voice in the better ear at not less than 5 feet, with or without a hearing aid or, if tested by use of an audiometric device, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz with or without a hearing aid when the audiometric device is calibrated to ANZI Z Not qualified if there is a current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis or any other cardiovascular disease of a variety know to be accompanied by syncope, dyspnea, collapse or congestive cardiac failure. Not qualified if there is an established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with ability to control, drive or operate vehicles or heavy equipment, or wear a respirator. Not qualified if clinical diagnosis of diabetes mellitus currently requiring insulin for control. IFB Page 11 of 20

12 IFB Attachment A Page 2 of 3 Missouri Department of Transportation Seasonal Maintenance Worker/ Maintenance Crew Worker Job Specific Protocols Extremities: Vital Signs Rheumatic, Arthritic, Orthopedic, Muscular, Neuromuscular and Vascular Back Hernia Strength: Not qualified if there is a loss of a foot, leg, hand or an arm unless they have been granted a Skill Performance Evaluation (SPE) Certificate through Mo. Motor Carriers. Has no impairment of a hand or finger which interferes with prehension or power grasping; or an arm, foot, or leg which interferes with the ability to perform normal tasks associated with operating a commercial motor vehicle (CMV) or any other significant limb defect or limitation which interferes with the ability to operate a CMV unless they have a SPE Certificate. <160/90 with or without medication Pulse persistently greater than 100 must be investigated. No established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease which interferes with the ability to control and operate heavy equipment or a CMV and perform the essential functions of their job. Full range of motion with no pain. Prior history of disabling back injuries, surgery or disc disease consider need for functional capacity evaluation. Not qualified until hernia is repaired and released by primary care physician. Muscular Development consisted with requirements in the Dictionary of Occupational Titles for "Extra Heavy" lifting. IFB Page 12 of 20

13 IFB Attachment A Page 3 of 3 Missouri Department of Transportation Seasonal Maintenance Worker/ Maintenance Crew Worker Job Specific Protocols Neuro: Verbal: Mental Status: MSR's Cerebellar/vestibular: Cerebellar/vestibular (continued) No current diagnosis of seizure disorders. Communication with spoken voice. No current mental, nervous, organic, or organic or functional disease or psychiatric disorder likely to interfere with ability to operate heavy equipment or a Commercial Motor Vehicle or work adjacent to moving traffic. Symmetrical Normal coordination and balance. Not afraid of heights or confined spaces. Component Required Optional History/physical w/test of smell * Vision: peripheral, color, & depth perception. * * Federal DOT Drug Screen collection, split specimen. Pulmonary Function Test * Only for respirator wears EKG/Stress test if clinically indicated, symptoms of multiple risk factors for heart disease or COPD. * Urinalysis dip test. * Total cholesterol & HDL mandatory if >40 y/o or if cardiovascular risk if present. Test sense of smell * Tetanus Diphtheria Booster should be up to date. Provide TD as needed. * Baseline Audiogram * Work simulation or range of motion Testing. * Grip Strength * * IFB Page 13 of 20

14 IFB Attachment B Certificate of Examination Missouri Department of Transportation Pre Employment/Post Offer Medical Examination Applicant s Name: (Print) S.S. #: JOB TITLE: [ ]Begin work without restrictions (after receiving drug test results) [ ]Does not meet requirements for position above [ ]May wear respiratory protection The applicant has been advised of the physical results [ ] yes[ ] no (APPLICANTS SIGNATURE) (DATE) (PHYSICIANS SIGNATURE) (DATE) PROVIDER INSTRUCTION: This form must be faxed to the Human Resource Department at the conclusion of the physical. Original must be mailed, with COMPLETE PHYSICAL EXAM TO: MoDOT Risk Management/Brenda Dudenhoeffer P.O. Box 270 Jefferson City, MO [ ] Faxed to Human Resources Manager (fax number of specific District) IFB Page 14 of 20

15 IFB Attachment C MoDOT Health History Name: SSN#: Date: Job Title being hired for: MoDOT Health History (To be completed by the applicant) Yes No 1. [] [] Any illness or injury in the past five years? (Including workers compensation) 2. [] [] Any head/brain, disorders, injuries or illnesses? 3. [] [] Seizure, epilepsy[] Medication: 4. [] [] Eye disorders or impaired vision (except corrective lenses) 5. [] [] Ear disorders, loss of hearing or balance 6. [] [] Heart disease or heart attack; other cardiovascular condition [] Medication: 7. [] [] Heart surgery (valve replacement/bypass, angioplasty, pacemaker) 8. [] [] High blood pressure [] Medication: 9. [] [] Muscular disease 10. [] [] Shortness of breath 11. [] [] Lung disease, emphysema, asthma, chronic bronchitis 12. [] [] Kidney disease, dialysis 13. [] [] Liver disease 14. [] [] Digestive problems 15. [] [] Diabetes or elevated blood sugar controlled by [] Diet & Exercise [] Oral Medication [] Insulin 16. [] [] Nervous or psychiatric disorders, e.g. severe depression [] Medication 17. [] [] Loss of, or altered consciousness 18. [] [] Fainting, dizziness 19. [] [] Sleep disorders, pauses in breathing while asleep, daytime sleepiness, loud snoring 20. [] [] Stroke or paralysis 21. [] [] Missing or impaired hand, arm, foot, leg, finger, toe 22. [] [] Chronic low back pain 23. [] [] Regular, frequent alcohol use 24. [] [] Narcotic or habit forming drug use For any YES answer, indicate onset date, diagnosis, treating physician s name & address, and any current limitation(s). List all medications (including over the counter medications) used regularly or recently: I certify that the above information is COMPLETE and TRUE. I understand the inaccurate, false or missing information will be grounds for withdrawing my conditional offer of employment or my dismissal, if hired, and discovered at a later date. Applicant s Signature: Date: Physician s Signature: Date: IFB Page 15 of 20

16 IFB ATTACHMENT D Page 1 of 2 Name: SSN#: Date: Job Title being hired for: MoDOT Physical Examination (For all jobs requiring a Commercial Driver s License) Ht: Wt. Pulse Rate: [ ] Regular [ ] Irregular Date of Birth: Age: Male: Female: 1. Vision: (Snellen) Right eye: Left eye: [ ]without correction [ ] with correction Color blind? [] No [ ] Yes, but can distinguish signal light red, amber, and green. [ ] Yes, and CANNOT distinguish signal light red, amber, & green. [ ] Yes [ ] No Field of vision at least 70 degrees in the horizontal meridian in each eye. [ ] Yes [ ] No Monocular Vision 2. Hearing: Standard: a) Must first perceive forced whispered voice > 5ft., with our without correction, or b) average hearing loss in better ear < 40 db. Record distance from individual at which forced whispered voice can first be heard. Right ear: ft. Left ear: ft. Results of Audiogram: [ ] Within normal ranges [ ] Outside normal ranges [ ] Current or frequent ear infection(s) [ ] Ringing in ears [ ] Able to wear hearing protection. (attach readout from audiometer) Right ear: 500 Hz 1000HZ 2000HZ Ave. Left ear: 500 Hz 1000HZ 2000HZ Ave. 3. Blood Pressure/Pulse Rate: Numerical readings must be recorded. Two readings should be taken to confirm BP. Blood Pressure #1: Blood Pressure #2: 4. Urinalysis: Numerical readings must be recorded. Specific Gravity: Protein Blood Sugar 5. Body Systems: Check YES if there are any abnormalities. Check NO if the body system is normal. Discuss any YES answers in detail in the space below, and indicate whether it would affect the applicant s ability to operate a commercial motor vehicle or any other essential functions of their job. IFB Page 16 of 20

17 IFB ATTACHMENT D Page 2 of 2 Body System Check for: YES* NO 1. General Appearance Marked overweight, tremor, signs of alcoholism, problem drinking, or drug abuse. 2. Eyes Pupillary equality, reaction to light, accommodation, ocular motility, ocular muscle imbalance, extraocular movement, nystagmus, exophthalmos. Ask about retinopathy, cataracts, aphakia glaucoma, macular degeneration. If there is a history, review medical records from treating physician. 3. Ears Scarring of tympanic membrane, occlusion of external canal, perforated eardrums. 4. Mouth and Throat Irremediable deformities likely to interfere with breathing or swallowing. 5. Heart 6. Lungs and Chest, not including breast examination. Murmurs, extra sounds, enlarged heart, pacemaker, implantable defibrillator. Abnormal chest wall expansion, abnormal respiratory rate, abnormal breath sounds including wheezes or alveolar rales, impaired respiratory function, cyanosis. Abnormal findings on physical exam may require further testing such as pulmonary tests and/or x ray of chest. 7. Abdomen and Viscera Enlarged liver, enlarged spleen, masses, bruits, hernia, significant abdominal wall muscle weakness. 8. Vascular System Abnormal pulse and amplitude, carotid or arterial bruits, varicose veins. 9. Genito urinary Hernias System 10. Extremities Limb impaired. 11. Spine, other musculoskeletal 12.Neurological Loss or impairment of leg, foot, toe, arm, hand, finger. Perceptible limp, deformities, atrophy, weakness, paralysis, clubbing, edema, hypotonia. Insufficient grasp and prehension in upper limbs to maintain grip, insufficient mobility and strength in lower limbs. Previous surgery, deformities, limitation of motion, tenderness. Impaired equilibrium, coordination or speech pattern; asymmetric deep tendon reflexes, sensory or positional abnormalities, abnormal patellar and Babinki s reflexes, ataxia. Comments: [ ] I have discussed the above information with the patient. [ ] I have not discussed the above information with the patient. Patient s Signature: Date: Physician s Signature: Date: Print Physician s Name: IFB Page 17 of 20

18 IFB Page 18 of 20 IFB ATTACHMENT E Page 1 of 3

19 IFB Page 19 of 20 IFB ATTACHMENT E Page 2 of 3

20 IFB Page 20 of 20 IFB ATTACHMENT E Page 3 of 3