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PROCUREMENT AGREEMENT
Agreement Number P-24-285
June 14, 2024
Occu-Med
2121 W Bullard Avenue
Fresno, CA 93721
The County of Fresno (County) hereby contracts with Occu-Med (Contractor)to provide medical
examinations and evaluation administrator services in accordance with the text of this agreement,
Attachment"A", County of Fresno Request for Proposal No: 24-049 and the attached contractors response
to County of Fresno Request for Proposal No: 24-049 by this reference made a part hereof.
TERM: This Agreement shall become effective July 1, 2024 and shall remain in effect through August 31,
2024.
MINIMUM ORDERS: Unless stated otherwise there shall be no minimum order quantity. The County
reserves the right to increase or decrease orders or quantities.
CONTRACTOR'S SERVICES: Contractor shall perform the services as described in Attachment"A"
attached, at the rates set forth in Attachment"A".
ORDERS: Orders will be placed on an as-needed basis by the County of Fresno Human Resources
Department under this contract.
PRICES: Prices shall be firm for the contract period.
MAXIMUM: In no event shall services performed and/or fees paid under this Agreement be in excess of
Seventy-Five Thousand Dollars ($75,000.00).
ADDITIONAL ITEMS: The County reserves the right to negotiate additional items to this Agreement as
deemed necessary. Such additions shall be made in writing and signed by both parties.
DELIVERY: The F.O.B. Point shall be the destination within the County of Fresno. All orders shall be
delivered complete as specified. All orders placed before Agreement expiration shall be honored under the
terms and conditions of this Agreement.
DEFAULT: In case of default by Contractor, the County may procure the articles/services from another
source and may recover the loss occasioned thereby from any unpaid balance due the Contractor or by any
other legal means available to the County. The prices paid by County shall be considered the prevailing
market price at the time such purchase is made. Inspection of deliveries or offers for delivery, which do not
meet specifications, will be at the expense of Contractor.
333 W. Pontiac Way,Clovis,CA 93612/(559)600-7110
*The County of Fresno is an Equal Employment Opportunity Employer
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INVOICING: An itemized invoice shall be sent to requesting County department in accordance with invoicing
instructions included in each order referencing this Agreement. The Agreement number must appear on all
shipping documents and invoices. Invoice terms shall be Net 45 Days.
INVOICE TERMS: Net forty-five (45) days from the receipt of invoice.
TERMINATION: The County reserves the right to terminate this Agreement upon thirty (30) days written
notice to the Contractor. In the event of such termination, the Contractor shall be paid for satisfactory
services or supplies provided to the date of termination.
LAWS AND REGULATIONS: The Contractor shall comply with all laws, rules and regulations whether they
be Federal, State or municipal, which may be applicable to Contractor's business, equipment and personnel
engaged in service covered by this Agreement.
AUDITS AND RETENTION: Terms and conditions set forth in the agreement associated with the purchased
goods are incorporated herein by reference. In addition, the Contractor shall maintain in good and legible
condition all books, documents, papers, data files and other records related to its performance under this
contract. Such records shall be complete and available to Fresno County, the State of California, the federal
government or their duly authorized representatives for the purpose of audit, examination, or copying during
the term of the contract and for a period of at least three years following the County's final payment under the
contract or until conclusion of any pending matter(e.g., litigation or audit), whichever is later. Such records
must be retained in the manner described above until all pending matters are closed.
LIABILITY: The Contractor agrees to:
Pay all claims for damage to property in any manner arising from Contractor's operations under this
Agreement.
Indemnify, save and hold harmless, and at County's request defend the County, its officers, agents and
employees from any and all claims for damage or other liability, including costs, expenses (including
attorney's fees and costs), causes of action, claims or judgments resulting out of or in any way connected
with Contractor's performance or failure to perform by Contractor, its agents, officers or employees under this
Agreement, and from any and all costs and expenses (including attorney's fees and costs), damages,
liabilities, claims, and losses occurring or resulting to any person, firm or corporation who may be injured or
damaged by the performance, or failure to perform, of Contractor, its officers, agents, or employees under
this Agreement.
INSURANCE: Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any
third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following
insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
arrangement or Joint Powers Agreement (JPA)throughout the term of the Agreement:
A. Commercial General Liability: Commercial general liability insurance with limits of not less than Two
Million Dollars ($2,000,000) per occurrence and an annual aggregate of Four Million Dollars
($4,000,000). This policy must be issued on a per occurrence basis. Coverage must include products,
completed operations, property damage, bodily injury, personal injury, and advertising injury. The
Contractor shall obtain an endorsement to this policy naming the County of Fresno, its officers, agents,
employees, and volunteers, individually and collectively, as additional insureds, but only insofar as the
operations under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County is excess only
and not contributing with insurance provided under the Contractor's policy.
B. Automobile Liability: Automobile liability insurance with limits of not less than One Million Dollars
($1,000,000) per occurrence for bodily injury and for property damages. Coverage must include any auto
used in connection with this Agreement.
C. Professional Liability: Professional liability insurance with limits of not less than One Million Dollars
($1,000,000) per occurrence and an annual aggregate of Three Million Dollars ($3,000,000). If this is a
claims-made policy, then (1)the retroactive date must be prior to the date on which services began
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under this Agreement; (2)the Contractor shall maintain the policy and provide to the County annual
evidence of insurance for not less than five years after completion of services under this Agreement; and
(3) if the policy is canceled or not renewed, and not replaced with another claims-made policy with a
retroactive date prior to the date on which services begin under this Agreement, then the Contractor shall
purchase extended reporting coverage on its claims-made policy for a minimum of five years after
completion of services under this Agreement.
D. Worker's Compensation: Workers compensation insurance as required by the laws of the State of
California with statutory limits.
Additional Requirements Relating to Insurance:
Contractor shall obtain endorsements to the Commercial General Liability insurance naming the County of
Fresno, its officers, agents, and employees, individually and collectively, as additional insured, but only
insofar as the operations under this Agreement are concerned. Such coverage for additional insured shall
apply as primary insurance and any other insurance, or self-insurance, maintained by County, its officers,
agents and employees shall be excess only and not contributing with insurance provided under Contractor's
policies herein. This insurance shall not be cancelled or changed without a minimum of thirty (30) days
advance written notice given to County.
Contractor hereby waives its right to recover from County, its officers, agents, and employees any amounts
paid by the policy of worker's compensation insurance required by this Agreement. Contractor is solely
responsible to obtain any endorsement to such policy that may be necessary to accomplish such waiver of
subrogation, but Contractor's waiver of subrogation under this paragraph is effective whether or not
Contractor obtains such an endorsement.
Within Thirty (30) days from the date Contractor signs and executes this Agreement, Contractor shall provide
certificates of insurance and endorsement as stated above for all of the foregoing policies, as required
herein, to the County of Fresno, Human Resources Department, 2220 Tulare Street, 14th Floor,
Fresno, CA 93721, stating that such insurance coverage have been obtained and are in full force; that the
County of Fresno, its officers, agents and employees will not be responsible for any premiums on the
policies; that such Commercial General Liability insurance names the County of Fresno, its officers, agents
and employees, individually and collectively, as additional insured, but only insofar as the operations under
this Agreement are concerned; that such coverage for additional insured shall apply as primary insurance
and any other insurance, or self-insurance, maintained by County, its officers, agents and employees, shall
be excess only and not contributing with insurance provided under Contractor's policies herein; and that this
insurance shall not be cancelled or changed without a minimum of thirty (30) days advance, written notice
given to County. Certificates of Insurance are to include the contract number at the top of the first
page.
In the event Contractor fails to keep in effect at all times insurance coverage as herein provided, the County
may, in addition to other remedies it may have, suspend or terminate this Agreement upon the occurrence of
such event.
All policies shall be with admitted insurers licensed to do business in the State of California. Insurance
purchased shall be purchased from companies possessing a current A.M. Best, Inc. rating of A FSC VII or
better.
COMING ON COUNTY PROPERTY TO DO WORK: Contractor agrees to provide maintain and furnish
proof of Comprehensive General Liability Insurance with limits of not less than $500,000 per occurrence.
INDEPENDENT CONTRACTOR: In performance of the work, duties and obligations assumed by Contractor
under this Agreement, it is mutually understood and agreed that Contractor, including any and all of
Contractor's officers, agents, and employees will at all times be acting and performing as an independent
contractor, and shall act in an independent capacity and not as an officer, agent, servant, employee,joint
venturer, partner, or associate of the County. Furthermore, County shall have no right to control or supervise
or direct the manner or method by which Contractor shall perform its work and function. However, County
shall retain the right to administer this Agreement so as to verify that Contractor is performing its obligations
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in accordance with the terms and conditions thereof. Contractor and County shall comply with all applicable
provisions of law and the rules and regulations, if any, of governmental authorities having jurisdiction over
matters the subject thereof.
Because of its status as an independent contractor, Contractor shall have absolutely no right to employment
rights and benefits available to County employees. Contractor shall be solely liable and responsible for
providing to, or on behalf of, its employees all legally-required employee benefits. In addition, Contractor
shall be solely responsible and save County harmless from all matters relating to payment of Contractor's
employees, including compliance with Social Security, withholding, and all other regulations governing such
matters. It is acknowledged that during the term of this Agreement, Contractor may be providing services to
others unrelated to the County or to this Agreement.
NON-ASSIGNMENT: Neither party shall assign, transfer or sub-contract this Agreement nor their rights or
duties under this Agreement without the written consent of the other party.
AMENDMENTS: This Agreement constitutes the entire Agreement between the Contractor and the County
with respect to the subject matter hereof and supersedes all previous negotiations, proposals, commitments,
writings, advertisements, publications, Request for Proposals, Bids and understandings of any nature
whatsoever unless expressly included in this Agreement. This Agreement supersedes any and all terms set
forth in Contractor's invoice. This Agreement may be amended only by written addendum signed by both
parties.
INCONSISTENCIES: In the event of any inconsistency in interpreting the documents which constitute this
Agreement, the inconsistency shall be resolved by giving precedence in the following order of priority: (1)the
text of this Agreement (excluding Attachment"A", County's Request for Proposal No. 24-049 and the
Contractor's Quote in response thereto); (2)Attachment"A"; (3)the County's Request for Proposal No. 24-
049 and (4)the Contractor's proposal made in response to County's Request for Proposal No. 24-049.
GOVERNING LAWS: This Agreement shall be construed, interpreted and enforced under the laws of the
State of California. Venue for any action shall only be in County of Fresno.
ELECTRONIC SIGNATURES: The parties agree that this Agreement may be executed by electronic
signature as provided in this section.
A. An "electronic signature" means any symbol or process intended by an individual signing this Agreement
to represent their signature, including but not limited to (1)a digital signature; (2) a faxed version of an
original handwritten signature; or(3) an electronically scanned and transmitted (for example by PDF
document)of a handwritten signature.
B. Each electronic signature affixed or attached to this Agreement (1) is deemed equivalent to a valid
original handwritten signature of the person signing this Agreement for all purposes, including but not
limited to evidentiary proof in any administrative or judicial proceeding, and (2) has the same force and
effect as the valid original handwritten signature of that person.
C. The provisions of this section satisfy the requirements of Civil Code section 1633.5, subdivision (b), in
the Uniform Electronic Transaction Act (Civil Code, Division 3, Part 2, Title 2.5, beginning with section
1633.1).
D. Each party using a digital signature represents that it has undertaken and satisfied the requirements of
Government Code section 16.5, subdivision (a), paragraphs (1)through (5), and agrees that each other
party may rely upon that representation.
This Agreement is not conditioned upon the parties conducting the transactions under it by electronic means
and either party may sign this Agreement with an original handwritten signature.
Please acknowledge your acceptance by returning all pages of this Agreement to my office via email.
Please refer any inquiries in this matter to Crystal Nino, Purchasing Analyst, at 559-600-7113 or
cnino@fresnocountyca.gov.
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FOR THE COUNTY OF FRESNO
Digitally signed by Manuel M.
Manuel M. Vilanova Vilanova
Date:2024.06.24 12:44:58-07'00'
Manuel Vilanova
Deputy Director
333 W. Pontiac Way
Clovis, CA 93612
MV:cn
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CONTRACTOR TO COMPLETE:
Company: OCCu-Med Ltd.
Type of Entity:
❑ Individual ■❑ Limited Liability Company
❑ Sole Proprietorship ❑ Limited Liability Partnership
❑ Corporation ❑ General Partnership
2121 West Bullard Ave Fresno CA 93711
Address City State Zip
559.435.2800 559.435.7200 ajohnson@occu-med.com
TELEPHONE NUMBER FAX NUMBER E-MAIL ADDRESS
Print Name & Jared Ka i, VP of BD Sherri Conley,Controller
Title: Print Name &Title:
Digitally signed by Jared Kaji Digitally signed by Sherri Conley
Jared Ka j i Date.2024.06.24 10:50 18 Sherri Conley Date:2024.06.21 07:23:00-07'00'
Signature: -07'00' Signature:
ACCOUNTING USE ONLY
ORG No.: 0100400
Account No.: 7295
Requisition No.: 1012400090
(08/2022)
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A TTACHMENT 'A"
SCOPE OF SERVICES
I. Background
Contractor shall perform medical examinations, screenings, and evaluations for certain
job classifications selected by the County and develop job-related medical
standards/guidelines.
All information developed including, but not limited to, job analyses, guidelines,
screenings, and evaluations will become the property of the County and may be
utilized by the County in any way, even after termination of Agreement with the
Contractor. The County will also require copies of any guidelines, screenings, and
evaluations developed for use as part of the administration of the medical standards
process.
The County requires medical screening and examinations for job classifications that
are physically demanding, and/or are required in compliance with applicable laws and
regulations.
A. Medical standards, guidelines, and evaluations developed for use with the County's
medical provider's medical screening and examination results will be used to:
1) Detect and document pre-existing medical conditions;
2) Ensure that the requisite physical requirements for proper job performance
are met so as to promote safety with regard to the employee/job applicant,
other employees, and members of the public;
3) Provide a legally defensible tool for making decisions about medical
screening, rehabilitation, transfer and promotion; and establish the potential
to identify applicants and job classifications in need of reasonable
accommodation to satisfy the legal requirements of applicable laws and
statutes including the Vocational Rehabilitation Act and the Americans with
Disabilities Act.
B. Consistent with the County's current practice, the Contractor shall:
1) Conduct a medical exam and provide a medical review and evaluation
program for all identified job profiles including, but not limited to, the
following series': Communications Dispatcher; Community Service Officer;
Correctional Officer; Deputy Coroner; Deputy Probation Officer; Deputy
Sheriff; District Attorney Investigator; Forensic Autopsy Technician; and
Juvenile Correctional Officer. The medical review and evaluation program
may include revisions to full analyses;
2) Conduct job analyses and update existing medical standards and medical
examination profiles, as needed, to comply with legal requirements
including, but not limited to, the Americans with Disabilities Act, California
Commission on Peace Officer Standards and Training, and California Board
of State and Community Corrections — Standards and Training for
Corrections;
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3) Develop medical exam profiles, standards, and screening guidelines for
additional job classifications as designated by the County;
4) Ensure complete, thorough, and accurate information is obtained through
the screening and examination process, evaluate the information with the
medical standards/guidelines for the job classification, and make the final
recommendation regarding medical qualification for placement decisions;
5) Be available to assist in the interpretation of existing and/or new laws and
regulations affecting the medical examination standards and guidelines.
Medical examinations are administered to ensure that: 1) an individual is medically
qualified to perform effectively the duties normally associated with a position in a specific
job classification; and 2) an individual, in performing a position's duties, does not present
a hazard to the health and safety of self, co-workers, or the public.
The medical examination program applies to permanent positions in both the classified
and unclassified service:
o Classified service includes those positions which entitle incumbents to civil service
status, which gives them the right of appeal from certain disciplinary actions including
dismissal, once they've successfully completed the probationary period. Selection
and retention for these positions are on the basis of merit principles.
o Unclassified service includes positions in which incumbents are exempt from civil
service status.
Additionally, under certain specific situations, medical examinations may be
administered to extra-help (temporary) employment prospects. This is generally the
case with those job classification series' regulated by the California Commission on
Peace Officer Standards and Training and California Board of State and Community
Corrections — Standards and Training for Corrections.
C. Medical Groups Defined
Each classification is assigned by the Director of Human Resources to one of five
medical group descriptions based upon the usual working conditions and duties of
positions in the classification. The medical examinations shall utilize the
appropriate medical group description information applying the medical standards
to an individual examinee.
As defined by Fresno County Personnel Rule 8 (Located at
https://www.fresnocountyca.gov/Departments/Human-Resources/References) The
following are the medical group descriptions and the distinguishing criteria:
1) Medical Group I — Light Physical Activity: This group includes positions
which require only light physical effort and may include lifting of small, light
objects and some bending, stooping, squatting, twisting, and reaching.
Considerable walking or standing may be involved.
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2) Medical Group II — Moderate Physical Activity: This group includes
positions which require moderate physical effort using arms, legs, back, and
trunk in frequent lifting, pushing, or pulling of objects weighing (or offering
resistance equivalent to) 10-25 pounds, and occasionally over 25 pounds.
Generally, bending, stooping, squatting, twisting, reaching, as well as standing
and walking are involved.
3) Medical Group III - Heavy Physical Activity: This group includes positions
which require heavy physical effort using arms, legs, back, and trunk in
frequent lifting, pushing, or pulling objects weighing (or offering resistance
equivalent to) over 25 pounds. Generally, considerable bending, stooping,
squatting, twisting, reaching, as well as standing and walking are involved.
Physical stamina is usually required and explosive strength using bursts of
energy may be required, depending upon specific position assignments.
4) Medical Group IV— Safety Officer: This group includes law enforcement
positions which are covered by the Safety Officer provisions of the County's
retirement plan. Sound physical condition in all respects is required because
of exposure to and need to counteract and control violent action or behavior.
Heavy physical activity as described in Medical Group III may be encountered
occasionally to frequently, depending upon specific assignments and
emergency situations.
5) Medical Group V— Safety Officer (Sworn): This group includes law
enforcement positions which are covered by the Safety Officer provisions of
the County's retirement plan. The same physical fitness requirements exist as
for Group IV. However, positions within Group V are exposed more frequently
to hostile environments in which heavy physical demands such as running,
jumping, and climbing occur. Also, positions within Group V more frequently
are involved in situations in which the incumbent must be able to handle
specific physical actions individually without immediate assistance.
D. Medical Examinations Required
Medical examinations are used by the County to make employment decisions
consistent with business necessity and specifically related to the job for which an
applicant or employee is being considered. Medical examinations are utilized by
the County to determine if an applicant/employee can perform the essential
functions of the job classification safely, with or without reasonable accommodation
as defined by applicable laws and regulations.
II. Medical Examinations
The County's medical examination program includes pre-placement (post-offer of
employment) medical exams, Department of Motor Vehicle (DMV) exams, and periodic
exams. The medical examination shall consist of a physical exam to ensure that
applicants/employees are both medically qualified to perform the essential functions of
the positions, and are able to perform their duties without endangering the health and
safety of themselves, co-workers, or the public. On average, the County requires
approximately 22 medical examinations be conducted per month, for all types of
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exams as enumerated below.
A. Types of Exams:
1) Pre-placement exams are for all persons selected for prospective
employment (new hires, promotions, etc.) within certain job classifications.
These applicants/employees are required to complete a pre-employment
medical history form and undergo a medical examination before beginning
work.
2) DMV exams are for all persons occupying job classifications that are
required to drive certain types of vehicles (based on gross weight,
passenger ability of 16 or more, or transports certain hazardous materials)
requiring DMV Class A or B licensure pursuant to the Code of Federal
regulations, Title 49. Affected classification series' may include, but are not
limited to, Agricultural Standards Specialist, Correctional Officer, Deputy
Sheriff, Driver, Juvenile Correctional Officer, Parks Groundskeeper, Road
Equipment Operator, Stock Clerk, and Traffic Equipment Operator.
3) Periodic exams may be required for all persons within safety officer job
classifications that are medically examined: employees under age 45 may
be examined every third year after employment; employees 45 years and
older may be examined annually. (Note — periodic exams are not currently
conducted, however, approximately 300 per year would be conducted
should they be requested.)
The County's medical examination program is subject to the federal Americans with
Disabilities Act and California's Fair Employment and Housing Act. These laws require
employers to afford any "qualified individual with a disability" equal opportunity to
compete for, secure, and retain employment. Barring undue hardship or health and
safety issues, this includes providing reasonable accommodations to applicants and
candidates, while ensuring that any medical criteria is job-related, reflect only what is
required to perform the essential functions of a position, and do not screen out
otherwise qualified individuals simply due to the presence of a disease or disability.
The medical criteria for County classifications differ depending upon the demands of
the job. The most stringent apply to law enforcement classifications which include, but
are not limited to, positions in the Correctional Officer, Deputy Sheriff, Deputy
Probation Officer, District Attorney Investigator, and Juvenile Correctional Officer
classification series'. The County's medical criteria for these classifications combine
applicable standards from the California Commission on Peace Officer Standards and
Training, California Board of State and Community Corrections — Standards and
Training for Corrections, federal Department of Transportation regulations (for DMV
exams), and County job descriptions and essential functions of positions.
III. Goals
The specific goals in applying comprehensive job-related medical standards/guidelines
and a medical review program are to:
1) Provide a valid and legally defensible job analysis of the critical and essential
functions performed, and the physically demanding tasks associated with each
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of the designated classifications. The County expects job analyses to be
conducted using techniques which are generally professionally acceptable and
consistent with either the Uniform Guidelines on Employee Selection Procedure
or other standards developed by recognized professional groups specializing in
issues of selection and industrial or organizational psychology or ergonomics.
2) Provide a set of medical screening standards or medical screening guidelines
that contain those medical conditions likely to be found in the applicant
population. Special emphasis should be placed on those medical conditions
likely to lead to serious disability, e.g., musculoskeletal, respiratory, or
cardiovascular body system.
3) Define the specific medical protocols (examination procedures and laboratory
tests) which should be used in examining applicants/employees for each of the
identified classifications; recommend new medical history forms and provide
other necessary reporting forms.
4) Describe and recommend a medical screening procedure and process which
includes the ability to reasonably accommodate individuals with disabilities in
accordance with the regulations including, but not limited to, the Vocational
Rehabilitation Act, the Americans with Disabilities Act, the Age Discrimination in
Employment Act, the Pregnancy Discrimination Act, the Civil Rights Act, and
the Uniform Guidelines on Employee Selection Procedures.
5) Ensure the medical screening program, medical protocols, procedures, and
medical standards/guidelines work to ensure that applicants/employees who
are eventually hired/selected will be able to perform in their position without
endangering the health or safety of self, other employees, or the general public.
6) Implement a medical review program for identified classifications to include a
review of all medical examinations and the application of medical standards to
medical examination results.
IV. Description of Work/Services to be Performed
1) Develop medical standards and/or guidelines that will assist the examining
physician in determining applicant/employee ability to perform safely and with a
minimal level of risk of injury to him/herself or others. Each medical
standard/guideline must be linked to the job classification or position
requirements and essential functions as measured by the job analysis.
2) Ensure the resulting medical screening standards/guidelines are acceptable and
legally defensible under applicable laws and regulations. Schedule and conduct
medical examinations within ten (10) County business days from the date of
request, unless agreed upon by County and contracted vendor.
3) Provide applicant/employee medical recommendations to designated County
staff within three (3) County business days from the date of completed medical
exam. Should the information be incomplete or require additional follow up,
contractor will notify designated County staff of delay within three (3) County
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business days from the date of medical exam. Maintain effective verbal and
written communication with designated County staff.
4) Provide updates to the County regarding significant medical and legal issues
relating to medical screening; make recommendations regarding the need for
updates and modifications to job analysis and medical exam profiles.
5) Train physicians and ancillary staff conducting medical examinations about the
requirements of the County, including information about the job profile and
medical examination requirements; training shall include written guidelines for
medical exam staff as well as on-site training on an as-needed basis as
determined by contractor, medical exam staff, and/or County.
6) Provide a medical examination review and quality assurance process that
includes a review of the medical examination documentation, application of
medical standards, a disqualification report, and recommendations for
reasonable accommodation if appropriate and consistent with the medical profile.
7) Contractor must retain a physician on staff who participates in the development
and update of medical standards/guidelines process as well as the review of
medical examination results provided by the medical examination staff.
8) Upon request, provide detailed reports including information such as utilization,
types of medical examinations reviewed,job profiles updated/developed, cost,
etc.
9) Provide monthly invoices (same date each month) for services rendered with the
following information:
• Invoice date
• Invoice/account number
• Amount due
• Payment due date (invoice terms are net 45 days)
• Addressed to Human Resources, 2220 Tulare St, 14t" Floor, Fresno, CA
93721
• Payment remittance address; contact information
• List of services provided for invoice period including the following, as
applicable:
- Examinee name
- Type of examination
- Job classification
- Date service rendered
- Medical profiles/screening guidelines developed or updated
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COMPENSATION
The Contractor will be compensated for performance of its services under this
Agreement as provided below. The Contractor is not entitled to any compensation
except as expressly provided in this document.
Medical Examination
Service Cost per exam
Pre-Placement
Chief Probation Officer $643.60
Probation Division Director $643.60
Probation Services Manager $643.60
Deputy Probation Officer III/IV $643.60
Deputy Probation Officer 1 $643.60
Supervising Juvenile Correctional Officer $643.60
Senior Juvenile Correctional Officer $643.60
Juvenile Correctional Officer II $643.60
Juvenile Correctional Officer 1 $643.60
Sheriff's Captain $643.60
Sheriff's Lieutenant $643.60
Sheriff's Sergeant $643.60
Deputy Sheriff III $643.60
Deputy Sheriff II $643.60
Deputy Sheriff 1 $643.60
Reserve Officer $643.60
Uniform Field Division Reserve Deputy Sheriff UFD $643.60
Reserve Deputy Sheriff (Special Guard — 108 $643.60
Communications Dispatcher $182.00
Community Service Officer $235.75
Correctional Officer Lieutenant $643.60
Correctional Officer Sergeant $643.60
Correctional Officer IV $643.60
Correctional Officer 1/11/III $643.60
Supervising District Attorney Investigator $458.60
District Attorney Investigator I/ll/Sr $644.20
Deputy Coroner 1 $256.35
Forensic Autopsy Technician $256.35
DMV $105.00
Periodic Same as Pre-
Placement
P-24-285 Occu-Med Agreement.docx
PROCUREMENT AGREEMENT NUMBER: P-24-285 Attachment Page 8 of 8
Occu-Med
June 14, 2024
Medical Examination Review
Service Cost per exam
Pre-Placement $80.00
DMV $40.00
Periodic $80.00
Medical Profiles/Screening Guidelines
• Updates of current medical profile per classification
• Development of new medical profiles per classification
Service
Job Analysis $2,000/da
Additional Services
Service
MECP Creation $50 each
P-24-285 Occu-Med Agreement.docx
Contractor's Response to
County of Fresno
Request for Proposal
No. 24-049
P-24-285 Occu-Med Agreement.docx
COUNTY OF FRESNO
cot,
FRE`'
REQUEST FOR PROPOSAL
NUMBER: 24-049
MEDICAL EXAMINATIONS AND EVALUATIONS
ADMINISTRATOR
Issue Date: March 18, 2024
Closing Date: APRIL 8, 2024 AT 9:00 AM
All Questions and Responses must be electronically submitted on the Bid Page on Public Purchase.
For assistance, contact Crystal Nino at Phone (559) 600-7110.
BIDDER TO COMPLETE
Undersigned agrees to furnish the commodity or service stipulated in the attached at the prices and terms stated in this RFP.
Bid must be signed and dated by an authorized officer or employee.
09
OCCU-MED
COMPANY
Chris St. George
CONTACT PERSON
2121 West Bullard Avenue
ADDRESS
Fresno CA 93711
CITY STATE ZIP CODE
(559)435.2800 x207 cstgeorge@occu-med.com
TELEPHONE NUMBER E-MAIL ADDRESS
AUTHORIZED SIGNATURE
Chris St. George Business Development Director
PRINT NAME TITLE
24-049 Medical Examinations and Evaluations Administrator PD-040(10/21/2019)
419
OCCUMED
April 5,2024
James A.Johnson
President&CEO
Crystal G.Nino
County of Fresno-Purchasing
333 West Pontiac Way
Clovis, CA 93612
RE: Response to Request for Proposal(E-RFP): #24-049
Medical Examinations and Evaluations Administrator- Cover Letter
Dear Ms.Nino:
Occu-Med is pleased to submit our proposal in response to the County of Fresno's Request for
Proposal(E-RFP)424-049. Occu-Med, a federally registered,wholly owned, small business
corporation(CA Corporate#C2472806),with regional offices throughout the United States and
headquartered here in Fresno,has been an industry leader in occupational health for 44 years.
Our approach to responding to the County's RFP is one that capitalizes on our expertise in order
to provide the County with a comprehensive and cost-effective solution for administering a
quality,ADAAA,FEHA, and POST compliant Occupational Health Program.
Therefore, our proposal offers the County a range of professional services across multiple
breadths of expertise including: Medical,Legal, and Human Resource. In due course,the goal of
our response is to demonstrate how Occu-Med's Program provides an end-to-end solution for all
services requested by the County. We know that 41%of workers' compensation claims occur
within the first year of employment, and moreover,with our Program we know that together we
can continue to significantly reduce that number.
Accordingly,we are offering the County an Occupational Health Program that has been effective
for over two decades. This includes the management of our network of medical providers
throughout Fresno County; and, a Proposal to re-administer our Job Analysis Services.
We hope that our described approach allows the County to understand how Occu-Med's services
would continue to ensure the County maintains a smooth and effective Occupational Health
Program.
I can be contacted directly at the number printed below at extension 207,we look forward to
hearing from you.
Sincerely,
Christopher St. George
Business Development Director
2121 West Bullard Avenue,Fresno,California 93711 1559.435.2800 1 Fax:559.435.7200 1 www.occu-med.com
The County of Fresno
Response to Request for Proposal(E-RFP): #24-049 Medical Examinations and Evaluations
Administrator
Employment Medical Programs & Services
' 1
Proposal Submitted by:
4kd
OCCU-MED
April 5,2024
Corporate HQ-2121 West Bullard Avenue,Fresno, CA 93711
Federal Tax ID: 52-2333519
State of California Corporate ID: C2472806
559.435.7200-Fax
Contact:
Christopher St. George
559.435.2800 x207-Telephone
cstgeorge(c�r�,occu-med.com-Email
www.Occu-Med.com
The County of Fresno Response to Request for Proposal(E-RFP): 424-049 Medical 4/5/24
Examinations and Evaluations Administrator
TABLE OF CONTENTS
PAGE NUMBER
I. RFP PAGE 1 COVER PAGE
IL COVER LETTER COVER LETTER
III. TABLE OF CONTENTS 2
IV. CONFLICT OF INTEREST STATEMENT 3
V. TRADE SECRET 3
VI. CERTIFICATION-DISCLOSURE- CRIMINAL HISTORY... 3
VIL REFERRENCES 3
VIII. PARTICIPATION 3
IX. EXCEPTIONS 3
X. VENDOR COMPANY DATA 4
XI. SCOPE OF WORK PROPOSAL REQUIREMETNS 13
XII. COST PROPOSAL 24
XIII. CHECK LIST N/A
COUNTY FORMS
EXHIBITS EXHIBITS
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Examinations and Evaluations Administrator
IV. CONFLICT OF INTEREST STATEMENT
Occu-Med hereby recognizes and endorses the County's ongoing efforts to comply fully with the
procurement laws that govern work done by the County. Occu-Med hereby certifies that it knows of no
facts or circumstances as a result of its other activities or relationships with other persons or entities that
could lead to an organizational conflict of interest as defined on pages 5-6 of the County's RFP.
Occu-Med recognizes that it has a continuing obligation to examine its other activities and relationships
to ensure the work being undertaken or considered will not conflict with or otherwise impair its judgment
in performance of any contract awarded as a result of this solicitation.If at any point during its
performance of the subcontract, Occu-Med becomes aware of any facts or circumstances that could create
an organizational conflict of interest, Occu-Med agrees to immediately disclose such information to the
County.
V. TRADE SECRET
See executed County Form(enclosed).
VI. CERTIFICATION-DISCLOSURE-CRIMINAL HISTORY...
See executed County Form(enclosed).
VII. REFERENCES
See completed County Form(enclosed).
VIII. PARTICIPATION
See executed County Form(enclosed).
IX. EXCEPTIONS
A. Exceptions to General Conditions. -None.
B. Exceptions to General Requirements. -None.
C. Exceptions to Specific Terms and Conditions. -None.
D. Exceptions to Scope of Work and/or Scope of Work Proposal Requirements.-None.
E. Exceptions to Proposal Content Requirements. -None.
F. Exceptions to any other part of this RFP. -None.
3 1 occu-Med
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Examinations and Evaluations Administrator
X.VENDOR COMPANY DATA
A. Company Narrative
Since 1979 Occu-Med's primary mission has been to reduce occupational injuries. Beginning in 1976,
Occu-Med's founder,James Johnson J.D.,directed a two-million dollar United States Civil Service
Commission grant"to develop and implement an improved system of physical and medical standards and
procedures for employment." The goals of this project were: a)to ensure workers were able to safely
perform the essential function of their jobs,b)reduce the costs associated with worker injuries, and c)
protecting the rights of the disabled by developing a medically appropriate and legally defensible
methodology for determining what medical conditions, injuries or illnesses allowed for reasonable
accommodation. The culmination of Occu-Med's initial research project would be the Occu-Med System
of medically evaluating applicants' and employees'job suitability.During the thousands of hours spent
analyzing various job classes amongst cities and counties throughout California(which were participating
in the research grant),Occu-Med was able to discover and statistically document that-regardless of job
class-approximately 4 1%of workers' compensation injuries occurred in the first year of employment.
Further analysis of this figure, conducted with Sacramento County,Los Angeles County, and many other
agencies(in coordination with Jean Felton,M.D., ("The Modern-Day Father of Occupational Medicine"
and Occu-Med's first Medical Director), as well as Lee Cady,M.D., Occu-Med's cardiologist [retired
2014]),resulted in what eventually became the basis of Occu-Med's signature service QA2,the gold-
standard in pre-placement and occupational health medical evaluations.
Many of the organizations that participated in this project were eager to begin utilizing the Occu-Med
Occupational Health Evaluation Program as they had to recently begin complying with the Vocational
Rehabilitation Act of 1973. Accordingly,the second phase of Occu-Med's research began with the goal
of discovering why such a disproportionate amount of injuries occurred almost immediately after an
employee was placed. The results of Occu-Med's second phase of research(conducted in coordination
with the State of Hawai'i)yielded a revelation, applicants and employees with pre-existing medical
conditions were being placed into jobs that,upon the performance of their essential functions,predisposed
the individual to injury. Therefore, if these medical conditions could be identified prior to the applicant
or employee being placed, entire injuries could be avoided,thus completely eliminating the associated
cost of the resulting workers' compensation claim.
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Examinations and Evaluations Administrator
One of three key elements in this process would be collecting and analyzing valid job information
pertaining to the most physically demanding essential job function for any physical ability required for a
job. In due course, Occu-Med developed Physical Abilities Analysis, its proprietary system of identifying
the most physically demanding essential functions of a job.
-But, how do you analyze so much information,jobs can be so complicated?
Physical Abilities Analysis is a structured group process that involves interviewing job incumbents from
the job being analyzed.During the Job Analysis sessions, incumbents are asked to identify the most
physically demanding essential job tasks for 19 physical ability categories, and then they are instructed to
rate those tasks on a 7-point,behaviorally-anchored scale. The incumbents are also asked to complete a
questionnaire that addresses the environmental factors that they may be exposed to in their job. Overall,
each session only requires about two(2)hours to complete. (Further details regarding how we perform
our Job Analysis can be found beginning on pages 14-15).
Thus, in light of the almost 5-years of research, Occu-Med began utilizing its Physical Abilities Analysis
in collaboration with many of the agencies who participated in the research and, in 1984 we opened our
own clinic. Utilizing our research-based Program designed specifically to understand what medical
conditions to look for during a pre-placement medical evaluation Occu-Med began to dramatically reduce
workers' compensation costs at any agency which utilized our Program.
Brief Case Study of Workers' Compensation Savings
An Occu-Lied client Qith over 1500 employees based in California.Colorado and Utah installed the
OccuAled System in Years 1 and 2(see graph on left)at all three of its facilities During this time the
employer was experiencing a 35c-c turnover rate at its Colorado operation.Qith workers compensation
suoo.aoc claims over S1 1 mullion annually Ninety percent of
the injuries being reported were from employees with
Si9u:�•
less than one rear of eapenence on the job. By the
sac. end of Year_'.workers compensation claims dipped
„ . to SS00.000. At the end of Year 3.workers'
compensation claims were at S230.000. Turnover
was reduced to 12'-c. By the end of Year 4.workers
compensation claims were at S200.000.and turnover
was reduced to 81-c OccuAled was credited as the
x major factor in this outstanding turnaround.
(SA Redocnon m Dvect Workers CoRrpensarron Cosa)
5 1 occu-Med
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Examinations and Evaluations Administrator
Throughout the rest of the 1980's and into the 1990's Occu-Med continued to apply its findings to help
reduce employee injuries and workers' compensation costs at hundreds of public agencies throughout
[primarily] the United States. Then, in 1990 with the legislation(and success)of the Americans with
Disabilities Act, employers would be required to comply with more stringent regulations regarding how
an occupational health evaluation was both administered and reviewed.
Out with, Standards&In-dividualized Assessment(Guidelines)
As it related to occupational health one of the key aspects of the 1990 Americans with Disabilities Act
(the"ADA")was the requirement that pre-placement medical testing be job-related and consistent with
business necessity. Previously,with varying degrees of ambiguity, employers could merely select a
medical test(they believed was diagnostic of an individuals' ability to perform a job function)and require
all job applicants"pass" such a test,regardless of whether or not that test was actually a valid measure of
safe job performance. The ADA, instead,now required a nexus be shown between the medical test and
one or more of the essential functions of the job into which the applicant was to be placed.
Fortunately, Occu-Med and its clients,were very well prepared for this legislation, after all we had
already been conducting only job related medical evaluations for over a decade utilizing the Physical
Abilities Analysis process(previously described).
PIP-
- • System
• - • Components
L_ Three
Medical Job
Evaluation Analysis
< k
Medical Standards/Guidelines
6 1 occu-Med
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Examinations and Evaluations Administrator
In due course, employers would now look to Occu-Med not only as medical experts but also for
discerning legal and risk management guidance regarding how to appropriately comply with the ADA
legislation which would now govern occupational health-related medical evaluations. For the remainder
of the 1990s Occu-Med would continue to establish itself as one of the premier authorities related to
occupational health evaluations.
By the early 21'century in addition to the 2008 ADAAA legislation Occu-Med saw the expansion and
updates to additional regulations and guidelines related to occupational health including: California Peace
Officer Standards and Training(POST),National Fire Protection Agency(NFPA) 1582 as well as updates
to the Federal Motor Carrier Safety Administration(FMCSA)Medical Examiners Handbook. In light of
these updates our team would work lockstep with our client employers to ensure continual compliance
with each update, from big things like POST's recommending back X-Rays no longer be performed on
Peace Officers and color vision deficiency being changed from a category A to a category B medical
condition under NFPA 1582;to more detail oriented items like the 2024 revision of the FMCSA Medical
Handbook.
Occu-Med has gained a thorough understanding of employment laws and regulations over its 44 years of
providing these services, and we know the importance of having a complete understanding of the physical
and environmental factors that the employee will face in the workplace before a placement
recommendation is made. In addition to having legal staff,we also thoroughly understand medicine, and
the requirements of the job in question,therefore we are able to confidently permit placement of
applicants and employees who are able to safely perform the essential duties of the job with or without
reasonable accommodation; and, are able to recommend(just as confidently)the disqualification of
individuals who are unable to safely perform the essential duties of the job(again,with or without
reasonable accommodation). For example, as part of our services we track,monitor and opine on updates
to the Occupational Health and Safety Administration(OSHA)and the Americans with Disabilities Act
Amendments Act of 2008 (ADAAA),2024's AB 2188,HIPAA,the California Fair Employment and
Housing Act(FEHA),POST Guidelines and NFPA 1582 which sometimes go unnoticed by Human
Resource,Risk and ESH&S Managers,yet it is the employer who will be left to pay the bill should an
applicant be tested inappropriately during a pre-placement medical exam. And just as importantly we
ensure the quality of each clinic,provider, and laboratory in our medical network including: Joint
Commission, State Medical Board and SAMHSA accreditation. We believe it is incumbent upon Occu-
Med to remain an authority in the relevant legal changes within which such employment decisions must
7 1 occu-Med
The County of Fresno Response to Request for Proposal(E-RFP): 424-049 Medical 4/5/24
Examinations and Evaluations Administrator
be made. We ae proud to have received numerous references from our clients regarding the quality of
our service.
B. Description of Similar or Related Contracts
Occu-Med currently performs the same or similar services for: The City of Fresno, CALTRANS,Fresno
City College,Fresno Irrigation District,UC Davis,the National Forest Service,the City of Modesto, and
the Counties of San Luis Obispo, San Joaquin, Sacramento, Santa Clara,El Dorado,Lake,Placer, Santa
Clara Siskiyou, Sutter,Yolo, and Yuba as well as many other satisfied agencies. Finally,Occu-Med
currently supports Fresno County's Department of Public Health in the management and performance of
compulsory periodic surveillance medical exams.
C. Description of Qualifications of Key Individuals
Below please find a partial organizational chart of key individuals responsible for the County's account
many of these individuals(as described on pages 9-11)are currently the points of contact for the existing
work that Occu-Med performs for the County:
Direct Ext.
CristalGmse c anseaoccu-med.com 148 Accomt Mmqer
PeterMar6neZ eter.martine oau-med.com 110 EXAMQA
NORM
Taylor Ha a to lor.ha occu-med,com 133 EXAMQA
Marianna Hemandez iim ixua.heniandez@occu-med.com 168 Provider Relations
Angela Coleman wgela.colemm@occu-med.cooi 195 EXAMQA
Maya Madsen niaya,madsen@oau-med.com 164 Scheduling
Joseph Rogers i.oseph.rogers@oau-nied.com 174 Scheduling
M ME Kendra Yaeger kendra.yaega@oau.nied.com 167 Scheduling
Bfittmey Cozad britMeyLeozad@occu-ined.com 182 Schedub
Rosahe"Rose"Midiere rosemm diere oau-med,com I 138 Scheduhn
P:1.877.0aumed
Devonna M. Kaji M.D. - Occu-Med's Head of Medical Research
Dr.Kaji graduated Magna Cum Laude from the University of California,Berkeley and the University of
Hawaii, John A.Burns School of Medicine. She received her surgery training at the University of
Southern California(USC)and is a Board Certified Urologist. She has served as Professor of Urology
and Assistant Chief of the Department of Urology at the Children's Hospital of Los Angeles,the
University of Southern California,the University of Colorado and Chief-of-Staff at Children's Hospital
Central Valley. Dr.Kaji has served on Occu-Med's Board of Directors and managed its Medical
Advisory Board for more than 30 years,and she has been the Company's Medical Director for more than
8 1 occu-Med
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Examinations and Evaluations Administrator
25 years. She has participated in all of the Company's medical research, having met with the medical
specialists and sub-specialists representing 12 separate body systems who initially formulated Occu-
Med's Compendium of Medical Standards(now termed Medical Guidelines). She has continued to
supervise and participate in every medical research meeting addressing the continued effectiveness and
appropriateness of this Compendium. Dr. Kaji supervises all medical specialists to Occu-Med. Further,
as Medical Director,Dr.Kaji oversees all medical aspects of the Company's QA2 Program.
Geoffrey W. Black M.D.-Staff Physician
Dr.Black overseas Occu-Med's day-to-day medical operation and is the primary provider at our medical
clinic here in Fresno. In addition to his day-to-day clinical duties,Dr.Black provides medical policy and
expert resources guidance to Occu-Med regarding OSHA and HAZMAT compliance.Dr.Black attended
medical school at USC's Keck School of Medicine. Dr.Black has previously performed the required
Occu-Med/County Sheriff Department Exams while working at the FIRM, and since joining Occu-Med
in 2017 he regularly performs exams for the City, County and other municipal agencies throughout the
Fresno area.
James A. Johnson J.D. - Occu-Med's CEO and Legal Research Executive
Mr. Johnson founded Occu-Med in 1979 with an initial focus on research and consulting.As interest in
the Company's proprietary research grew,Mr. Johnson expanded operations to include occupational
medicine clinic management(including Occu-Med's own clinics),workers' compensation cost
containment,vocational rehabilitation counseling(with a department of 9 counselors), franchise
operations, and an international network of medical providers committed to providing timely,professional
and cost-effective medical examinations for our clients.Under Mr. Johnson's guidance, Occu-Med has
been the vanguard of medical standards/guidelines research and risk management programs designed
around such research.
Mr. Johnson is responsible for the development of QA2,the Company's program to manage a client's
entire medical evaluation activity, including Occu-Med's state of the art quality assurance program,
EXAMQAR. He has also guided the Company's national expansion for 44 years.
Prior to founding Occu-Med,Mr. Johnson was a private consultant directing several major civil rights
consulting projects.Mr. Johnson was a Legal Analyst and an Affirmative Action Advisor with the County
Supervisors' Association of California and a Legislative Analyst with the State of Hawaii's Commission
on the Handicapped.
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Examinations and Evaluations Administrator
Mr. Johnson is a graduate of The Ohio State University and the University of the Pacific's McGeorge
School of Law.
Chase Coyle—Job Analysis Manager; Operations Director
Mr. Coyle obtained his BS in Business Management with a focus on Organizational Leadership at Fresno
State University in 2012. Since his graduation,Mr. Coyle has built upon the foundation of education with
over six years of experience in executive management and customer service.Mr. Coyle has a natural
passion for finding ways to better others and continues his education in management theories by attending
various leadership seminars and reading leadership publications.
Cristal Granse-Account Manager and Director of Team Bailey
Ms. Granse has been with Occu-Med for over 10 years. She initially began her journey with us as an
EXAMQA Analyst,but has since progressed into a role as the Director for Team Bailey. Her focus is to
be an advocate for our clients and their needs, large or small.
Ms. Granse has also recently expanded her role to include performing Job Analysis. This includes both
administering Job Analysis onsite at our clients' places of work; and the analysis of the data collected as
part of the creation of Job&Medical Exam Component Profiles.
Sean Edin, PTA,ATC-Quality Manager
Mr. Edin is a certified assistant physical therapist and has performed hundreds of job analysis sessions
and thousands of evaluations for Occu-Med clients throughout the United States. These aspects of his job
allow him to see many different job classifications enhancing his consulting abilities. Whether the job
class is a Librarian for a Public Sector municipality, or Satellite Technician for NASA's Deep Space
Network,Mr.Edin is able to synthesize the critical data in a job in order to ensure medically appropriate
and legally defensible testing practices.
(Additional resumes and licensure for key individuals can be found in Exhibit 1).
10 1 Occu-Med
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Examinations and Evaluations Administrator
D.Additional letters of endorsement
Enclosed as Exhibit 2 are additional letters of Endorsement, Occu-Med has also completed the reference
section of this proposal.
E. Brief Description of Current Operations
Occu-Med, an S-Corporation, is open Monday-Friday 6:00am-6:00pm PT. Occu-Med maintains multiple
offices throughout the United States including: Denver,CO,Fort Worth, TX,Herndon,VA Greenville,
SC as well as our Headquarters here in Fresno.Between the five(5)offices we maintain an average staff
of approximately 80-85 employees. We also generally rotate between 2-3 personnel in support of our
country's ongoing global stability operations. In this capacity our staff have recently traveled to: Dubai,
Guam,Iraq,Peru,Puerto Rico and India to manage and perform occupational health evaluations.
In Fresno the primary clinic we work with is Apollo Health Inc. This location evaluates between 5-15
Occu-Med referrals a week. It is located at 6042 North Fresno Street, Suite 104.It is opened Monday-
Friday 8am-5pm. We also contract with Cardiovascular Consultants Heart Center to complete the
treadmill portion of the evaluation. CCHC is located at: 1207 East Herndon Ave. Whenever the applicants
schedule can accommodate it we schedule these appointments to occur concurrently in order to minimize
travel and wait time.
Additionally,as referenced in the Key Personnel section,the County will continue to have the same Team
-Team Bailey-assigned to it in order to ensure continuity and quality in the scheduling,performance,
management and review of all medical evaluations.
F. Copies of Financial Statements
Pursuant to the instructions of the RFP(page 23)Financial Statements are not being provided with
Occu-Med's proposal,however,reviewed financial statements are available upon request.And we have
provided a letter of Endorsement from our Bank(Exhibit 2).
G. Describe all contracts that have been terminated before completion within the last five(5)years:
None.
H. Describe all lawsuit(s)or legal action(s)that are currently pending; and any lawsuit(s)or legal
action(s)that have been resolved within the last five(5)years:
111 Occu-Med
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Examinations and Evaluations Administrator
None.
L Describe any payment problems that you have had with the County within the past three(3)years:
Occu-Med currently provides professional services to the County both with the Sheriffs' and the Public
Health Department. We believe we have had an excellent contracting relationship and have not
experienced any payment problems in our almost 20-year business relationship.
12 1 Occu-Med
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Examinations and Evaluations Administrator
XI. SCOPE OF WORK PROPOSAL REQUIREMENTS
Every medical exam performed by Occu-Med is done so in order to comply with a legal requirements
surrounding what is permissible for pre-placement and periodic medical evaluations under the ADAAA,
FEHA, GINA and when applicable POST Guidelines. Put simply,we do not merely ask the applicant or
employee if he or she is able to"do the job"or"return to work",rather, our approach provides a
quantifiable way to make such a determination for each applicant and/or employee as part of an
individualized assessment.
The cornerstone of creating legal defensibility in Occu-Med's"QA2 Occupational Medicine Program"
begins with the administration of Job Analysis, i.e. initially validating all medical testing performed
through a statistically validated method. Job Profiles(see sample EXHIBIT 3)are prepared for use in
evaluating pre-placement, periodic, fitness-for-duty and return-to-work medical examinations by
conducting on-site job analysis sessions. The procedure utilized during the job analysis sessions is the
same one that we have used for more than 3,000 other agencies: Physical Abilities Analysis (some of
which was described on page 5).
Data collected is qualitatively and statistically analyzed to develop Job and Medical Examination
Component Profiles(MECP)for each job class studied- like those included in the County's RFP
"Attachment A". The Job Profile accurately and fully captures the most demanding essential job tasks of
the jobs studied, and the MECP will detail the specific medical tests that are job-related and consistent
with business necessity and therefore recommended to find or diagnose the medical or physical conditions
that would be of concern for that job.
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Additionally,as part of our Job Analysis Occu-Med PHYSICAL ABILITIES
will include a review of the County's current
GROXS BODY LrrORT
testing protocols and procedures to determine if any EQUILIIIRIUM
additional CAL/OSHA specific testing could be FAR VISION
NEAR VISION
included as part of the pre-placement medical
exam. NEARING VISUAL COLOR
DISCRIMINATION
Occu-Med projects it can accomplish an analysis of
STAMINA STATIC STRENGTH
the County's job classifications in 1-week. This
presumes the County can work with Occu-Med to TRUNK STRENGTIN 1 DYNAMIC FLEXIBILITY
schedule efficient class sizes in order to perform the
sessions. ARM-HAND
EXTENT FL EXI RII ITr
STEADINESS
The County could expect to pay the fees identified GROSS BODY
EXI-LOSIYC SYRCNGTH COORDINATION
in the Cost Proposal Section of Occu-Med's response,
Section"C". Thereafter, if additional job classes required SRCCO OF MANUAL DCXTCRITY
LINK MOVEMENT
analysis we could perform a review of an existing job
FINGER Dr TCRITY
description to create an MECP, or perform a supplemental
MOU LITY
onsite session. 0 DYNAMIC STRENGTH
With the completion of Job Analysis and approved Medical Exam Component Profile the County can be
confident that all medical testing is job related and consistent with business necessity. After our initial
Job Analysis is completed Occu-Med can on an biennial basis refresh the County's Job Profiles to reflect
changes to the physical demands of the position. This will also be performed for the County's Medical
Exam Component Profiles in order to stay compliant with changes to applicable laws, like the Lanier
case, or updates to Guidelines like POST or NFPA. Occu-Med is prepared to begin work for the County
on April 8, 2024, or sooner, in order to ramp up job analysis planning. NOTE: If the County elects not
to purchase this service Occu-Med can work from the County's existing Job Profiles and Medical
Examination Protocols (like those included in the County's RFP)and our current medical
guidelines. Our job analysis service can always be performed at a later date.
As an additional value to Job Analysis,this Program will provide the County an effective method of
managing the possible return to work of employees who require a medical leave of absence due to injury
or medical conditions, as well as an Americans With Disabilities(ADA)and the ADAAA/FEHA
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Examinations and Evaluations Administrator
compliant reasonable accommodation forum for engaging such employees. Occu-Med's FFD/IRTW
Program is currently in use by hundreds of employers nationwide. Occu-Med is uniquely positioned to
assist the County with the human resources matters involving complex medical cases that require a
prompt and discerning assessment of the medical factors that may constitute a contraindication to an
employee's performing one or more of the essential functions of the job.
Medical Network
Occu-Med contracts with multiple medical providers throughout the Central Valley which will allow the
County's applicants and employees to always attend an appointment close to his or her current job or
home. This service extends beyond the County's immediate geographical area, as Occu-Med has over
14,000 medical providers nationwide, so no matter where the County is recruiting from rest-assured
Occu-Med will have a clinic nearby. Primary clinics include:
Apollo Health Inc. Cardiovascular Consultants Heart Center
6042 North Fresno Street, Suite 104. 1207 East Herndon Ave.
Fresno,CA 93710 Fresno,CA 93720
PREAMBLE
QA2 is the name given to Occu-Med's end-to-end solution for the scheduling and on-going review of all
medical examinations for applicants or employees for jobs with the County. Our QA2 Program is the
essence of how Occu-Med will accomplish the scope of work requirements on pages 13-15 of the
County's RFP. When applicable the same methodology outlined in this section for scheduling,tracking
and reporting the results of the medical exam will be applied when scheduling periodic, surveillance and
separation exams as well. This service includes the performance and review of each evaluation as well as
the further investigation of medical conditions identified during these exams(through the"RDQA"
service--see description on page 18). The preparation of letters to applicants or employees who are
determined to be Medically Disqualified for the job for which they applied or currently work-in, an
analysis of Reasonable Accommodation for each individual Medically Disqualified, and the preparation
of periodic production/performance/status reports.
SOW 2.Medical Examination Results
As identified in section C. Description of Qualifications of Key Personnel pages 8-10 of our proposal
Occu-Med will continue to utilize and make available to the County many of the same key personnel that
currently are responsible for the County's operations.
15 1 Occu-Med
The County of Fresno Response to Request for Proposal(E-RFP): 424-049 Medical 4/5/24
Examinations and Evaluations Administrator
As identified on Page 8, Section B, Occu-Med currently performs the same and similar services for
numerous public agencies throughout California.Additionally,we currently perform many of the same
services for the County's under separate Agreements(see right awarded in 2023).
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Scheduling _
Scheduling pre-placement, or periodic medical exams through Occu-Med could not be easier. A County
representative contacts Occu-Med's Exam Scheduling Hotline or submits an Occu-Med Exam
Requisition Form(see Exhibit 4),—or spreadsheet-via e-mail and the necessary medical exam is
scheduled the same day as the referral. Alternatively, all referrals can be made using our customer web-
portal, "The Occu-Portal". Next, Occu-Med,within two(2)hours of receipt of your referral,will contact
your applicant or employee in order to arrange a medical appointment with him or her. Upon completion
of scheduling,your representative will immediately receive email confirmation of the appointment time
and date,which will be scheduled to occur within three(3)County business days of the referral.
Normally,the exam will be scheduled at Occu-Med's owned and operated medical clinic however,with
your permission, exams could be scheduled at an alternative clinic if the applicant lives closer to an
alternative clinic for instance someone living in Modesto. Upon scheduling the medical exam the
applicant is provided in advance all the necessary paperwork in order to complete the exam successfully.
This includes a copy of Occu-Med's GINA compliant medical history forms(see Exhibit 5)which are
used in place of generic"return to work/school"forms. We do this to ensure no inappropriate medical
history questions are solicited as often times, generic forms lack compliance as they are used for various
other types of medical evaluations.
16 1 Occu-Med
The County of Fresno Response to Request for Proposal(E-RFP): 424-049 Medical 4/5/24
Examinations and Evaluations Administrator
Using The Occu-Portal
Having scheduled the medical exam, and with knowledge of the length of time required to obtain results
from the laboratory(i.e.,Blood Chemistry Panel takes 24 to 48 hours for results),Occu-Med commits to
submitting a Medical Exam Summary Report to the County on the same day an exam is completed.
EXAMQA-Quality Assurance
• - .
When reviewing an exam Occu-Med combines: ExaLm
a) a thorough knowledge of the essential physical and Timeline
environmental components of the jobs in question;
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b) the medical expertise to gather all necessary and appropriate m ° "° °'
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medical information upon which to base safe placement, ; '
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This aspect of our services means that Occu-Med and its medical
review staff review all completed medical exams and it is Occu-Med's 1 �
recommendation that is made to the County regarding an applicant or
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employees safe placement. This process ensures that pertinent aspects
46
regarding a placement decision are considered for instance a thorough
review of each Job Profile by the examining physician. For NNNCOC*CU-ME1D
Conditional Qualifications(CQ), an Employment Agreement
accompanies each such report. For Recommended Delayed for Qualification(RDQ),RDQA is initiated
with the applicant, and the County is simply notified that the process has begun. This eliminates the
17 1 Occu-Med
The County of Fresno Response to Request for Proposal(E-RFP): 424-049 Medical 4/5/24
Examinations and Evaluations Administrator
possibility of disclosure of protected personal medical information that may be undesirable for the County
to have received. For each Disqualification(DQ), an appropriate medical-legal report is submitted
documenting the specific justifications for the disqualification and informing the County of the
requirement of a consideration of Reasonable Accommodation(a process in which we encourage the
County to involve us).
Qualification Recommendations are as follows:
Occu-Med's Qualification Recommendations and Reports
Medically Qualified-Applicant/employee is an immediate safe placement.
Conditionally Qualified -Applicant/empleee may be placed immediately but has work restrictions or
accommodation as outlined on the medical restrictions and/or reasonable accommodations page of the
report. The specific restrictions or accommodations are always included as part of the Conditionally
Qualified Medical Exam Summary Report.
Recommendation Delayed for Qualification-Applicant/employee will be required to submit further
information regarding one or more medical conditions before being placed. This process is facilitated by
Occu-Med via RDQA. The applicant is contacted on the day that he/she becomes delayed and informed
that he or she has 10 business days to complete the request for additional medical information(extensions
of the timeframe can be granted at the County's discretion).
Medically Disqualified-Applicant/employee has been deemed medically unsuited for this job class and
will not be placed. Occu-Med's report outlining relevant issues will be attached. The County must
consider Reasonable Accommodation for this Medical Disqualification and must determine whether such
an accommodation is feasible.
See Exhibit 6 for sample reports.
Recommendation Delayed for Qualification—RDQA
The RDQA process is one of the most dynamic services associated with the Occu-Med Program, for the
County this process will be the mechanism for completing Page 16 Section IV"T'of the County's RFP.
When the Occu-Med recommendation is that a decision be delayed until certain medical information can
be further explored(that is,when the applicant is classified as"Recommendation Delayed for
Qualification"—or"RDQ"—under Occu-Med terminology), Occu-Med will submit that report as well as
18 1 Occu-Med
The County of Fresno Response to Request for Proposal(E-RFP): 424-049 Medical 4/5/24
Examinations and Evaluations Administrator
an additional report when the requested additional information is received and Occu-Med is able to offer a
conclusive placement recommendation. Since the law permits making"further medical inquiry"into
medical conditions that could pose a direct threat of injury from the performance of the job's essential
duties, it is necessary to notify the applicant of the specific findings as well as the information that will be
necessary to submit in order to be cleared for the job. Since County staff may not have the time or the
medical expertise to contact each of these applicants to describe in detail the medical findings and to
answer their questions about the medical information needed for clearance to be approved,Occu-Med
staff communicates directly with these applicants. Further,there is also a growing fear by employers that
they may be receiving medical information about job applicants from medical examinations in violation
of state and federal laws relating to such information(specifically,when the medical condition being
investigated more fully pursuant to an"RDQ"designation is found to be benign in relation to the job's
essential duties). For these reasons Occu-Med has developed—and will institute as part of this contract—
a service designated as"RDQA." Under RDQA Occu-Med corresponds directly with job applicants to
discuss the medical findings,to answer any questions about the medical condition or the process being
employed,and to describe any medical records or documentation required for clearance. Applicants will
have five(5)days to respond to Occu-Med and ten(10)days to provide further information-unless the
County dictates the application of different time requirements. The County's staff will simply be notified
that such a review has been initiated, and the County will be informed on a periodic basis(as directed)on
the status of each RDQ. Then,when the requested information is submitted, Occu-Med will prepare the
appropriate clearance report.
Sworn Officer(POST)Exams
Occu-Med is responsible for the pre-placement medical evaluation program for dozens of Police and
Sheriff departments throughout the State of California. Our experience in this field has given us profound
and wide-reaching experience with the Peace Officer Standards and Training(POST)Medical Screening
Manual a.k.a POST Guidelines.
"The process and decisions resulting from the medical screening of patrol officer candidates are dictated
as much by state and federal regulations as by accepted medical practices. It is therefore imperative that
physicians as well as hiring authorities have a full and complete understanding of the legal issues
underlying medical screening for occupational suitability."—Excerpt from POST
Occu-Med,by standing at the crossroads of both the medical and legal community(having both medical
and legal staff) is able to make discerning recommendations regarding officer placement that our client
employers can be confident in.
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The County of Fresno Response to Request for Proposal(E-RFP): 424-049 Medical 4/5/24
Examinations and Evaluations Administrator
DMV(CDL)Examinations
Pursuant to 49 CFR§ 391.41 Department of Transportation Physical Qualifications and Examination of
Drivers Motor Carrier Safety Regulations, a DMV medical exam will be administered.A Department of
Motor Vehicles Medical Examiners Certificate per 49 CFR 391.41-49 will be prepared by Occu-Med's
FMCSA certified examining medical provider and will be given to the employee with a copy emailed by
Occu-Med to the County's Human Resources Department. Pursuant to the May 19,2014 revisions to the
Federal Motor Carrier Safety Regulations Occu-Med will ensure all medical providers conducting DOT
exams are certified on the National Registry.
As required, Occu-Med will also schedule ancillary required commercial driver components including but
not limited to: DMV DL 51 Medical Examination Report requirements and Audiometric baseline per
CCR Title 8 § 5097(audiogram to assess hearing between 500hz-6000hz). Information will be recorded
in accordance with CCR Title 8 § 5097.
Drug screening at many clinics is"hit or miss." Additionally, if a Medical Review Officer(MRO)is ever
required,that service is subject to a separate fee. And, finally,many issues that arise are beyond the
experience of the clinic to address(i.e.,dilute negative tests and shy bladder). To alleviate these issues,
Occu-Med has developed a national program that manages all such drug screening issues for its clients,
including assisting in the development of drug screening programs and procedures,pursuant to CFR Title
49 Part 40. Further, due to our national purchasing power,we are able to offer attractive pricing with no
add-on charges for MRO services. Further,we are readily available to address any issues in this area that
arise this service will be substituted for the clinic's typical program, ensuring compliance for the County's
DOT drug screen program. Licenses for Occu-Med's SAMHSA&CAP accredited lab are enclosed.
DOT- Urine Collections
Occu-Med is able to provide the County a comprehensive solution for collecting DOT urine drug screens
and BAT in compliance with CFR Title 49,PART 40. We are also able to offer after-hours,post-accident
and reasonable suspicion services as well. Of course,regardless of when or where a collection takes
place, only Certified Specimen Collectors having received the CFR Title 49,PART 40.213 Training will
be used for these collections.
All urine results will be sent to Labcorp Laboratories for confirmation. Labcorb is SAMHSA certified
and is able to conduct confirmatory tests using the split-specimen regulations and MRO confirmation.
These results are typically available within 48-72 hours,with up to 72 additional hours needed if MRO
confirmation is required pursuant to a DOT requirements for a positive finding using GCMS
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The County of Fresno Response to Request for Proposal(E-RFP): 424-049 Medical 4/5/24
Examinations and Evaluations Administrator
confirmation. When MRO confirmation is required the County wi I be notified of up to the required three
(3)day delay.
Periodic/Surveillance Exams
Instituting a program that regularly evaluates pertinent aspects of your employees' health can prevent
injuries resulting from deterioration in employee health, as well as maintain compliance with regulations
that require medical surveillance. We understand that pursuant to page 14,II, "3"at this time the County
does not currently perform periodic evaluations,however should the County decide to begin such
evaluations Occu-Med can assist with policy and procedure recommendation in order to ensure both
ADAAA/FEHA compliance as well as an appropriate return-on-investment. A large segment of Occu-
Med's business has become the performance and management of compliance for required periodic testing
including: CAL/OSHA Compliance,POST,hearing conservation,HAZMAT,respiratory protection, and
many other regulations.
Occu-Med would be pleased to begin providing the necessary medical tests associated with ongoing
compliance of these many regulations. Further, information regarding this service can be discussed with
the County should Occu-Med be selected as the vendor.
Communicable Diseases
Based on Occu-Med's Job Analysis,POST,CAL/OSHA regulation §5193.Bloodborne Pathogens Occu-
Med is able to tailor its Occu-VAX services to provide robust support to the County in helping to mitigate
communicable diseases.
Occu-Med performs over 50,000 occupational health related immunizations annually, from annual flu
shots to yellow fever prophylaxis. Occu-Med maintains an entire department dedicated to this ongoing
endeavor, Occu-VAX. At the time of each referral for individuals requiring immunizations Occu-Med
will request a copy of the applicant's vaccination record. Pursuant to the County's request an assessment
will be made regarding whether or not the applicant has received the necessary immunizations including:
MMR, Tetanus&TDAP,Hepatitis B,Varicella and the current influenza immunization. If it is
determined that one or more immunizations are necessary,the immunizations will be made available (but
not required)to the applicant at the time of the medical exam. If the applicant declines the immunizations
Occu-Med will administer the necessary declination form.
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The County of Fresno Response to Request for Proposal(E-RFP): 424-049 Medical 4/5/24
Examinations and Evaluations Administrator
Occu-VAX
Occu-VAX is the scheduling and coordination, immunization record management and the on-going
management of all immunizations for applicants and employees for jobs. This service includes an
individualized evaluation of each applicant/employee to assess the appropriateness and necessity for
administering the immunization outlined in the specific Occu-VAX Profile prior to and,when appropriate,
during employment.
Scheduling and Coordination: Upon completion of the medical evaluation or concurrently by request
from a designated County employee, Occu-Med will promptly contact applicants/employees to: a)
assess the appropriateness and necessity for receiving immunizations and b) schedule and coordinate the
administration of those immunizations deemed appropriate and necessary prior to and during
employment.
Immunization Record Management: Applicants and employees will be given an immunization record
(documentation of immunization history)upon completion of a) initial administration of
immunization[s]; or b)an assessment concluding that no immunizations are necessary. Immunization
records for all applicants and employees evaluated will be maintained electronically by Occu-Med. In the
event an applicant for employee declines an immunization Occu-Med will obtain the appropriate
declination from the individual.
On-Going Immunization Management: All immunization recommended by NFPA,POST or the CDC
will be managed by Occu-Med. This service includes tracking to assure compliance with the CDC, in
addition to other applicable guidelines;notification of employees and designated supervisory personnel of
all periodic follow-ups associated with immunization treatments; and,upon request,preparation and
provision of customized tracking reports documenting any aspect of the immunization program.
Occu-VAX is a dynamic service that any employer can access, from including a Hepatitis B Titer as part
of a pre-placement evaluation so that Hepatitis immunity can be immediately documented, or providing
on-site flu immunizations during the flu season. Should the County elect to incorporate Occu-VAX a
medical records management fee would be applied.
OSHA Respirator Medical Evaluation Questionnaire review pursuant to CCR Title 8 § 5144.
Occu-Med will administer OSHA Respirator Medical Evaluation Questionnaire pursuant to CCR Title 8 §
5144 to the applicant once the referral is received. Occu-Med can either use the County's form, or the
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The County of Fresno Response to Request for Proposal(E-RFP): 424-049 Medical 4/5/24
Examinations and Evaluations Administrator
Cal/OSHA form. These forms will be provided to the applicant electronically. Once returned to
Occu-Med the OSHA Respirator Medical Evaluation Questionnaire is reviewed by one of our physicians
or other licensed health care professional(PLHCP). When necessary,the applicant or employee will
undergo a Pulmonary Function Test Occu-Med requires that three(3)blows be taken with the best result
becoming the medical record.
Occu-Portal
At the request of the County result will also be made available via an online web-based portal known as
the Occu-Portal. Occu-Med will provide personnel, designated as authorized by the County,with access
to the Occu-Med Portal. This web-based tool will permit designated the County's personnel to access real-
time statuses of individuals referred to Occu-Med for evaluation.Additional tutorial information
regarding utilizing Occu-Med's vendor portal will also be made available online should new users need
training on the site.
Occu-Med will also provide to the County, at its convenience, a telephonic or face-to-face walk-through
of our portal features so that the County can customize which fields it wishes to have appear on the portal.
Occu-Med will create vendor logins for six(6)County personnel, and more can be added at the County's
convenience. Login access will be emailed by Occu-Med to the designated County representatives. It
will be incumbent upon the County to notify Occu-Med should a representative change or no longer
require access. Occu-Med's web-based portal prioritizes data security both in transit and at rest.Utilizing
industry-standard encryption technology, all data transmissions are safeguarded during communication.
Additionally,each client contact receives a unique login for accessing the platform, further enhancing the
security of our solution.
As part of Occu-Med's services Occu-Med serves as the custodian of records for all medical records for
our clients. Occu-Med maintains this information in a HIPAA compliant softcopy that is available to the
County with a one(I)-business day request.
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Examinations and Evaluations Administrator
XII. Cost Proposal
Pursuant to the County's RFP Occu-Med has completed the County's Cost Proposal Document items A-
D.
A. Medical Examination
On the first day of each month, Occu-Med will submit an invoice to the County for the prior month's
medical services and examinations. Our invoices will be itemized by: Invoice Date,Invoice Number,
Amount Due,Payment Due Date(net45)and list of all services provided. This will include Examinee
name,type of exam,job classification, date services rendered and Profile Developed.
Our knowledge of the precise medical exam components that are of value for each specific job class
(eliminating useless, improper and overly expensive medical tests), our national buying power for
laboratory services(blood chemistry panels and urine drug screens), and our careful auditing of clinic and
laboratory charges allow us to offer a vastly expanded array of services to our clients for fees typically
charged by their medical provider for just the medical examination and laboratory charges.
Occu-Med will in-turn be able to submit clear and straightforward monthly invoices to the County. This
stands in contrast to the amorphous and often incorrect invoices typically submitted by clinics.
B. Medical Examination Review
QA2 Medical Examination Review Services
Our QA2 services consists of our customary medical examination review fee which includes the
following:
• Scheduling of each medical exam
• Tracking each medical exam for applicant/employee attendance
• Harvesting all medical exam results from the laboratory
• Occu-Med Medical Network allowing County applicants to be seen anywhere in the United
States
• Review and evaluation of completed medical examinations with results sent to you on the same
day that the exam is received
• Written reports for each review undertaken for each applicant
• Employment Agreements for any employees placed with accommodations
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Examinations and Evaluations Administrator
• Additional reviews for applicants with medical or physical conditions requiring further testing or
submission of additional information
• Explanation(by telephone and by letter)to prospective employees of additional medical
information necessary for job clearance
• Submission of legally defensible hiring recommendations
• Assistance with reasonable accommodation recommendations
• Consultation relative to pre-placement,return-to-work, and fitness-for-duty issues
• RDQA services
• Assurance of excellent clinic performance issues,as needed
• Periodic reports documenting the results of Occu-Med's work
• Occu-Portal
C. Medical Profiles/Screening Guidelines
Services described on pages 14-16.
D. Additional Services
As described on page 21-23.
We hope you enjoyed reviewing our proposal,we would be honored to continue to provide our services to
the County of Fresno and we look forward to hearing from you.
Proposal Respectfully Submitted By:
Christopher St. George
Business Development Director
25 1 Occu-Med
Proposal No. 24-049 Page 18
COST PROPOSAL
The cost proposal should describe in detail the cost for services for the following. Bidders must include all
taxes, wage increases, materials and supplies necessary to complete the service. The County will not pay
any additional fees outside of the costs below unless requested and approved by the County.
• Medical examinations;
• Medical examination reviews;
• Updates to existing medical exam profiles; and
• Development of job profiles and medical screening guidelines/standards.
A. Medical Examination
Cost per exam for(County's usage for all categories of medical examinations has averaged
approximately 22 per month, primarily for pre-placement and DMV exams):
1) Pre-placement medical exams
2) DMV exams
3) Periodic exams
B. Medical Examination Review Program
Cost per review for(County's usage for all categories of medical examinations has averaged
approximately 22 per month, primarily for pre-placement and DMV exams):
1) Pre-placement medical exams
2) DMV exams
3) Periodic exams
C. Medical Profiles/Screening Guidelines
1) Updates of current medical profile per classification.
2) Development of new medical profiles per classification.
D. Additional Services
Identify cost for any additional services you offer/recommend that you would require to be included in
an Agreement or that may be optional. Please clearly state whether the service is required or
optional and why it should be included or considered.
A. Medical Examination
Cost per exam for (see Attachment A; County's usage for all categories of medical examinations has
averaged approximately 22 per month, primarily for pre-placement and DMV exams):
Service Year 1 Year 2 Year 3 Year 4 Year 5
Pre-Placement $643.60 $675.78 $709.57 $745.05 $782.30
Chief Probation Officer $643.60 $675.78 $709.57 $745.05 $782.30
Probation Division Director $643.60 $675.78 $709.57 $745.05 $782.30
Probation Services Manager $643.60 $675.78 $709.57 $745.05 $782.30
Deputy Probation Officer III/IV $643.60 $675.78 $709.57 $745.05 $782.30
Deputy Probation Officer I $643.60 $675.78 $709.57 $745.05 $782.30
Supervising Juvenile Correctional
Officer $643.60 $675.78 $709.57 $745.05 $782.30
24-049 Medical Examinations and Evaluations Administrator
Proposal No. 24-049 Page 19
Senior Juvenile Correctional
Officer $643.60 $675.78 $709.57 $745.05 $782.30
Juvenile Correctional Officer II $643.60 $675.78 $709.57 $745.05 $782.30
Juvenile Correctional Officer 1 $643.60 $675.78 $709.57
$745.05 $782.30
Sheriff's Captain $643.60 $675.78 $709.57 $745.05 $782.30
Sheriff's Lieutenant $643.60 $675.78 $709.57 $745.05 $782.30
Sheriff's Sergeant $643.60 $675.78 $709.57 $745.05 $782.30
Deputy Sheriff III $643.60 $675.78 $709.57 $745.05 $782.30
Deputy Sheriff 11 $643.60 $675.78 $709.57 $745.05 $782.30
Deputy Sheriff 1 $643.60 $675.78 $709.57 $745.05 $782.30
Reserve Officer $589.85 $619.34 $650.31 $682.83 $716.97
Uniform Field Division Reserve
Deputy Sheriff(UFD) $643.60 $675.78 $709.57 $745.05 $782.30
Reserve Deputy Sheriff(Special
Guard - 108) $643.60 $675.78 $709.57 $745.05 $782.30
Communications Dispatcher $182.00 $191.10 $200.66 $210.69 $221.22
Community Service Officer $235.75 $247.54 $259.91 $272.91 $286.56
Correctional Officer Lieutenant $643.60 $675.78 $709.57 $745.05 $782.30
Correctional Officer Sergeant $643.60 $675.78 $709.57 $745.05 $782.30
Correctional Officer IV $643.60 $675.78 $709.57 $745.05 $782.30
Correctional Officer 1/11/111 $643.60 $675.78 $709.57 $745.05 $782.30
Supervising District Attorney
Investigator $458.60 $481.53 $505.61 $530.89 $557.43
District Attorney Investigator I/II/Sr $644 20 $697.41 $732.28 $768.89 $807.34
Deputy Coroner 1 $256.35 $269.17 $282.63 $296.76 $311.60
Forensic Autopsy Technician $256.35 $269.17 $282.63 $296.76 $311.60
DMV $105.00 $110.25 $115.76 $121.55 $127.63
Periodic same as Pre- same as Pre- same as Pre- same as Pre- same as Pre-
Placement Placement Placement Placement Placement
B. Medical Examination Review
Cost per review for (County's usage for all categories of medical examinations has averaged
approximately 22 per month, primarily for pre-placement and DMV exams):
Service Year 1 Year 2 Year 3 Year 4 Year 5
Pre-Placement $80.00 $84.00 $88.20 $92.61 $97.24
DMV $40.00 $42.00 $44.10 $46.31 $48.62
Periodic $80.00 $84.00 $88.20 $92.61 $97.24
24-049 Medical Examinations and Evaluations Administrator
Proposal No. 24-049 Page 20
C. Medical Profiles/Screening Guidelines
1. Updates of current medical profile per classification
2. Development of new medical profiles per classification.
Service Year 1 Year 2 Year 3 Year 4 Year 5
Job Analysis $2,000/day $2,000/day $2,000/day $2,000/day $2,000/day
D. Additional Services
Identify cost for any additional services you offer/recommend that you would require to be included in an
Agreement or that may be optional. Please clearly state whether the service is required or optional and
why it should be included or considered.
Service Year 1 Year 2 Year 3 Year 4 Year 5
MECP Creation $50 each $50 each $50 each $50 each $50 each
24-049 Medical Examinations and Evaluations Administrator
Proposal No. 24-049 Page 30
CHECK LIST
This Checklist is provided to assist vendors in the preparation of their RFP response. Included are important
requirements the bidder is responsible to submit with the RFP package in order to make the RFP compliant.
Check off each of the following (if applicable):
1. X Signed cover page of Request for Proposal (RFP).
Check http://www.FresnoCountyCA.gov/departments/internal-services/purchasing/bid-
2. X opportunities for any addenda.
3. X Signed cover page of each Addendum.
4. X Provide a Conflict of Interest Statement.
Signed Trade Secret Form as provided with this RFP (Trade Secret Information, if provided,
5. X must be electronically submitted in a separate PDF file and marked as Confidential).
6. X Signed Criminal History Disclosure Form as provided with this RFP.
7. X Signed Participation Form as provided with this RFP.
8. X The completed Reference List as provided with this RFP.
Indicate all of bidder exceptions to the County's requirements, conditions and specifications
9. X as stated within this RFP.
Bidder's proposal, in PDF format, electronically submitted to the Bid Page on Public
10. X Purchase.
Return Checklist with your RFP response
24-049 Medical Examinations and Evaluations Administrator
Proposal No. 24-049 Page 24
TRADE SECRET ACKNOWLEDGEMENT
Each proposal submitted is public record under the California Public Records Act(Cal. Gov. Code, secs. 7920.000 and
following)and is therefore open to inspection by the public as required by Section 7922.525 of the California Government
Code. This section generally states that"every person has a right to inspect any public record". The County will not
exclude any proposal or portion of a proposal from treatment as a public record except information that it is properly
submitted as a"trade secret"(defined below), and determined by the County to be a"trade secret"(if not otherwise
subject to disclosure, as stated below). Information submitted as"proprietary", "confidential"or under any other terms that
might state or suggest restricted public access will not be excluded from treatment as public record.
"Trade secrets"as defined by Section 7924.510 of the California Government Code are not treated as a public record
under that section. This section defines trade secrets as:
"...Trade secrets,"as used in this section, may include, but are not limited to, any formula,plan,pattern,process, tool,
mechanism, compound,procedure,production data or compilation of information that is not patented, which is known only
to certain individuals within a commercial concern who are using it to fabricate,produce, or compound an article of trade or
a service having commercial value and which gives its user an opportunity to obtain a business advantage over competitors
who do not know or use it."
Such information must be submitted in a separate PDF file named"Trade Secret"and marked as"Confidential"in the
Public Purchase system. Bidders must include a clear and concise statement that sets out the reasons for confidentiality
in accordance with the foregoing definition of"trade secret." Examples of information not considered trade secrets are
pricing, cover letter, promotional materials, references, and the like.
Information submitted by a bidder as"trade secret"will be reviewed by County of Fresno's Purchasing Division,with the
assistance of the County's legal counsel,to determine conformance or non-conformance to the foregoing definition.
Information that is properly identified as"trade secret"and which the County determines to conform to the definition will
not become public record (if not otherwise subject to disclosure, as stated below). The County will safeguard this
information in an appropriate manner, provided however, in the event of a request, demand, or legal action by any
person or entity seeking access to the"trade secret"information,the County will inform the bidder of such request,
demand,or legal action, and the bidder shall defend, indemnify,and hold harmless the County, including its officers and
employees,against any and all claims, liabilities, damages, or costs or expenses, including attorney's fees and costs,
relating to such request, demand or legal action, seeking access to the"trade secret"information.
Information submitted by bidder as trade secret and determined by the County not to be in conformance with the
foregoing California Government Code definition shall be excluded from the proposal and deleted by the County.
The County shall not in any way be liable or responsible for the disclosure of any proposals or portions thereof, if(1)they
are not electronically submitted in a separate PDF that is marked"Trade Secret"and marked as Confidential in the
Public Purchase system; or(2)disclosure thereof is required or allowed under the law or by order of court.
Bidders are advised that the County does not wish to receive trade secrets and that bidders are not to supply trade
secrets unless they are absolutely necessary.
I have read and understand, and agree to the above"Trade Secret Acknowledgement."
BIDDER MUST CHECK ONE OF THE FOLLOWING:
Has bidder submitted certain bid information that is a"trade secret,"as defined by Section 7924.510 of the Califorr
Government Code, and in compliance with the requirements of this Trade Secrets Acknowledgement?
By marking "NO", bidder does not claim any confidentiality of any bid information submitted to the County.
YES X NO
ACKNOWLEDGED AND AGREED BY BIDDER:
March 25, 2024
Signature Date
Chris St. George Business Development Director
Print Name Title
24-049 Medical Examinations and Evaluations Administrator
Proposal No. 24-049 Page 27
CERTIFICATION
(1)The prospective primary participant certifies to the best of its knowledge and belief, that it, its owners,
officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State or local)transaction or contract under a
public transaction; violation of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(c) Have not within a three-year period preceding this application/proposal had one or more public
transactions (Federal, State or local)terminated for cause or default.
(2)Where the prospective primary participant is unable to certify to any of the statements in this certification,
such prospective participant shall attach an explanation to this proposal.
Signature: -- - Date: March 25, 2024
Chris St.George; Business Development Director Occu-Med Ltd.
(Printed Name&Title) (Name of Agency or Company)
24-049 Medical Examinations and Evaluations Administrator
Proposal No. 24-049 Page 28
REFERENCE LIST
VENDOR MUST COMPLETE AND RETURN WITH REQUEST FOR PROPOSAL
Firm: Occu-Med Ltd.
Provide a list of at least five (5)customers for whom you have recently provided similar services. If you have
held a contract for these or similar services with the County of Fresno within the past seven (7)years, list the
County as one of your customers. Please list the person most familiar with your contract. Be sure to include
all requested information.
Reference Name: San Joaquin County Contact: Rachel Novetzke
Address: 44 N. San Joaquin Street
City: Stockton State: CA Zip: 95202
Phone No.: ( 209 ) 468.9555 Project Date: 1990-Present
Service Provided: Pre-Placement and periodic occupational health evaluations
Reference Name: EI Dorado County Contact: Kelley Lawrie
Address: 330 Fair Lane, Bldg.A
City: Placerville State: CA Zip: 95667
Phone No.: ( 530 ) 621-6729 Project Date: 2011-2015 2018-Present
Service Provided: Pre-Placement and periodic occupational health evaluations
Reference Name: Santa Clara County Fire Contact: Doug Baker
Address: 14700 Winchester Blvd.
City: Los Gatos State: CA Zip: 95032
Phone No.: ( 408 ) 341.4482 Project Date: 2017-Present
Service Provided: Pre-Placement and periodic occupational health evaluations including complex NFPA 1582 exams
. . . .......................................................
Reference Name: Siskiyou County Contact: Melissa Cummins
Address: 1312 Fairlane Road
City: Yreka State: CA Zip: 96097
Phone No.: ( 530 ) 842.8017 Project Date: 2022-Present
Service Provided: Pre-Placement and periodic occupational health evaluations
Reference Name: City of Fresno Contact: Ana Rocha
Address: 2600 Fresno Street
City: Fresno State: CA Zip:
Phone No.: ( 559 621.6952 Project Date: 2016-Present
Service Provided: Pre-Placement and periodic occupational health evaluations
Failure to provide a list of at least five (5) customers may be cause for rejection of this RFP.
24-049 Medical Examinations and Evaluations Administrator
Proposal No. 24-049 Page 29
PARTICIPATION
The County of Fresno is a member of the California Association of Public Procurement Officials (CAPPO)
Central Valley Chapter. This group consists of Fresno, Kern, Kings, and Tulare Counties and all
governmental, tax supported agencies within these counties.
Whenever possible, these and other tax supported agencies co-op (piggyback) on contracts put in place by
one of the other agencies.
Any agency choosing to avail itself of this opportunity, will make purchases in their own name, make
payment directly to the contractor, be liable to the contractor and vice versa, per the terms of the original
contract, all the while holding the County of Fresno harmless. If awarded this contract, please indicate
whether you would extend the same terms and conditions to all tax supported agencies within this group as
you are proposing to extend to Fresno County.
* Note: This form/information is not rated or ranked for evaluation purposes.
Yes, we will extend contract terms and conditions to all qualified agencies within the California
Association of Public Procurement Officials (CAPPO) Central Valley Chapter and other tax
supported agencies.
No, we will not extend contract terms to any agency other than the County of Fresno.
(Authorized Signature)
Business Development Director
Title
24-049 Medical Examinations and Evaluations Administrator
EXHIBIT 1
Dr. Valerie Gibson (Schuman) D.O.
(559) 681-1039
vaschuman@yahoo.com
Education:
Internal Medicine Internship UCSF/Fresno, June 2005- June 2006
D.O., TOURO University of Osteopathic Medicine
Vallejo, CA. June 2005
B.A. Biological Sciences, University of Southern California 1997
Experience:
June 2019-Current: Physician at Apollo Medical Group Inc. in Fresno. Duties include
evaluating and treating industrial injuries, personal injuries, DOT physical's.
November 2013-June 2019 Self employed as Dr. Valerie Gibson Inc. Duties include
providing physician services to US Veterans with QTC Lockhead Martin.
April 2010-October 2013: Center Medical Director, Concentra Downtown Fresno
Urgent Care until August 2013 as I relocated to Denver, CO. Duties include evaluating
and treating industrial injuries and urgent care patients. Participate in administrative
duties as related to providing quality of care and practice management. Provided training
for newly hired physicians in the Fresno area. Supervise other physicians and physician
assistants.
August 2009- March 2010: Physician at Palm Medical Group Inc. in Fresno. Duties
include evaluating and treating industrial injuries, personal injuries,physical's, providing
community education on health related issues.
January 1, 2007-September 2009:
Medical Director at Concentra Medical Center in Downtown Fresno.
September 2006-January 1, 2007:
Floating physician at Concentra Medical Centers in Fresno area and Madera. Promoted
to Center Medical Director effective January 1, 2007.
Skills:
Effective communicator and team player.
Laceration repairs, I+D's, removal of foreign bodies.
Ability to coordinate care with specialists as needed.
Friendly, yet effective motivator for patients with focus on preventative health.
Ability to triage and work efficiently even in a busy practice setting.
Research:
• Participation in Gilenya(fingolimod) First Dose observation program for multiple
sclerosis patients. April 2012-October 2013
•UCLA Occupational Residency Education research project participating provider, April
2009
Howard Hughes Medical Institute
*Department of Microbiology and Immunology, UCLA 1998-2001
Responsibilities included radiation safety and management. Laboratory safety and
management.
Participated in research projects related to cell dysfunction in Leukemia.
Managed murine colony.
Performed ELISA's, FACS, Southern blots, murine autopsies and cell cultivation.
University of Southern California
*Biochemistry teaching laboratory technician 1998
*Exercise Science Department research assistant 1995
•Department of Microbiology and Immunology research assistant 1995
Publications:
Under maiden name Schuman
Transgenic Expression of Helios in B lineage Cells Alters B cell Properties and Promotes
Lymphomagenesis. Sinisa Dovat, Encarnacion Montecino-Rodrigues, Valerie Schuman,
Michael Teitell, Keneth Dorshkind and Steven Smale. The Journal of Immunology,
2005, 175: 3508-3515.
The Young Investigator Award of American Society of Pediatric Hematology/Oncology
for"The role of Helios in the immune response." (141h annual Meeting of the American
Society of Pediatric Hematology/Oncology, Baltimore, MD, USA, April 16-29, 2001).
Dovat, S; Schuman, V.A.; Montecino-Rodriguez, E; Dorshkind, K; Smale, S.T.
"Ectopic expression of Helios in B cells causes partial arrest in B cell development and
alters isotype switching." (42"d Annual Meeting of the American Society of Hematology,
San Francisco, CA, USA, December 1-5, 2000).
Awards:
Deans List, Touro University of Osteopathic Medicine
Phi Sigma Honors society
Membership/professional appointments:
Osteopathic Physicians and Surgeons of California
American Osteopathic Medical Association
Member of State Fund Medical Provider Network in California.
Education Committee Representative, UCSF/Fresno Internal Medicine Department 2006
Education Committee Representative, Touro University 2001-2003
Community Outreach Officer 2001-2002
Languages:
Spanish(fluent written and spoken)
References available upon request
City of
I■I
Why are business taxes assessed?
To help fund certain governmental services, such as police, fire, street maintenance, parks, economic development, and general
administration.
When are business taxes due?
Taxes are due on or before the payment due date on the tax return.
The City mails business tax return forms for your business. Late fees of at least twenty per cent(20%)
are assessed if such taxes are not paid(or postmarked)by the due date.
How are business taxes determined?
Depending on your type of business, business taxes are either a fixed amount (flat tax) or a variable amount based on the gross
receipts of your business. The business tax return form sent to you will provide the specific instructions on how to determine the
proper amount of tax due.
Where are business taxes paid?
You may mail your payment to: Fresno City Business Tax Section
PO Box 45017,Fresno 93718-5017
If you are paying your current tax renewal before the due date,you may renew online at the link below.
Your Web Security Code is found on your renewal form.
www.businesstax.fresno.gov/webrenewals
If your business tax return cannot be mailed or postmarked before the due date,and you need help
calculating the late penalty,please bring the tax return and payment to our office:
Fresno City Hall,Tulare and P Street,Second Floor
Monday-Friday 9:00a.m.-4:30 p.m.
Whom do I contact to update my Business Tax Certificate records or to get additional information?
If the business ownership, business name, location, mailing address, or phone number changes, or the business closes, you are
required to report the change to our office. For changes or additional information, please contact our Customer Service Division
at: Telephone: (559)621-6880 Mon.-Fri.9 AM-4:30 PM
Fax Machine: (559)457-1080
Mailing Address: PO Box 45017,Fresno 93718-5017
Email Address: businesstax@fresno.gov
Some business may receive additional tax return or permit renewal forms from the City. Additional taxes or permit fees may be required if
your business is located within certain special assessment districts or engaged in a particular type of business activity. Additional taxes
or permit fees are required for hotels and motels (room tax), taxicab companies and drivers, card rooms, billiard rooms, mobile food
vendors and certain other activities.
In most instances,a separate Business Tax Certificate must be filed for each location of the same business within Fresno.
With few exceptions,a Business Tax Certificate must be renewed either monthly,semi-annually or annually for it to remain valid.
Obtaining a Business Tax Certificate does not entitle the holder thereof to carry on any business without having complied
with all applicable provisions of the Fresno Municipal Code(FMC),or carry on any business in any building or location
where the conduct of such business would be in violation of the FMC.
Your Tax Certificate is attached at the bottom of this form. Please detach and display your Tax Certificate in your place of
business. Businesses which do not maintain a fixed location,or are located outside the City of Fresno, should carry this Tax Certificate
CITY OF FRESNO BUSINESS TAX CERTIFICATE
EXPIRES: 03/31/2024
Business Name: APOLLO HEALTH INC. Location: 6042 N FRESNO ST STE 104
Contact/Owner:: APOLLO HEALTH INC. Tax Account No. 434549
This tax certificate may be accepted as valid up to thirty (30) days after the expiration date above if appropriate tax returns have been
filed and business tax paid before the due date. This tax certificate must be available for inspection by any authorized City of Fresno employee.
Businesses that do not maintain a fixed location, or are located outside the city, should carry this Tax Certificate while conducting business within the
City. This certifies that the noted business has a Business Tax Certificate with the City of Fresno. It does not entitle the holder to carry on business
activities in a manner inconsistent with any applicable provision of the Fresno Municipal Code.
c
APOLLO HEALTH INC.
PO BOX 748 Santino Danisi
CLOVIS CA 93613-0748 Finance Director/Controller
City of
I■I
Why are business taxes assessed?
To help fund certain governmental services, such as police, fire, street maintenance, parks, economic development, and general
administration.
When are business taxes due?
Taxes are due on or before the payment due date on the tax return.
The City mails business tax return forms for your business. Late fees of at least twenty per cent(20%)
are assessed if such taxes are not paid(or postmarked)by the due date.
How are business taxes determined?
Depending on your type of business, business taxes are either a fixed amount (flat tax) or a variable amount based on the gross
receipts of your business. The business tax return form sent to you will provide the specific instructions on how to determine the
proper amount of tax due.
Where are business taxes paid?
You may mail your payment to: Fresno City Business Tax Section
PO Box 45017,Fresno 93718-5017
If you are paying your current tax renewal before the due date,you may renew online at the link below.
Your Web Security Code is found on your renewal form.
www.businesstax.fresno.gov/webrenewals
If your business tax return cannot be mailed or postmarked before the due date,and you need help
calculating the late penalty,please bring the tax return and payment to our office:
Fresno City Hall,Tulare and P Street,Second Floor
Monday-Friday 9:00a.m.-4:30 p.m.
Whom do I contact to update my Business Tax Certificate records or to get additional information?
If the business ownership, business name, location, mailing address, or phone number changes, or the business closes, you are
required to report the change to our office. For changes or additional information, please contact our Customer Service Division
at: Telephone: (559)621-6880 Mon.-Fri.9 AM-4:30 PM
Fax Machine: (559)457-1080
Mailing Address: PO Box 45017,Fresno 93718-5017
Email Address: businesstax@fresno.gov
Some business may receive additional tax return or permit renewal forms from the City. Additional taxes or permit fees may be required if
your business is located within certain special assessment districts or engaged in a particular type of business activity. Additional taxes
or permit fees are required for hotels and motels (room tax), taxicab companies and drivers, card rooms, billiard rooms, mobile food
vendors and certain other activities.
In most instances,a separate Business Tax Certificate must be filed for each location of the same business within Fresno.
With few exceptions,a Business Tax Certificate must be renewed either monthly,semi-annually or annually for it to remain valid.
Obtaining a Business Tax Certificate does not entitle the holder thereof to carry on any business without having complied
with all applicable provisions of the Fresno Municipal Code(FMC),or carry on any business in any building or location
where the conduct of such business would be in violation of the FMC.
Your Tax Certificate is attached at the bottom of this form. Please detach and display your Tax Certificate in your place of
business. Businesses which do not maintain a fixed location,or are located outside the City of Fresno, should carry this Tax Certificate
CITY OF FRESNO BUSINESS TAX CERTIFICATE
EXPIRES: 03/31/2024
Business Name: APOLLO HEALTH INC. Location: 6042 N FRESNO ST STE 104
Contact/Owner:: APOLLO HEALTH INC. Tax Account No. 434549
This tax certificate may be accepted as valid up to thirty (30) days after the expiration date above if appropriate tax returns have been
filed and business tax paid before the due date. This tax certificate must be available for inspection by any authorized City of Fresno employee.
Businesses that do not maintain a fixed location, or are located outside the city, should carry this Tax Certificate while conducting business within the
City. This certifies that the noted business has a Business Tax Certificate with the City of Fresno. It does not entitle the holder to carry on business
activities in a manner inconsistent with any applicable provision of the Fresno Municipal Code.
c
APOLLO HEALTH INC.
PO BOX 748 Santino Danisi
CLOVIS CA 93613-0748 Finance Director/Controller
Anthony Bianchi, M.D.
PO Box 26405 Fresno,CA 93729
(760)213-0773•newlifedocmdOgmail.com
Work Experience
Case Management and Clinical October 2018-Present
Apollo Medical
•Generate PR4/P&S Reports.
•Preside over contracts,billing,staffing,disputes,and quality assurance.
•Perform DOT and other employment exams.NRCME Certified.
•Evaluate,diagnose,and complete treatment plans for injuries,illnesses,and health risk exposures related
to worker's compensation.
•Take medical history information and answer complex health and injury inquiries.
•Manage 20 to 30 patients daily with acute and chronic conditions.
Clinical Advisor August 2o18—Present
Retrogen Incorporated
•Attend regular meetings to educate,validate and verify quality of information distribution.
•Communicate directly with physicians and key decision makers corporately.
•Administer policies and ensure competence and compliance.
•Assess processes and advise in educational and directional decisions.
Chief Physician Liaison January 2017—Present
BRIDGenomics,LLC
•Travel to meetings to facilitate on-boarding of new projects.
• Review policies and ensure compliance while bridging research to exam room science-provider-patient gaps.
•Grant physician and other administrators'vital access to corporate leads and privileges upon review of
credibility and credentials.
•Assess opportunities and review processes to aid new directional prospects and decisions.
Director-Case Management and Clinical November 2014—October 2018
UregencyMED
•Create clinical contract protocols and facilitate corporate staff meetings.
•Provide on-call service and respond to off-hour emergencies.
•Performed as licensed physician to evaluate,diagnose,and complete treatment plans for injuries,illnesses,
and health risk exposures.
•Take occupational and environmental medical histories and answer complex health and injury inquiries.
•Manage high patient volumes daily with acute and chronic conditions.
Consultant-Medical Legal November 2014-Present
Quinlan,Kershaw&Fanucchi
• Review medical documents and provide feedback to legal team.
•Create comprehensive reports detailing and decrypting medical reports.
•Assess validity of medical negligence cases.
Physician and Medical Director June 2014—November 2014
Riverside Recovery Resources Men's LTR
•Perform as licensed physician providing comprehensive care to residential patients.
•Take medical-psychological-social histories and perform targeted exams involving complex processes.
•Assess and address health,recovery,and wellness needs with a variety of men's health issues.
•Provide on-call service in response to off-hour emergencies.
Board of Trustees-Fallbrook Hospital January 2007—December 2013
Fallbrook Healthcare District
•Attended regular meetings to validate and verify quality of care at Fallbrook Hospital.
•Administered policies and ensured compliance.
•Granted physician and other healthcare providers privileges upon review of credentials.
•Assessed the peer review process and aided in disciplinary and educational decisions.
Physician and Medical Director/Owner July 1999—December 2013
Bianchi OB/GYN Associates,Fallbrook,CA.
•Performed as administrative owner and board-certified licensed physician.
•Provided comprehensive care to patients and their families.
•Performed wellness checks,physical exams,and ordered diagnostics for patients.
•Took medical history information and answered complex health inquiries.
•Performed surgeries in both hospital/in-patient and out-patient settings.
•Managed patients with acute and chronic conditions.
•Presided over contracts,billing,staffing,disputes,and quality assurance.
•Provided on-call service and responded to off-hour emergencies.
•Worked as surgical specialist and as a primary care provider.
Chief of Staff-Fallbrook Hospital January 2007—December 2009
Community Health Systems
•Appointed by colleagues on Medical Executive Committee.
•Oversight for all committees including;peer review,surgical services,medicine,physician wellness,etc.
•Frequent direct contact with CEO,CFO,and Chief Nursing Officer for oversight of hospital operations.
•Planned and coordinated annual physician retreats,administrative staff,and executive committee's meetings.
Education
Residency in Obstetrics&Gynecology June 1996—May 1999
University of Texas Health Science Center at Houston-St.Joseph's Hospital
Internship in Pre-Specialty General Medicine June 1995—May 1996
University of Texas Health Science Center at Houston-St.Joseph's Hospital
Medical Doctorate May 1995
University of Texas at Houston,Health Science Center
• Scholarship-Academic Four Year.
Bachelor of Science in Biopsychology May 1991
University of California at Santa Barbara
Awards
Fallbrook Healthcare District Recognition and Appreciation Award December 2013
Patient's Choice Award 20o8-2012
Compassionate Doctor Recognition 2001-2009
On Time Doctor Award 2009
Top Resident Award—American Association of Gynecologic Laparoscopists 1999
Chief Resident Teaching Award 1999
Licenses and Certifications
Medical Board of California August 29,1997—Current(exp.1/31/21)
Physician and Surgeon License-A63365
Drug Enforcement Agency(DEA) April 16,2014—Current(exp.7/31/20)
Drug prescribing license-FB4471758
National Registry Certified Medical Examiner October 23, 2014—Current(exp. 10/23/24
Certified DOT-#3910460038
American Board of Obstetrics and Gynecology January 11,2002—June 11,2014
Board Certified
Additional Information
•Active member of SLS—Society of Laparo-endoscopic Surgeons.
• Skilled at working with complex issues,integrating a variety of viewpoints.
•A team player who works well with others.
•Excellent communication and personal and business computing skills.
•Fluent in Spanish.
References
Available upon request.
David Moons
5128 North College Avenue
Fresno,CA 93704
626-M3-0669
MX
Education: Masters ofM91clanAssistsvt Studies(graduated January 2008)
Touro University,Nevada
Bachelor of Science in Microbiology ;graduated Juno 2000)
California State Poly wchm c varm sity, Pomona
Work Uperience:
Nov. 2019-preseru Laid Ziyar,N.D,Inc
Ph sician A.ssxs
Treat a variety,of psychiatric disorders ranging from s±chmphrenia&W bipolar
disorder to anxiety,depression,OUD and ADM. Out-patient setting only.
Jan 2018-Oct.2019 iviid Valley Hospital
Physician Assistant thquitaliso
Treated hospitalized patients that covered a litaM of maladies including
pneurnanis, ChT DKA,CVA,W etc. Duties urcludc H&P's,progress notes
and discharge swnnmries,as well as,assisting stugeons vnth medical
managemertt or their patients. Covered chs ED during times of high volume.
Sept 2015-Sept. 2017 Ageless\4en's Health
PJ►vsician,Assistant
Diagnose and tieat item v►*h hypogonadrsm through W irgections of
testosterone cypionate_Monitor patient progress though regular exams and lab
work.
March 2015-June 2015 Pain Th+orapy Solutions
Ehysician Assistant
Diag iosed and treated chronic pain conditions. ftscnibed pain
medication and recommended Facia mauragernent procedures.
Feb. 2015-March 2015 Chino WIN),4edical Weight Loss Center
Phvt;ician Assistant
Supervised the medical wrepltt loss of patients and dispensed medication
accordingly.
Feb. 2014-Jan 2015 Low T Ceuta
l bgieian Assistaat
Clinical director of a testosterone r+eplacemeltt clinic. Supervised three
employees. Performed H&P on prospective patients.Imenpreted labs
and dosed testosterone dose accordingly. Performed 1M testosterone
irpchons
Nov.2012-Nov.2013 Sierra Pacific OrtliAn As � nter Weedic Ce
e rmc P,paycuxl ex2itt anu trea rnem P1am for vanous onhopearc
injuries. Perfoans infra-articular and trigger point injections.Assists surgeon
with procedures such as arduoscopy,total joint replaoemerrt,carpal tunnel
release,numipulation under anesthres*open reduction and sternal fixation of
various fractures. Responsible for suturing and administexii*Local anesthouc
after surgical procedures. Collaborated with sapmgsing lD with hospital
duties(admitting,munding and discharging surgical patients)&M taking cWt
July 2008-Nm,.2012 San Joaquin Accident and Medical Clroup
ialan A sa
Diagnose and treat a varirty of injuries on Worl"Ran's Compensation and
pefsonal injury cases. PerforvrA HPI, ptrysical exam and treatmer4 plan
Admnistered intra-articular 4ections
Licensesi CertHications:
• Physician AssiMt nt Cnlifotla stare License iwmber. PA 19765
• DEA m mber MM1838602
• NPI cumber 1467608786
• NCC -k number. 1081246
RESUME
Breena Siliznoff NP,PHN, HEM
614 W. Muncie
Clovis, CA 93619
Cell: (559) 977-8477
QUALIFICATIONS: *Excellent communication, organizational and
inter-personal skills.
*Managing and updating policies
* Writing Standardsof Practice
*Family practice experience in management of
chronic and acute illnesses in both adult and
pediatric patients_
*Management of Workers Compensation and
Personal Injury cases involving the musculo-
skeletal system.wound care and lacerations.
PROFESS IONALEXPERIENCE:
9/1 3-present Community Medical Center, Fresno,CA
Supervisor & Assistant Safety Officer
Nurse Practitioner - Employee Health
8109- 8/13 FIRM Associates. Fresno, CA
Nurse Practitioner(Workers Compensation &
Family Practice)
10i08-present Big Fresno Fair. Fresno, CA
Track physician forjockeys & ancillary staff(horse races)
6/02- 1112010 Intra-Corp
RN Case Manager(Workers Compensation)
7/01 - 6102 Central California Faculty Medical Group-Fresno
UMC- Woman's Ilealth ClinivLJSCF Faculty
11/99- 7/01 Harold Grooms. MU -Fresno. CA
Nurse Practitioner (OB/GYN)
5/97- 10199 Gail Mallard Warren, MI) -Fresno. CA
Nurse Practitioner (OB/GYN)
3196 - 5 97 Palm Medical Group - Fresno, CA
Nurse Practitioner(Family Practice & PIAk'C)
11194— 3l96 Mountain Family Health Care - Fresno, CA
Nurse Practitioner (family practice)
EDUCATION:
Fresno City College -Fresno, CA
Associate of Science Degree in Nursing - 1991
Planned Parenthoo&UCSF-Fresno, CA
Nurse Practitioner Certificate- 1994
University of Phoenix - Fresno, CA
Bachelors of Science Degree Program —2012
ECRI Institute
Healthcare Environmental Manager Certification-2017
Ct)MMITTEES: I nfection Control Committee
Needle Stick Safety Committee
Environment of Care Committee
Laser Eye Committee
Immunization Core Measure Committee
Musculoskeletal Injury Prevention Program
Work Place Violence Committee
USP 800 Pharmacy Committee
1118— 1,'20 Vice President California NP Association
Central Valley Chapter
CREDENTIALS:
California RN License 9470626
Nurse Practitioner Certificate#7007
Nurse Practitioner Furnishing #7007
DEA#MS2270661
NPI# 1285912121
Bachelors of Science Degree in Nursing
Public Health Nursing Certificate r#84834
Medical staff privileges for Conununity Medical Centers
Healthcare Environmental Manager Certification
COLLEGE of AMERICAN
PATHOLOGISTS
CERTIFICATE OF ISO 15189
ACCREDITATION
Laboratory Corporation of America Holdings
Los Angeles, California
CAP#7176332 IF IS015189
CAP
The organization named above is granted this accreditation in accordance with the recognized D
International Standard ISO 15189:2012,Medical Laboratories—Requirements for quality and
competence.This accreditation demonstrates competence for a defined scope and the operation
of a laboratory quality management system.
Effective From August 26,2021 through August 26,2024
Gaurav Sharma MD,FCAP Patrick Godbey,MD,FCAP
Chair,CAP 15189 Committee President,College of American Pathologists
The scope of this accreditation includes Quality Management System and the discipline of Anatomic Pathology.
0 EXHIBIT 2
N=,w
October 24, 2023
To Whom it may concern:
I would like to take this opportunity to offer a formal recommendation for Occu-Med. Occu-
Med is instrumental in providing time-sensitive pre-placement and periodic occupational
health services for V2X and to a significant population of its 15,000 employees. These
services include those performed both in the United States and at numerous international
locations to comply with United States Department of Defense (DoD) and State (DoS)
medical screening and legal requirements.
Occu-Med is a respected business partner on all programs for which it provides medical
services for V2X and our thousands of employees. Throughout the course of my experience
with Occu-Med, their services have consistently demonstrated a commitment to excellence,
and they utilize best in class industry practices while performing ADAAA and HIPAA
compliant occupational health evaluations.
If I can provide any further information regarding my recommendation of Occu-Med, please
contact me at 719-637-5725
Sincerely,
Matt Venon
Director, Global Staffing V2X
__ Pa ,, e
Tuesday, March 19, 2024 at 09:28:39 Mountain Daylight Time
Subject: Reference
Date: Friday,October 27,2023 at 2:26:15 PM Mountain Daylight Time
From: WOLF-MCCORMICK Penny L*DCBS
To: Chris St.George,BROWN Tracy K*DCBS
CC: WOLF-MCCORMICK Penny L*DCBS
Attachments: image001.png
Hello Chris,
As per our conversation, we're very happy with the service provided by Occu-Med.
Occu-Med is a trusted source for Oregon OSHA in managing our occupational health evaluations.
Particularly, OSHA 1910.134 Respirator medical evaluations and compliance. For more than 5 years,
Occu-Med has been able to provide the State with timely and effective occupational health guidance
and we appreciate them as a vendor for such services.
Regards,
Penny Wolf-McCormick/ Industrial Hygienist
Statewide Health Enforcement Manager
Emergency Preparedness Coordinator
Oregon OSHA
503.229.5910
971.707.0867 (cell)
P---O
Oregon
OSHA ,
OSHA
L.
Department of Consumer
and Business Services
E-mail correspondence to and from this address may be subject to Oregon Public Records Law and
may therefore be disclosed to third parties.
1of1
BANK OF AMERICA �
Date 03/19//2024
Sherri Conley
Controller
Occu-Med
2121 W. Bullard
Fresno, CA 93711
To Whom it May Concern:
As of March 20, 2024, there have been no adverse actions taken in regards to Occu-med, LTD line of
credit and/or its accounts.
Please reach out if you have further questions.
Compl�enta�lose,
Raul Sa om ra
Vice President; Bus Bank Relationship Manager
Business Banking
1
EXHIBIT 3
OCCJ-MED JOB PROFILE
September 2001
*Consensus*
JOB CLASS: Deputy Sheriff I
EMPLOYER: Fresno County
Physical Ability Rating Most Demanding Essential Tasks Environmental
Factors
1. Stamina 5.5 Chase/wrestle/apprehend combative suspect l. EXPOSURE TO THE SUN: 10%
or less of work time spent outside
2. Extent Flexibility 5.8 Place restraints on suspect;search suspect a building and exposed to the sun.
2. HIGH TEMP:Considerable work
time in light and moderate work in
3. Dynamic Flexibility 5.8 Break up fight between suspects temperatures above 80 degrees.
3. WETNESS:Occasional work
4. Static Strength 6.0 Lift/move/carry unconscious suspects requires getting part or all of the
body and/or clothing wet.
4. NOISE:Occasionally there are
5. Explosive Strength 6.0 Respond to emergency call;take down suspect unusually loud sounds.
5. SLIPPERY SURFACES:
6. Dynamic Strength 5.0 Climb over fence during foot pursuit Frequent work on unusually
slippery surfaces.
6. INJURY POTENTIAL:Frequent
7. Trunk Strength 5.5 Search for evidence possibility of bodily injury.
7. BURNS:Possibility of superficial
8. Speed of Limb Movement 5.8 Defend self during altercation with suspect bums.
8. DUST:Works in or around areas
with major amounts of dust.
9. Gross Body Coordination 5.0 Chase/wrestle/apprehend combative suspect 9. HAZARDOUS MATERIALS:
Exposure is a regular part of the
10. Gross Body Equilibrium 5.0 Chase suspect on slippery surface job.
10. IRREGULAR OR EXTENDED
WORK HOURS:Occasionally
It. Arm-Hand Steadiness 5.5 Fire weapon required to change working hours
or work overtime.
12. Manual Dexterity 5.0 Place restraints on suspect
13. Finger Dexterity 4.0 Type reports;load weapon
14. Near Vision 5.8 Read/write reports;load weapon
15. Far Vision 5.0 Fire weapon;read addresses
16. Visual Color 4.0 Identify suspect
Discrimination
4.5 Hear call for help/radio transmissions
17. Hearing
6.0 Pursue a suspect on foot
18. Mobility
6.0 Chase/wrestle/apprehend combative suspect
19. Effort
RESPIRATOR USE
Required? No
EXHIBIT 4
09
OCCU-MED
Pre-Placement Medical Exam Requisition Form
Submit completed form to Occu-Med via email at Scheduling(a),occu-med.com
If you are unable to Email,please Fax to(800)262-2863.
❑ Occu-Med to Schedule Applicant
@ Clinic:
❑ Date/Time Preference ❑ Morning ❑Afternoon
EMPLOYER INFO
EMPLOYER:
EMPLOYER REPRESENTATIVE:
PHONE:
EMAIL ADDRESS:
DEADLINE FOR RETURNING RESULTS:
APPLICANT INFO
APPLICANT:
JOB CLASS:
PRIMARY PHONE #:
ALTERNATE PHONE #:
EMAIL ADDRESS:
LOCATION(City,State):
DATE OF REQUEST:
Any questions regarding Exam Scheduling should be directed to Cristal Granse @ (559)
435-2800 x148.
4/24/2014 KMZ
"' EXHIBIT 5
O C C U-MED OCCU-MED MEDICAL HISTORY QUESTIONNAIRE
INFORMATIONAPPLICANT
APPLICANT'S NAME(Last,First,Middle) SOCIAL SECURITY NUMBER BIRTHDATE(MM/DD/YYYY)
ILING ADDRESS STATE/ZIP
MW
PHONE NUMBERS WHERE YOU CAN BE REACHED EMAIL ADDRESS PASSPORT NUMBER
Home: Cell:
EMPLOYER JOB CLASS OR JOB TITLE
1
A thorough evaluation of the information provided will permit an accurate assessment of an applicant's ability to safely perform the essential duties
of the job. This statement is confidential. The information you provide will be maintained in a manner that appropriately protects its confidentiality.
I, THE UNDERSIGNED, DO HEREBY CONSENT TO UNDERGO A MEDICAL EXAMINATION, INCLUDING BLOOD
SPECIMEN, X-RAYS, SKIN TESTS, AND OTHER EXAMINATIONS WHICH ARE NECESSARY TO DOCUMENT MY ABILITY
TO SAFELY PERFORM THE ESSENTIAL DUTIES OF THE JOB THAT I AM CURRENTLY PERFORMING (PERIODIC
EXAM) OR HAVE BEEN OFFERED CONTINGENT UPON PASSING THIS MEDICAL EXAMINATION (PRE-PLACEMENT
EXAM). I CERTIFY THAT ALL INFORMATION PROVIDED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE,
AND I AGREE AND UNDERSTAND THAT ANY MISSTATEMENT OF MATERIAL FACT HEREIN MAY RESULT IN
DISCIPLINARY ACTION,AS DETERMINED BY MY EMPLOYER.
SIGNATURE IN FULL . DATE COMPLETED 7
1. Please list all prescription medications you regularly use.
2. Please list any other prescription medications,not taken regularly,which you have taken in the last 2 months.
A. Reasons for Medications Taken(Questions 1 &2)
Medication Medical Condition Treated Side Effects Experienced Date Started Date Ended Frequency Taken
3. Please list any known allergies(e.g.,Latex Bee or Wasp Stings,etc.).
4. Have you ever had a positive reaction to a PPD(Tuberculosis)Skin Test? Yes ❑ No 0 Date:
Name:
MEDICAL HISTORY QUESTIONNAIRE
MEDICALO'
5. Please list our last three(3)hospitalizations,beginning with the most recent(excluding routine childbirth):
REASON 1 HOSPITAL/CITY DATE(MM/DD/YYYY)
REASON 2 HOSPITAL/CITY DATE(MM/DD/YYYY)
REASON 3 HOSPITAL/CITY DATE(MM/DD/YYYY)
6. Please list any operations you may have had or were advised to have which are not listed above.
Have you ever been exposed to any of the following(at home,work,or in any other setting)or do you have a problem with:
Yes No Please provide dates and explain any`Yes'responses to the following questions in the space provided.
7. ❑ ❑ Substances that irritated your skin or eyes?
Explanation:
8. ❑ ❑ Substances that caused you breathing difficulties?
Explanation:
9. ❑ ❑ Have you ever had a bad reaction to high environmental temperatures?
Explanation:
10. ❑ ❑ Have you ever had a bad reaction to low environmental temperatures?
Explanation:
Please respond to the following:
Yes No Please provide dates and explain any`Yes'responses to the following questions in the space provided.
11. ❑ ❑ Have you ever been injured?
Explanation:
12. ❑ ❑ Have you ever had a limiting injury?
Explanation:
13. ❑ ❑ Have you been determined to be disabled through VA,Federal,State or Medical Disability assessments?
Explanation:
Information relative to Workers'Compensation claims cannot be used by an employer in making employment decisions. Your responses to questions 11,
12,and 13 will be used by the medical examiner in determining your current health status as it pertains to the safe performance of essential job duties.
1 1ICAL 1-11STORY
Have you ever had,now have or believe you may have any of the following:
Yes No Please provide dates and explain any`Yes'responses to the following questions in the space provided.
14. ❑ ❑ Tuberculosis
15. ❑ ❑ Emphysema
16. ❑ ❑ Asthma
17. ❑ ❑ Shortness of Breath
18. ❑ ❑ High Blood Pressure
19. ❑ ❑ Heart Murmur,Heart
Disease
20. ❑ ❑ Stroke
21. ❑ ❑ Blood Disorders(e.g.,
Anemia,etc.)
Name:
MEDICAL HISTORY QUESTIONNAIRE
MEDICAIL MSTORY
Have you ever had,now have or believe you may have any of the following:
Yes No Please provide dates and explain any`Yes'responses to the following questions in the space provided
22. ❑ ❑ Psychological Conditions(PTSD,
ADHD,Bipolar Disorder,depression)
23. ❑ ❑ Pulmonary or Other Embolism
24. ❑ ❑ Pneumothorax
25. ❑ ❑ Infection
26. ❑ ❑ Hernia
27. ❑ ❑ Loss of Consciousness
28. ❑ ❑ Chest Pains
29. ❑ ❑ Dizziness,Vertigo or Motion
Sickness
30. ❑ ❑ Problems with Eyes/Vision
31. ❑ ❑ Back or Joint Surgery
32. ❑ ❑ Epilepsy,Seizures
33. ❑ ❑ Encephalitis,Meningitis
34. ❑ ❑ Glaucoma
35. ❑ ❑ Vascular Problems(e.g.,
PVD,phlebitis,etc.)
36. ❑ ❑ Gall Bladder Trouble
37. ❑ ❑ Liver Trouble or Hepatitis
38. ❑ ❑ Sleep Apnea
39. ❑ ❑ Diabetes
40. ❑ ❑ Kidney Disease or Stones
41. ❑ ❑ Rheumatism
Arthritis/Gout
42. ❑ ❑ Ear or Ear Drum Issues
43. ❑ ❑ Migraines
44. ❑ ❑ Frequent Headaches
45. ❑ ❑ Cancer
46. ❑ ❑ Skin Cancer(s)
47. ❑ ❑ Hyperthyroidism
48. ❑ ❑ Hypothyroidism
Name:
MEDICAL HISTORY QUESTIONNAIRE
MEDICAL MSTORY
Have you ever had,now have or believe you may have any of the following:
Yes No Please provide dates and explain any`Yes'responses to the following questions in the space provided.
49. ❑ ❑ Thyroid Trouble
50. ❑ ❑ Immune Disorders
51. ❑ ❑ Back or Joint Pain
52. ❑ ❑ Back Injury
53. ❑ ❑ Cervical Neck Injury or
Problem
54. ❑ ❑ Knee Surgery
55. ❑ ❑ Upper extremity injury or
problem
56. ❑ ❑ Lower Extremity injury or
problem
57.Medical Conditions or concerns you have which are not listed above:
Please Explain:
58.Are you presently experiencing any pain or discomfort? IF YES,please mark the affected areas on the body diagram below:
�r
67
Have you ever had,now have or believe you may have any of the
following:
Yes No
59. ❑ ❑ Have you gained or lost more than 10 lbs.in the past 2 years without trying to do so?
Explanation:
60. ❑ ❑ Have you had any changes in your appetite in the past 6 months?
Explanation:
61. ❑ ❑ Have you noticed an unusual fatigue or weakness recently?
Explanation:
62. ❑ ❑ Have you noticed a change in size or color of a mole(dark growth)or wart in the last year?
Explanation:
63. ❑ ❑ Do you have a skin rash,burning,itching or other skin sensitivity?
Explanation:
64. ❑ ❑ Have you coughed up blood or have/had chronic cough?
Explanation:
65. ❑ ❑ Have you or are you currently being treated for alcoholism? Date:
/1' EXHIBIT 6
James A.Johnson
President&C.E.O.
OCCU-MED
Medical Suitability Declaration
Applicant Name Employer
Anthony Tyler Fresno County
Social Security Number Job Class
555-55-5555 Deputy Sheriff I
Date of Exam Date Completed
2/18/2024 2/21/2024
PLACEMENT RECOMMENDATION
Recommendation Description
MQ Medically Qualified
Summary
Medical evaluation is within normal limits established for this job class. The evaluation was conducted in accordance with
Government Code Section 1031 (f)and POST Commission Regulation 1954. The applicant/candidate is deemed medically
suitable to exercise the powers of a peace officer and meets minimum acceptable physical qualifications for the position as
established by the hiring department.
OCCU-MED [Physician Signature Here]
Devonna M.Kaji,M.D.,Medical Director,License Number:G057238
Comments:
License#: G057238 -2121 West Bullard Ave.,Fresno,CA 93711 - (559)435-2800 x100
Report Sent To: [Specify County Personnel Here]
Report generated 212112024 Mike Ramos
2121 West Bullard Ave,Fresno,CA 9371 1 1 559.435.28001 Fax:800.262.2863 1 www.occu-med.com
EMPLOYER:
NAME SS#
JOB TITLE DATE OF EXAM
COMPLETE EXAM RECEIVED:
MEDICAL EXAMINATION SUMMARY
MEDICALLY Applicant/employee is fit to perform the essential functions
QUALIFIED of this job class.
X . CONDITIONALLY Applicant/employee will be placed but has work
QUALIFIED restrictions as outlined on the Medical Restrictions and/or
Reasonable Accommodations (attached).
RECOMMENDATION Applicant/employee will be reconsidered for placement
DELAYED FOR upon submission of the following requested medical
QUALIFICATION* information.
MEDICALLY Applicant/employee is not fit to perform the essential
DISQUALIFIED functions of this job class with or without reasonable
accommodations. Employer has considered various
accommodations and has determined that no reasonable
accommodation exists that would enable the safe performance
of the essential functions of the job.
[PHYSICIAN'S SIGNATURE]
*****************************************************************************
OCCU-MED Devonna M. Kaji,M.D.
Medical Director
REPORT SENT TO—ON—BY George Smeed
Comments:
*****************************************************************************
FOR PERSONNEL DEPARTMENT USE ONLY:
Applicant/Employee Disqualification Letter: Hand-delivered (Date)
or
Mailed (Date)
EMPLOYER:
NAME SS#
JOB TITLE DATE OF EXAM
COMPLETE EXAM RECEIVED:
MEDICAL RESTRICTIONS AND/OR REASONABLE ACCOMMODATION(S)
DATE:
EMPLOYER AND EMPLOYEE AGREE TO THE FOLLOWING CONDITION(S) OF
EMPLOYMENT OR REASONABLE ACCOMMODATIONS:
Bee sting allergy requires the carrying of appropriate treatment at all times while on duty.
EMPLOYEE AGREEMENT TO MEDICAL WORK RESTRICTIONS
I understand that my medical condition may be detrimental to the safe performance of certain job
duties with the above-named employer. I also understand that it is the duty of the above-named
employer to maintain a safe work environment for all employees and to protect the general public from
safety hazards. Therefore, I agree to the conditions of employment or reasonable accommodations
with the above-named employer, described above, which I have read and understand completely.
Further, I acknowledge that violation of any of the terms of this Agreement by me will result in
disciplinary action up to and including termination of my employment.
Signature of Employee Date
OCCU-MED Devonna M. Kaji, M.D.
Medical Director
EMPLOYER:
NAME SS#
JOB TITLE DATE OF EXAM
COMPLETE EXAM RECEIVED:
SUPERVISORS ACKNOWLEDGMENT OF CONDITION OF EMPLOYMENT
I have reviewed this document and understand the condition of employment placed upon this
employee. I further understand that it is my responsibility to report any symptoms to the employer that
may impact this condition of employment. I have witnessed the explanation of the conditions of
employment to the employee. I further understand that violation of this Agreement may result in
disciplinary action being taken against the employee.
Supervisor's Name:
Signature Date
MEDICAL EVALUATION SUMMARY REPORT
EMPLOYER:
JOB TITLE:
NAME James Gill DATE OF EXAM 1/12/2024
SS# xxx-xx-4321 DATE COMPLETE N/A
RECOMMENDED QUALIFICATION
MEDICALLY Medical evaluation is within normal limits established for
QUALIFIED this job. Applicant meets the criteria for deployment to
Afghanistan. Per the provisions of Central Command
(CENTCOM)Modification 11,this medical examination is
valid for a period of 15 months from the date of
examination.
CONDITIONALLY Applicant/employee will be placed but has work restrictions
QUALIFIED as outlined on the"MEDICAL RESTRICTIONS AND/OR
REASONABLE ACCOMMODATION(S)"form.
x RECOMMENDATION Applicant/employee will be reconsidered for placement
DELAYED FOR upon resolution of the medical condition(s)detailed on the
QUALIFICATION "REQUEST FOR ADDITIONAL INFORMATION"form.
MEDICALLY Applicant/employee is medically unsuited for this job class.
DISQUALIFIED Disqualification report is attached. Employer must always
consider Reasonable Accommodation for all Medical
Disqualifications.
OCCU-MED
Devonna M.Kaji,M.D.,Medical Director
REPORT SENT TO
ON 1124/202 BY Thomas Kanesaki
Comments:
Copyright 2024 OCCU-MED All rights reserved.
MEDICAL EVALUATION SUMMARY REPORT
EMPLOYER:
JOB TITLE:
NAME James Gill DATE OF EXAM 1/12/2024
SS# xxx-xx-4321 DATE COMPLETE N/A
REQUEST FOR ADDITIONAL INFORMATION
Your applicant has been delayed for qualification for 1 issue(s). Recommendation Delayed for Qualification
Assurance(RDQA)was initiated for this applicant today, 1/24/2024. Occu-Med has contacted the applicant and
discussed what he or she will need to provide before a final qualification recommendation can be provided. The
applicant has until 2n/2024(10 business days)to submit the requested additional information. We will notify
you immediately of: a)any status change recommended as a result of the applicant's submission of additional
information,or b) at the expiration of the time permitted for the submission of such information. If I may be of
assistance with this case prior to the expiration date,you may contact me at(559)435-2800 x100.
OCCU-MED
Devonna M.Kaji,M.D.,Medical Director
Coppight 2024 OCCU-MED All rights reserved.
James A.Johnson
GO President&C.E.O.
OCCU-MED
September 18,2018
John Doe
2121 W.Bullard Ave.
Fresno,CA 93711
Re: Medical Information Necessary for POST Evaluation
Dear Mr.Doe:
You recently underwent an POST compliant medical evaluation for the Deputy Sheriff position with
Fresno County to advise you of any health concerns and,in relation to this request,demonstrate your
ability to perform the essential duties of this job safely with or without reasonable accommodation. You
underwent this medical examination and the results of that examination have been
reviewed bg OMud h%s&eQi retained by the County
to evaluate this information.
Occu-Med has evaluated your medical examination and determined that further medical information
must be provided to us before we are able to recommend that you can continue to work safely in this
position. Specifically,our evaluation will be concluded when the information requested has been
submitted and reviewed.
Please refer to the next page for the specific information that is being requested.
2121 West Bullard Ave,Fresno,CA 9371 1 1 559.435.28001 Fax:800.262.2863
/1' James A.Johnson
President&C.E.O.
OCCU-MED
John Doe
September 18,2018
Page 2 of 3
Medical Information Requested
Possibly abnormal treadmill stress test(ST depression indicative of ischemia) requires report
from cardiological evaluation. The evaluation may include additional testing(e.g.,stress
echocardiogram,etc.) as indicated by the evaluating physician. The evaluating physician must
also provide a statement addressing the employee's ability to safely perform [insert job class]
job functions(attached)from a cardiovascular perspective. Any work restrictions indicated
should be clearly documented.
2121 West Bullard Ave,Fresno,CA 93711 1 559.435.28001 Fax:800.262.2863
James A.Johnson
GO President&C.E.O.
OCCU-MED
John Doe
September 18,2018
Page 3 of 3
Please submit all requested medical information and documents to us as soon as possible,but in no event
later than Tuesday,October 2,2018,to:
Attn: Records
2121 West Bullard Avenue
Fresno,CA 93711
Fax: (800) 262-2863
Email: HarvestingCCOccu—Med.com
[Please fax or email the requested information to Occu—Med.]
Once all requested information is received and evaluated,we will contact Contra Costa County Fire
Protection District with our recommendation. County personnel will then notify you regarding your
continuing to work in the Deputy Sheriff position.
It is your responsibility to provide the requested information to Occu—Med by Tuesday,October 2,2018.
It is also your financial responsibility to pay for any expenses connected with exams,tests and reports.
If I do not hear from you by the date indicated,we will notify the County
District that your physical is not complete,and that Occu Med cannot verify your ability to safely
perform your duties. Please feel free to contact me should you have any questions about this letter or the
processing of the information requested,toll-free,at(877) OCCU-MED x100 or(559)435-2800.
Sincerely,
Andrew Johnson
Director,Operations
Occu—Med
p: (559)435-2800 x127
f: (800) 262-2863
www.occu-med.com
2121 West Bullard Ave,Fresno,CA 9371 1 1 559.435.28001 Fax:800.262.2863
End Exhibit 6
MEDICAL EXAMINATION REPORT
AGENCY: Buildings Incorporated
APPLICANT: John Smith
JOB CLASS: Construction Crew Worker
MEDICAL FINDINGS:
Orthopedic: "16 left shoulder dislocations." "He is at risk for recurrent left shoulder
instability or dislocation."
[ Will G. Doc, M.D.] March 3, 2024
JOB DEMANDS
The essential duties of the Construction Crew Worker job class for Buildings Inc.
include:
• Climb ladder to hang trusses/install roofing;
• Climb ladder to work on roofing;
• Reach to place beams on roof,
• Move/carry beams/tools/buildings materials;
• Hammer nails into siding;
• Pull steel roof sheets up a ladder, and;
• Install beams/roofing from ladder.
RECOMMENDATION
Based upon the medical information provided regarding the applicant's continued
orthopedic risk of injury, and based upon the essential job requirements of this job class,
it is our recommendation that Mr. Smith be Medically Disqualified from the job of
Construction Crew Worker for Buildings Incorporated.