26-42 Comprehensive Medical Evaluation Services

RESPONDENT INSTRUCTIONS

Some of the instructions below may not apply to all projects.

The scope of work/specifications shall control any conflicting provisions.

INTRODUCTION

The Bay County Board of County Commissioners is seeking qualified medical professionals to provide health screening, evaluation, and physical services in adherence to the current version of National Fire Protection Association (NFPA) 1582 & 1583 for Bay County Fire Services firefighters and hazmat team members: 1) annually for each member; 2) prior to employment to establish a baseline; and 3) for firefighter candidates.

QUALIFICATIONS

Vendor shall have licensed staff in accordance with Florida Department of Health – Medical Quality Assurance.

• Physician (MD or DO)

• Physician Assistant (PA)

• Advanced Practice Registered Nurse (APRN)

PROPOSAL DEADLINE/DELIVERY

SEALED PROPOSALS for RFP NO: 26-42 Comprehensive Medical Evaluation Services will be received by the BOARD OF COUNTY COMMISSIONERS OF BAY COUNTY, FLORIDA up until 2:00 PM (central time) Tuesday, August 11, 2026. Proposals will be publicly opened immediately following the deadline. ANY PROPOSAL RECEIVED AFTER THE SPECIFIED TIME WILL NOT BE CONSIDERED.

Proposals for this solicitation may be submitted either electronically via OPENGOV PROCUREMENT or by paper, sealed and delivered to the Board of County Commissioners Purchasing Department, at 840 W. 11th Street, Suite 2500, Panama City, Florida 32401.

Special Accommodation: Any person requiring a special accommodation at a Pre-Proposal Conference or Proposal opening because of a disability should call the Purchasing Department at (850) 248-8270 at least five (5) workdays prior to the Submittal opening. For Hearing Impaired, Dial 1-800-955-8771 (TOO), and 1-800-955-8770 (Voice).

SOLICITATION DOCUMENTS

Electronic versions of the solicitation documents are available via OpenGov Procurement https://procurement.opengov.com/portal/baycountyfl

Proposal documents, plans, blueprints, or other materials may also be obtained by contacting the Bay County Purchasing Department, purchasing@baycountyfl.gov , 840 West 11th Street, Suite 2500, Panama City, FL 32401, (850) 248-8270.

For those projects with separate plans, blueprints, or other materials that cannot be accessed through the internet, the Purchasing Department will make a good faith effort to ensure that all registered respondents (those who have been registered as receiving a proposal package) receive the documents.

POINT OF CONTACT

The County Purchasing Department will be the only point of contact for this RFP. Under no circumstances may a Respondent contact any County Commissioner, County Administrator, or County employee concerning this RFP until after award. Any such contact may result in disqualification as per Bay County Code Section 2-124.

QUESTIONS

Respondents shall submit all questions, in writing, to the Purchasing Department at Purchasing@baycountyfl.gov or through OpenGov . All questions shall be submitted no later than 5:00 pm (central time) on Wednesday, July 29, 2026.

ADDENDA

If any addenda are issued after the initial specifications are released, the County will post the addenda on the Bay County website: http://co.bay.fl.us/169/Purchasing and OpenGov .

It is the responsibility of the Respondent prior to submission of any Submittal to check the above website or contact the Purchasing Department to verify any addenda issued. The receipt of all addenda must be acknowledged on the addenda response sheet.

PROPOSAL FORM

To receive consideration, all Proposals shall be made on the forms provided, properly executed and with all items filled out. Do not change the wording of the Proposal Form. No conditions, limitations or provisions will be attached or added to the Proposal Form by the Respondent. Alterations by erasure or interlineations must be explained or noted in the Proposal over the signature of the Respondent.

COMPLETE PRICE PROPOSAL; EXAMINATIONS OF SPECIFICATIONS; WORK SITES

Price proposals shall be compensation in full for the complete work. The price shall include all charges for completing the work and include layout, insurance, taxes, field office and supervision, overhead and profit, permits, impact fees, bonds, and miscellaneous items needed to complete the work. All prospective firms may visit the site and become familiar with the existing conditions. No allowance will be made to any respondent because of a claimed lack of examination or knowledge. The submission of a proposal shall be construed as conclusive evidence that the respondent has made such examination.

WITHDRAWAL OF PROPOSALS

Any Respondent may withdraw its Proposal, either personally or by written request, at any time prior to the scheduled time for opening Proposals. No Respondent may withdraw its Proposal for a period of 180 days after the date for opening and all Proposals shall be subject to acceptance by the County during this period.

CANCELLATION

The County may cancel this RFP, or reject in whole or in part, when it is in the best interests of the County, as determined by the Board of County Commissioners. Notice of cancellation shall be posted on OpenGov and the County website. The notice shall identify the solicitation, and, where appropriate, explain that an opportunity will be given to compete on any re-solicitation or any future procurement of similar items.

BASIS OF AWARD

The contract will be awarded to the responsive, responsible Respondent who ranks highest in the evaluation process based on the criteria specified in the Request for Proposals Respondent Instructions.

TIE PROPOSALS

Should a tie occur, an alternate committee member will be asked to evaluate the firms based on the submitted proposals this alternate score will be the tie-breaker.

RIGHT TO REJECT

In accordance with section 2-113 of the Bay County Code, the County reserves the right to:

a. reject any or all Proposals received;

b. select and award any portion of any or all Proposal items;

c. waive minor informalities and irregularities in the Respondent’s Proposal.

A Proposal may be rejected if it is non-responsive or does not conform to the requirements and instructions in this RFP. A Proposal may be non-responsive by reasons, including, but not limited to, failure to utilize or complete prescribed forms, conditional Proposals, incomplete Proposals, indefinite or ambiguous Proposals, failure to meet deadlines and improper and/or undated signatures. Other conditions which may cause rejection of Proposals include evidence of collusion, obvious lack of experience or expertise to perform the required work, submission of more than one Proposal for the same work from an individual, Respondent or corporation under the same or a different name, failure to perform or meet financial obligations on previous contracts. Proposals may be rejected if not delivered on or before the date and time specified as the due date for submission of the Proposal.

EXECUTION OF AGREEMENT

The successful firm shall, within 10 days after receipt of the Notice of Award and the contract forms or documents, sign and deliver to the County Chief Procurement Officer all required contract documents. The awarded firm shall also deliver any required bonds and all certificates of insurance as required. All certificates of insurance shall be approved by the Bay County Risk Management Office before the successful firm may proceed with the work.

Neither the Notice of Award nor the execution of the required contract documents by the Vendor create any rights in the proposer.  The proposer has no rights with respect to the award of the contract until a fully executed contract is signed by all required parties and all certificates of insurance and other required deliverables are provided and approved by the County.

LICENSING

Firm shall be properly licensed for the appropriate work specified in this Request for Proposals. All Respondents are requested to submit any required license(s) with their qualifications. License(s) must be effective as of the opening date and must be maintained throughout the Contract Period. Failure to be properly licensed as stated above will result in the rejection of the Proposal as nonresponsive.

GENERAL TERMS

Companies that are required to register with the State of Florida Division of Corporations as a domestic or foreign business entity should provide evidence of their registration.

PUBLIC RECORDS

In accordance with Chapter 119 of the Florida Statutes (Public Records Law), and except as many be provided by other applicable State or Federal Law, all Respondents should be aware that Requests for Proposals and the responses thereto are in the public domain.  Respondents must identify specifically any information contained in their response which they consider confidential and/or proprietary and which they believe to be exempt from disclosure, citing specifically the applicable exempting law.

Pursuant to Fla. Stat. §119.071(1)(b), proposals received as a result of this RFP will not become public record until such time as the County provides notice of an intended decision or until 30 days after opening the bids, whichever is earlier.

EXEMPTION OF MEETINGS/PRESENTATIONS

Pursuant to Florida Statute section 286.0113(2), any portion of a meeting at which a negotiation with a vendor is conducted pursuant to a competitive solicitation, at which a vendor makes an oral presentation as part of a competitive solicitation, or at which a vendor answers questions as part of a competitive solicitation is exempt from public meeting requirements. However, the County must make a complete recording of any portion of an exempt meeting and no portion of the exempt meeting may be held off the record. The recording of, and any records presented at, the exempt meeting are exempt from the public records law of section 119.07(1), Fla. Stat. (2011) and section 24(a), Art. I of the State Constitution, until such time as the agency provides notice of an intended decision or until 30 days after opening the bids, submittals, or final replies, whichever occurs earlier. If the County rejects all bids, submittals, or replies and concurrently provides notice of its intent to reissue a competitive solicitation, the recording and any records presented at the exempt meeting remain exempt from section 119.07(1), Fla. Stat. (2011) and section 24(a), Art. I of the State Constitution until such time as the agency provides notice of an intended decision concerning the reissued competitive solicitation or until the agency withdraws the reissued competitive solicitation. A recording and any records presented at an exempt meeting are not exempt for longer than 12 months after the initial agency notice rejecting all bids, submittals, or replies.

REPRESENTATIONS

The contract documents contain the provisions required for the project. Information obtained from an officer, agent, or employee of the County or any other person shall not affect the risks or obligations assumed by the Contractor or relieve the Contractor from fulfilling any of the conditions of the contract.

WARRANTY

All goods and services furnished by respondent, relating to and pursuant to this RFP, will be warranted to meet or exceed the specifications contained herein. In the event of breach, the respondent will take all necessary action, at respondent’s expense, to correct such breach in the most expeditious manner possible.

SUBCONTRACTORS

The Vendor will be the prime service provider and shall be responsible for all work performed and contract deliverables. Proposed use of subcontracts should be included in the Proposer’s Response. Requests for use of subcontractors received subsequent to the solicitation process are subject to review and approval by the County.

The County reserves the right to request and review information in conjunction with its determination regarding a subcontract request. All subcontractorsare subject to the same requirements of this solicitation as the awarded vendor.

SCRUTINIZED COMPANIES

Respondent must certify that the company is not participating in a boycott of Israel.

Respondent must also certify that Vendor is not on the Scrutinized Companies that Boycott Israel list, not on the Scrutinized Companies with Activities in Sudan List, and not on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or has been engaged in business operations in Cuba or Syria. Subject to limited exceptions provided in state law, the County will not contract for the provision of goods or services with any scrutinized company referred to above.

Respondent must submit the certification that is attached to this solicitation. Submitting a false certification shall be deemed a material breach of contract. The County shall provide notice, in writing, to the Vendor of the County's determination concerning the false certification. The Vendor shall have five (5) days from receipt of notice to refute the false certification allegation. If such false certification is discovered during the active contract term, the Vendor shall have ninety (90) days following receipt of the notice to respond in writing and demonstrate that the determination of false certification was made in error. If the Vendor does not demonstrate that the County's determination of false certification was made in error then the County shall have the right to terminate the contract and seek civil remedies pursuant to Section 287.135, Florida Statutes, as amended from time to time.

PROHIBITION AGAINST CONSIDERING SOCIAL, POLITICAL, OR IDEOLOGICAL INTEREST IN GOVERNMENT CONTRACTING

Respondents are hereby notified of the provisions of section 287.05701, Florida Statutes, as amended, that the County will not request documentation of or consider a Respondent’s social, political, or ideological interests when determining if the Respondent is a responsible Respondent.  Respondents are further notified that the County’s governing body may not give preference to a Respondent based on the Bidder's social, political, or ideological interests.

PURCHASES BY OTHER PUBLIC AGENCIES

With the consent and agreement of the successful respondent(s), purchases may be made under this solicitation by other governmental agencies or political subdivisions within the State of Florida. Such purchases shall be governed by the same pricing, terms, and conditions stated herein with no deviations allowed. This agreement in no way restricts or interferes with the right of any public agency or political subdivision to solicit any or all of the items or services independently.

PRICE ESCALATION/DE-ESCALATION

No price adjustments may be allowed during the first twelve (12) months of the contract. Price increases will be considered after the first 12 months if substantiated by the producer price index. Written notice of a request for pricing changes and proof to substantiate must be submitted to the Bay County Purchasing Department at no less than 90 days prior to the anniversary date of this contract.

PROTEST

A notice of protest must be submitted in accordance with section 2-114 of the Bay County Code, as amended from time to time. If a party intends to initiate such an action, it must electronically notify the Chief Procurement Officer and the County Attorney no later than one business day after notice of the awarding authority’s decision.

PROPOSAL REQUIREMENTS

Each Firm’s submittal shall include sufficient information to enable the County to evaluate the capability of the Firm to provide the desired services. The data shall be significant to the project and discussions of past performances on other projects shall be minimized except as they relate to the proposed work.

Submittals shall be prepared simply and economically, providing a straightforward, concise delineation of Respondent’s capabilities to satisfy the requirement of the RFQ. Colored displays and promotional material are not desired; however, technical literature may be included as attachments to the Submittal.

Respondents submitting paper submittals should submit one (1) original clearly labeled “Original” and one (1) electronic version of the package. The electronic version should be in pdf format on usb drive.

Respondents submitting an electronic submittal should submit one (1) electronic version of the package in pdf format through the OpenGov web portal.

Electronic versions submitted via e-mail will not be accepted. If the submittal contains confidential information, such information shall be in a separate pdf document marked confidential. Submittals shall be valid to BAY COUNTY for a period of 180 days after the opening.

Emphasis in each Submittal must be on completeness and clarity of content.

In order to expedite the evaluation of Proposals, it is essential that Respondents follow the format and instructions contained in the RFP.

The following information is the minimum content required for the Proposal and will be used to compare and evaluate the firms:

1. Letter of Transmittal (Tab 1) – 0 points

a. The proposer’s understanding of the work to be performed.

b. A positive commitment to perform the required services.

c. The name of key persons, representatives, contract managers who will be the main point of contact with the County.

2. General Information (Tab 2) – 15 points

a. Firm information

i) Name, address, phone, fax, email, Federal ID#, and website (if applicable)

ii) Date the firm was established under the name given.

iii) Type of ownership or legal structure of the firm. (Corporation, joint venture, partnership)

iv) Incorporation by the Secretary of State and current Florida Professional License.

v) Indicate if the firm is a certified minority business enterprise

vi) Brief history of the firm.

a.

b. Litigation, disputes, default, & liens

Describe and explain any disputes, litigations and defaults, the results and settlements of any prior litigation, arbitration, mediation or other claims for a period of five years prior to submission of the proposal.

1)

2)

a)

b)

c) Location – provide a detailed list of the provider’s location(s), hours of operation, and other relevant information.

a)

b)

c)

3. Approach and Understanding, Scheduling, Timeliness of Services, Reporting Capabilities (Tab 3) – 25 points

Describe your understanding of the County’s needs, the services required, and your proposed method to accomplish these needs. Provide a detailed explanation for the following performance elements:

a) Explain the provider’s scheduling process, availability of appointments, and notification requirements.

b) Overview of the provider’s timeliness of services – approximate wait times for patients/customers and provide any available summarized patient survey feedback or comments.

4. Background and Demonstrated Experience of Provider (Tab 4) – 25 points

a. A statement of qualifications – which are necessary to provide the County with the required services for the specified period

b. Provide appropriate staffing, resources, and show a history of demonstrated competence to include qualifications and experience with NFPA standards.

c. An assessment of the provider’s abilities to meet the needs of the County, taking into consideration the requested services, additional services, and/or expertise offered that exceed the requirement, or the provider’s inability to meet some of the requirements of the specifications.

d. Identification of professional medical staff initially assigned to the County. Resumes with relevant experience should be included.

5. References (Tab 5) – 10 points

Provide a minimum of three (3) references, preferably from other public entities or companies in the area, for whom you have provided similar services. Include the name of the entity, contact person’s names, phone number, email address, mailing address, type of service provided, and term of contract or dates services were provided.

6. Scope of Services Available and Cost of Services (Tab 6) – 25 points

a. Provide a detailed list of the specific services requested, as well as additional services that would be available to the County. Describe the provider’s role and willingness to participate in any employee grievance as a result of testing process/results. Include the cost of each service and any supplemental information relative to the Scope of Services. Provide a total cost of all fees included as part of the comprehensive medical evaluation.

b. The Respondent submitting the lowest total price per evaluation will receive the maximum points for the cost element of the evaluation. The other Respondents’ scores will be based on a relative percentage of the dollar amount higher than the lowest price.

c. The Price points will be determined in accordance with the following formula:

Lowest Price - A

Respondent’s Price - B

Total Possible Points for Price - C

Points Earned by Respondent - D

A x C = D

B

7. Required Additional Forms (Tab 8)

a. Proposal Form

b. Addendum Acknowledgement

c. Affidavit of Compliance with Section 287.138, Florida Statues, Contracting with Foreign Entities of Concern

d. Affidavit of Compliance with Section 787.06, Florida Statues, Human Trafficking Attestation

e. Anti-Collusion Clause

f. Certification Regarding Scrutinized Companies

g. Conflict of Interest

h. Drug Free Workplace

i. Waiver of Exemption of Meetings/Presentations

ANTICIPATED SCHEDULE

This schedule may be altered solely at the County’s discretion:

EVALUATION PROCESS AND CRITERIA

Representatives from the County Purchasing Department will review the submittals for completeness. Those submittals deemed complete and responsive will be forwarded to the Evaluation Committee.

Evaluation Committee

A. Evaluation Committee may consist of 3 or 5 members or the Board of County Commissioners. Initial scoring and final ranking may be determined by separate

Evaluation Committees.

B. The County Manager or designee shall determine the Evaluation Committee(s) that will best serve the needs of the County.

C. Membership of all Evaluation Committees shall be approved by the County Manager or designee.

D. The Purchasing Department will provide reasonable notice of all meetings, no less than 72 hours in advance of such scheduled meeting, excluding holidays and weekends, by posting a Notice of Evaluation Committee Meeting on the public notice bulletin board in the Purchasing Department and on the Bay County website.

E. Contact with the Evaluation Committee. Members of the Evaluation Committee are prohibited from discussing a project with any professional or professional firm that may submit a proposal during the procurement process, except in formal committee meetings.

F. Evaluation of Proposals. Only written responses of statements of qualifications, performance data, and other data received in the purchasing office by the publicized submission time and date shall be evaluated.

G. The initial ranking of proposals is based upon the points given in the scoring sheet utilizing the evaluation criteria in the RFP.

H. Shortlisting. The best-qualified respondents shall be based upon the Evaluation Committee's ability to differentiate qualifications applicable to the scope and nature of the services to be performed as indicated by the ratings on the scoring sheet. Typically, the top three rated firms, if there are at least three responsive respondents, will be considered as the shortlisted firms, unless the County Manager, after input and discussion with the Evaluation Committee, approves adding additional firms to the shortlist.

I. Presentations/Interviews. The Evaluation Committee may choose to conduct formal presentations/interviews with shortlisted firms prior to final ranking.

J. Final Ranking. The Evaluation Committee or the Board of County Commissioners, as appropriate, shall use the ordinal process to rank the firms. The respondents shall be listed in order of preference. The list of best-qualified persons shall be approved by the County Manager or Board, as appropriate, prior to beginning contract negotiations.

The County shall negotiate a contract with the top ranked firm for services at compensation which the County determines is fair, competitive and reasonable as further described in the Scope of Services.

The provisions of the Request for Proposals and the receipt of submittals from respondents shall not create any legal or other obligation between Bay County and respondents (except as expressly set out in this RFP).

Bay County will make the selections primarily on the basis of the response to this RFP and any further information received from respondents if interviewed. Although information additional to that requested in this RFP may be provided by respondents, any consideration of this information shall be at the discretion of Bay County. Bay County shall award this project to the respondent considered by the County to offer the best overall response with a resulting negotiated agreement that is most advantageous and in the best interest of Bay County.

ATTACHMENT 1

REQUIRED ADDITIONAL FORMS

PROPOSAL FORM

RFP 26-42

This proposal of , (“Firm”) organized and existing under the laws of the State of doing business as

(Insert a corporation”, “a partnership” or “an individual” as applicable), is hereby submitted to the Board of County Commissioners, Bay County, (“County”).

In compliance with the Request for Proposals, this Firm proposes to perform all work as detailed in this solicitation.

By this Proposal, this Firm certifies, and in the case of a joint proposal each party certifies as to its own organization, that this proposal has been arrived at independently, without consultation, communication or agreement as to any matter relating to this solicitation with any other competitor.

Submitted By:

Name of Firm/Contractor Submitting This Bid

Bid Prepared By:

Name of Individual Who Prepared This Bid

Contact Email:

Address:

Phone:

Contractor’s License No.

Signature of Authorized Representative of Firm/Contractor Date

SEAL: (If bid is by Corporation)

ADDENDUM ACKNOWLEDGEMENT

I acknowledge receipt of the following addenda:

ADDENDUM NO. DATED

ADDENDUM NO. DATED

ADDENDUM NO. DATED

ADDENDUM NO. DATED

ADDENDUM NO. DATED

Name of Firm:

Authorized Signature:

Printed Name:

Title:

Date:

It is the responsibility of the firm to ensure that they have received addendums if issued. Call (850) 248-8270 or email purchasing@baycountyfl.gov prior to submitting your Proposal to ensure that you have received addendums.

AFFIDAVIT OF COMPLIANCE WITH SECTION 287.138, FLORIDA STATUTES,
CONTRACTING WITH FOREIGN ENTITIES OF CONCERN

Before me, the undersigned authority, personally appeared (Name of Affiant) _______________ ____________________, who, after being first duly sworn, deposes and says of his or her personal knowledge the following:

1. Affiant is the (Title) ___________________________ of (Business Name) _________________________________ which does business in the State of Florida, hereinafter called the “Nongovernmental Entity.”

2. Nongovernmental Entity, pursuant to § 287.138, Florida Statues, certifies that (1) Nongovernmental Entity is not owned by a government of a foreign country of concern; (2) a government of a foreign country of concern does not have a “controlling interest” in Nongovernmental Entity, as defined by Section 287.138(1)(a), Florida Statutes; and (3) Nongovernmental Entity is not organized under the law of nor has its principal place of business in a foreign country of concern. For the purposes of this affidavit, foreign country of concern means the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolás Maduro, or the Syrian Arab Republic, including any agency of or any other entity of significant control of such foreign country of concern, as defined in § 287.138(1)(c), Florida Statutes.

3. This Affidavit is executed by the Nongovernmental Entity accordance with § 287.138, Florida Statutes, for the purposes of preventing Bay County, Florida, from entering contracts with foreign entities of concern which would provide Nongovernmental Entity access to an individual’s personal identifying information.

Signed and Delivered on this _____ day of __________, 2026.

____________________________ ________________________________

Signature of Affiant Printed Name of Affiant

STATE OF__________________

COUNTY OF________________________

Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization, this ______ day of _____________, 2026, by ___________________________.

Personally Known OR Produced Identification

Type of Identification Produced________ ____________________________

(Notary Signature)

(SEAL)

AFFIDAVIT OF COMPLIANCE WITH SECTION 787.06, FLORIDA STATUTES,
HUMAN TRAFFICKING ATTESTATION

Before me, the undersigned authority, personally appeared (Name of Affiant) _________________________________, who, after being first duly sworn, deposes and says of his or her personal knowledge the following:

1. Affiant is the (Title) ______________________________ of (Business Name) __________________________________ which does business in the State of Florida, hereinafter called the “Nongovernmental Entity.”

2. Nongovernmental Entity, pursuant to § 787.06(13), Florida Statues, certifies that 1) neither Nongovernmental Entity nor any of its subsidiaries or affiliates uses coercion for labor or services, as terms are defined in § 787.06, Fla. Stat., as may be amended from time to time; (2) Nongovernmental Entity will immediately notify Bay County, Florida, if, at any time in the future, Nongovernmental Entity does use coercion for labor or services, and understands that pursuant to such notification no contracts may be executed, renewed, or extended between the parties; and (3) Nongovernmental Entity has read the foregoing attestation, confirms the facts stated in it are true, ad are made for the benefit of, and reliance by, Bay County, Florida.

Signed and Delivered on this _____ day of __________, 2026.

_____________________________ _________________________________

Signature of Affiant Printed Name of Affiant

STATE OF ___________

COUNTY OF ______________

Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization, this ____ day of _____________, 2026, by ___________________. .

Personally Known OR Produced Identification

Type of Identification Produced______ _______________________________

(Notary Signature)

(SEAL)

ANTI-COLLUSION CLAUSE

Firm certifies that their response is made without prior understanding, agreement or

connection with any Corporation, Firm or person submitting a response for the same

services and is in all respects fair and without collusion or fraud.

Name of Firm:

Authorized Signature:

Printed Name:

Title:

Date:

CERTIFICATION REGARDING SCRUTINIZED COMPANIES LIST

Section 287.135, Florida Statutes prohibits agencies from contracting with companies, for goods or services over $1,000,000, that are participating in a boycott of Israel, are on the Scrutinized Companies that Boycott Israel list, the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or has been engaged in business operations in Cuba or Syria. Both lists are created pursuant to Section 215.473, Florida Statutes.

As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the sector entitled "Respondent Vendor Name" is not participating in a boycott of Israel, is not listed on the Scrutinized Companies that Boycott Israel List, the Scrutinized Companies with Activities in Sudan List, or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and has not been engaged in business operations in Cuba or Syria. I understand that pursuant to Section 287.135, Florida Statutes, the submission of false certification may subject company to civil penalties, attorney's fees, and/or costs.

CONFLICT OF INTEREST DISCLOSURE FORM

For purposes of determining any possible conflict of interest, all firms, must disclose if any Bay County Board of County Commissioner(s), employee(s), elected officials(s), of if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their firm.

Indicate either “yes” (a county employee, elected official, or agency is also associated with your firm), or “no”. If yes, give person(s) name(s) and position(s) with your firm.

YES NO

NAME(S) POSITION(S)

Name of Firm:

Authorized Signature:

Printed Name:

Title:

Date:

DRUG FREE WORKPLACE

To have a drug-free workplace program, a business shall:

Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.

Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.

Give each employee engaged in providing the commodities or contractual services that are under Bid a copy of the statement specified in subsection (1).

In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under Bid, the employees will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction.

Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, by an employee who is so convicted.

Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.

As the person authorized to sign the statement, I certify the following:

(Check one and sign in the space provided.)

This firm complies fully with the above requirements.

This firm does not have a drug free work place program at this time.

Name of Firm:

Authorized Signature:

Printed Name:

Title:

WAIVER OF EXEMPTION OF MEETINGS/PRESENTATIONS

Pursuant to section 286.0113(2), Fla. Stat. (2011), any portion of a meeting at which a negotiation with a vendor is conducted pursuant to a competitive solicitation, at which a vendor makes an oral presentation as part of a competitive solicitation, or at which a vendor answers questions as part of a competitive solicitation is exempt from public meeting requirements. The County encourages transparent and open meetings and decision-making but will honor any request by a Firm to maintain the exemptions provided by section 286.0113(2).

Please indicate your preference regarding any meetings at which you may provide an oral presentation or answer questions regarding your submittal or at which negotiations may be conducted:

_______ Waive all requirements to keep such meetings and negotiations exempt from public meeting laws.

_______ Maintain all requirements to keep such meetings and negotiations exempt

from public meeting laws.

INDICATE WAIVE OR MAINTAIN, HOWEVER DO NOT SIGN THIS FORM

ATTACHMENT 1

SAMPLE PROFESSIONAL SERVICES CONTRACT

CONTRACT 26-42 EMERGENCY SERVICES DEPARTMENT

COMPREHENSIVE MEDICAL EVALUATION SERVICES

This Contract, dated is between the Bay County Board of Commissioners, located at 840 West 11th Street, Panama City, FL 32401 ("County"), and located at to provide comprehensive medical evaluation services to the Bay County Emergency Services Department. ("Vendor”).

1. Scope of Services

The County is engaging the services of the Vendor to provide health screening, evaluation, and physical services in adherence to the current version of National Fire Protection Association (NFPA) 1582 & 1583 for Bay County Fire Services firefighters and hazmat team members: 1) annually for each member; 2) prior to employment to establish a baseline; and 3) for firefighters candidates. Those services will be performed by the vendor after coordination with the County. Initial appointments shall be scheduled within five (5) calendar days from request for appointment, and routine physical examinations shall be completed and fit for duty report will be provided to the County within ten (10) calendar days of appointment.

National Fire Protection Association (NFPA) 1582 & 1583 for Bay County Fire Services firefighters and hazmat team members are further outlined in the Scope of Services attached hereto as Exhibit 1 and made a part hereof. An electronic or physical copy of examination results, findings, and medical records shall be provided to each patient within the provision of HIPAA and FIPA. This Contract standing alone does not authorize the performance of any work or require the County to place any orders for work.

2. Compensation

Vendor shall receive compensation for services rendered in accordance with the price schedule which is attached hereto and included herein as Exhibit 2. Rates will remain fixed for the initial term.

Invoices shall be submitted to the County in a format and distribution schedule defined by the County, no later than the 10th day of the following month. Each invoice shall set forth the number of examinations completed by the Vendor during the month and the total amount due to Vendor.

Notwithstanding anything contained herein to the contrary (including exhibits and attachments), payments shall be made in accordance with the Florida Prompt Payment Act, Section 218, Florida Statutes.

Payments shall be made in accordance with the Florida Prompt Payment Act, Section 218, Florida Statutes.

INVOICE REQUIREMENTS: All invoices are required to have the following information included:

Vendor’s name

Invoice number

Invoice date

Contract Number/PO

Project Number

Dates of service/activities were provided (mm/dd/yy-mm/dd/yy)

Site of work

Details of work provided

Amount of the invoice

3. Effective Date and Time of Performance

This Contract shall commence upon execution by the County and continue in effect for one (1) year. Upon mutual agreement between the County and Vendor, the Contract may be renewed for three (3) additional one-year periods under the same terms and conditions. Any Contract or amendment to the contract shall be subject to fund availability and mutual written agreement between the County and the Vendor.

No price adjustments may be allowed during the first twelve (12) months of the contract. Price increases will be considered after the first 12 months if substantiated by the producer price index. Written notice of a request for pricing changes and proof to substantiate must be submitted to the Bay County Purchasing Department at no less than 90 days prior to the anniversary date of this contract.