Compliant Firefighter Physical...

For the best experience, open this PDF portfolio in Acrobat X or Adobe Reader X, or later. Get Adobe Reader Now! http://www.adobe.com/go/reader STATE OF NEW HAMPSHIRE DEPARTMENT OF MILITARY AFFAIRS AND VETERANS SERVICES NFPA 1582 COMPLIANT FIREFIGHTER PHYSICALS RFP DMAVS 2020-02 Section 1 – Overview and Schedule A. Executive Summary This bid document is a Request for Proposals (RFP) issued by The Department of Military Affairs and Veterans Services, for the provision of Initial, Annual and return to Duty Firefighter Physicals for State employed firefighters, located at Pease Air National Guard facility in Newington, New Hampshire. To ensure the safety and well-being of our firefighters, the Department of Military Affairs and Veterans Services is soliciting proposals from qualified healthcare providers that include the components as outlined within the Scope of Work. This RFP is for comprehensive initial,

annual and return to duty medical evaluations designed to meet the guidelines of National Fire Protection Agency (NFPA) 1582, current Edition. Approximately 40 participates are expected annually. The firefighter physicals program contract shall be for one (1) year subject to G&C approval. B. Schedule The following table provides a Schedule of Events for this RFP through contract finalization and approval. The Agency reserves the right to amend this Schedule at its sole discretion and at any time through a published Addendum. EVENT DATE LOCAL TIME RFP Released to Vendors (Advertisement) 1/22/2020 4:00 PM Vendor Inquiry Period Ends 1/29/2020 4:00 PM Final Agency Responses to Vendor Inquiries 2/3/2020 1:00 PM Vendors Submit Proposals 2/10/2020 1:00 PM Public Opening of Submissions 2/10/2020 1:15 PM Estimate Timeframe of Vendor Oral Presentations and Interviews (if applicable) TBD Estimate Notification of Selection and Begin Contract Negotiations TBD Section 2 - Description of Agency/Program Issuing the Request for Proposals The purpose of the Firefighter Physicals Program is to reduce the risk of injury, illness, or death to our firefighters and to insure they are medically fit for duty. By insuring the firefighter’s overall health and wellness, the fire department will have physically fit firefighters to perform in a physically demanding profession. Additionally, these physicals establish baseline values for future comparison and as a preventative measure to identify any potential high-risk areas the members and their physician should be aware of. The purpose of the medical clearance is to determine whether the firefighter’s current physical condition precludes him or her from performing essential job functions or if it poses a direct threat to the health and safety of themselves or others. The purpose of the examination is not diagnostic and no diagnosis will be provided. Section 3 – Proposed Scope of Work The vendor shall be able to provide all services as outlined within this scope of work. 1) The fire department shall provide the contracted physician with the list of essential job tasks to be used in each medical evaluation of members and candidates. 2) The contracted physician shall consider the physical, physiological, intellectual, and psychological demands of the occupation when evaluating a candidate’s or member’s ability to perform the essential job tasks. 3) All examinations conducted by the vendor must adhere to the following standards: • United States Occupational Safety and Health Administration (OSHA) standards, including 29 CFR 1910.120, “Hazardous waste operations and emergency response”; 29 CFR 1910.134 “Respiratory protection”; 29 CFR 1910.95 “Occupational noise exposure”; and 29 CFR 1910.1030 “Bloodborne pathogens.” • National Fire Protection Agency (NFPA) 1582, comprehensive Occupational Medical Program for Fire Departments which contains minimal standards for release to work (attachment A). 4) All examinations shall be provided by the vendor through the use of a board certified MD and/or mid-level healthcare provider defined as a certified nurse practitioner or physician’s assistant familiar with the medical review requirements of the National Fire Protection Association (NFPA) 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments as updated. 5) All medical information associated with the Pease Firefighter Physicals Program shall be handled as confidential information, subject to the confidentiality provisions under the Health Insurance Portability and Accountability Act (HIPAA). 6) Confidential medical records for each firefighter must be maintained by the selected vendor in accordance with OSHA requirement for Occupational Medical Records and in alignment with industry standards. 7) According to NFPA 1582, a medical history questionnaire to be completed by each member to provide baseline information with which to compare future medical concerns. This questionnaire will include changes in health status and known occupational exposures since the previous evaluation, and shall be completed by each member to provide follow-up information. Information on the questionnaire and interval concerns shall be reviewed with each member by the physician. 8) Physical Exam- each member shall receive an evaluation of the following concentrations that are identified in the NFPA 1582 Guidelines. These items include: • Vital signs • Medical history & medical conditions • Head and Neck • Eyes and Vision • Ears and Hearing • Nose, Oropharynx, Trachea, Esophagus & Larynx • Lungs and Chest Wall • Heart and Vascular System • Abdominal Organs • Gastrointestinal System • Hernia • Urinary System • Spine and Axial Skeleton • Extremities • Neurological Disorders • Skin • Blood • Endocrine and Metabolic Disorders • Lymphatic System • Tumors • Breast • Musculoskeletal System 9) Blood Work- Blood testing shall be performed and shall include the following: CBC with differential, RBC indices and morphology, and platelet count: • Electrolytes (NA, K, HCO3, or CO2) • Renal Function (BUN, creatinine) • Glucose • Liver function tests (ALT, AST, direct and indirect bilirubin, alkaline phosphatase) • Total cholesterol, HDL, LDL, clinically useful lipid ratios, and triglycerides • Prostate specific antigen (PSA) test 10) Urine Lab Tests- the urine laboratory tests required shall include the following: • Microscopic analysis for RBC, WBC, casts and crystals. 11) Audiology- Audiology thresholds shall be assessed in each ear. 12) Spirometry- Pulmonary function testing shall be conducted 13) Chest Radiographs- Chest x-rays shall be performed as part of the medical evaluation and interpreted by a NIOSH certified “B” reader. 14) Electrocardiograms- A resting 12 lead EKG shall be performed as part of the medical evaluation. Initial Firefighter Exam: 1) The vendor shall provide an initial physical examination of Fire Department candidates (hereinafter referred to as “candidate”) prior to the candidate being placed in training or fire department emergency response activities. The medical evaluation shall include a medical history, examination, and any laboratory tests required to detect physical or medical condition(s) that could adversely affect his/her ability to safely perform essential job tasks. 2) The Department of Military Affairs and Veterans Services and Pease Fire Department anticipate a need of approximately10-15 initial firefighter exams annually. 3) The board certified physician or healthcare provider will issue a written opinion to the fire chief indicating the candidate’s qualification status as: a. Fit for Duty: Healthy enough to engage in firefighting b. Not Fit for Duty: Not healthy enough to engage in firefighting 4) The complete results of the medical evaluation are provided to the individual candidate only. This medical evaluation is not intended to discriminate against any individuals with pre-existing medical conditions or disabilities. The purpose of the medical evaluation is solely to ensure that the individual is able to perform the physical demanding work of firefighting and rescue operations. Annual Physical Examinations: 1) The vendor shall provide annual physical examinations and blood tests for approximately 40 Department of Military Affairs and Veterans Services Pease Fire Department personnel (hereinafter referred to as “firefighter”). The medical evaluation shall be completed every 12 months and be compared to baseline and subsequent evaluation to identify clinically relevant changes. 2) The vendor will work with the Pease Fire Department Chief and/or his designee to ensure that all requirements of the agreement are met in a timely manner. This includes the scheduling for annual physicals and follow ups. Annual firefighter physicals shall be done in agreement with the Pease Fire Department duty schedule in order to maintain continuous operations and service to Pease. 3) Each annual physical shall consist of applicable components as outlined in NFPA Components of the Annual Occupational Medical Evaluation of Members (1582-18, 7.4) 4) The board certified physician or healthcare provider will issue a written opinion to the fire chief indicating the candidate’s qualification status as: a. Fit for Duty: Healthy enough to engage in firefighting. b. Not Fit for Duty: Not healthy enough to engage in firefighting. c. Referred to his/her personal physician for a follow-up consultation. Return to work Examination: 1) The vendor shall provide return to work examinations on an as-needed basis with an anticipated annual volume of approximately 10 examinations. 2) Once a member has been cleared by his/her personal physician to return to work, the vendor shall evaluate whether or not the member can perform the following outlined tasks: a. Wearing personal protective ensemble and SCBA, performing fire-fighting tasks (e.g., hose-line operations, extensive crawling, lifting and carrying heavy objects, ventilating roofs or walls using power or hand tools, forcible entry), rescue operations, and other emergency response actions under stressful conditions, including working in extremely hot or cold environments for prolonged time periods b. Wearing an SCBA, which includes a demand valve–type positive-pressure face- piece or HEPA filter masks, which requires the ability to tolerate increased respiratory workloads c. Exposure to toxic fumes, irritants, particulates, biological (i.e., infectious) and non-biological hazards, and/or heated gases, despite the use of personal protective ensembles and SCBA d. Depending on the local jurisdiction, climbing six or more flights of stairs while wearing fire protective ensemble weighing at least 50 lb (22.6 kg) or more and carrying equipment/tools weighing an additional 20 to 40 lb (9 to 18 kg) e. Wearing fire protective ensemble that is encapsulating and insulated, which will result in significant fluid loss that frequently progresses to clinical dehydration and can elevate core temperature to levels exceeding 102.2°F (39°C) f. Wearing personal protective ensemble and SCBA, searching, finding, and rescue- dragging or carrying victims ranging from newborns to adults weighing over 200 lb (90 kg) to safety despite hazardous conditions and low visibility g. Wearing personal protective ensemble and SCBA, advancing water-filled hose- lines up to 2 1∕ 2 in. (65 mm) in diameter from fire apparatus to occupancy [approximately 150 ft (50 m)], which can involve negotiating multiple flights of stairs, ladders, and other obstacles h. Wearing personal protective ensemble and SCBA, climbing ladders, operating from heights, walking or crawling in the dark along narrow and uneven surfaces, and operating in proximity to electrical power lines and/or other hazards i. Unpredictable emergency requirements for prolonged periods of extreme physical exertion without benefit of warm-up, scheduled rest periods, meals, access to medication(s), or hydration j. Operating fire apparatus or other vehicles in an emergency mode with emergency lights and sirens k. Critical, time-sensitive, complex problem solving during physical exertion in stressful, hazardous environments, including hot, dark, tightly enclosed spaces, that is further aggravated by fatigue, flashing lights, sirens, and other distractions l. Ability to communicate (i.e., give and comprehend verbal orders) while wearing personal protective ensembles and SCBA under conditions of high background noise, poor visibility, and drenching from hose-lines and/or fixed protection systems (e.g., sprinklers) m. Functioning as an integral component of a team, where sudden incapacitation of a member can result in mission failure or in risk of injury or death to civilians or other team members n. Working in shifts, including during nighttime, that can extend beyond 12 hours 3) The board certified physician or healthcare provider will issue an opinion to the fire chief indicating the candidate’s qualification status as: a. Fit for Duty: Healthy enough to engage in firefighting. b. Referred to his/her personal physician for a follow-up consultation Section 4 – Process for Submitting a Proposal A. Proposal Submission, Deadline, and Location Instructions Proposals submitted in response to this RFP must be received by the Department of Military Affairs and Veterans Services, no later than the time and date specified in the Schedule section, herein. Proposals may be submitted by (U.S. Mail, Delivery Service, In Person, and Electronic) Proposals must be addressed to: Department of Military Affairs and Veterans Services Business Office 4 Pembroke Road Concord, NH 03301 c/o Helen Champa Proposals must be clearly marked as follows: STATE OF NEW HAMPSHIRE RESPONSE TO RFP DMAVS 2020-02 NFPA 1582 COMPLIANT FIREFIGHTER PHYSICALS Unless waived as a non-material deviation in accordance with Section 6B, late submissions will not be accepted and will be returned to the vendors unopened. Delivery of the Proposals shall be at the Vendor’s expense. The time of receipt shall be considered when a Proposal has been officially documented by the Agency, in accordance with its established policies, as having been received at the location designated above. The Agency accepts no responsibility for mislabeled mail or mail that is not delivered or undeliverable for whatever reason. Any damage that may occur due to shipping shall be the Vendor’s responsibility. All Proposals submitted in response to this RFP must consist of at least: a) One (1) original and three (3) clearly identified copies of the Proposal, including all required attachments; b) One (1) original clearly identified electronic copy of the Proposal, including all required attachments contained on digital media: CD format. c) One electronic copy of the Proposal with all Confidential Information fully redacted, as provided for in Section 7E of this RFP: CD format. Vendors who are ineligible to bid on proposals, bids or quotes issued by the Department of Administrative Services, Division of Procurement and Support Services pursuant to the provisions of RSA 21-I:11-c shall not be considered eligible for an award under this proposal. B. Proposal Inquiries All inquiries concerning this RFP, including but not limited to, requests for clarifications, questions, and any changes to the RFP, shall be submitted via email to the following RFP designated Points of Contact: TO: Ryan.Godin@nh.gov CC: Helen.Champa @nh.gov Inquiries must be received by the Agency’s RFP Points of Contact no later than the conclusion of the Vendor Inquiry Period (see Schedule of Events section, herein). Inquiries received later than the conclusion of the Vendor Inquiry Period shall not be considered properly submitted and may not be considered. The Agency intends to issue official responses to properly submitted inquiries on or before the date specified in the Schedule section, herein; however, this date is subject to change at the Agency’s discretion. The Agency may consolidate and/or paraphrase questions for sufficiency and clarity. The Agency may, at its discretion, amend this RFP on its own initiative or in response to issues raised by inquiries, as it deems appropriate. Oral statements, representations, clarifications, or modifications concerning the RFP shall not be binding upon the Agency. Official responses by the Agency will be made only in writing by the process described above. Vendors shall be responsible for reviewing the most updated information related to this RFP before submitting a proposal. C. Restriction of Contact with Agency Employees From the date of release of this RFP until an award is made and announced regarding the selection of a Vendor, all communication with personnel employed by or under contract with the Agency and Federal personnel working with the Agency regarding this RFP is forbidden unless first approved by the RFP Points of Contact listed in the Proposal Inquiries section, herein D. Validity of Proposal Proposals must be valid for one hundred and eighty (180) days following the deadline for submission of Proposals in Schedule of Events, or until the Effective Date of any resulting Contract, whichever is later. SECTION 5 - Content and Requirements for a Proposal A letter of introduction and include the following information: a) Name, address, telephone/fax number web page address & e-mail address. b) Date of proposal, and a Statement that the offer has the ability to provide the services are requested and will comply with the sample agreement terms and conditions set forth in this request. c) A complete listing of service locations and hours of availability. d) Work plan or approach to Scope of Services included herein. e) Ability to perform all medical and physical requirements as stated in Scope of Services section. f) Listing of proposed staff, including resumes, credentials and applicable licenses. g) Related Experience of firm as it relates to this RFP. h) Three (3) references for the Vendor. Each reference must include: • Name, address, telephone number of reference. • Description of the nature of the relationship between vendor and reference. • Length of time the reference has been affiliated with the vendor. i) Annual cost proposal for services January 1, 2020 through December 31, 2020 (in a separate, sealed envelope). Failure to adequately address and meet the above requirements will disqualify Vendor’s proposal. Proposals shall include the following pricing information: • Testing Location for firefighter physicals and Location hours of operation. • Equipment, Labor & Administrative Charges • Exam Elements Charges • Total Cost per firefighter for o Initial Exam o Annual Exam o Return to work Exam Proposals shall include the following components: • All firefighter physicals shall be by appointment between the hours of 8:00 am and 4:00 pm, Monday through Friday. • Medical report to each firefighter in a confidential envelope The vendor shall supply the following information with their proposal: • A sample Medical History Form describing what is included in the comprehensive medical examination • Sample blood laboratory testing form describing what components are included in the test. • Policy on dealing with pre-existing conditions • Firefighter Medical Classification Form • Medical Records retention policy Location of Firefighter Physicals: Out of convenience to our firefighters’ work schedules; the department prefers to have the medical assessment conducted at a medically licensed and insured facility with a location that falls within a 10-mile radius of the Pease Fire Department located at 302 Newmarket Street, Newington, NH 03801. Proposals that are not able to provide facilities within the desired radius will not be excluded from consideration. If facilities within the desired radius are not available, facility locations to be used shall be identified along with any deviation in scheduled hours identified within the RFP. Vendor Certifications and Requirements: All vendors shall be duly registered as a Vendor authorized to conduct business in the State of New Hampshire. • STATE OF NEW HAMPSHIRE VENDOR APPLICATION: Vendors shall have a completed Vendor Application and Alternate W-9 Form which shall be on file with the State of New Hampshire Bureau of Purchase and Property. See the following website for information on obtaining and filing the required forms: http://admin.state.nh.us/purchasing/vendor.asp • REGISTRATION WITH THE NEW HAMPSHIRE DEPARTMENT OF STATE (Secretary of State): A contract award, will only be considered/awarded to a Vendor who is registered to do business and is in good standing with the State of New Hampshire. Please visit the following website to find out more about the requirements for registration with the NH Secretary of State: http://www.sos.nh.gov/corporate • CONFIDENTIALITY & CRIMINAL RECORD: The Vendor must have a State of New Hampshire Criminal Record Check Authorization Form signed by each of their employees. These forms shall be returned to the Pease Security Program Manager agency prior to the start of any employment assignment. • DEBARMENT: The successful Vendor shall also meet the requirements of the Federal System for Awards Management (SAM). Please see: https://www.sam.gov/portal/public/SAM http://admin.state.nh.us/purchasing/vendor.asp http://www.sos.nh.gov/corporate https://www.sam.gov/portal/public/SAM • CERTIFICATE OF INSURANCE: The successful Vendor will be required to submit proof of coverage prior to entering into a resulting contract. Please see the State Contract Form P-37 (attached), included in this packet, and the Exhibit C included with the Scope of Services document for the specific terms regarding insurance. SECTION 6 – Evaluation of Proposals A. Criteria for Evaluation and Scoring Each responsive Proposal will be evaluated and considered with regard to the following criteria: A. Work Plan a. Customer Service b. Comparable Client Services c. Clarity of Forms and Procedures d. Service Locations e. Hours Available f. Training B. Pertinent Experience of Vendor and Staff Expertise a. Experience b. Credentials c. Licensures d. Qualifications of Individual(s) employed by the vendor. C. Cost Proposal If the Agency determines to make an award based on these evaluations, the Agency will notify the selected Vendor(s). Should the Agency be unable to reach agreement with the selected Vendor(s) during Contract discussions, the Agency may then undertake Contract discussions with the next preferred Vendor and so on, or the Agency may reject all proposals, cancel this RFP, or solicit new Proposals under a new acquisition process. The Agency will use a scoring scale of 500 points as set forth in the table below. The Agency will select a Vendor based upon the criteria and standards contained in this RFP and from applying the weighting in this section. Oral interviews and reference checks, to the extent they are utilized by the Agency, will be used to refine and finalize scores. Weighted Values Score 1-5 (Evaluation Points: 1-Lowest to 5-Highest) Evaluation Points Maximum Score A. Work Plan • Customer Service • Comparable Client Services • Clarity of Forms and Procedures • Service Locations • Hours Available • Training 50% 250 B. Pertinent Experience of Vendor and Staff Expertise • Experience • Credentials • Licensures • Qualifications of Individual(s) employed by the proponent. 25% 125 375 Weighted Values Proposer’s Price Score = (Lowest Proposed Price / Proposer’s Proposed Price) x Number of Points from Score (125) Evaluation Points Maximum Score C. Cost Proposal 25% 125 FINAL SCORE 100% 500 Technical Evaluation Technical Scoring Total Points (Proposals scores must achieve minimal score of 300 in order to be evaluated for cost) Cost Evaluation B. Planned Evaluations The Agency plans to use the following process: • Initial screening to ensure that the Proposals are in compliance with submission requirements; • Preliminary evaluation of the Proposals; • Oral interviews and Product Demonstrations (if necessary); • Final Evaluation of Work Plan and scoring; • Final Evaluation of Pertinent Experience of Vendor and Staff Expertise and scoring • Review of Price Proposals and final scoring; • Best and Final Offer (BAFO) if appropriate; and • Select the highest scoring Vendor (s) and begin contract negotiation. C. Initial Screening The Agency will conduct an initial screening step to verify Vendor compliance with the technical submission requirements set forth in the RFP and the minimum content set forth in Section 5 of this RFP. The Agency may waive or offer a limited opportunity to cure immaterial deviations from the RFP requirements if it is determined to be in the best interest of the State. D. Preliminary Technical Scoring of Proposals The Agency will establish an evaluation team to initially score the Technical Proposals. This evaluation team will review the technical proposals and give a preliminary score to the technical proposals under the guidelines set forth in Section 6. Should a Vendor fail to achieve 300 points in the technical scoring section, it will receive no further consideration from the evaluation team and the Vendor’s Price Proposal will be returned unopened. Price Proposals will remain sealed during the preliminary technical review. E. Oral Interviews and Product Demonstrations If the Agency determines that it is appropriate, vendors may be invited to oral interviews and/or product demonstrations including demonstrations of any proposed automated systems or technology components. The Agency retains the sole discretion to determine whether to conduct oral interviews, with which vendors; and the number of interviews. Vendors are advised that the Agency may decide to conduct interviews with less than all responsive vendors. The purpose of oral interviews and product demonstrations is to clarify and expound upon information provided in the written Proposals. Vendors are prohibited from altering the basic substance of their Proposals during the oral interviews and product demonstrations. The Agency may ask the Vendor to provide written clarifications of elements in their Technical Proposal regardless of whether it intends to conduct Oral Interviews. Information gained from oral interviews and product demonstrations will be used to refine technical review scores assigned from the initial review of the Proposals. F. Final Technical Scoring of Proposals Following Oral Interviews, Product Demonstrations, Reference Checks (if appropriate) and/or review of written clarifications of proposals requested by the Agency, the evaluation team will determine a final score for each Technical Proposal. G. Price Proposal Review Price proposals will be reviewed upon completion of the final technical scoring of proposals. The Vendor’s Price Proposal will be allocated a maximum potential score of 125 points (C in the evaluation table above). Vendors are advised that this is not a low bid award and that the scoring of the price proposal will be combined with the scoring of the technical proposal to determine the overall highest scoring Vendor. The following formula will be used to assign points for costs: Vendor’s Price Score = (Lowest Proposed Price / Vendor’s Proposed Price) x Number of Points for Score (125) For the purpose of use of this formula, the lowest proposed price is defined as the lowest price proposed by a Vendor who has scored above the minimum necessary for consideration on the Technical Score. H. Best and Final Offer (BAFO) Upon completion of the scoring process outlined in Section 6, the Agency may, at its sole option, invite the highest scoring Vendors to submit a “Best and Final Offer” for the Agency’s consideration. The Agency reserves the right to select the Vendor based solely on the initial proposals and is under no obligation to solicit or accept a BAFO from any vendors. As the Agency may not request a Best and Final Offer, Vendors are encouraged to provide their most competitive prices in their initial proposals. The Best and Final Offer (BAFO) is a one-time invitation only process for a vendor to submit its lowest priced offer for the Agency’s consideration. In its invitation to submit a BAFO, the Agency will provide a deadline submission date for the BAFO. The Agency may communicate in writing any price/cost targets that the Agency is seeking in the BAFO. If such target(s) is provided, the Agency will do so uniformly to all Vendors selected to participate in the BAFO. All restrictions on contact with State employees outlined in Section 4C shall remain in effect for the BAFO period. Each invited Vendor may only make one BAFO. The BAFO may not alter the substance of the Vendor’s technical proposal. The BAFO may only amend the Vendor’s initial price proposal. To the extent the Agency solicits and receives a BAFO pursuant to this section, the Agency will re-score the BAFO participants’ price proposals after review of the BAFO in accordance with section 6G (Calculation of the Price Proposal Score). The Agency will not select a Vendor based on the lowest priced BAFO proposal. A final selection, if any, shall be based on the combined score of the technical proposal and BAFO price proposal. Only those Vendors who were invited to submit a BAFO will be considered for the award. I. Final Selection The Agency will conduct a final selection based on the final evaluation of the initial proposals or, if requested, as a result of the Best and Final Offer and begin contract negotiations with the selected Vendor(s). J. Rights of the Agency in Accepting and Evaluating Proposals The Agency reserves the right to: • Make independent investigations in evaluating Proposals; • Request additional information to clarify elements of a Proposal; • Waive minor or immaterial deviations from the RFP requirements, if determined to be in the best interest of the State; • Omit any planned evaluation step if, in the Agency’s view, the step is not needed; • At its sole discretion, reject any and all Proposals at any time; and • Open contract discussions with the second highest scoring Vendor and so on, if the Agency is unable to reach an agreement on Contract terms with the higher scoring Vendor(s). SECTION 7 – Terms and Conditions Related To The RFP Process A. RFP Addendum The Agency reserves the right to amend this RFP at its discretion, prior to the Proposal submission deadline. In the event of an addendum to this RFP, the Agency, at its sole discretion, may extend the Proposal submission deadline, as it deems appropriate. B. Non-Collusion The Vendor’s signature on a Proposal submitted in response to this RFP guarantees that the prices, terms and conditions, and Work quoted have been established without collusion with other Vendors and without effort to preclude the Agency from obtaining the best possible competitive Proposal. C. Property of the Agency All material received in response to this RFP shall become the property of the State and will not be returned to the vendor. Upon Contract award, the State reserves the right to use any information presented in any Proposal. D. Confidentiality of a Proposal Unless necessary for the approval of a contract, the substance of a proposal must remain confidential until the Effective Date of any Contract resulting from this RFP. A Vendor’s disclosure or distribution of Proposals other than to the Agency will be grounds for disqualification. E. Public Disclosure Pursuant to RSA 21-G:37, all responses to this RFP shall be considered confidential until the award of a contract. At the time of receipt of proposals, the Agency will post the number of responses received with no further information. No later than five (5) business days prior to submission of a contract to the Department of Administrative Services pursuant to this RFP, the Agency will post the name, rank or score of each vendor. In the event that the contract does not require Governor & Executive Council approval, the Agency shall disclose the rank or score of the Proposals at least 5 business days before final approval of the contract. The content of each Vendor’s Proposal shall become public information upon the award of any resulting Contract. Any information submitted as part of a response to this request for proposal (RFP) may be subject to public disclosure under RSA 91-A. In addition, in accordance with RSA 9-F:1, any contract entered into as a result of this RFP will be made accessible to the public online via the website Transparent NH (http://www.nh.gov/transparentnh/). However, business http://www.nh.gov/transparentnh/ financial information and proprietary information such as trade secrets, business and financials models and forecasts, and proprietary formulas may be exempt from public disclosure under RSA 91-A:5, IV. If you believe any information being submitted in response to this request for proposal, bid or information should be kept confidential as financial or proprietary information; you must specifically identify that information in a letter to the agency, and must mark/stamp each page of the materials that you claim must be exempt from disclosure as “CONFIDENTIAL”. A designation by the Vendor of information it believes exempt does not have the effect of making such information exempt. The Agency will determine the information it believes is properly exempted from disclosure. Marking of the entire Proposal or entire sections of the Proposal (e.g. pricing) as confidential will neither be accepted nor honored. Notwithstanding any provision of this RFP to the contrary, Vendor pricing will be subject to disclosure upon approval of the contract. The Agency will endeavor to maintain the confidentiality of portions of the Proposal that are clearly and properly marked confidential. If a request is made to the Agency to view portions of a Proposal that the Vendor has properly and clearly marked confidential, the Agency will notify the Vendor of the request and of the date the Agency plans to release the records. By submitting a Proposal, Vendors agree that unless the Vendor obtains a court order, at its sole expense, enjoining the release of the requested information, the Agency may release the requested information on the date specified in the Agency’s notice without any liability to the Vendors. F. Non-Commitment Notwithstanding any other provision of this RFP, this RFP does not commit the Agency to award a Contract. The Agency reserves the right, at its sole discretion, to reject any and all Proposals, or any portions thereof, at any time; to cancel this RFP; and to solicit new Proposals under a new acquisition process. G. Proposal Preparation Cost By submitting a Proposal, a Vendor agrees that in no event shall the Agency be either responsible for or held liable for any costs incurred by a Vendor in the preparation of or in connection with the Proposal, or for Work performed prior to the Effective Date of a resulting Contract. H. Ethical Requirements From the time this RFP is published until a contract is awarded, no bidder shall offer or give, directly or indirectly, any gift, expense reimbursement, or honorarium, as defined by RSA 15-B, to any elected official, public official, public employee, constitutional official, or family member of any such official or employee who will or has selected, evaluated, or awarded an RFP, or similar submission. Any bidder that violates RSA 21-G:38 shall be subject to prosecution for an offense under RSA 640:2. Any bidder who has been convicted of an offense based on conduct in violation of this section, which has not been annulled, or who is subject to a pending criminal charge for such an offense, shall be disqualified from bidding on the RFP, or similar request for submission and every such bidder shall be disqualified from bidding on any RFP or similar request for submission issued by any state agency. A bidder that was disqualified under this section because of a pending criminal charge which is subsequently dismissed, results in an acquittal, or is annulled, may notify the department of administrative services, which shall note that information on the list maintained on the state’s internal intranet system, except in the case of annulment, the information, shall be deleted from the list. I. Challenges on Form or Process of the RFP Any challenges regarding the validity or legality of the form and procedures of this RFP, including but not limited to the evaluation and scoring of Proposals, shall be brought to the attention of the Agency at least ten (10) business days prior to the Proposal Submission Deadline. By submitting a proposal, the Vendor is deemed to have waived any challenges to the agency’s authority to conduct this procurement and the form and procedures of this RFP. Section 8 – Contract Terms and Award A. Non-Exclusive Contract Any resulting Contract from this RFP will be a non-exclusive Contract. The State reserves the right, at its discretion, to retain other Vendors to provide any of the Services or Deliverables identified under this procurement or make an award by item, part or portion of an item, group of items, or total Proposal. B. Award If the State decides to award a contract as a result of this RFP process, any award is contingent upon approval of the Contract by Governor and Executive Council of the State of New Hampshire and upon continued appropriation of funding for the contract. C. Standard Contract Terms The Agency will require the successful bidder to execute a Not to Exceed Contract using the Standard Terms and Conditions of the State of New Hampshire which is attached as Appendix A. The Term of the Contract will be for one (1) year subject to G&C approval. The contract term may be extended by an additional term of one (1) year at the sole option of the State, subject to the parties’ prior written agreement on terms and applicable fees for each extended term contingent upon satisfactory vendor performance, continued funding and Governor and Executive Council approval. To the extent that a Vendor believes that exceptions to the standard form contract will be necessary for the Vendor to enter into the Agreement, the Vendor should note those issues during the Vendor Inquiry Period. The Agency will review requested exceptions and accept, reject or note that it is open to negotiation of the proposed exception at its sole discretion. If the Agency accepts a Vendor’s exception the Agency will, at the conclusion of the inquiry period, provide notice to all potential vendors of the exceptions which have been accepted and indicate that exception is available to all potential vendors. Any exceptions to the standard form contract that are not raised during the vendor inquiry period are waived. In no event is a Vendor to submit its own standard contract terms and conditions as a replacement for the State’s terms in response to this solicitation. THE STATE OF NEW HAMPSHIRE DEPARTMENT OF MILITARY AFFAIRS AND VETERAN SERVICES NFPA 1582 COMPLIANT FIREFIGHTER PHYSICALS EXHIBIT A – SPECIAL PROVISIONS, State Contract Form P-37 The following special provisions modify, change, delete or add to the General Provisions of the agreement. Where any part of the General Provisions is modified or voided by these Special Provisions, the unaltered provisions for that part shall remain in effect. 1. This agreement is funded, wholly or in part, by monies of the Federal Government of the United States; therefore, all parts and provisions of this agreement that refer to contract which are funded in any part by the federal government are applicable to this agreement. 2. The term “Contracting Officer” as used in this agreement shall mean the State’s Contracting Officer as is specified at item #1.9 of the General Provisions of this agreement or his authorized representative. No individual shall be an authorized representative of the Contracting Officer unless he or she is so appointed in writing by the Contracting Officer, in which case such written appointment shall be provided to the Contractor. 3. The Contractor shall be responsible to correct, at his own cost and expense, defective work, or damaged property when defects and damage are caused by the Contractor’s employees, equipment or supplies. The Contracting Officer may withhold all, or part of, payments due to the Contractor until defective work or damaged property caused by the Contractor, his employees, equipment or materials, is placed in satisfactory condition 4. General Provisions of are amended as follows: a. Provision 7. PERSONNEL sub-part 7.2: Delete the period at the end of the provision, and add the following: “or who is a National Guardsperson or who is a federal employee of the National Guard.” b. Provision 9. DATA: ACCESS; CONFIDENTIALITY; PRESERVATION: Add the following sub-part: 9.4 Between the Effective Date and three (3) years after the Completion Date, as often as the State or Federal Government shall demand, the Contractor shall make available for audit purposes, all records that pertain to this Agreement. Upon demand the contractor shall provide copies of such documents which may include invoices, payrolls, records of personnel, and other information relating to all matters covered in this agreement. c. Provision 14. INSURANCE AND BOND: Add the following sub-sub-part: 14.1.3 Insurance against all claims arising from the upon contract award, the Contractor must obtain insurance at the following minimum amounts: -Automobile Liability – Any Automobile $2,000,000.00 single limit -Excess Liability – Umbrella $4,000,000.00 each occurrence, Aggregate $4,000,000.00 -All Risk – Real and Personal Property - $10,000,000.00. 5. GOVERNING REGULATIONS: Title 2 Code of Federal Regulations (CFR) Part 200, and NGR 5-1, shall govern this Agreement and include the following terms and conditions: Nondiscrimination. The Grantee covenants and agrees that no person shall be subject to discrimination or denied benefits in connection with the State’s performance under the MCA. Accordingly, and to the extent applicable, the Grantee covenants and agrees to comply with the following national policies prohibiting discrimination: a. On the basis of race, color or national origin, in Title VI of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d et seq.), as implemented by DoD regulations at 32 CFR Part 195. b. On the basis of race, color or national origin, in Executive Order 11246 as implemented by Department of Labor regulations at 41 CFR Chapter 60. c. On the basis of sex or blindness, in Title IX of the Education Amendments of 1972 (20 U.S.C. Section 1681, et seq.), as implemented by DOD regulations at 32 CFR Part 196. d. On the basis of age, in The Age Discrimination Act of 1975 (42 U.S.C. Section 6101, et seq.), as implemented by Department of Health and Human Services regulations at 45 CFR Part 90. e. On the basis of handicap, in Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as implemented by Department of Justice regulations at 28 CFR part 41 and DoD regulations at 32 CFR Part 56. Lobbying. a. The state covenants and agrees that it will not expend any funds appropriated by Congress to pay any person for influencing or attempting to influence an officer or employee of any agency, or a Member of Congress in connection with any of the following covered federal actions. The awarding of any federal contract; the making of any federal grant; the making of any federal loan; the entering into of any CA; and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or Cooperative Agreement. b. The Final Rule, New Restrictions on Lobbying, issued by the Office of Management and Budget and the Department of Defense (32 CFR Part 28) to implement the provisions of Section 319 of Public Law 101-121 (31 U.S.C. Section 1352) is incorporated by reference and the state agrees to comply with all the provisions thereof, including any amendments to the Interim Final Rule that may hereafter be issued. Drug-Free work Place. The Grantee covenants and agrees to comply with the requirements regarding drug-free workplace requirements in of 32 CFR Part 26, which implements Section 5151-5160 of the Drug- Free Workplace act of 1988 (Public Law 100-690, Title V, Subtitle D; 41 U.S.C. 701, et seq.). Environmental Protection. a. The Grantee covenants and agrees that its performance under this Agreement shall comply with: (1) The requirements of Section 114 of the Clean Air Act (42 U.S.C. Section 7414); (2) Section 308 of the Federal Water Pollution Control Act (33 U.S.C. Section 1318), that relates generally to inspection, monitoring, entry reports, and information, and with all regulations and guidelines issued thereunder; (3) The Resources Conservation and Recovery Act (RCRA); (4) The Comprehensive Environmental Response, Compensation and Liabilities Act (CERCLA); (5) The National Environmental Policy Act (NEPA); (6) The Solid Waste Disposal Act (SWDA)); (7) The applicable provisions of the Clean Air Act (42 U.S.C. 7401, et seq.) and Clean Water Act (33 U.S.C. 1251, et seq.), as implemented by Executive Order 11738 and Environmental Protection Agency (EPA) rules at 40 CFR Part 31; (8) To identify any impact this award may have on the quality of the human environment and provide help as needed to comply with the National Environmental Policy Act (NEPA, at 42 U.S.C. 4321, et seq.) and any applicable federal, state or local environmental regulation. b. In accordance with the EPA rules, the parties further agree that the Grantee shall also identify to the awarding agency (NGB) any impact this award may have on: (1) The quality of the human environment, and provide help the agency may need to comply with the National Environmental Policy Act (NEPA, at 42 U.S.C 4321, et seq.) and to prepare Environment Impact Statements or other required environmental documentation. In such cases, the recipient agrees to take no action that will have an adverse environmental impact (e.g., physical disturbance of a site such as breaking of ground) until the agency provides written notification of compliance with the environmental impact analysis process. (2) Flood-prone areas, and provide help the agency may need to comply with the National Flood Insurance Act of 1968 and Flood Disaster Protection Act of 1973 (42 U.S.C. 4001, et seq.), which require flood insurance, when available, for federally assisted construction or acquisition in flood-prone areas. (3) Coastal zones, and provide help the agency may need to comply with the Coastal Zone Management Act of 1972 (16 U.S.C. 1451, et seq.), concerning protection of U.S. coastal resources. (4) Coastal barriers, and provide help the agency may need to comply with the Coastal Barriers Resource Act (16 U.S.C. 3501 et seq.), concerning preservation of barrier resources. (5) Any existing or proposed component of the National Wild and Scenic Rivers System, and provide help the agency may need to comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.). (6) Underground sources of drinking water in areas that have an aquifer that is the sole or principal drinking water source, and provide help the agency may need to comply with the Safe Drinking Water Act (42 U.S.C 300H-3). Use of United States Flag Carriers. a. The state covenants and agrees that travel supported by U.S. Government funds under this agreement shall use U.S.-flag air carriers (air carriers holding certificates under 49 U.S.C. 41102) for international air transportation of people and property to the extent that such service is available, in accordance with the International Air Transportation Fair Competitive Practices Act of 1974 (49 U.S.C. 40118) and the inter-operative guidelines issued by the Comptroller General of the United States in the March 31, 1981, amendment to Comptroller General Decision B138942. b. The state agrees that it will comply with the Cargo Preference Act of 1954 (46 U.S.C. Chapter 553), as implemented by Department of Transportation regulation at 46 CFR 381.7, and 46 CFR 381.7(b). Debarment and Suspension. Non-federal entities and contractors are subject to the non-procurement debarment and suspension regulations implementing Executive Orders 12549 and 12689, 2 CFR part 180. These regulations restrict awards, sub awards, and contracts with certain parties that are debarred, suspended, or otherwise excluded from or ineligible for participation in Federal assistance programs or activities. The grantee agrees to comply with the DOD implementation of 2 CFR Part 180 (at 2 CFR Part 1125) by checking the Excluded Parties List System (EPLS) at www.sam.gov to verify contractor eligibility to receive contracts and subcontracts resulting from this Agreement. The grantee and sub recipients shall not solicit offers from, nor award contracts to contractors listed in EPLS. This verification shall be documented in the grantee and sub recipient contract files, and shall be subject to audit by the grantor and Federal/State audit agencies Buy American Act. The state covenants and agrees that it will not expend any funds appropriated by Congress without complying with The Buy American Act (41 U.S.C.10a et seq.). The Buy American Act gives preference to domestic end products and domestic construction material. In addition, the Memorandum of Understanding between the United States of America and the European Economic Community (EEC) on Government Procurement, and the North American Free Trade Agreement (NAFTA), provide that EEC and NAFTA end products and construction materials are exempted from application of the Buy American Act. Uniform Relocation Assistance and real Property Acquisition Policies. The state covenants and agrees that it will comply with CFR 49 part 24, which implements the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (42 U.S.C. Section 4601 et seq.) and provides for fair and equitable treatment of persons displaced by federally assisted programs or persons whose property is acquired as a result of such programs. http://www.sam.gov/ Copeland “Anti-Kickback” Act. The state covenants and agrees that it will comply with the Copeland “Anti-Kickback” Act (18 U.S.C. Section 874) as supplemented in Department of Labor regulations (29 CFR Part 3). As applied to this agreement, the Copeland “Anti-Kickback” Act makes it unlawful to induce, by force, intimidation, threat of procuring dismissal from employment, or otherwise, any person employed in the construction or repair of public buildings or public works, financed in whole or in part by the United States, to give up any part of the compensation to which that person is entitled under a contract of employment. Contract Work Hours and Safety Standards Act. The state covenants and agrees that it will comply with Sections 103 and 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. Sections 3701-3708) as supplemented by Department of Labor regulations (29 CFR Part 5). As applied to this agreement, the Contract Work Hours and Safety Standards Act specifies that no laborer or mechanic doing any part of the work contemplated by this agreement shall be required or permitted to work more than 40 hours in any workweek unless paid for all additional hours at not less than 1.5 times the basic rate of pay. THE STATE OF NEW HAMPSHIRE DEPARTMENT OF MILITARY AFFAIRS AND VETERAN SERVICES NFPA 1582 COMPLIANT FIREFIGHTER PHYSICALS EXHIBIT B- SCOPE OF SERVICES The vender shall be able to provide all services as outlined within this scope of work. 1) The fire department shall provide the contracted physician with the list of essential job tasks to be used in each medical evaluation of members and candidates. 2) The contracted physician shall consider the physical, physiological, intellectual, and psychological demands of the occupation when evaluating a candidate’s or member’s ability to perform the essential job tasks. 3) All examinations conducted by the vender must adhere to the following standards: • United States Occupational Safety and Health Administration (OSHA) standards, including 29 CFR 1910.120, “Hazardous waste operations and emergency response”; 29 CFR 1910.134 “Respiratory protection”; 29 CFR 1910.95 “Occupational noise exposure”; and 29 CFR 1910.1030 “Bloodborne pathogens.” • National Fire Protection Agency (NFPA) 1582, comprehensive Occupational Medical Program for Fire Departments which contains minimal standards for release to work (attachment A). 4) All examinations shall be provided by the vender through the use of a board certified MD and/or mid-level healthcare provider defined as a certified nurse practitioner or physician’s assistant familiar with the medical review requirements of the National Fire Protection Association (NFPA) 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments as updated. 5) All medical information associated with the Pease Firefighter Physicals Program shall be handled as confidential information, subject to the confidentiality provisions under the Health Insurance Portability and Accountability Act (HIPAA). 6) Confidential medical records for each firefighter must be maintained by the selected vendor in accordance with OSHA requirement for Occupational Medical Records and in alignment with industry standards. 7) According to NFPA 1582, a medical history questionnaire to be completed by each member to provide baseline information with which to compare future medical concerns. This questionnaire will include changes in health status and known occupational exposures since the previous evaluation, and shall be completed by each member to provide follow-up information. Information on the questionnaire and interval concerns shall be reviewed with each member by the physician. 8) Physical Exam- each member shall receive an evaluation of the following concentrations that are identified in the NFPA 1582 Guidelines. These items include: • Vital signs • Medical history & medical conditions • Head and Neck • Eyes and Vision • Ears and Hearing • Nose, Oropharynx, Trachea, Esophagus & Larynx • Lungs and Chest Wall • Heart and Vascular System • Abdominal Organs • Gastrointestinal System • Hernia • Urinary System • Spine and Axial Skeleton • Extremities • Neurological Disorders • Skin • Blood • Endocrine and Metabolic Disorders • Lymphatic System • Tumors • Breast • Musculoskeletal System 9) Blood Work- Blood testing shall be performed and shall include the following: CBC with differential, RBC indices and morphology, and platelet count: • Electrolytes (NA, K, HCO3, or CO2) • Renal Function (BUN, creatinine) • Glucose • Liver function tests (ALT, AST, direct and indirect bilirubin, alkaline phosphatase) • Total cholesterol, HDL, LDL, clinically useful lipid ratios, and triglycerides • Prostate specific antigen (PSA) test 10) Urine Lab Tests- the urine laboratory tests required shall include the following: • Microscopic analysis for RBC, WBC, casts and crystals. 11) Audiology- Audiology thresholds shall be assessed in each ear. 12) Spirometry- Pulmonary function testing shall be conducted 13) Chest Radiographs- Chest x-rays shall be performed as part of the medical evaluation and interpreted by a NIOSH certified “B” reader. 14) Electrocardiograms- A resting 12 lead EKG shall be performed as part of the medical evaluation. Initial Firefighter Exam: 1) The vender shall provide an initial physical examination of Fire Department candidates (hereinafter referred to as “candidate”) prior to the candidate being placed in training or fire department emergency response activities. The medical evaluation shall include a medical history, examination, and any laboratory tests required to detect physical or medical condition(s) that could adversely affect his/her ability to safely perform essential job tasks. 2) The Department of Military Affairs and Veterans Services and Pease Fire Department anticipate a need of approximately10-15 initial firefighter exams annually. 3) The board certified physician or healthcare provider will issue an opinion to the fire chief indicating the candidate’s qualification status as: a. Fit for Duty: Healthy enough to engage in firefighting b. Not Fit for Duty: Not healthy enough to engage in firefighting 4) The complete results of the medical evaluation are provided to the individual candidate only. This medical evaluation is not intended to discriminate against any individuals with pre-existing medical conditions or disabilities. The purpose of the medical evaluation is solely to ensure that the individual is able to perform the physical demanding work of firefighting and rescue operations. Annual Physical Examinations: 1) The vender shall provide annual physical examinations and blood tests for approximately 40 Department of Military Affairs and Veterans Services Pease Fire Department personnel (hereinafter referred to as “firefighter”). The medical evaluation shall be completed every 12 months and be compared to baseline and subsequent evaluation to identify clinically relevant changes. 2) The vender will work with the Pease Fire Department Chief and/or his designee to ensure that all requirements of the agreement are met in a timely manner. This includes the scheduling for annual physicals and follow ups. Annual firefighter physicals shall be done in agreement with the Pease Fire Department duty schedule in order to maintain continuous operations and service to Pease. 3) Each firefighter annual physical shall consist of applicable components as outlined in NFPA Components of the Annual Occupational Medical Evaluation of Members (1582-18, 7.4) 4) The board certified physician or healthcare provider will issue an opinion to the fire chief indicating the candidate’s qualification status as: a. Fit for Duty: Healthy enough to engage in firefighting. b. Not Fit for Duty: Not healthy enough to engage in firefighting. c. Referred to his/her personal physician for a follow-up consultation. Return to work Examination: 1) The vender shall provide return to work examinations on an as needed basis with an anticipated annual volume of approximately 10 examinations. 2) Once a member has been cleared by his/her personal physician to return to work, the vender shall evaluate whether or not the member can perform the following outlined tasks: a. Wearing personal protective ensemble and SCBA, performing fire- fighting tasks (e.g., hose-line operations, extensive crawling, lifting and carrying heavy objects, ventilating roofs or walls using power or hand tools, forcible entry), rescue operations, and other emergency response actions under stressful conditions, including working in extremely hot or cold environments for prolonged time periods b. Wearing an SCBA, which includes a demand valve–type positive-pressure face-piece or HEPA filter masks, which requires the ability to tolerate increased respiratory workloads c. Exposure to toxic fumes, irritants, particulates, biological (i.e., infectious) and non-biological hazards, and/or heated gases, despite the use of personal protective ensembles and SCBA d. Depending on the local jurisdiction, climbing six or more flights of stairs while wearing fire protective ensemble weighing at least 50 lb (22.6 kg) or more and carrying equipment/tools weighing an additional 20 to 40 lb (9 to 18 kg) e. Wearing fire protective ensemble that is encapsulating and insulated, which will result in significant fluid loss that frequently progresses to clinical dehydration and can elevate core temperature to levels exceeding 102.2°F (39°C) f. Wearing personal protective ensemble and SCBA, searching, finding, and rescue-dragging or carrying victims ranging from newborns to adults weighing over 200 lb (90 kg) to safety despite hazardous conditions and low visibility g. Wearing personal protective ensemble and SCBA, advancing water-filled hose-lines up to 2 1∕ 2 in. (65 mm) in diameter from fire apparatus to occupancy [approximately 150 ft (50 m)], which can involve negotiating multiple flights of stairs, ladders, and other obstacles h. Wearing personal protective ensemble and SCBA, climbing ladders, operating from heights, walking or crawling in the dark along narrow and uneven surfaces, and operating in proximity to electrical power lines and/or other hazards i. Unpredictable emergency requirements for prolonged periods of extreme physical exertion without benefit of warm-up, scheduled rest periods, meals, access to medication(s), or hydration j. Operating fire apparatus or other vehicles in an emergency mode with emergency lights and sirens k. Critical, time-sensitive, complex problem solving during physical exertion in stressful, hazardous environments, including hot, dark, tightly enclosed spaces, that is further aggravated by fatigue, flashing lights, sirens, and other distractions l. Ability to communicate (i.e., give and comprehend verbal orders) while wearing personal protective ensembles and SCBA under conditions of high background noise, poor visibility, and drenching from hose-lines and/or fixed protection systems (e.g., sprinklers) m. Functioning as an integral component of a team, where sudden incapacitation of a member can result in mission failure or in risk of injury or death to civilians or other team members n. Working in shifts, including during nighttime, that can extend beyond 12 hours 3) The board certified physician or healthcare provider will issue an opinion to the fire chief indicating the candidate’s qualification status as: a. Fit for Duty: Healthy enough to engage in firefighting. b. Referred to his/her personal physician for a follow-up consultation This page intentionally left blank EXAMPLE THE STATE OF NEW HAMPSHIRE DEPARTMENT OF MILITARY AFFAIRS AND VETERAN SERVICES NFPA 1582 COMPLIANT FIREFIGHTER PHYSICALS EXHIBIT C – COST AND PAYMENT TERMS The contract price and financial arrangements for the services provided under this agreement shall be as follows: 1. The sum to the Contractor shall not exceed $xxx.xx 2. The total contract amount for contracted physician to conduct NFPA 1582 COMPLIANT FIREFIGHTER PHYSICALS at their facilities for the period Date through Date to include the contractor-provided supplies, equipment, property, insurance and other ancillary costs as specified in EXHIBIT B (Scope of Services) of this agreement shall be paid by the State of New Hampshire to the Contractor in twelve (12) equal monthly payments of $xxx.xx. 3. The payments under this portion of the agreement shall be made to the Contractor at the end of each specified month of service during the term of the agreement and within 30 days after the receipt of a proper invoice by the Contractor. 4. Invoices will be submitted by the contractor to: The Department of Military Affairs and Veteran Services Attn: State BA Office - Accounting 4 Pembroke Road Concord, New Hampshire 03301 EXAMPLE NFPA 1582 COMPLIANT FIREFIGHTER PHYSICALS EXHIBIT A – SPECIAL PROVISIONS, State Contract Form P-37 NFPA 1582 COMPLIANT FIREFIGHTER PHYSICALS NFPA 1582 COMPLIANT FIREFIGHTER PHYSICALS EXHIBIT C – COST AND PAYMENT TERMS Notice: This agreement and all of its attachments shall become public upon submission to Governor and Executive Council for approval. Any information that is private, confidential or proprietary must be clearly identified to the agency and agreed to in writing prior to signing the contract. SAMPLE FOR RFP PURPOSES ONLY FORM NUMBER P-37 (version 12/11/2019) AGREEMENT The State of New Hampshire and the Contractor hereby mutually agree as follows: GENERAL PROVISIONS 1. IDENTIFICATION. 1.1 State Agency Name 1.2 State Agency Address 1.3 Contractor Name 1.4 Contractor Address 1.5 Contractor Phone Number 1.6 Account Number 1.7 Completion Date 1.8 Price Limitation 1.9 Contracting Officer for State Agency 1.10 State Agency Telephone Number 1.11 Contractor Signature Date: 1.12 Name and Title of Contractor Signatory 1.13 State Agency Signature Date: 1.14 Name and Title of State Agency Signatory 1.15 Approval by the N.H. Department of Administration, Division of Personnel (if applicable) By: Director, On: 1.16 Approval by the Attorney General (Form, Substance and Execution) (if applicable) By: On: 1.17 Approval by the Governor and Executive Council (if applicable) G&C Item number: G&C Meeting Date: 2. SERVICES TO BE PERFORMED. The State of New Hampshire, acting through the agency identified in block 1.1 (“State”), engages contractor identified in block 1.3 (“Contractor”) to perform, and the Contractor shall perform, the work or sale of goods, or both, identified and more particularly described in the attached EXHIBIT B which is incorporated herein by reference (“Services”). 3. EFFECTIVE DATE/COMPLETION OF SERVICES. 3.1 Notwithstanding any provision of this Agreement to the contrary, and subject to the approval of the Governor and Executive Council of the State of New Hampshire, if applicable, this Agreement, and all obligations of the parties hereunder, shall become effective on the date the Governor and Executive Council approve this Agreement as indicated in block 1.17, unless no such approval is required, in which case the Agreement shall become effective on the date the Agreement is signed by the State Agency as shown in block 1.13 (“Effective Date”). 3.2 If the Contractor commences the Services prior to the Effective Date, all Services performed by the Contractor prior to the Effective Date shall be performed at the sole risk of the Contractor, and in the event that this Agreement does not become effective, the State shall have no liability to the Contractor, including without limitation, any obligation to pay the Contractor for any costs incurred or Services performed. Contractor must complete all Services by the Completion Date specified in block 1.7. 4. CONDITIONAL NATURE OF AGREEMENT. Notwithstanding any provision of this Agreement to the contrary, all obligations of the State hereunder, including, without limitation, the continuance of payments hereunder, are contingent upon the availability and continued appropriation of funds affected by any state or federal legislative or executive action that reduces, eliminates or otherwise modifies the appropriation or availability of funding for this Agreement and the Scope for Services provided in EXHIBIT B, in whole or in part. In no event shall the State be liable for any payments hereunder in excess of such available appropriated funds. In the event of a reduction or termination of appropriated funds, the State shall have the right to withhold payment until such funds become available, if ever, and shall have the right to reduce or terminate the Services under this Agreement immediately upon giving the Contractor notice of such reduction or termination. The State shall not be required to transfer funds from any other account or source to the Account identified in block 1.6 in the event funds in that Account are reduced or unavailable. 5. CONTRACT PRICE/PRICE LIMITATION/ PAYMENT. 5.1 The contract price, method of payment, and terms of payment are identified and more particularly described in EXHIBIT C which is incorporated herein by reference. 5.2 The payment by the State of the contract price shall be the only and the complete reimbursement to the Contractor for all expenses, of whatever nature incurred by the Contractor in the performance hereof, and shall be the only and the complete compensation to the Contractor for the Services. The State shall have no liability to the Contractor other than the contract price. 5.3 The State reserves the right to offset from any amounts otherwise payable to the Contractor under this Agreement those liquidated amounts required or permitted by N.H. RSA 80:7 through RSA 80:7-c or any other provision of law. 5.4 Notwithstanding any provision in this Agreement to the contrary, and notwithstanding unexpected circumstances, in no event shall the total of all payments authorized, or actually made hereunder, exceed the Price Limitation set forth in block 1.8. 6. COMPLIANCE BY CONTRACTOR WITH LAWS AND REGULATIONS/ EQUAL EMPLOYMENT OPPORTUNITY. 6.1 In connection with the performance of the Services, the Contractor shall comply with all applicable statutes, laws, regulations, and orders of federal, state, county or municipal authorities which impose any obligation or duty upon the Contractor, including, but not limited to, civil rights and equal employment opportunity laws. In addition, if this Agreement is funded in any part by monies of the United States, the Contractor shall comply with all federal executive orders, rules, regulations and statutes, and with any rules, regulations and guidelines as the State or the United States issue to implement these regulations. The Contractor shall also comply with all applicable intellectual property laws. 6.2 During the term of this Agreement, the Contractor shall not discriminate against employees or applicants for employment because of race, color, religion, creed, age, sex, handicap, sexual orientation, or national origin and will take affirmative action to prevent such discrimination. 6.3. The Contractor agrees to permit the State or United States access to any of the Contractor’s books, records and accounts for the purpose of ascertaining compliance with all rules, regulations and orders, and the covenants, terms and conditions of this Agreement. 7. PERSONNEL. 7.1 The Contractor shall at its own expense provide all personnel necessary to perform the Services. The Contractor warrants that all personnel engaged in the Services shall be qualified to perform the Services, and shall be properly licensed and otherwise authorized to do so under all applicable laws. 7.2 Unless otherwise authorized in writing, during the term of this Agreement, and for a period of six (6) months after the Completion Date in block 1.7, the Contractor shall not hire, and shall not permit any subcontractor or other person, firm or corporation with whom it is engaged in a combined effort to perform the Services to hire, any person who is a State employee or official, who is materially involved in the procurement, administration or performance of this Agreement. This provision shall survive termination of this Agreement. 7.3 The Contracting Officer specified in block 1.9, or his or her successor, shall be the State’s representative. In the event of any dispute concerning the interpretation of this Agreement, the Contracting Officer’s decision shall be final for the State. 8. EVENT OF DEFAULT/REMEDIES. 8.1 Any one or more of the following acts or omissions of the Contractor shall constitute an event of default hereunder (“Event of Default”): 8.1.1 failure to perform the Services satisfactorily or on schedule; 8.1.2 failure to submit any report required hereunder; and/or 8.1.3 failure to perform any other covenant, term or condition of this Agreement. 8.2 Upon the occurrence of any Event of Default, the State may take any one, or more, or all, of the following actions: 8.2.1 give the Contractor a written notice specifying the Event of Default and requiring it to be remedied within, in the absence of a greater or lesser specification of time, thirty (30) days from the date of the notice; and if the Event of Default is not timely cured, terminate this Agreement, effective two (2) days after giving the Contractor notice of termination; 8.2.2 give the Contractor a written notice specifying the Event of Default and suspending all payments to be made under this Agreement and ordering that the portion of the contract price which would otherwise accrue to the Contractor during the period from the date of such notice until such time as the State determines that the Contractor has cured the Event of Default shall never be paid to the Contractor; 8.2.3 give the Contractor a written notice specifying the Event of Default and set off against any other obligations the State may owe to the Contractor any damages the State suffers by reason of any Event of Default; and/or 8.2.4 give the Contractor a written notice specifying the Event of Default, treat the Agreement as breached, terminate the Agreement and pursue any of its remedies at law or in equity, or both. 8.3. No failure by the State to enforce any provisions hereof after any Event of Default shall be deemed a waiver of its rights with regard to that Event of Default, or any subsequent Event of Default. No express failure to enforce any Event of Default shall be deemed a waiver of the right of the State to enforce each and all of the provisions hereof upon any further or other Event of Default on the part of the Contractor. 9. TERMINATION. 9.1 Notwithstanding paragraph 8, the State may, at its sole discretion, terminate the Agreement for any reason, in whole or in part, by thirty (30) days written notice to the Contractor that the State is exercising its option to terminate the Agreement. 9.2 In the event of an early termination of this Agreement for any reason other than the completion of the Services, the Contractor shall, at the State’s discretion, deliver to the Contracting Officer, not later than fifteen (15) days after the date of termination, a report (“Termination Report”) describing in detail all Services performed, and the contract price earned, to and including the date of termination. The form, subject matter, content, and number of copies of the Termination Report shall be identical to those of any Final Report described in the attached EXHIBIT B. In addition, at the State’s discretion, the Contractor shall, within 15 days of notice of early termination, develop and submit to the State a Transition Plan for services under the Agreement. 10. DATA/ACCESS/CONFIDENTIALITY/ PRESERVATION. 10.1 As used in this Agreement, the word “data” shall mean all information and things developed or obtained during the performance of, or acquired or developed by reason of, this Agreement, including, but not limited to, all studies, reports, files, formulae, surveys, maps, charts, sound recordings, video recordings, pictorial reproductions, drawings, analyses, graphic representations, computer programs, computer printouts, notes, letters, memoranda, papers, and documents, all whether finished or unfinished. 10.2 All data and any property which has been received from the State or purchased with funds provided for that purpose under this Agreement, shall be the property of the State, and shall be returned to the State upon demand or upon termination of this Agreement for any reason. 10.3 Confidentiality of data shall be governed by N.H. RSA chapter 91-A or other existing law. Disclosure of data requires prior written approval of the State. 11. CONTRACTOR’S RELATION TO THE STATE. In the performance of this Agreement the Contractor is in all respects an independent contractor, and is neither an agent nor an employee of the State. Neither the Contractor nor any of its officers, employees, agents or members shall have authority to bind the State or receive any benefits, workers’ compensation or other emoluments provided by the State to its employees. 12. ASSIGNMENT/DELEGATION/SUBCONTRACTS. 12.1 The Contractor shall not assign, or otherwise transfer any interest in this Agreement without the prior written notice, which shall be provided to the State at least fifteen (15) days prior to the assignment, and a written consent of the State. For purposes of this paragraph, a Change of Control shall constitute assignment. “Change of Control” means (a) merger, consolidation, or a transaction or series of related transactions in which a third party, together with its affiliates, becomes the direct or indirect owner of fifty percent (50%) or more of the voting shares or similar equity interests, or combined voting power of the Contractor, or (b) the sale of all or substantially all of the assets of the Contractor. 12.2 None of the Services shall be subcontracted by the Contractor without prior written notice and consent of the State. The State is entitled to copies of all subcontracts and assignment agreements and shall not be bound by any provisions contained in a subcontract or an assignment agreement to which it is not a party. 13. INDEMNIFICATION. Unless otherwise exempted by law, the Contractor shall indemnify and hold harmless the State, its officers and employees, from and against any and all claims, liabilities and costs for any personal injury or property damages, patent or copyright infringement, or other claims asserted against the State, its officers or employees, which arise out of (or which may be claimed to arise out of) the acts or omission of the Contractor, or subcontractors, including but not limited to the negligence, reckless or intentional conduct. The State shall not be liable for any costs incurred by the Contractor arising under this paragraph 13. Notwithstanding the foregoing, nothing herein contained shall be deemed to constitute a waiver of the sovereign immunity of the State, which immunity is hereby reserved to the State. This covenant in paragraph 13 shall survive the termination of this Agreement. 14. INSURANCE. 14.1 The Contractor shall, at its sole expense, obtain and continuously maintain in force, and shall require any subcontractor or assignee to obtain and maintain in force, the following insurance: 14.1.1 commercial general liability insurance against all claims of bodily injury, death or property damage, in amounts of not less than $1,000,000 per occurrence and $2,000,000 aggregate or excess; and 14.1.2 special cause of loss coverage form covering all property subject to subparagraph 10.2 herein, in an amount not less than 80% of the whole replacement value of the property. 14.2 The policies described in subparagraph 14.1 herein shall be on policy forms and endorsements approved for use in the State of New Hampshire by the N.H. Department of Insurance, and issued by insurers licensed in the State of New Hampshire. 14.3 The Contractor shall furnish to the Contracting Officer identified in block 1.9, or his or her successor, a certificate(s) of insurance for all insurance required under this Agreement. Contractor shall also furnish to the Contracting Officer identified in block 1.9, or his or her successor, certificate(s) of insurance for all renewal(s) of insurance required under this Agreement no later than ten (10) days prior to the expiration date of each insurance policy. The certificate(s) of insurance and any renewals thereof shall be attached and are incorporated herein by reference. 15. WORKERS’ COMPENSATION. 15.1 By signing this agreement, the Contractor agrees, certifies and warrants that the Contractor is in compliance with or exempt from, the requirements of N.H. RSA chapter 281-A (“Workers’ Compensation”). 15.2 To the extent the Contractor is subject to the requirements of N.H. RSA chapter 281-A, Contractor shall maintain, and require any subcontractor or assignee to secure and maintain, payment of Workers’ Compensation in connection with activities which the person proposes to undertake pursuant to this Agreement. The Contractor shall furnish the Contracting Officer identified in block 1.9, or his or her successor, proof of Workers’ Compensation in the manner described in N.H. RSA chapter 281-A and any applicable renewal(s) thereof, which shall be attached and are incorporated herein by reference. The State shall not be responsible for payment of any Workers’ Compensation premiums or for any other claim or benefit for Contractor, or any subcontractor or employee of Contractor, which might arise under applicable State of New Hampshire Workers’ Compensation laws in connection with the performance of the Services under this Agreement. 16. NOTICE. Any notice by a party hereto to the other party shall be deemed to have been duly delivered or given at the time of mailing by certified mail, postage prepaid, in a United States Post Office addressed to the parties at the addresses given in blocks 1.2 and 1.4, herein. 17. AMENDMENT. This Agreement may be amended, waived or discharged only by an instrument in writing signed by the parties hereto and only after approval of such amendment, waiver or discharge by the Governor and Executive Council of the State of New Hampshire unless no such approval is required under the circumstances pursuant to State law, rule or policy. 18. CHOICE OF LAW AND FORUM. This Agreement shall be governed, interpreted and construed in accordance with the laws of the State of New Hampshire, and is binding upon and inures to the benefit of the parties and their respective successors and assigns. The wording used in this Agreement is the wording chosen by the parties to express their mutual intent, and no rule of construction shall be applied against or in favor of any party. Any actions arising out of this Agreement shall be brought and maintained in New Hampshire Superior Court which shall have exclusive jurisdiction thereof. 19. CONFLICTING TERMS. In the event of a conflict between the terms of this P-37 form (as modified in EXHIBIT A) and/or attachments and amendment thereof, the terms of the P-37 (as modified in EXHIBIT A) shall control. 20. THIRD PARTIES. The parties hereto do not intend to benefit any third parties and this Agreement shall not be construed to confer any such benefit. 21. HEADINGS. The headings throughout the Agreement are for reference purposes only, and the words contained therein shall in no way be held to explain, modify, amplify or aid in the interpretation, construction or meaning of the provisions of this Agreement. 22. SPECIAL PROVISIONS. Additional or modifying provisions set forth in the attached EXHIBIT A are incorporated herein by reference. 23. SEVERABILITY. In the event any of the provisions of this Agreement are held by a court of competent jurisdiction to be contrary to any state or federal law, the remaining provisions of this Agreement will remain in full force and effect. 24. ENTIRE AGREEMENT. This Agreement, which may be executed in a number of counterparts, each of which shall be deemed an original, constitutes the entire agreement and understanding between the parties, and supersedes all prior agreements and understandings with respect to the subject matter hereof/ AGREEMENT