18-142 Resolution No. 18-142
RESOLUTION
AUTHORIZING EXECUTION OF AN AGREEMENT WITH ADVOCATE SHERMAN
HOSPITAL FOR PROFESSIONAL SERVICES IN CONNECTION WITH THE PRE-
PLACEMENT PHYSICAL EXAMINATIONS & OTHER SERVICES FOR THE FIRE
DEPARTMENT
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN, ILLINOIS,
that Richard G. Kozal, City Manager, be and is hereby authorized and directed to execute an
Agreement on behalf of the City of Elgin with Advocate Sherman Hospital, for professional
services in connection with the pre-placement physical examinations and other services for the fire
department, a copy of which is attached hereto and made a part hereof by reference.
s/ David J. Kaptain
David J. Kaptain, Mayor
Presented: December 19, 2018
Adopted: December 19, 2018
Omnibus Vote: Yeas: 8 Nays: 0
Attest:
s/Kimberly Dewis
Kimberly Dewis, City Clerk
AGREEMENT
THIS AGREEMENT, made and entered into this 19 day of December , 2018 by
and between the CITY OF ELGIN, an Illinois municipal corporation (hereinafter referred to as
"CITY") and Advocate Sherman Hospital, a Healthcare Facility,
authorized to do business in the State of Illinois (hereinafter referred to as "HEALTH CARE
FACILITY").
WHEREAS, the CITY desires to engage the HEALTH CARE FACILITY to furnish certain
professional services in connection with the Pre-Placement Physical Examinations & Other
Services for the Fire Department.
AND
NOW, THEREFORE, it is hereby agreed by and between the CITY and the HEALTH CARE
FACILITIY that the CITY does hereby retain the HEALTH CARE FACILITY for and in
consideration of the mutual promises and covenants contained herein,the sufficiency of which is
hereby acknowledged to act for and represent it in all consulting matters involved in the Pre-
Placement Physical Examinations & Other Services for the Fire Department., subject to the
following terms and conditions and stipulations, to-wit:
I. SCOPE OF SERVICES
A. All work hereunder shall be performed under the direction of the Asst. Fire Chief
of the CITY, herein after referred to as the "Asst. Chief'.
B. The HEALTH CARE FACILITY shall provide to the CITY the services as set
forth in the Scope of Services is attached hereto as Attachment A, proposal dated
11/15/18. In the event of any conflict between the terms and provisions of this
Agreement and the terms and provisions of Attachment A, the terms and
provisions of this Agreement shall control.
IL PROGRESS REPORTS
A. A verbal pass or fail result shall be communicated to the designated City of Elgin
representative within 48 hours of the conclusion of testing for all musculo-skeletal
evaluations, computerized lifting analysis, and cardiovascular assessments.
B. A written report of test results shall be provided to the designated City of Elgin
representative within one week of the completion of testing. The written report
shall contain the information from each part of the pre hire testing process.
C. Respirator Certification Form for each individual.
D. TB testing consent/denial form for each individual.
III. WORK PRODUCTS
All work products prepared by the HEALTH CARE FACILITY pursuant hereto
including,but not limited to,reports,studies,and recommendations shall be the property
of the CITY and shall be delivered to the CITY upon request of the Asst.Chief provided,
however,that the HEALTH CARE FACILITY may retain copies of such work products
for its records.
IV. PAYMENTS TO THE HEALTH CARE FACILITY (Not To Exceed Method)
A. The CITY shall make periodic payments to the HEALTH CARE FACILITY
based upon actual progress within 30 days after receipt and approval of invoice.
Said periodic payments to the HEALTH CARE FACILITY shall not exceed the
amounts shown in the following schedule in Attachment B, and full payments for
each task shall not be made until the task is completed and accepted by the Asst.
Chief.
V. INVOICES
A The HEALTH CARE FACILITY shall submit invoices in a format approved by
the CITY.
B. The HEALTH CARE FACILITY shall maintain records showing actual time
devoted and cost incurred. The HEALTH CARE FACILITY shall permit the
authorized representative of the CITY to inspect and audit all data and records of
the HEALTH CARE FACILITY for work done under this Agreement. The
HEALTH CARE FACILITY shall make these records available at reasonable
times during the Agreement period, and for a year after termination of this
Agreement.
VI. TERMINATION OF AGREEMENT
Notwithstanding any other provision hereof, the CITY may terminate this Agreement
at any time upon fifteen (15) days prior written notice to the HEALTH CARE
FACILITY. In the event that this Agreement is so terminated, the HEALTH CARE
FACILITY shall be paid for services actually performed and reimbursable expenses
actually incurred prior to termination, except that reimbursement shall not exceed the
task amounts set forth under Paragraph IV above.
VII. TERM
This Agreement shall become effective as of the date the HEALTH CARE FACILITY
is given a notice to proceed by the CITY and unless terminated by the CITY pursuant
to Article VI, the Agreement shall terminate on December 31, 2021. At the mutual
option of the parties hereto, this Agreement may be further extended for two (2)
additional one-year terms for 2022 and 2023 under the same terms and conditions as
provided in this Agreement.
VIII. NOTICE OF CLAIM
If the HEALTH CARE FACILITY wishes to make a claim for additional compensation
as a result of action taken by the CITY, the HEALTH CARE FACILITY shall give
written notice of his claim within 15 days after occurrence of such action. No claim for
additional compensation shall be valid unless so made. Any changes in the HEALTH
CARE FACILITY's fee shall be valid only to the extent that such changes are included
in writing signed by the CITY and the HEALTH CARE FACILITY. Regardless of the
decision of the Asst. Chief relative to a claim submitted by the HEALTH CARE
FACILITY, all work required under this Agreement as determined by the Asst. Chief
shall proceed without interruption.
IX. BREACH OF CONTRACT
If either party violates or breaches any term of this Agreement, such violation or breach
shall be deemed to constitute a default, and the other party has the right to seek such
administrative, contractual or legal remedies as may be suitable to the violation or
breach; and, in addition, if either party, by reason of any default, fails within fifteen(15)
days after notice thereof by the other party to comply with the conditions of the
Agreement, the other party may terminate this Agreement.
X. INDEMNIFICATION
To the fullest extent permitted by law, HEALTH CARE FACILITY agrees to and shall
indemnify, defend and hold harmless the CITY, its officers, employees, agents, boards
and commissions from and against any and all claims,suits,judgments,costs,attorney's
fees,damages or other relief, including but not limited to workers compensation claims,
in any way resulting from or arising out of negligent actions or omissions of the
HEALTH CARE FACILITY in connection herewith,including negligence or omissions
of employees or agents of the HEALTH CARE FACILITY arising out of the
performance of this Agreement. In the event of any action against the CITY,its officers,
employees,agents,boards or commissions,covered by the foregoing duty to indemnify,
defend and hold harmless such action shall be defended by legal counsel of the CITY's
choosing. The provisions of this paragraph shall survive any completion, expiration
and/or termination of this Agreement.
XI. NO PERSONAL LIABILITY
No official,director, officer,agent or employee of the CITY shall be charged personally
or held contractually liable under any term or provision of this Agreement or because
of their execution, approval or attempted execution of this Agreement.
XII. INSURANCE
A. Comprehensive Liability. The HEALTH CARE FACILITY shall provide, pay
for and maintain in effect, during the term of this Agreement, a policy of
comprehensive general liability insurance with limits of at least $1,000,000
aggregate for bodily injury and $1,000,000 aggregate for property damage.
The HEALTH CARE FACILITY shall deliver to the Purchasing Director a
Certification of Insurance naming the CITY as additional insured. The policy
shall not be modified or terminated without thirty (30) days prior written notice
to the City.
The Certificate of Insurance which shall include Contractual obligation assumed
by the HEALTH CARE FACILITY under Article X entitled "Indemnification"
shall be provided.
This insurance shall apply as primary insurance with respect to any other
insurance or self-insurance programs afforded to the CITY. There shall be no
endorsement or modification of this insurance to make it excess over other
available insurance,alternatively,if the insurance states that it is excess or prorate,
it shall be endorsed to be primary with respect to the CITY.
B. Comprehensive Automobile Liability. Comprehensive Automobile Liability
Insurance covering all owned,non-owned and hired motor vehicles with limits of
not less than $500,000 per occurrence for damage to property.
C. Combined Single Limit Policy. The requirements for insurance coverage for the
general liability and auto exposures may be met with a combined single limit of
$1,000,000 per occurrence subject to a$1,000,000 aggregate.
D. Professional Liability. The HEALTH CARE FACILITY shall carry Professional
Liability Insurance Covering claims resulting from error, omissions or negligent
acts with a combined single limit of not less than $1,000,000 per occurrence. A
Certificate of Insurance shall be submitted to the Purchasing Director as evidence
of insurance protection. The policy shall not be modified or terminated without
thirty (30) days prior written notice to the Purchasing Director.
XIII. NONDISCRIMINATION
In all hiring or employment made possible or resulting from this Agreement,there shall
be no discrimination against any employee or applicant for employment because of sex,
age, race, color, creed, national origin, marital status, of the presence of any sensory,
mental or physical handicap, unless based upon a bona fide occupational qualification,
and this requirement shall apply to, but not be limited to, the following: employment
advertising, layoff or termination, rates of pay or other forms of compensation and
selection for training, including apprenticeship.
No person shall be denied or subjected to discrimination in receipt of the benefit of any
services or activities made possible by or resulting from this Agreement on the grounds
of sex, race, color, creed, national origin, age except minimum age and retirement
provisions, marital status or the presence of any sensory, mental or physical handicap.
Any violation of this provision shall be considered a violation of a material provision of
this Agreement and shall be grounds for cancellation, termination or suspension, in
whole or in part, of the Agreement by the CITY.
XIV. ASSIGNMENT AND SUCCESSORS
This Agreement and each and every portion thereof shall be binding upon the successors
and the assigns of the parties hereto; provided, however, that no assignment shall be
made without the prior written consent of the CITY.
XV. DELEGATIONS AND SUBCONTRACTORS
Any assignment, delegation or subcontracting shall be subject to all the terms,
conditions and other provisions of this Agreement and the HEALTH CARE FACILITY
shall remain liable to the CITY with respect to each and every item, condition and other
provision hereof to the same extent that the HEALTH CARE FACILITY would have
been obligated if it had done the work itself and no assignment, delegation or
subcontract had been made. Any proposed subcontractor shall require the CITY's
advanced written approval.
XVI. NO CO-PARTNERSHIP OR AGENCY
This agreement shall not be construed so as to create a partnership, joint venture,
employment or other agency relationship between the parties hereto.
XVII. SEVERABILITY
The parties intend and agreed that, if any paragraph, sub-paragraph, phrase, clause or
other provision of this Agreement, or any portion thereof, shall be held to be void or
otherwise unenforceable, all other portions of this Agreement shall remain in full force
and effect.
XVIII. HEADINGS
The headings of the several paragraphs of this Agreement are inserted only as a matter
of convenience and for reference and in no way are they intended to define, limit or
describe the scope of intent of any provision of this Agreement, nor shall they be
construed to affect in any manner the terms and provisions hereof or the interpretation
or construction thereof.
XIX. MODIFICATION OR AMENDMENT
This Agreement and its attachments constitutes the entire Agreement of the parties on
the subject matter hereof and may not be changed, modified, discharged or extended
except by written amendment duly executed by the parties. Each party agrees that no
representations or warranties shall be binding upon the other party unless expressed in
writing herein or in a duly executed amendment hereof, or change order as herein
provided.
XX. APPLICABLE LAW
This Agreement shall be deemed to have been made in, and shall be construed in
accordance with the laws of the State of Illinois.Venue for the resolution of any disputes
or the enforcement of any rights pursuant to this agreement shall be in the Circuit Court
of Kane County, Illinois.
XXI. NEWS RELEASES
The HEALTH CARE FACILITY may not issue any news releases without prior
approval from the Asst. Chief, nor will the HEALTH CARE FACILITY make public
proposals developed under this Agreement without prior written approval from the Asst.
Chief, prior to said documentation becoming matters of public record.
XXII. COOPERATION WITH OTHER HEALTH CARE FACILITIES
The HEALTH CARE FACILITY shall cooperate with any other Health Care
FACILITY in the CITY's employ or any work associated with the Pre-Placement
Physical Examinations& Other Services for the Fire Department.
XXIII. INTERFERENCE WITH PUBLIC CONTRACTING
The HEALTH CARE FACILITY certifies hereby that it is not barred from bidding on this contract
as a result of a violation of 720 ILCS 5/33E et seq. Or any similar state or federal statute regarding
bid rigging.
XXIV. SEXUAL HARASSMENT
As a condition of this contract, the HEALTH CARE FACILITY shall have written sexual
harassment policies that include, at a minimum, the following information:
A. the illegality of sexual harassment;
B. the definition of sexual harassment under state law;
C. a description of sexual harassment, utilizing examples;
D. the Health Care Facility's internal complaint process including penalties;
E. the legal recourse, investigative and complaint process available through the Illinois
Department of Human Rights, and the Illinois Human Rights Commission;
F. directions on how to contact the department and commission;
G. protection against retaliation as provided by Section 6-101 of the Human Rights Act.
A copy of the policies must be provided to the Department of Human Rights upon request 775
ILCS 5/2-105.
XXV. WRITTEN COMMUNICATIONS
All recommendations and other communications by the HEALTH CARE FACILITY to the Asst.
Chief and to other participants which may affect cost or time of completion, shall be made or
confirmed in writing. The Asst. Chief may also require other recommendations and
communications by the HEALTH CARE FACILITY be made or confirmed in writing.
XXVI. COMPLIANCE WITH LAWS
Notwithstanding any other provision of this AGREEMENT it is expressly agreed and understood
that in connection with the performance of this AGREEMENT that the HEALTH CARE
FACILITY shall comply with all applicable Federal, State, City and other requirements of law,
including, but not limited to, any applicable requirements regarding prevailing wages, minimum
wage, workplace safety and legal status of employees. HEALTH CARE FACILITY shall also at
its expense secure all permits and licenses,pay all charges and fees and give all notices necessary
and incident to the due and lawful prosecution of the work, and/or the products and/or services to
be provided for in this AGREEMENT."
XXVII. NOTICES
All notices,reports and documents required under this Agreement shall be in writing and shall be
mailed by First Class Mail, postage prepaid, addressed as follows:
A. As to CITY:
Brian McMahan
Asst. Fire Chief
City of Elgin
150 Dexter Court
Elgin, Illinois 60120-5555
B. As to HEALTH CARE FACILITY:
IN WITNESS WHEREOF, the undersigned have placed their hands and seals upon and executed
this Agreement in triplicate as though each copy hereof was an original and that there are no other
oral agreements that have not been reduced to writing in this statement.
For the CITY:
THE CITY OF ELGIN
By: ,&1i1
Richard G. Kozal, City a ge
dined tics (5 tan-t 171164
For the HEALTH CARE FACILITY:
By .
Title \/`p -E r-+t os.
ATTACHMENT A
Advocate Sherman Hospital
Tomorrow starts today.
RECOMMENDED MEDICAL EVALUATIONS AND SERVICES FOR
CITY OF ELGIN FIRE FIGHTERS
I. SPECIFIC COMPONENTS OF PRE-PLACEMENT EVALUATION
II. ON-GOING ANNUAL AND PERIODIC MEDICAL EXAMINATIONS
III. REPORTING OF MEDICAL RESULTS AND RECORD KEEPING
IV. ADDITIONAL SERVICES
V. GENERAL INFORMATION
Recommendations and Pricing effective: 1-1-19 to 12-31-21
Advocate Sherman Occupational Health Created by:Laurie Totton—11,12,18
PROPOSAL PART 2: SCOPE OF SERVICES
I. SPECIFIC COMPONENTS OF PRE-PLACEMENT EVALUATION
This is a two part evaluation process consisting of a Medical Examination, Cardiovascular
Assessment. All pre-placement testing shall be in accordance with the requirements of NFPA
Standard 1582 Medical Requirements for Firefighters, 2013 edition.
PART ONE:
*PRE-PLACEMENT EVALUATION PRICE
Comprehensive Metabolic Panel $45.00
Baseline Chest X-Ray (with Radiology interpretation) $145.00
Complete Blood Count $28.00
Comprehensive Medical and Physical Exam (per NFPA 1582) $56.00
Occupational Exposure History $0.00
EKG with Cardiology Interpretation $65.00
Audiogram (includes training video) $27.00
Pulmonary Function Testing (Spirometry and Respirator Certification) $50.00
Tuberculosis Skin Testing $15.00
Urinalysis $0.00
Urine Drug Screen (10 panel, includes GCMS Confirmation) $40.00
Vision Testing (Titmus; Color and Depth Perception) $0.00
Part 1 Total: $471.00
Not requested, but recommended for baseline: Lipid Profile (HDL/LDL) $35.42
*All test results for Part One, Pre-placement Evaluation, are available within 48 hours.
Advocate Sherman Occupational Health Page 2 of 10
PART TWO:
CARDIOVASCULAR ASSESSMENT
The evaluation of the candidate's Metabolic Demands Assessment (METS) level is to be determined
through the use of a submaximal graded treadmill evaluation using the WFI protocol. The WFI
protocol is typically performed on a treadmill as this allows the speed, incline and heart rate to be
easily measured. The WFI protocol is recommended in NFPA 1582 when using a treadmill. The WFI
protocol was specifically recommended to evaluate the sub-maximal aerobic capacity of Fire
Department members to assess cardiovascular endurance of their members. The assessment will be
performed by a member of our experienced physical therapy fitness staff with several years of
experience, knowledgeable in various protocols.
The testing is to include:
• Initial medical assessment
• Heart rate monitoring
• Blood pressure monitoring
Part 2: Total: CARDIOVASCULAR ASSESSMENT
$75.00
Advocate Sherman Occupational Health Page 3 of 10
II. ON-GOING ANNUAL AND PERIODIC MEDICAL EXAMINATIONS
This component of the Occupational Health Services program shall be for annual and periodic
medical examinations based on the requirements of NFPA standard 1582 Medical Requirements for
Firefighters, 2013 edition. Listed below are three age specific physicals followed by optional
additional elements.
*Annual Brief Examination
(Ages: Up to age 39, done in between Periodic Evaluations) Price
Brief Medical Exam (Height, Weight, Blood Pressure)
Hearing Test(Audiogram)
OSHA Questionnaire
Pulmonary Function Test(Spirometry and Respiratory Certification)
Vision Testing (Titmus, Color and Depth Perception)
Total: (reflects total charge when exam is performed at clinic locations) $93.00
*All test results for Annual Brief Exams are available within 48 hours.
Charges for staffing on-site services:
Physician per hour = $115.00
Nurse per hour = $80.00
(Can be charged in 15 minute increments)
Advocate Sherman Occupational Health Page 4 of 10
*Periodic Evaluation Price
(Ages: <30, done every 3 years; 30-39, done every 2 years; 40 and up, done every year)
Comprehensive Metabolic Panel $45.00
Blood Lipid Profile (HDL/LDL) $35.42
Complete Blood Count $28.00
Comprehensive Medical/Physical Exam (includes medical and occupational exposure history) $56.00
EKG with Cardiology Interpretation $65.00
Audiogram (includes training video) $27.00
Pulmonary Function Testing (Spirometry and Respirator Certification) $50.00
Urinalysis $0.00
Vision Testing (Titmus; Color and Depth Perception) $0.00
Total: $306.42
*Haz-Mat Testing (In addition to periodic evaluation)
Recommend testing every two years
Chest X-ray- 2 Views (with Radiology interpretation) $145.00
Heavy Metals Blood Screen $147.00
Total: $292.00
*All test results for Periodic Evaluations are available within 48 hours.
Advocate Sherman Occupational Health Page 5 of 10
*ADDITIONAL ELEMENTS
Price
Upon MD Discretion
Chest X-Ray with Radiology Interpretation $145.00
Boostrix (Diphtheria-Pertussis-Tetanus) (replaces Tetanus as per CDC
recommendation) $31.70
Colonoscopy (will refer to physician of choice — per physician charges)
Employee Requests (requested by and paid by employee)
Hemoccult Kit $52.80
PSA $53.00
Mammography $104.50
Pap Smear (will refer to physician of choice - per physician charges)
*All test results for Additional Elements are available within 48 hours.
Advocate Sherman Occupational Health Page 6 of 10
III. REPORTING OF MEDICAL RESULTS AND RECORD KEEPING
Advocate Sherman shall supply and/or maintain computerized records of the following information
regarding the Fire Department examinations and other services:
1. A verbal pass or fail shall be communicated to the designated Fire Department contact within
48 hours after the conclusion of the testing. A written report of test results shall be provided to
the designated Fire Department contact within one week of the completion of testing.
2. The Fire Department shall be supplied with the following information on an annual basis:
a) Respirator Certification Form for each individual.
b) TB Testing Consent/Denial Form for each individual.
c) A list of individuals due for the Annual Medical Examination.
d) A list of individuals due for the Periodic Medical Examination.
e) A list of individuals due for Hepatitis Titers.
f) Informational handouts and/or brochures related to infectious disease for each individual.
3. Advocate Sherman shall function as the 3rd party keeper of the record for specific or
confidential medical information. Medical Records are permanently kept by Advocate
Sherman.
Advocate Sherman Occupational Health Page 7 of 10
IV. ADDITIONAL SERVICES
1. Employee Access to Medical Records
Cost: $24.20 per person for each calendar year of records (no maximum # of pages)
2. Educational Classes
Advocate Sherman has the ability to provide health and wellness classes at the request of the Fire
Department. These can be provided on-site at the Fire Department on topics such as nutrition, back
injury prevention, general fitness, etc. We can customize programs to meet the specific needs of the
Department based on the findings of the physical assessments and the cardiovascular profile, as well
as general interests.
Cost: $73.21 per hour
Advocate Sherman Occupational Health Page 8 of 10
V. GENERAL INFORMATION
ACCESS TO SERVICES/SCHEDULING
1. See attached Occupational Health Clinics hours of operation and locations.*
2. Select Occupational Health Services are provided at the Advocate Sherman Hospital
Emergency Department on a 24 hour basis.
3. *All Occupational Health Services are performed at any of the three (3) locations cited above in
#1. In addition, professional staff members of Physical Medicine and Rehabilitation will perform
parts of the Pre-Placement Medical Evaluation at a designated Advocate Sherman location.
4. Approximately three (3) to five (5) business days are required to schedule all components of
the pre-placement physical.
EXPERIENCE
Advocate Sherman provides services for nine (9) Municipalities/Fire Departments. The names of the
municipalities served will be shared upon Advocate Sherman's receipt of the municipalities'
permission to do so.
Advocate Sherman Occupational Health Page 9 or 10
ORGANIZATIONS, AFFILIATIONS, CREDENTIALS, CERTIFICATIONS
1. All clinical and non-clinical staff of Advocate Sherman is required to demonstrate performance
skills based on job competencies. The competencies are related to the area of expertise of the
individual.
2. All clinical staff at the Occupational Health Clinics is certified in the particular screenings they
provide, which includes training with technical equipment and hands on medical procedures.
Advocate Sherman's staff specialist, Stacy Bennett, the Cardiovascular evaluations, is an MPT and
has over 18 years of experience performing these evaluations.
3. Advocate Sherman's Occupational Health Lead Physician, Dr. Kevin Thompson, is Board
Certified with over 23 years of clinical experience in Occupational Health. With over 15 years of
experience in Fire department examinations and medical requirements, he also has a keen
understanding of the NFPA guidelines to accurately gauge Firefighter health risks and recommend
actions to mitigate these risks.
4. Advocate Sherman Hospital is inspected on a regular and on-going basis by such organizations
as DNV (DetNorske Veritas), Illinois Department of Health (IDPH) and Center for Medicare/Medicaid
Services (CMS). In addition to these internal inspections, the staff of Advocate Sherman attends
classes and seminars for continuing hours of education. All efforts are made to educate Sherman's
staff with the goal of gaining expertise in the organizations regulating the corporate community we
serve, including organizations such as Occupational Safety & Health Administration (OSHA), the
National Fire Protection Association (NFPA), the Illinois Department of Labor (IDOL) and the Illinois
Department of Transportation (IDOT).
5. In 2012, Advocate Sherman Hospital achieved Magnet nursing status, the highest national
standard for nursing excellence.
Advocate Sherman Occupational Health Page 10 of 10
ATTACHMENT B-RFP 15-050 Pre Placement
Physicals for Fire Department
Invitation No: 15-050 Advocate Sherman
Date of Opening: 11/15/18 1425 N. Randall
Department: Fire Elgin, IL 60123
Description Pricing
PRE-PLACEMENT
Medical Examination
Element
Blood Chemistry Profile No Bid
Baseline Chest X-Ray $ 145.00
Cardiovascular Wellness Profile/
Personal Health Profile $ 75.00
Complete Blood Count $ 28.00
Comprehensive Medical and
Physical Exam $ 56.00
Occupational Exposure History $ -
EKG with Cardiology
Interpretation $ 65.00
Audiogram $ 27.00
Pulmonary Function Testing
Consisting of Spirometry and
Respirator Certification $ 50.00
Tuberculosis Skin Testing $ 15.00
Urinalysis No Bid
Urine Drug Screen consisting of 10
Panel including GCMS
Confirmation $ 40.00
Vision Testing including Titmus,
Color and Depth Perception $ _
Total Pre-Placement
Examination $ 501.00
ONGOING ANNUAL
Medical Examination
Brief Medical Exam $ 56.00
Audiogram $ 27.00
OSHA Questionnaire No Bid
Pulmonary Function Testing
Consisting of Spirometry and
Respirator Certification $ 50.00
Invitation No: 15-050 Advocate Sherman
Date of Opening: 11/15/18 1425 N. Randall
Department: Fire Elgin, IL 60123
Description Pricing
Vision Testing including Titmus,
Color and Depth Perception $ _
Total Ongoing Annual
Examination $ 133.00
PERIODIC
Medical Examination
Blood Chemistry Profile
Blood Lipid Profile (HDL/LDL) $ 35.42
Cardiovascular Wellness Profile/
Personal Health Profile $ 75.00
Complete Blood Count $ 28.00
Comprehensive Medical and
Physical Exam $ 56.00
EKG including Cardiology
Interpretation and Treadmill Stress
Test $ 65.00
Hearing Testing(Audiogram) $ 27.00
Pulmonary Function Testing
Consisting of Spirometry and
Respirator Certification $ 50.00
Urine Dip Stick $ -
Vision Testing including Titmus,
Color and Depth Perception $ _
Total Periodic Examination $ 336.42
Additional Elements Based
on MD Discretion
Chest X-Ray:2 Views(with
Radiology Interpretation) $ 145.00
Tetanus Shot $ 31.70
Total MD Additional Elements $ 176.70
Additional Elements Based
on Employee Request
Hemocult Kit $ 52.80
Invitation No: 15-050 Advocate Sherman
Date of Opening: 11/15/18 1425 N. Randall
Department: Fire Elgin, IL 60123
Description Pricing
PSA $ 53.00
Mammography $ 104.50
Pap Smear Not Available
Total Employee Additional
Elements $ 210.30
GRAND TOTAL $ 1,357.42