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["Transportation Employee Medical Examinations and Screening Services"]
["RFP0919TRANMESS"]
["EXHIBIT A"]
[]
["Vendor:"]
[]
["Instructions:",null,"Complete all yellow fields"]
[]
["Questions:",{"$nulls":4},"Responses:"]
["1.","How many physicians can you provide for the end of year physical examinations?"]
["2.","How will  random screenings for employees be handled?"]
["3.","Where will post-offer/pre-employment screenings be administered?"]
["4.","How will post-collision screenings be handled?"]
["a.",null,"What if the employee is hospitalized and the District needs a post-collision screening?"]
[null,"b.","If the collision occurs out of state, are you able to perform out-of-state drug and alcohol screenings?"]
["5.","What is the average time to report results of screening after specimen collection?"]
["6.","Is there a separate charge for an MRO?"]
["a.",null,"If so, what is the charge?",null,null,"2020:",null,"2021:",null,"2022:"]
["7.","Is there a separate charge for a positive test result?"]
["a.",null,"If so, what is the charge?",null,null,"2020:",null,"2021:",null,"2022:"]
["8.","Are there any costs for preparing DOT annual reports, if needed?"]
["a.",null,"If so, what is the charge?",null,null,"2020:",null,"2021:",null,"2022:"]
["9.","Are there any costs involved in DOT compliance preparation?"]
["a.",null,"If so, what is the charge?",null,null,"2020:",null,"2021:",null,"2022:"]
["10.","Are there any costs involved in DOT record keeping?"]
["a.",null,"If so, what is the charge?",null,null,"2020:",null,"2021:",null,"2022:"]
["11.","If contract is awarded to another vendor after contract expiration, would there be a fee for the new provider to obtain the District's DOT reports?"]
["a.",null,"If so, what is the charge?",null,null,"2020:",null,"2021:",null,"2022:"]
["12.","Are you able to provide CDL driver and supervisor training consistent with FMCSA requirements (49 CFR, Part 382.601 and 382.603)?"]
[]
["Clinic Locations:"]
["Provide address(es) of clinic(s) located within 15 miles of each Bus Lot:"]
[null,"Eureka Bus Lot\n442 West Fourth Street\nEureka, MO 63025"]
[null,"High Ridge Bus Lot\n4555 Commerce Avenue\nHigh Ridge, MO 63049"]
[null,"Wildwood Bus Lot\n17146 Manchester Road\nWildwood, MO 63040"]
[]
["Pricing:"]
["Propose pricing for all services listed. If Proposer chooses not to provide pricing on some services or a category of services, mark those services as \"No Bid.\""]
[]
["Medical Examinations for School Bus Drivers and Monitors"]
["Description of Service",{"$nulls":7},2020,2021,2022]
[null,"Missouri School Bus Driver Medical Examinations per Missouri Statute 162.064 Medical Endorsement (MO Form 3056)",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Clinic Site Exam"]
[null,null,"Onsite Exams (District Location)"]
[null,"Medical Examinations of Bus Monitors (RSD Form 9001)",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Clinic Site Exam"]
[null,null,"Onsite Exams (District Location)"]
[null,"Immunizations",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Hepatitis A"]
[null,null,"Hepatitis B"]
[null,null,"Tdap (tetanus, diphtheria and pertussis)"]
[null,null,"TD (tetanus, diphtheria booster)"]
[null,"TB Test"]
[null,"Additional charges not included above, if any, with description",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[]
[]
[]
[]
["DOT Compliant Medical Examinations for all District Transportation Employees possessing a CDL"]
["Description of Service",{"$nulls":7},2020,2021,2022]
[null,"DOT Compliant Medical Examinations",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Clinic Site Exam"]
[null,null,"Onsite Exams (District Location)"]
[]
["DOT Compliant Drug and Alcohol Screening for all District Transportation Employees possessing a CDL"]
["Description of Service",{"$nulls":7},2020,2021,2022]
[null,"Post-offer/Pre-employment Five (5) Panel* Screening (Urine Specimen)",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Clinic Site Exam"]
[null,null,"Onsite Exams (District Location)"]
[null,"Random Five (5) Panel* Screening (Urine Specimen)",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Clinic Site Exam"]
[null,null,"Onsite Exams (District Location)"]
[null,"Random Alcohol Screening (Breath and Saliva Specimens)",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Clinic Site Exam"]
[null,null,"Onsite Exams (District Location)"]
[null,"Post-collision Drug and Alcohol Testing (Urine and Breath Specimens)",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Clinic Site Exam"]
[null,null,"Onsite Exams (District Location)"]
[null,"Reasonable Suspicion Drug Test (Urine Specimen)",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Clinic Site Exam"]
[null,null,"Onsite Exams (District Location)"]
[null,"Reasonable Suspicion Alcohol Test (Breath Specimen)",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Clinic Site Exam"]
[null,null,"Onsite Exams (District Location)"]
["Miscellaneous Screening Charges (If pricing is already included above, mark charge as \"Included.\")",{"$nulls":4},"Description:",null,null,"Price:","Price:","Price:"]
[null,"Collection Fee"]
[null,"Supplies"]
[null,"Chain of Custody"]
[null,"Transportation of Specimen"]
[null,"Out-of-town/Out-of-state Testing"]
[null,"After-Hours/Emergency Testing"]
[null,"Medical Review Officer Services"]
[null,"Computer Generated Random Selection"]
[null,"Certification and Verification"]
[null,"Reports",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Employee qualification reports"]
[null,null,"Statistical reports"]
[null,"Administration",{"$nulls":3},"Description:",null,null,"Price:","Price:","Price:"]
[null,null,"Annual Administration "]
[null,null,"Employee Record Set-Up"]
[null,null,"Employee Record Maintenance"]
[null,null,"Employee Records Administration off-site"]
[null,null,"Positive Specimen Documentation and Storage"]
[null,null,"Blind Specimen and Maintenance"]
[]
["Totals",{"$nulls":7}," "," "," "]
[]
[null,"* DOT Drug Testing requires HSS-certified laboratory confirmation testing for 14 drugs under a 5-panel test:"]
[null,null,"Marijuana (THC)"]
[null,null,"Cocaine"]
[null,null,"Amphetamines (Amphetamine, Methamphetamine, MDMA, MDA)"]
[null,null,"Opioids (Codeine, Morphine, Heroin, Hydrocodone, Hydromorphone, Oxycodone, Oxymorphone)"]
[null,null,"Phencyclidine (PCP)"]
[]
["References:"]
["Provide a minimum of five references from public K-12 school District or higher education institutions in Missouri (Greater St Louis area preferred) for which the Proposer has, within the past 18 months, provided services as outlined in the RFP."]
[]
["District Name:",{"$nulls":5},"District Name:"]
["District Address:",{"$nulls":5},"District Address:"]
[]
["Contact:",{"$nulls":5},"Contact:"]
["Contact's Title:",{"$nulls":5},"Contact's Title:"]
["Contact's Email:",{"$nulls":5},"Contact's Email:"]
["Contact's Number:",{"$nulls":5},"Contact's Number:"]
[]
["District Name:",{"$nulls":5},"District Name:"]
["District Address:",{"$nulls":5},"District Address:"]
[]
["Contact:",{"$nulls":5},"Contact:"]
["Contact's Title:",{"$nulls":5},"Contact's Title:"]
["Contact's Email:",{"$nulls":5},"Contact's Email:"]
["Contact's Number:",{"$nulls":5},"Contact's Number:"]
[]
["District Name:",{"$nulls":5},"District Name:"]
["District Address:",{"$nulls":5},"District Address:"]
[]
["Contact:",{"$nulls":5},"Contact:"]
["Contact's Title:",{"$nulls":5},"Contact's Title:"]
["Contact's Email:",{"$nulls":5},"Contact's Email:"]
["Contact's Number:",{"$nulls":5},"Contact's Number:"]
[]
["Addenda:"]
["Acknowledge below receipt of Addenda issued, if any."]
["Addendum Number",{"$nulls":3},"dated"]
["Addendum Number",{"$nulls":3},"dated"]
[]
[null,"The undersigned certifies that the proposed prices contained within have been carefully checked and are submitted as correct and final. The undersigned certifies that he/she has the authority to submit a bona fide proposal on behalf of said firm."]
[]
["Firm Name:"]
["Address:"]
["Contact:"]
["Title:"]
["Phone:"]
["Fax:"]
["Email:"]
[]
[]
[{"$nulls":3},"Printed Name",null,"Signature of Officer",null,null,"Date"]