Integrated Medical Evaluations Linking Agreement 8.23.22 signed by vendor

City of Glendale — Regular Meeting (2022-08-23)

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EXHIBIT A

REQUEST FOR QUOTATION

RFQ# 22-014
Independent Medical Evaluations

RFQ ISSUE DATE:
May 28, 2021

DEADLINE FOR INQUIRIES/QUESTIONS:
THURSDAY, JUNE 24, 2021, AT 5:00 P.M. LOCAL ARIZONA TIME

RFQ DUE DATE AND TIME:
THURSDAY, JULY 1, 2021, 3:30 P.M. LOCAL ARIZONA TIME

ALL INQUIRIES MUST BE DIRECTED TO:
Daniel Wojcik
EMAIL: daniel_wojcik@tempe.gov
PHONE: 480-350-8682

SUBMITTAL LOCATION: Due to the COVID Virus, Tempe will only accept an e-copy of the
completed and signed proposal via e-mail to the following address:

Bids@tempe.gov

No hard copy proposals will be accepted at this time.

Table of Contents
Standard Terms and Conditions ........................................................................................................................ 3
Special Terms & Conditions and Instructions ................................................................................................... 10
Scope of Work ................................................................................................................................................. 14
Specifications .................................................................................................................................................. 15
Quote Questionnaire ....................................................................................................................................... 19
Evaluation Criteria ........................................................................................................................................... 20
Pricing Section ................................................................................................................................................ 21
Vendor’s Offer ................................................................................................................................................. 22
Supplier Sustainability Questionnaire .............................................................................................................. 23
Checklist for Submittal ..................................................................................................................................... 25

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Standard Terms and Conditions
1.
Certification: By signing the “Vendor’s Offer”, the Offeror certifies:

A.
The submission of the vendor’s quote Offer response did not involve collusion or other anti-competitive
practices.

B.
Offeror agrees that it will comply with section 2-603(5) of the Tempe City Code (“TCC”), and will not refuse
to hire or employ or bar or discharge from employment any person or discriminate against such person in
compensation, conditions, or privileges of employment because of race, color, gender, gender identity,
sexual orientation, religion, national origin, familial status, age, disability, or United States military veteran
status.

C.
Offeror has not given, offered to give, nor intends to give at any time hereafter any economic opportunity,
future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in
connection with the submitted Offer. Failure to sign the “Vendor’s Offer” or signing it with a false statement
shall void the submitted quote and any resulting Contract. In addition, the Offeror may be barred from
future quote and bidding participation with the City and may be subject to such further actions as permitted
by law.

D.
The Offeror agrees to promote and offer to the City only those materials and/or services as stated and
allowed by this Request for Quote and resultant Contract award. Violation of this condition shall be grounds
for Contract termination by the City.

E.
The Offeror expressly warrants that it has and will continue to comply in all respects with Arizona law
concerning employment practices and working conditions, pursuant to A.R.S. § 23-211, et seq., and all
laws, regulations, requirements and duties relating thereto. Offeror further warrants that to the extent
permitted by law, it will fully indemnify the City for any and all losses arising from or relating to any violation
thereof.

F.
Offeror agrees and covenants that it will comply with any and all applicable governmental restrictions,
regulations and rules of duly constituted authorities having jurisdiction insofar as the performance of the
work and services pursuant to the Contract, and all applicable safety and employment laws, rules and
regulations, including but not limited to, the Fair Labor Standards Act, the Walsh-Healey Act, Arizona
Executive Order No. 99-4, and the Arizona Fair and Legal Employment Act, along with all laws, rules and
regulations attendant thereto. Offeror acknowledges that a breach of this warranty is a material breach of
this Contract and Offeror is subject to penalties for violation(s) of this provision, including termination of this
Contract. The City retains the right to inspect the documents of any and all contractors, subcontractors
and sub-subcontractors performing work and/or services relating to the Contract to ensure compliance with
this warranty. Any and all costs associated with City inspection are the sole responsibility of Offeror. Offeror
hereby agrees to indemnify, defend and hold the City harmless for, from and against all losses and liabilities
arising from any and all violations thereof.

G.
The City Procurement Office is committed to fair and equal procurement opportunities for all firms wishing
to do business with the City and encourages the participation of small and disadvantaged business.

2.
New Materials/Equipment: Unless otherwise specifically provided in this Request for Quotation, all materials and
services covered by this contract shall be completely new, of the latest model and of the most suitable grade for the
purpose intended. Any and all work under this contract shall be performed in a skilled and workmanlike manner.

3.
Mistakes and Errors: In case of error in the extension prices in the quotation, the unit price will govern. No
quotation shall be altered, amended or withdrawn after the specific date and time for receiving quotations.
Negligence by the vendor in preparing the quotation response confers no right for the withdrawal of the quotation
after it has been opened.

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4.
Award Discretion: Unless the vendor states otherwise, the City Procurement Office reserves the right to award
by individual line item, by groups of line items or as a total, whichever is deemed most advantageous to the City.

5.
Additional Purchases: Quote solicitations may with the consent of the awarded vendor(s)/contractor(s) be utilized
to satisfy new requisition needs for similar quantities of the same product for a period up to one (1) year. Quotes
that exceed $100,000 in total cost, including tax and shipping, cannot be awarded by a Request for Quotation and
should any resulting contract exceed the $100,000 limit, the contract shall become terminated.

6.
Invoice: A separate invoice shall be issued for each shipment and no payment will be issued prior to receipt of
materials or services and correct invoice.

7.
Payment: Payment discount periods will be computed from the date of receipt of materials or services or correct
invoice, whichever is later, to the date payment warrant is mailed. Unless freight and other charges are itemized,
any discount provided will be taken on full amount of invoice. Payment discounts of 30 calendar days or more will
be deducted from the quote price in determining the lowest quote. However, the Procurement Officer shall be
entitled to take advantage of any payment discount offered by the vendor provided payment is made within the
discount period.

8.
Cooperative Use of Contract: Any Contract resulting from this solicitation shall be for the use of the City of Tempe.
In addition, public and nonprofit agencies that have entered into a Cooperative Purchasing Agreement with the City
of Tempe’s Department of Procurement are eligible to participate in any subsequent Contract. Additionally, this
Contract is eligible for use by the Strategic Alliance for Volume Expenditures (SAVE) cooperative. See
http://www.mesaaz.gov/business/purchasing/save for a listing of participating agencies. The parties agree that
these lists are subject to change. Any such usage by other municipalities and government agencies must be in
accord with the ordinance, charter and/or rules and regulations of the respective political entity.

Any orders placed to, or services required from, the successful Contractor(s) will be requested by each participating
agency. Payment for purchases made under this agreement will be the sole responsibility of each participating
agency. The City shall not be responsible for any disputes arising out of transactions made by others. Contractor
shall be responsible for correctly administering this Contract in accordance with all terms, conditions, requirements,
and approved pricing to any eligible procurement unit.

9.
Calendar Days: Periods of time shall be in calendar days unless otherwise designated.

10.
Samples: Samples, if requested, must be furnished free of any expense and, if not destroyed or required as a
future quality standard on award items, will upon request, be returned at the vendor's expense.

11.
Indemnification: To the fullest extent permitted by law, the Contractor shall defend, indemnify and hold harmless
the City, its agents, officer, officials, and employees from and against all claims, damages, losses and expenses
(including but not limited to attorney's fees, court costs, and the costs of appellate proceedings), arising out of, or
alleged to have resulted from the acts, errors, mistakes, omissions, work, services, or professional services of the
Contractor, its agents, employees, or any other person (not the City) for whose acts, errors, mistakes, omissions,
work, services, or professional services the Contractor may be legally liable in the performance of this contract.
Contractor’s duty to hold harmless and indemnify the City, its agents, officers, officials and employees shall arise in
connection with any claim for damage, loss or expenses that is attributable to bodily injury, sickness disease, death,
or injury to, impairment, or destruction of any person or property, including loss of use resulting from, caused by
any acts, errors, mistakes, omissions, work, services, or professional services in the performance of this contract
by Contractor or any employee of the Contractor or any other person (not the City) for whose acts, errors, mistakes,
omissions, work, or services the Contractor may be legally liable. The amount and type of insurance coverage
requirement set forth herein will in no way be construed as limiting the scope of indemnity in this paragraph. This
provision shall survive the term of this Contract.

12.
Rejection of Quote: The right is reserved to reject any, or all, quotes combinations or items, or lot, and to waive
informalities not consistent with law.

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13.
Brand Name or Equal Specifications: When the specification calls for “Brand Name or Equal,” the brand name
product is acceptable. The use of a brand name is for the purposes of describing the standard of quality,
performance, and characteristics desired and is not intended to limit or restrict competition. If an Offeror wishes to
provide a material or service that is not the brand name, the equivalent material or service must meet the standard
of quality of the brand name product., which is determined at the City’s sole discretion. Equivalent products will be
considered upon showing the other product meets stated specifications and is equivalent to the brand name product
in terms of quality, performance and desired characteristics. Products that are substantially equivalent to those
brands designated will qualify for consideration. Burden of proof that the product meets the minimum standards or
is equal to the brand name product is on the Offeror. The City reserves the right to reject Responses that the City
deems unacceptable for any reason.

14.
Authorization: Erasures, interlineations or other changes must be initialed by the individual signing the Request
for Quotation.

15.
UCC: This Request for Quotation and any resulting contract shall be governed by the Uniform Commercial Code,
as adopted in the State of Arizona.

16.
Termination for Conflict of Interest: This Contract is subject to the cancellation provisions of AR.S. 38-511. The
City may cancel this Contract within three (3) years after its execution, without penalty or further obligation if any
person significantly involved in initiating, securing, drafting or creating the Contract for the City becomes an
employee or agent of the Contractor.

17.
Freight Conditions: Prices quoted shall be F.O.B. Destination to the delivery location(s) designated herein.
Contractor shall retain title and control of all goods until they are delivered and the contract of coverage has been
completed. All risks of transportation and all related charges shall be the responsibility of the contractor. The City
will notify the contractor promptly of any damaged goods and shall assist the contractor in arranging for inspection.

18.
Availability of Funds for the Next Fiscal Year: Funds are not presently available for performance under this contract
beyond the current fiscal year. The City's obligation for performance of this contract beyond this fiscal year is
contingent upon the availability of funds from which payment for contract purposes can be made. No legal liability on
the part of the City for any payment may arise for performance under this contract beyond the current fiscal year until
funds are made available for performance of this contract.

19.
Events of Default and Termination:

A.
In the event a party is in default then the other party may, at its option and at any time, provide written notice
to the defaulting party of the default. The defaulting party will have thirty (30) days from the receipt of the
written notice to cure the default; the thirty (30) day cure period may be extended by mutual agreement of
the parties, but no cure period may exceed ninety (90) days. A default notice will be deemed to be sufficient
if it is reasonably calculated to provide notice of the nature and extent of such default. Failure of the non-
defaulting party to provide written notice of the default does not waive any rights under the Agreement. The
occurrence of any one or more of the following events shall constitute a material breach of and default
under the Contract.

i)
Any failure by Contractor to pay funds or furnish materials, services and/or goods that fail to
conform to any requirement of this Contract or provide personnel that do not meet Contract
requirements;

ii)
Any party’s failure to observe, perform or undertake any provision, covenant or condition of this
Contract to be observed or performed by Contractor or City herein, including but not limited to failing
to submit any report required herein;

iii)
Any failure to make progress in the performance required pursuant to the Contract and/or gives
either party reason to believe that the other party cannot or will not perform to the requirements of
the Contract; or,

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iv)
Any failure of Contractor to commence construction, work or services within the time specified
herein, and to diligently undertake Contractor’s work to completion.

B.
In the event the default has not been corrected to the non-defaulting party’s satisfaction within the cure time
specified, the non-defaulting party, at its option and in addition to any other remedies available by law or in
equity, without further notice or demand of any kind to Contractor, may do the following:

i)
Terminate the Contract;

ii)
Pursue and/or reserve any and all rights for claims to damages for breach or default of the Contract;
and/or,

iii)
Recover any and all monies due from Contractor, including but not limited to, the detriment
proximately caused by Contractor’s failure to perform its obligations under the Contract, or which
in the ordinary course would likely result therefrom, including, any and all costs and expenses
incurred by the City in: (a) maintaining, repairing, altering and/or preserving the premises (if any)
of the project; (b) costs incurred in selecting and retaining a substitute Contractor for the purchase
of services, materials and/or work; and/or (c) attorneys’ fees and costs in pursuing any remedies
under the Contract and/or arising therefrom.

C.
The exercise of any one of the City’s remedies as set forth herein shall not preclude subsequent or
concurrent exercise of further or additional remedies. In addition, the City shall be entitled to terminate this
Contract at any time, in its discretion. The City may terminate this Contract for default, non-performance,
breach or convenience, or pursuant to A.R.S. § 38-511, or abandon any portion of the project for which
services have not been fully and/or properly performed by the Contractor.

D.
Termination shall be commenced by delivery of written notice to Contractor by the City personally or by
certified mail, return receipt requested. Upon notice of termination, Contractor shall immediately stop all
work, services and/or shipment of goods hereunder and cause its suppliers and/or subcontractors to cease
work pursuant to the Contract. Contractor shall not be paid for work or services performed or costs incurred
after receipt of notice of termination, nor for any costs incurred that Contractor could reasonably have
avoided.

E.
The City, in its sole discretion, may terminate or reduce the scope of this Contract if available funding is
reduced for any reason.

F.
Whenever the City in good faith has reason to question Contractor’s intent or ability to perform, the City
may demand that Contractor give a written assurance of its intent and ability to perform. In the event that
the demand is made, and no written assurance is given within the time period required, the City may treat
this failure as an anticipatory repudiation of the Agreement.

20.
Termination for Convenience: The City at its sole discretion may terminate this contract for convenience with 30
days advance notice to Contractor. Contractor shall be reimbursed for all appropriate costs as provided for within
the contract up to the termination date specified.

21.
Quote Response Evaluation: Awards shall be made to the responsible offeror submitting the quotation that is most
advantageous to the City and conforms in all materials respects to the solicitation. The City shall be the sole judge
as to the acceptability of the products and/or services offered.

Evaluation criteria will include, but are not limited to:

A.
Conformity with quote solicitation specifications, performance requirements, terms and conditions and
contractual clauses;

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B.
Demonstrated performance and/or rated quality of items offered as reported in trade journals, professional
reports and published testing results;

C.
Operational and/or ergonomic compatibility with existing City resources, as applicable;

D.
Availability of competent service and prompt delivery of supplies, parts and services;

E.
Having legally required licenses, certifications and/or qualifications to perform the contract;

F.
Cost considerations including item pricing; delivery, installation, operation and life cycle costs; vendor’s
financial capability to perform the contract; and any other cost factors that would be advantageous to the City.

G.
Record of past performance and integrity on City and/or other public agency contracts; and

H.
Production capability of equipment as determined by product samples, customer references, and/or City
inspection.

I.
The overall length and quality of warranty offered.

22.
Non-exclusive Contract: Any contract resulting from this quote solicitation shall be awarded with the understanding
and agreement that it is for the sole convenience of the City of Tempe. The City reserves the right to obtain like
products or services from another source to secure significant cost savings or when timely delivery cannot be met by
the contractor.

23.
Notices: All notices, requests, demands, consents, approvals, and other communications which may or are required
to be served or given hereunder (for the purposes of this provision collectively called "Notices"), shall be in writing and
shall be sent by registered or certified United States mail, return receipt requested, postage prepaid, addressed to the
party or parties to receive such notice as follows:

A.
If intended for the City, to:

CITY OF TEMPE
PROCUREMENT OFFICE
PO Box 5002
Tempe, Arizona 85280
B.
If intended for the Contractor, to:
The Contractor at the Contractor’s address
and the attention of the person named as
provided in the offer of this contract.

Or to such other address as either party may from time to time furnish in writing to the other by notice hereunder. Any
notice so mailed shall be deemed to have been given as of the date such notice is received as shown on the return
receipt. Furthermore, such notice may be given by delivering personally such notice, if intended for the City, to the
City Procurement Administrator and, if intended for the contractor, to the person named in the offer of this contract, or
to such other person as either party may from time to time furnish in writing to the other by notice hereunder. Any
notice so delivered shall be deemed to have been given as of the date such notice is personally delivered to the other
party.

24.
Offer Acceptance Period: In order to allow for an adequate evaluation, the City requires an offer in response to this
Solicitation to be valid and irrevocable for 90 days after the quote opening time and date.

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25.
Quote Opening: Quotes shall be opened at the time and place designated on the cover page of this document. The
name of each offeror, identity of the quote solicitation for which the Quote was submitted and quoted prices shall be
publicly read and recorded in the presence of witnesses. Offerors will make their interest known to the Procurement
Officer (prior to the scheduled opening) if they wish to be present (virtually) to witness the proposal opening. After
contract award, the quotation and the evaluation documentation shall be open for public inspection.

26.
Taxes: Include any applicable sales tax as a separate line item as indicated on the Price Section. The City is
exempt from paying Federal Excise Tax. For quote evaluation purposes, the transaction (sales) Privilege Tax paid
to the City of Tempe (1.8%) is considered as a pass-through cost, calculated as zero ($0) expense when comparing
pricing among competing companies that are located outside of Tempe. For information on privilege sales tax,
please contact the City’s Tax and License Office at 480-350-2955 or visit their web site at salestax@tempe.gov.

27.
Contracts Administration: Contractor must notify the City Procurement Office (designated Procurement Officer) for
guidance or direction of matters of contract interpretation or problems regarding the terms, conditions or scope of this
contract.

28.
Licenses: Contractor shall maintain in current status all Federal, State and Local licenses and permits required for
the operation of the business conducted by the contractor.

29.
Permits: The contractor shall be responsible for obtaining all required permits for installations.

30.
Safety Standards: All items supplied on this contract must comply with the current applicable Occupational Safety
and Health Standards of the State of Arizona Industrial Commission, the National Electric Code, and the National Fire
Protection Association Standards.

31.
Confidential Information:

A.
If a person believes that a quote offer or specification, contains information that should be withheld as
confidential, a statement advising the Procurement Officer of this fact shall accompany the submission and
the information shall be so identified wherever it appears.

B.
The information identified by the person as confidential shall not be disclosed until the City Procurement Office
makes a written determination or until after award of contract.

C.
The City Procurement Office shall review the statement and information and shall determine in writing whether
the information shall be withheld. After award of contract, all quote response information shall be available
for public inspection.

D.
If the City Procurement Office determines to disclose the information, the quote offeror shall be informed in
writing of such determination. After award of contract, all quote response information shall be available for
public inspection.

E.
A simple statement that is made at the beginning of the offer that the entire offer should be held confidential
or the inclusion of the word “confidential” appearing throughout the document with no specific reference to
what is being specifically requested to be treated as confidential shall not be considered confidential and
will not place any responsibility on the City to comply with the request.

32.
Payments - After Acceptance of Delivery: Payment in full shall be made to the successful contractor within thirty-
(30) days after receipt and acceptance of delivery by the City, unless terms other than net 30 days are offered as a
discount.

33.
Unauthorized Firearms & Explosives: No person conducting business on City property is to carry a firearm or
explosive of any type. Any City quote offeror, contractor or subcontractor is to honor this requirement at all times and
failure to honor this requirement will result in contract cancellation. This requirement also applies to persons who
maintain a concealed weapons permit. In addition to contract cancellation, anyone carrying a firearm or explosive
device will be subject to police and legal action.

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34.
Contract Formation: This Contract shall consist of this Request for Quotation and the vendor’s proposal Offer
submitted, as may be found responsive and approved by the City. In the event of a conflict in language between
the documents, the provisions of the City’s Request for Quotation shall govern. The City’s Request for Quotation
shall govern in all other matters not otherwise specified by the Contract between the parties. All previous contracts
between the Offeror and the City are not applicable to this Contract or other resultant contracts. Any contracted
vendor documents that conflict with the language and requirements of the City's solicitation are not acceptable and
void the Contract.

35.
Contract Modifications: This Request for Quotation and resultant Contact may only be modified by a written
Contract modification issued by the Procurement Office and counter-signed by the Contractor. Contractors are not
authorized to modify any portion of this solicitation or resulting Contract without the written approval of the
Procurement Office and issuance of an official modification notice.

36.
Estimated Quantities: This Request for Quotation references quantities as a general indication of the City’s needs.
The City anticipates considerable activity resulting from Contracts that will be awarded as a result of this Request
for Quotation; however, the quantities shown are estimates only and the City reserves the right to increase or
decrease any quantities actually acquired, in its sole discretion. No commitment of any kind is made concerning
quantities and Offeror hereby acknowledges and accepts same.

37.
Interpretation of Parole Evidence: This Contract is intended as a final expression of the agreement between the
parties and as a complete and exclusive statement of the Contract, unless the signing of a subsequent Contract is
specifically called for in this Request for Quotation. No course of prior dealings between the parties and no usage
of the trade shall be relevant to supplement or explain any term used in the Contract. Acceptance or acquiescence
in a course of performance rendered under this Contract shall not be relevant to determine the meaning of the
Contract, even though the accepting or acquiescing party has knowledge of the nature of the performance and
opportunity to object.

38.
No Assignment: No right or interest in this Contract shall be assigned by Contractor and no delegation of any
duty of Contractor shall be made without prior written permission of the City, which consent may be granted or
withheld in City’s unfettered discretion.

39.
No Waiver: No breach of default hereunder shall be deemed to have been waived by the City, except by written
instrument to that effect signed by an authorized agent of the City. No waiver of any such breach or default shall
operate as a waiver of any other succeeding or preceding breach or default or as a waiver of that breach or default
after demand by the City for strict performance of this Contract. Acceptance of partial or delinquent payments or
performance shall not constitute the waiver of any right of the City. Acceptance by the City for any materials shall
not bind the City to accept remaining materials, future shipments or deprive the City of the right to return materials
already accepted. Acceptance by the City of delinquent or late delivery shall not constitute a waiver of a later claim
for damages and/or bind the City for future or subsequent deliveries.

40.
Provisions by Law: Each and every provision of law and any clause required by law to be in this Contract will be
read and enforced as though it were included herein, and if through mistake or otherwise any such provision is not
inserted, or is not correctly inserted, then upon the application of either party the Contract will forthwith be physically
amended to make such insertion or correction.

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Special Terms & Conditions and Instructions
1.
City Procurement Document: This Request for Quotation is issued by the City Procurement Office. No alteration
of any portion of this Request for Quotation document by a vendor is permitted and any attempt to do so shall result
in vendor’s quote being considered non-responsive. No alteration of any portion of a resultant contract is permitted
without the written approval of the City Procurement Office and any attempt to do so shall be a violation of the contract.
Any such action is subject to the legal and contractual remedies available to the City, inclusive of, but not limited to,
contract cancellation, suspension and/or debarment of the Contractor.

2.
Contract Type: Term with justifiable price adjustment allowed, indefinite quantity.

3.
Term of Contract: The term of any resultant contract shall commence on the date of award and shall continue for a
period of one (1) year thereafter, unless terminated, canceled or extended as otherwise provided herein. Resultant
contract is non-transferable and cannot be assigned by the contractor without the approval of the City Procurement
Office; and then only when all prices, discounts, terms and conditions of the original bid solicitation and contract award
remains unchanged. Contract becomes terminate should the cost to the City exceed $100,000, the ceiling amount
for a contract awarded through a Request for Quotation process.

4.
Contract Renewal: The City reserves the right to unilaterally extend the period of any resultant contract for 90 days
beyond the stated expiration date. In addition, by mutual written Contract Modification, any resultant contract may be
renewed for supplemental periods of up to a maximum of four (4) additional years

5.
Price Adjustment: The City Procurement Office will review fully documented requests for price increases after the
contract has been in effect for twelve (12) months. The requested price increase must be based upon a cost increase
that was clearly unpredictable at the time of the offer and can be shown to directly affect the price of the item
concerned. The City Procurement Office will determine whether the requested price increase, or an alternative option,
is in the best interest of the City. Advanced 30 day written notification by contractor is required for any price changes.
All price adjustments will be effective on the first day of the month following approval or acceptance by the City
Procurement Office. After the City approves a price increase the contractor shall not be eligible to receive an
additional increase until twelve (12) months from the date of the last approved price increase.

Price increase requests must be acknowledged in writing by the City Procurement Office before becoming effective.
If not acknowledged within 30 days, it is the vendor's/contractor's responsibility to contact the City Procurement Office
to ensure the price increase request was received.

The contractor shall likewise offer any published price reduction or if applicable to contract, profit sharing price
advantage to the City concurrent with its announcement to other customers. A price reduction or profit-sharing price
advantage may be offered at any time during the terms of an awarded contract and shall become effective upon notice
and acceptance. The City shall likewise take advantage of any special sales discounts offered to the general public,
which exceeds contracted price discounts extended to the City by the vendor.

6.
Multiple Awards: In order to ensure that any ensuing contracts will allow the City to fulfill current and future
requirements, the City reserves the right to award contracts to multiple companies. The actual utilization of any
contract will be at the sole discretion of the City. The fact that the City may make multiple awards should be taken into
consideration by each vendor submitting a quote.

7.
Insurance:

A.
Insurance Required: Prior to commencing services under this Contract, Contractor shall procure and
maintain for the duration of the Contract insurance against claims for injuries (including death) to persons
and damages to property, which may arise from or in connection with the performance of the work
hereunder by the Contractor, its agents, representatives, employees, subcontractors, or sub-
subcontractors. For Bidders with self-insurance, proof of self-insurance with minimum limits expressed
below must be submitted on proper forms for evaluation prior to award of Contract.

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A Contract Award Notice or Purchase Order will not be issued to the Contractor until receipt of all required
insurance documents by the City Procurement Office with such documents meeting all requirements herein.
In addition, before any Contract renewal, all required insurance must be in force and on file with the City
Procurement Office. Contractor must submit required insurance within ten (10) calendar days after request
by the City Procurement Office or the award may be rescinded and another Contractor selected for award.

B.
Minimum Limits of Coverage: Without limiting any obligations or liabilities, the Contractor, at its sole
expense, shall purchase and maintain the minimum insurance specified below with companies duly
licensed or otherwise approved by the State of Arizona, Department of Insurance and with forms
satisfactory to the City. Each insurer shall have a current A.M. Best Company, Inc., rating of not less than
A-VII. Use of alternative insurers requires prior approval from the City.

i.
Minimum Limits of Insurance. Contractor shall maintain the following minimum limits:

a.
Commercial General Liability

Commercial general liability insurance limit of not less than $1,000,000 for each occurrence, with
a $1,000,000 general aggregate limit. The general aggregate limit shall apply separately to the
services under this Contract or the general aggregate shall be twice the required per claim limit.
The policy shall be primary and include coverage for bodily injury, property damage, personal injury,
products, completed operations, and blanket contractual coverage, including but not limited to the
liability assumed under the indemnification provisions of this Contract which coverage will be at
least as broad as insurance service officer policy form CG2010 11/85 edition or any replacement
thereof.

In the event the general liability policy is written on a "claims made" basis, coverage shall extend
for two (2) years past completion and acceptance of the services as evidenced by annual
certificates of insurance.

Such policy shall contain a "severability of interests" provision.

b.
Worker’s Compensation

The Contractor shall carry worker’s compensation insurance to cover obligations imposed by
federal and state statutes having jurisdiction of Contractor employees engaged in the performance
of services; and employer’s liability insurance of not less than $100,000 for each accident, $100,000
disease for each employee and $500,000 disease policy limit.

In case services are subcontracted, the Contractor will require the subcontractor to provide worker’s
compensation and employer’s liability to at least the same extent as provided by Contractor.

c.
Automobile Liability

Commercial business automobile liability insurance with a combined single life or bodily injury and
property damages of not less than $1,000,000 per accident regarding any owned, hired, and non-
owned vehicles assigned to or used in performance of the Contractor services. Coverage will be
at least as broad as coverage Code 1 "any auto". Insurance Service Office policy form CA0001
Y87 or any replacements thereof. Such coverage shall include coverage for loading and unloading
hazards.

C.
Additional Insured: The insurance coverage, except for workers compensation and professional liability
coverage, required by this Contract, shall name the City, its agents, representatives, directors, officials,
employees, and officers, as additional insureds, and shall specify that insurance afforded the Contractor
shall be primary insurance, and that any insurance coverage carried by the City or its employees shall be
excess coverage, and not contributory coverage to that provided by the Contractor.

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D.
Coverage Term: All insurance required herein shall be maintained in full force and effect until all work or
service required to be performed under the terms of the Contract is satisfactorily completed and formally
accepted by the City. Failure to do so shall constitute a material breach of this Contract.

E.
Primary Coverage: Contractor’s insurance shall be primary insurance to the City, and any insurance or
self-insurance maintained by City shall be excess of the Contractor’s insurance and shall not contribute to
it.

F.
Claim Reporting: Any failure to comply with the claim reporting provisions of the policies or any breach of
a policy warranty shall not affect coverage afforded under the policy to protect City.

G.
Waiver: The policies, including workers’ compensation, shall contain a waiver of transfer rights of recovery
(subrogation) against City, its agents, representatives, directors, officers, and employees for any claims
arising out of the work or services of the Contractor.

H.
Deductible/Retention: The policies may provide coverage which contains deductibles or self-insured
retentions. Such deductible and/or self-insured retentions shall not be applicable with respect to the
coverage provided to City under such policies. Contractor shall be solely responsible for deductible and/or
self-insurance retention and City, at its option, may require Contractor to secure the payment of such
deductible or self-insured retentions by a surety bond or an irrevocable and unconditional letter of credit.

I.
Certificates of Insurance: Prior to commencing work or services under this Contract, Contractor shall
furnish the City with certificates of insurance, or formal endorsements as required by the Contract, issued
by the Contractor’s insurer(s), as evidence that policies providing the required coverages, conditions, and
limits required by this Contract are in full force and effect. Such certificates shall identify this Contract
number or name and shall provide for not less than thirty (30) days advance notice of cancellation,
termination, or material alteration. Such certificates shall be sent directly to: Contract Administrator, City of
Tempe, P. O. Box 5002, Tempe, AZ 85280.

J.
Copies of Policies: City reserves the right to request and to receive, within ten (10) working days, certified
copies of any or all of the above policies and/or endorsements. City of Tempe shall not be obligated,
however, to review same or to advise Contractor of any deficiencies in such policies and endorsements,
and such receipt shall not relieve Contractor from, or be deemed a waiver of, City’s right to insist on strict
fulfillment of Contractor’s obligations under this Contract.

9.
Professional Liability: The Contractor shall maintain professional liability insurance covering errors and omissions
arising out of the services performed by the Contractor and/or any person(s) employed by it, with an unimpaired
limit of not less than $1,000,000 each claim and $1,000,000 all claims. In the event the insurance policy is written
on a "claims made" basis, coverage shall extend for two years past completion and acceptance of services as
evidenced by annual certificates of insurance provided by Contractor to the City. In addition, Contractor shall
maintain property coverage on an all-risk, replacement cost basis in an amount established by the City with valuable
papers insurance sufficient to assure the restoration of any documents, memoranda, reports, or other similar data
relating to the services of the Contractor used in the completion of this Contract.

10.
Records: Under this contract each contractor shall retain, and shall contractually require each subcontractor to retain,
all books, accounts, reports, files and other records relating to the acquisition and performance of the contract for a
period of five- (5) years after the completion of the contract. All such documents shall be subject to inspection and
audit at reasonable times. Upon request, a legible copy of any or all such documents shall be produced at the offices
of the City Attorney or City Procurement Office.

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11.
Confidentiality of Records: The contractor shall establish and maintain procedures and controls that are acceptable
to the City for the purpose of assuring that no information contained in its records or obtained from the City or from
others in carrying out its functions under the contract shall be used by or disclosed by it, its agents, officers, or
employees, except as required to efficiently perform duties under the contract. Persons requesting such information
should be referred to the City. Contractor also agrees that any information pertaining to individual persons shall not
be divulged other than to employees or officers of contractor as needed for the performance of duties under the
contract, unless otherwise agreed to in writing by the City of Tempe.

12.
Key Personnel: It is essential that the contractor provide adequate experienced personnel, capable of and devoted
to the successful accomplishment of work to be performed under this contract. The contractor must agree to assign
specific individuals to the key positions.

A.
The contractor agrees that, once assigned to work under this contract, key personnel shall not be removed or
replaced without written notice to the City.

B.
If key personnel are not available for work under this contract for a continuous period exceeding 30 calendar
days or are expected to devote substantially less effort to the work than initially anticipated, the contractor
shall immediately notify the City, and shall, subject to the concurrence of the City, replace each person with
personnel of substantially equal ability and qualifications.

13.
Payments - After Monthly Statement: Payment in full shall be made to the successful contractor within thirty- (30)
days after receipt and acceptance of itemized monthly statement, unless terms other than net 30 days are offered as
a discount.

14.
Conduct and Dress Code: The contractor's employees shall maintain proper conduct at all times while on City
property. Employees shall respect other personnel at the work site. Abusive language, ethnic and racial slurs, sexual
comments and jokes, shouting, and gestures toward other personnel will not be tolerated. Any occurrence will result
in immediate action with possible dismissal of that employee.

Employees will be neatly dressed in badges or uniforms that identify them as employees of the contractor.

15.
Safety, Health and Sanitation: The contractor shall provide and maintain in a neat, sanitary condition such facility
accommodations for the use by their employees as may be necessary to comply with the requirements and regulations
of the Arizona State Department of Health or as specified by the Maricopa County Health Department, Sanitary Code.

The contractor shall be fully responsible for the safety of their employees, the public and property in connection with
the performance of the work covered by this contract. The contractor(s) shall provide all safeguards, safety devices
and protective equipment and be responsible for taking any needed actions to protect the life and health of their
employees and the public during work activity. The contractor(s) shall also take any necessary actions as directed by
the City of Tempe Project Manager to reasonably protect the life and health of employees on this job and others
coming into contact with the job site.

Precaution shall be exercised by the contractor(s) at all times for the protection of persons (including employees) and
property. The contractor shall comply with the provisions of all applicable laws, pertaining to such protection including
all Federal and State Occupational Safety and Health Acts, and Standards and Regulations promulgated there under.

16.
Sub-Contractor (s): The City of Tempe reserves the right to approve all sub-contractor(s). Contractor is responsible
for all actions of sub-contractor(s). Contractor shall name sub-contractor(s) as additionally insured, in addition to the
City of Tempe on all required insurance documents.

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Scope of Work

The City of Tempe is seeking proposals from qualified firms to provide Independent Medical Evaluations (IME) and Fitness
for Duty examinations for our employees that are members of the Public Safety Personnel Retirement System (PSPRS)
and/or Arizona State Retirement System (ASRS).

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Specifications
Independent Medical Evaluations:

A. The selected contractor(s) will be required to perform IME’s on claimants and render a written report on said claimants
in compliance with the following guidelines.

•
If an employee fails to appear for the IME, City of Tempe must be notified by telephone on the day of the scheduled
appointment. If necessary, City of Tempe will contact the contractor(s) to reschedule the examination. After
scheduling an IME appointment, contractor(s) must send written notification of the date, time, and location of the
IME appointment to the City of Tempe.

•
Appointments must be confirmed by email or telephone with City of Tempe Human Resources Representative.

•
Written authorization must be obtained from City of Tempe prior to performing any type of diagnostic testing (invasive
or non-invasive) prior to examinations. All medical providers must provide CPT codes to City of Tempe in order to
process said payments.

•
If an employee and/or an attorney contact the contractor(s) to reschedule or cancel an appointment, the
contractor(s) must refer the call to City of Tempe. Any changes or cancellations without City of Tempe knowledge
will result in non-payment of services.

•
Contractor(s) will provide a comprehensive report no later than the date specified by the City of Tempe Coordinator.
Delays for any reason must be communicated to City of Tempe Coordinator as soon as possible.

•
The examination must take place in an ADA accessible facility.

•
The contractor(s) must perform medical record reviews and comment on specific issues related to the employee’s
illness or injury.

•
The examining physician must appear in court and/or at a deposition, at the request of the City of Tempe Attorney’s
Office and/or the Office of the Attorney General.

•
Contractor(s) must communicate with City of Tempe as necessary to obtain additional information to complete the
IME process, prior to rendering a report, i.e., requesting MRIs and additional medical records.

•
Establish and document positive identification of the employee prior to conducting an examination. City of Tempe
requires that the physician or contractor(s) obtain a copy of the employee’s photo identification (i.e., driver’s license,
state employee identification card). If identification is not available, the physician or contractor(s) is required to take
a photo of the employee. The copy of the identification or the photo must be submitted to City of Tempe, along with
the examination report and invoice for payment.

•
Physicians must not conduct examinations on employees whom they have treated or in cases where it is felt that
the physician cannot render an objective report.

•
Physicians must not discuss IME findings or offer treatment recommendations during the IME, nor should they
contact the employee’s treating doctor.

•
If investigation/surveillance videos are submitted for review, the physician must view them and comment as to
whether or not he/she believes the videos change his/her opinion. The doctor should not mention any surveillance
tapes to the employee.

•
All reports must be reviewed for spelling, punctuation, grammar, and accuracy prior to submission to City of Tempe

•
All addendums must be completed within 2 to 5 business days.

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•
Contractor(s) must provide an electronic letter confirming appointment date, time, and location for the IME and
distribute IME reports electronically to City’s Contract Administration/designee and/or Human Resources.

•
Contractor(s) are required to make all copies of medical records to be considered by the physician. No City of
Tempe file may leave the premises.

•
Physicians should have access to a computer and view any CDs and/or DVDs provided prior to writing the IME
report. If the physician will not review any CDs and/or DVDs, then the vendor must inform the City of Tempe prior
to scheduling the examination.

•
Contractor(s) and Physicians to provide Curriculum Vitae(s) upon request by the City of Tempe.

B. MANDATORY IME REPORTING REQUIREMENTS
•
Always identify the source of the medical information, i.e., employee, medical records, etc. and the date of injury.
Physicians must list medical records, X-rays, MRIs, CT Scans or other images reviewed by them in the final IME
report.

•
State the nature of the injury, comment on the initial medical evaluation, and subsequent care (include pre-existing
injuries and/or hospitalizations).

•
Review medical records and job description to comment on the employee’s ability to return to work.

•
Document the injured employee’s description of his/her activities since the injury or illness. Please ask the
employee the following questions and use quotations when reporting the employee’s answers:
1. Are you disabled from working?
2. Are you now working (including part-time or self-employed work)?
3. Have you worked since the date of the injury?
4. What are your daily activities?
5. What is your activity level (walking, jogging, running, driving (automatic or standard transmission),
swimming, hobbies, etc.)?
6. Have you had any injuries to this body part(s) in the past?
7. Do you smoke, drink, or use recreational drugs?
8. What medications are you currently taking and are they causally related to the injury or illness?

C. PHYSICAL EXAMINATIONS

The examination should include customary neurologic and physical tests, including range of motion per the
American Medical Association (AMA) guidelines. Examinations must be appropriate for the type of examination
being conducted (i.e., orthopedic, pulmonary, cardiac, etc.) and should include the injured employee’s:
•
Accurate height and weight and brief physical description
•
Manner of walk and stance, along with support devices being used
•
Disfigurement or scarring as a result of the injury or surgical intervention
•
Customary neurological and physical tests, including Range of Motion measurements per AMA Guidelines, and
any surgical intervention or degenerative diseases

D. ASSESSMENT

The assessment should include the following:
•
Specify date of injury or illness
•
Diagnosis
•
Comment on pre-existing and/or co-morbid condition(s)/injuries
•
Opinion regarding causation (indicate the basis for your opinion)
•
Disability: partial or total, temporary, or permanent

RFQ# 22-014 INDEPENDENT MEDICAL EVALUATIONS

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•
Percent loss of function according to AMA Guidelines, 5th Edition (only if requested)
•
Indicate whether the injured or ill employee is at maximum medical improvement (MMI)
•
Work capacity or ability to return to work
•
Indicate if the employee provided 100% effort
•
Has the employee fully recovered from the illness or injury
•
Any additional questions/issues raised on the referral sheet
•
Note the length of time spent on the examination and the length of time spent reviewing the medical records.

E. DISTRIBUTION OF REPORTS
Distribution of reports shall be as follows:
•
One signed copy of the IME report must be sent to the CITY OF TEMPE and this report must contain the
signature of the evaluating physician.

Return To Work and Fitness for Duty Examinations to include:

•
Employees returning to full duty after an extended period of work due to a non-work related injury or illness and
upon request of City’s Contract Administration/designee and/or Human Resource.

Type 1 (Simple)

•
Evaluation by a physician licensed in the State of Arizona
•
History and physical examination with the contract of that examination dependent upon the type of injury/illness and
the job requirements and safe return of work
•
Occasional ancillary test (blood, pulmonary function, lift tests), which may be needed to determine whether the
employee can safely perform the functions of their position
•
Results reported to the City’s Contract Administrator/designee by fax or email, Human Resources and/or requesting
Division
Type 2 (Complex)
•
This examination is appropriate for complex situation and/or comorbidities affecting safe job performance
•
Evaluation by a physician licensed in the State of Arizona.
•
History and physical examination with the context of that examination dependent upon the type of injury/illness, the
job requirements, and safe return to work
•
Ancillary testing, as necessary, to help determine the abilities of the employee such as functional capacity evaluation
•
Review of prior treatments records
•
Results reported to the City’s Administrator/designee by fax, Human Resources and/or requesting Division
Performance Measurement:

The selected contractor(s) will be required to demonstrate satisfactory performance under this contract through periodic
review by the City of Tempe. Performance measurements shall include but are not limited to the following:

•
Physician(s) must be individually licensed and must be in good standing.
•
Contractor(s) must provide a signed statement acknowledging that all physicians performing IME’s have current
active licenses and agree to withdraw from the list of IME physicians during any pending disciplinary proceedings
litigation, judgements, settlements, or restrictions related to licensure.
•
Physicians performing IME’s must be involved in an active private practice.
•
Misrepresentation of any credentials will constitute sufficient cause form removing a contractor(s) from the approved
list of vendors.

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•
Contractor(s) must represent the City of Tempe in a professional, ethical, and confidential manner.
•
Testify at court appearances or give deposition at the request of the City of Tempe.
•
Contractor(s) must observe all other applicable federal, state, and local laws and regulations.
•
Contractor(s) must be available for meetings to resolve issues. Meetings can occur anytime.
•
Contractor(s) must be able to provide a written report within forty-eight hours of examination in a format chosen by
the City of Tempe.
•
Contractor(s) must have current Worker’s Compensation Insurance for all employees within proper classification
and maintain it throughout the life of the contract. Proof of coverage must accompany the application. Failure to
maintain proper insurance will result in termination of the contract.
•
Reports that do not completely and fully answer the questions posed will be returned to the contractor(s) for
correction with no charge to the City of Tempe. The correction will be completed within 2 to 5 days after notification.
•
Contractor(s) that does not meet City of Tempe performance measurements will be removed from the list of
approved contractors.

“Return this Section with your Response”
RFQ# 22-014 INDEPENDENT MEDICAL EVALUATIONS

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Quote Questionnaire

Firm’s Experience and Qualifications
Response
1.
Describe your company and its history including years of service.

How many physicians/medical doctors does your firm currently have on
contract?

What experience does the organization and/or its personnel have
providing services relative to municipal or similar organizations?

References from other Arizona public entities are preferred.
•
Contact name
•
Email
•
Phone number
•
Description of services provided

In the past five years, has your organization merged with any other
organization?

In the past year, how many public sector employees were treated by your
facilities?

Implementation
Response
1.

Provide a method of approach for how you would initiate provision of
requested service(s) to the City of Tempe employees. Assume the
effective date is July 1, 2021.

Describe your communication plan for providing timely results of service(s)
rendered.

Administration and Customer Service
Response
1.

What are facility hours of operation, phone numbers and locations, to
include after-hours phone number answered by staff and not a recording?

What is your firm’s average turnaround time to receive a completed
report?

Will there be a dedicated liaison for the City of Tempe? If so please
describe who, their contact info and briefly describe their experience.

4.
What type of discounts or other services are available?

RFQ# 22-014 INDEPENDENT MEDICAL EVALUATIONS

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Evaluation Criteria
Quotes will be reviewed by an Evaluation Committee consisting of City staff using the criteria and process outlined below.

Evaluation Process

1. The Procurement Office will verify that all responses meet the requirements to be considered responsive.
Responses that do not comply with any mandatory requirements will be considered non-responsive for award and
not forwarded to the Evaluation Committee for scoring.
2. The Evaluation Committee will review and score all responsive submittals and rank them based on the committee’s
scores. Offerors may be invited for interviews, clarifications, and site visits as determined at the sole discretion of
the City.

Award Criteria
Weight
X
Rating
=
Points
1.
Method of Approach
20
X
_____
=
______
2.
Qualifications and Experience of firm
20
X
_____
=
______
3.
Price
30
X
_____
=
______
4.
Administration and Customer Service
20
X
_____
=
______
5.
Firms’ ability to provide differentiating medical services.
10
X
_____
=
______

Total
=
______

This proposal will be evaluated on a cumulative point system using the rating scale shown below (fractional points may be
selected within this range).

Scoring
Outstanding ……………………………..10
9
Good ………………………………….….8
7
6
Average ……………………………….…5
4
3
Poor ……………………………………...2
1
Not Addressed or Unacceptable ……...0

To evaluate the cost portion of the above criteria, the City may elect to evaluate each firm on a percentage basis of the
lowest cost offer. The formula would be: (Lowest Priced Offer/Evaluated Firm’s Price) x Points Possible = Evaluation Points.

“Return this Section with your Response”
RFQ# 22-014 INDEPENDENT MEDICAL EVALUATIONS

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Pricing Section
ITEM
NO.
DESCRIPTION OF REQUIRED MATERIAL, SERVICE OR CONSTRUCTION
UNIT PRICE
1.
Independent Medical Evaluation
$___________
2.
Return to Work/Fitness for Duty Examinations-Simple
$___________
3.
Return to Work/Fitness for Duty Examinations-Complex
$___________
4.
Firms may submit alternative pricing that more closely matches customary billing
rates for this type of service.
$___________
5.
Provide all applicable pricing schedules to this scope
$___________

Identify any and all miscellaneous fees that would apply to this agreement beyond the
pricing shown above.

* Applicable Tax %

* State correct jurisdiction to receive sales tax on the Vendor's Offer, included in this Request for Quotation.
Less prompt payments discount terms of % days/ or net thirty (30) days. (To apply after receipt and acceptance of an
itemized monthly statement.) For evaluation purposes, the City cannot utilize pricing discounts based upon payments being
made in less than thirty (30) days from receipt of statement.
Ordering and Invoice Instructions
Invoices shall be issued directly to the ordering department. Invoices shall be accurate and complete including the
information shown below. Failure to provide a properly documented invoice may cause a delay in receipt of payment. The
City will not process an invoice for payment until it has been approved by the ordering department and forwarded to Accounts
Payable. The City endeavors to process invoices within 30 days after receipt of an accurate and complete document.
Invoices shall include:
1.
Line item listing of all ordered items to include description of items;
2.
Unit cost and extended cost for each line item;
3.
Applicable Tax;
4.
Payment Terms;
5.
Purchase Order Number;
6.
Name of selling organization clearly stated on invoice along with address;
7.
Phone number and or e-mail address for contact person to clarify invoicing questions;

Invoices that do not follow the above minimum invoicing requirements will not be paid. Payment must be applied to only
invoices referenced on check/payment stub. The City reserves the right to process payments via check or P-Card.
Accounting Contacts:

Yesenia Loredo-Flores
Letters A – H and Numbers

Carlene Foster

Letters I – Z

Scott Gruber

General AP Inquiries and AP Checks

“Return this Section with your Response”
RFQ# 22-014 INDEPENDENT MEDICAL EVALUATIONS

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Vendor’s Offer
Offeror must complete, sign and submit this form to the Procurement Office with the proposal response. An unsigned
“Vendor’s Offer”, late proposal response, and/or a materially incomplete response will be considered nonresponsive and
rejected. Offeror is to type or legibly write in ink all information required below. A scanned copy of this page is acceptable.

Company Name:

Company Purchase Order Mailing Address:

Street Address:

City, State, Zip:

Contact Person:
Phone Number:

E-mail Address:
Cell Number:

Remit to Information

Company Name (as it appears on invoice):

Company Payment Remit to Address:

Street Address:

City, State, Zip:

Company Tax Information
If a Tempe-based firm, provide Tempe Transaction Privilege (Sales) Tax No.:

Payment Options
Will your company accept the City’s Master Card for payment?
Yes

Will your company accept Payment via ACH (Automated Clearing House) for payment?
Yes

THIS QUOTE IS OFFERED BY
REQUIRED SIGNATURE OF AUTHORIZED OFFEROR
By signing this Vendor’s Offer, Offeror acknowledges acceptance of all terms and conditions contained herein and that
prices offered were independently developed without consultation with any other Offeror or potential Offeror. Failure to sign
and return this form with proposal response will be considered nonresponsive and rejected.

Signature of Authorized Offer

Date

Print or Type Name of Authorized Individual

Title of Authorized Individual

RFQ# 22-014 INDEPENDENT MEDICAL EVALUATIONS

23 | Page

Item

Question

Response

Corporate Sustainable Actions

What sustainability guidelines or environmental statement does
your company have to guide the company as a whole? Please
include a link.

What is your company doing to be more energy efficient?

What is your company doing to reduce greenhouse gas
emissions?

What is your company doing to reduce waste transferred to
landfills?

What is your company doing to reduce water waste?

What kind of effort does your company make to reduce the use of
environmentally harmful materials (such as cleaning products,
etc.)?

Does your company take any actions to manage the sustainability
of your supply chain? If yes, please explain.

Has your company received any environmental or sustainability
related independent certifications or recognitions? If yes, please
explain.

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Sustainable Packaging:
https://www.epa.gov/smm/sustainable-packaging
https://www.epa.gov/facts-and-figures-about-materials-waste-and-recycling/containers-and-packaging-product-specific-
data

Cleaning Products:
https://www.epa.gov/saferchoice

Tool to Measure and Track your Waste and Recycling:
http://www.epa.gov/smm/wastewise/measure-progress.htm

Water Conservation:
http://water.epa.gov/polwaste/nps/chap3.cfm

Item

Question

Response

Product Sustainable Attributes

Has your company performed an environmental life cycle analysis
on the product being offered the City? If yes, please provide
documentation

Can the product being offered be refurbished, recycled, or
composted at the end of its life? If yes, please elaborate

Does the product being offered include any recycled materials? If
yes, please explain.

What measures have been taken to reduce unnecessary
packaging materials associated with the product being offered?

5.
What kind of reusable, recyclable, and/or compostable packaging
materials does your company use?

Has the product being offered been rated or certified by a third-
party organization such as Energy Star, Green Seal, Leadership
in Energy and Environmental Design (LEED), Forest
Stewardship Council, etc.? If yes, please provide certification
documentation.

Please provide any additional information you would like to share
regarding your product’s sustainable attributes.

RFQ# 22-014 INDEPENDENT MEDICAL EVALUATIONS

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Checklist for Submittal

The following checklist has been provided to assist you in submission of your offer.
This list should not be considered complete, other information or documents may be necessary as part of your submission.
The items listed are the primary documents and information that must be completed and/or included with your response.
Please include any additional information or documents that will clarify your submittals.
This document has been issued in Word format to allow the responding firm the ability to provide requested information,
answer questions and provide pricing within the actual document.

Description
Included
√
1.
One signed and completed copy of the quote response – only
sections marked “Return this Section with your Response” are
required but you may include supplemental materials you believe
necessary to clarify your submittal.

a.
Signed and Completed Vendor’s Offer Form

2.
Due to the COVID Virus, please submit a single e-copy of the signed
and completed proposal. The City’s e-mail is capable of accepting
up to a 10MB attachment. Please try and keep the proposal under
this size limit. However, if you need to exceed 10MB, please break
the proposal up into two sections and e-mail in two separate
messages clearly indicating the solicitation number on the subject
line and denoting Part 1 and Part 2 response. We will be unable to
accept any hard copies of the proposal so please e-mail the
response as noted above.

3.
Quote Questionnaire

4.
Pricing Section

5.
Signed Addenda (if applicable)

6.
Supplier Sustainability Questionnaire

Alert – If you received this solicitation via a third-party plan-holder company and did not
directly download it from the City of Tempe’s Procurement home page you might not
have received any addendums that were published during the bidding period. To ensure
you are notified of addendums it is critical that you download this solicitation from the
City’s web site per the below link:
https://ww2.tempe.gov/bids/

REQUEST FOR QUOTATION
RFQ# 22-014
Independent Medical Evaluations
RFQ ISSUE DATE:
May 28, 2021
DEADLINE FOR INQUIRIES/QUESTIONS:
THURSDAY, JUNE 24, 2021, AT 5:00 P.M. LOCAL ARIZONA TIME
RFQ DUE DATE AND TIME:
THURSDAY, JULY 1, 2021, 3:30 P.M. LOCAL ARIZONA TIME
ALL INQUIRIES MUST BE DIRECTED TO:
Daniel Wojcik
EMAIL: daniel_wojcik@tempe.gov
PHONE: 480-350-8682
SUBMITTAL LOCATION: Due to the COVID Virus, Tempe will only accept an e-copy of the
completed and signed proposal via e-mail to the following address:
Bids@tempe.gov
No hard copy proposals will be accepted at this time.

“Return this Section with your Response”
Quote Questionnaire
Firm’s Experience and Qualifications
Response
1.
Describe your company and its history including years of service.
Please see attached
2.
How many physicians/medical doctors does your firm currently have on
contract?
Please see attached
3.
What experience does the organization and/or its personnel have
providing services relative to municipal or similar organizations?
Please see attached
4.
References from other Arizona public entities are preferred.
•
Contact name
•
Email
•
Phone number
•
Description of services provided
Please see attached
5.
In the past five years, has your organization merged with any other
organization?
No
6.
In the past year, how many public sector employees were treated by your
facilities?
Over 60 including 9 for City of Tempe
Implementation
Response
1.
Provide a method of approach for how you would initiate provision of
requested service(s) to the City of Tempe employees. Assume the
effective date is July 1, 2021.
Please see attached
2.
Describe your communication plan for providing timely results of service(s)
rendered.
Please see attached
Administration and Customer Service
Response
1.
What are facility hours of operation, phone numbers and locations, to
include after-hours phone number answered by staff and not a recording?
Please see attached
2.
What is your firm’s average turnaround time to receive a completed
report?
Please see attached.
3.
Will there be a dedicated liaison for the City of Tempe? If so please
describe who, their contact info and briefly describe their experience.
Please see attached
4.
What type of discounts or other services are available?
Our rate is the discounted rate
provided to all municipalities in
Arizona

Evaluation Criteria
Quotes will be reviewed by an Evaluation Committee consisting of City staff using the criteria and process outlined below.
Evaluation Process
1.
The Procurement Office will verify that all responses meet the requirements to be considered responsive.
Responses that do not comply with any mandatory requirements will be considered non-responsive for award and
not forwarded to the Evaluation Committee for scoring.
2.
The Evaluation Committee will review and score all responsive submittals and rank them based on the committee’s
scores. Offerors may be invited for interviews, clarifications, and site visits as determined at the sole discretion of
the City.
Award Criteria
Weight
X
Rating
=
Points
1.
Method of Approach
20
X
_____
=
______
2.
Qualifications and Experience of firm
20
X
_____
=
______
3.
Price
30
X
_____
=
______
4.
Administration and Customer Service
20
X
_____
=
______
5.
Firms’ ability to provide differentiating medical services.
10
X
_____
=
______
Total
=
______
This proposal will be evaluated on a cumulative point system using the rating scale shown below (fractional points may be
selected within this range).
Scoring
Outstanding ……………………………..10
9
Good ………………………………….….8
7
6
Average ……………………………….…5
4
3
Poor ……………………………………...2
1
Not Addressed or Unacceptable ……...0
To evaluate the cost portion of the above criteria, the City may elect to evaluate each firm on a percentage basis of the
lowest cost offer. The formula would be: (Lowest Priced Offer/Evaluated Firm’s Price) x Points Possible = Evaluation Points.

“Return this Section with your Response”
Pricing Section
ITEM
NO.
DESCRIPTION OF REQUIRED MATERIAL, SERVICE OR CONSTRUCTION
UNIT PRICE
1.
Independent Medical Evaluation
$875.00 + provider fees &
ancillary fees if warranted
2.
Return to Work/Fitness for Duty Examinations-Simple
$875.00 + provider fees &
ancillary fees if warranted
3.
Return to Work/Fitness for Duty Examinations-Complex
$875.00 + provider fees &
ancillary fees if warranted
4.
Firms may submit alternative pricing that more closely matches customary billing
rates for this type of service.
$___________
5.
Provide all applicable pricing schedules to this scope
$___________

Identify any and all miscellaneous fees that would apply to this agreement beyond the
pricing shown above.

Doctor charges and possible interpreter/translator, exam room rental (if
outside of Phoenix metro), chaperone if needed, independent videographer
if needed.

A typical fee range by provider specialty can be made available upon
request.

* Applicable Tax 0 %

Yesenia Loredo-Flores
Letters A – H and Numbers

Carlene Foster

Letters I – Z

Scott Gruber

General AP Inquiries and AP Checks

Quote Questionnaire Responses
Firm’s Experience and Qualifications
1. Describe your company and its history including years of service.
Integrated Medical Evaluations, Inc. (IME, Inc.) is a medical legal scheduling company that
facilitates independent medical examinations, medical record reviews (chart reviews),
impairment/disability ratings and Public Safety Personnel Retirement System (PRPRS) exams. Over
the past 15 years we have developed expertise in our processes to ensure that our clients’ needs are heard and
met. The result is transforming a referral from City of Tempe, into the information your team needs
to make an appropriate claim evaluation.
IME, Inc. facilitates thousands of evaluations each year for the broader insurance, legal, and
governmental fields from our offices in Tempe, Arizona, Salt Lake City, Utah and Denver, Colorado,
Along with the evaluations, IME, Inc. also facilitates deposition and trial testimony for the hundreds
of board-certified physicians with whom we work, as well as conferences, case addendums and
clarifications. With our experienced Tempe, Arizona staff, and management with nearly 75 years of
combined experience in the industry, IME, Inc. is a vendor/partner that City of Tempe can count on
to deliver an arms-length, objective transaction in an efficient, service-oriented manner.
2. How many physicians/medical doctors does your firm currently have on contract?
Physicians remain independent contractors. However, we do credential all of our physicians and
currently schedule services with over 200 medical providers in Arizona.
3. What experience does the organization and/or its personnel have providing services
relative to municipal or similar organizations?
IME, Inc. has scheduled 134 independent medical examinations and records reviews for
municipalities and government agencies throughout the state of Arizona in the last five years.

4. References from other Arizona public entities are preferred.
•
Contact name
•
Email
•
Phone number
•
Description of services provided
City of Scottsdale
Darlene Ganger
DGanger@Scottsdaleaz.gov
480-312-2429
IME and chart review scheduling along with the coordination of ancillary services.
(Verbal only)
City of Glendale
Diannee Shoemake
DShoemake@GLENDALEAZ.com
623-930-2856
IME and chart review scheduling along with the coordination of ancillary services.
Lee & Brown, LLC
Michael Salazar, Esq.
msalazar@leeandbrown.com
720-891-4630
IME and chart review scheduling along with the coordination of ancillary services.
Implementation
1. Provide a method of approach for how you would initiate provision of requested
service(s) to the City of Tempe employees. Assume the effective date is July 1, 2021.
The method of approach for how IME, Inc. will initiate services to the City of Tempe employees will
be as follows:
•
Receive the initial request. The individual from the City of Tempe requesting the service is
free to call or email IME, Inc. and will be asked to provide: Examinee name, date of birth,
date of injury (if applicable) and issue(s) to be addressed.
•
Once we obtain this informations, we can clear any potential conflicts with the assigned
evaluator(s). We will also confirm any necessary ancillary services (transportation, interpreter,
etc.)
•
We will then arrange the appropriate service with the requested or suggested provider and will
keep the City of Tempe updated regularly throughout this process.

•
As soon as the service is scheduled, the examinee and the requesting party from the City of
Tempe will be notified. An email will be sent to the City of Tempe with an attached
appointment letter and an appointment letter along with any provider requested intake
paperwork will be mailed to the examinee via certified mail and first class mail.
•
When the request is initially received, we reach out to the requesting party from the City of
Tempe with a password protected secure link to upload records for the physician to review.
The records will be organized per the doctor’s specifications and preferences.
•
IME, Inc. will then draft a cover letter, based on the records provided, to include the following
questions:

Are you disabled from working?

Are you now working (including part-time or self-employed work)?

Have you worked since the date of the injury?

What are your daily activities?

What is your activity level (walking, jogging, running, driving (automatic or
standard transmission), swimming, hobbies, etc.)?

Have you had any injuries to this body part(s) in the past?

Do you smoke, drink, or use recreational drugs?

What medications are you currently taking and are they causally related to the
injury or illness?
As well as any specific questions the requesting party has asked to be addressed.
•
Once completed, the letter will be sent to the requesting party from the City of Tempe for
review and approval.
•
IME, Inc. will send appointment reminders to all parties 3 days prior to the exam and 1 day
prior to the exam.
•
IME, Inc. will inform the requesting party when the exam takes place. If the exam does not
take place, the City of Tempe will be notified immediately.
•
The City of Tempe will be sent a 24 hour preliminary form filled out by the provider after the
exam. (Form will be chosen by the City of Tempe)
•
Once the exam is complete, IME, Inc. will track and send reminders to the doctor to ensure
the report is received by the deadline.
•
IME, Inc. will carefully review the report for spelling, grammar and to confirm all the issues
outlined in the purpose letter have been addressed.
•
The report is sent to the requesting party from the City of Tempe.
•
IME, Inc. will adhere to and comply with the specifications outlined on pages 15-18 of RFQ#
22-014

•
The following is a list of IME, Inc. staff who will be working with the City of Tempe:

Leslie Olmsted (City of Tempe dedicated Liaison)

Melanie Loeffler (Manager)

Wendi Whipple (Scheduling)

Tisha Heater (Scheduling)

BJ Ciscar (Scheduling)

Stevie Mannarino (Records)

Tamara Patino (Records)

Nathan Graham (Reports)

Rebecca Winegar (Reports)

Emily Schnoor (Confirmations/Reminders)

Richard Klages (Accounting)

Sonya Hood (Accounting)
In addition to the staff listed above, company President William Hombach, and is available to the
City of Tempe.
2. Describe your communication plan for providing timely results of service(s) rendered.
At IME, Inc. we take pride in providing the best experience possible for all involved parties and
understand the importance of accurate and regular communication. We will keep the
requesting party updated at every step of the process. In addition, we will ask questions if we
need clarification. Most requested services are scheduled within 48 hours of receiving the
request and most reports are completed within10 business days of an event. The City of Tempe
will be provided with mobile numbers for dedicated liaison and local management.
Administration and Customer Service
1. What are facility hours of operation, phone numbers and locations, to include after-
hours phone number answered by staff and not a recording?
IME, Inc. is located at:
401 West Baseline Road, Suite 206
Tempe, AZ 85283
602-365-0132 (main number)
866-584-9810 (toll free)
888-692-8995 (fax)
Office hours are 8:00am to 5:00pm Monday through Friday
We offer after hours exam arrangements on an individual basis.
Our main line is answered by a live person during business hours.
Mobile numbers for the dedicated liaison and local management will be provided for any needs
outside of normal business hours.

2. What is your firm’s average turnaround time to receive a completed report?
Each provider is different, but typically the City of Tempe can expect to receive a report within 10
business days of the exam.
3. Will there be a dedicated liaison for the City of Tempe? If so please describe who, their
contact info and briefly describe their experience.
All the staff at IME, Inc. will be available to assist the City of Tempe and Leslie Olmsted will be the
dedicated liaison for the City of Tempe. Her direct contact information:
Leslie Olmsted
401 West Baseline Road, Suite 206
Tempe, AZ 85283
480-577-9883 (direct)
602-365-0132 (main number)
866-584-9810 (toll free)
888-692-8995 (fax)
Ms. Olmsted’s experience includes:
•
20 + years of experience in workers compensation and auto liability contracting and account
management
•
Worked closely with municipalities, insurance companies and third-party administrators for
20 years
•
Executing customer account instructions
•
Credentialing physicians and providers for managed care & ancillary networks
•
2013-2021 AWCCA Board Member-at-large (Arizona Workers Compensation Claims
Association)
•
Co-Chair –AWCCA 2014-2017 Holiday Party & 2018 – 2021 Rehabilitant of the Year
Awards night
•
Member of AZ PRIMA, RIMS, ASIA & AWCCA associations
•
Strong relationships in the managed care industry

“Return this Section with your Response”
Vendor’s Offer
Offeror must complete, sign and submit this form to the Procurement Office with the proposal response. An unsigned
“Vendor’s Offer”, late proposal response, and/or a materially incomplete response will be considered nonresponsive and
rejected. Offeror is to type or legibly write in ink all information required below. A scanned copy of this page is acceptable.
Company Name:
Integrated Medical Evaluations, Inc.
Company Purchase Order Mailing Address:
Street Address:
401 West Baseline Road Ste. 206
City, State, Zip:
Tempe, AZ 85283
Contact Person: Melanie Loeffler
Phone Number: 602-365-0132
E-mail Address: mloeffler@imewest.com
Cell Number:
303-886-0110
Remit to Information
Company Name (as it appears on invoice):
Integrated Medical Evaluations, Inc.
Company Payment Remit to Address:
Street Address:
6087 South Quebec Street Ste. #200
City, State, Zip:
Centennial, CO 80111
Company Tax Information
If a Tempe-based firm, provide Tempe Transaction Privilege (Sales) Tax No.:
47-1403854
Payment Options
Will your company accept the City’s Master Card for payment?
Yes
No
X
Will your company accept Payment via ACH (Automated Clearing House) for payment?
Yes
X
No
THIS QUOTE IS OFFERED BY
REQUIRED SIGNATURE OF AUTHORIZED OFFEROR
By signing this Vendor's Offer, Offeror acknowledges acceptance of all terms and conditions contained herein and that
prices offered were independently developed without consultation with any other Offeror or potential Offeror. Failure to sign
and return this form with proposal response will be considered nonresponsive and rejected.
Print or Type Name of Authorized Individual
Title of Authorized Individual

Supplier Sustainability Questionnaire
The City of Tempe is strongly committed to sustainable practices and programs that help build a vibrant and resilient
community. The City accomplishes this through a variety of innovative programs, including water and energy conservation,
recycling, composting, alternative transportation, sustainable business practices and environmental stewardship. Tempe
recently established its 2019 Climate Action Plan (CAP) that provides a guideline for how the City will take local action on
global climate change by reducing its greenhouse gas (GHG) emissions and adapting to the changing climate. The Climate
Action Plan serves as a guideline for the City’s path toward a sustainable and resilient future that will benefit the entire City.
The City has strengthened its commitment to sustainability by adopting a new carbon neutrality goal by 2050 and a strategy
of sourcing 100 percent of its electricity from renewable sources by 2035. To learn more about the City’s commitment to
sustainability, please visit https://www.tempe.gov/government/sustainable-tempe.
To further this commitment, the City has developed a Sustainable Procurement Policy that provides specific guidelines for
how these important sustainable practices and programs will be reflected in contract award decisions. By partnering with
companies who share these sustainability goals, the City will be able to significantly enhance sustainable outcomes.
To support these efforts, the following Supplier Sustainability Questionnaire has been developed that will allow the City to
better understand your company’s efforts and commitments regarding sustainable practices and initiatives. This
questionnaire has two sections – a section to understand what your company is doing regarding sustainable actions and a
section to understand the specific sustainable attributes of the product or service that you are offering.
Item
Question
Response
Corporate Sustainable Actions
1.
What sustainability guidelines or environmental statement does
your company have to guide the company as a whole? Please
include a link.
Copy paper used is made in the USA.
2.
What is your company doing to be more energy efficient?
Electronically sending records and
reports to physicians and clients when
possible.
3.
What is your company doing to reduce greenhouse gas
emissions?
N/A
4.
What is your company doing to reduce waste transferred to
landfills?
Shred & recycle
5.
What is your company doing to reduce water waste?
N/A
6.
What kind of effort does your company make to reduce the use of
environmentally harmful materials (such as cleaning products,
etc.)?
N/A
7.
Does your company take any actions to manage the sustainability
of your supply chain? If yes, please explain.
N/A
8.
Has your company received any environmental or sustainability
related independent certifications or recognitions? If yes, please
explain.
No

Please find some helpful links below that will provide additional information, tools and resources regarding
sustainable practices:
Greenhouse Gas Calculators:
https://www.epa.gov/energy/greenhouse-gases-equivalencies-calculator-calculations-and-references
Sustainable Packaging:
https://www.epa.gov/smm/sustainable-packaging
https://www.epa.gov/facts-and-figures-about-materials-waste-and-recycling/containers-and-packaging-product-specific-
data
Cleaning Products:
https://www.epa.gov/saferchoice
Tool to Measure and Track your Waste and Recycling:
http://www.epa.gov/smm/wastewise/measure-progress.htm
Water Conservation:
http://water.epa.gov/polwaste/nps/chap3.cfm
Item
Question
Response
Product Sustainable Attributes
1.
Has your company performed an environmental life cycle analysis
on the product being offered the City? If yes, please provide
documentation
N/A we are a service.
2.
Can the product being offered be refurbished, recycled, or
composted at the end of its life? If yes, please elaborate
All of our paper records are shredded
and recycled through a local shredding
service.
3.
Does the product being offered include any recycled materials? If
yes, please explain.
N/A
4.
What measures have been taken to reduce unnecessary
packaging materials associated with the product being offered?
N/A
5.
What kind of reusable, recyclable, and/or compostable packaging
materials does your company use?
N/A
6.
Has the product being offered been rated or certified by a third-
party organization such as Energy Star, Green Seal, Leadership
in Energy and Environmental Design (LEED), Forest
Stewardship Council, etc.? If yes, please provide certification
documentation.
N/A
7.
Please provide any additional information you would like to share
regarding your product’s sustainable attributes.
N/A

Checklist for Submittal
The following checklist has been provided to assist you in submission of your offer.
This list should not be considered complete, other information or documents may be necessary as part of your submission.
The items listed are the primary documents and information that must be completed and/or included with your response.
Please include any additional information or documents that will clarify your submittals.
This document has been issued in Word format to allow the responding firm the ability to provide requested information,
answer questions and provide pricing within the actual document.
Description
Included
√
1.
One signed and completed copy of the quote response – only
sections marked “Return this Section with your Response” are
required but you may include supplemental materials you believe
necessary to clarify your submittal.
X
a.
Signed and Completed Vendor’s Offer Form
X
2.
Due to the COVID Virus, please submit a single e-copy of the signed
and completed proposal. The City’s e-mail is capable of accepting
up to a 10MB attachment. Please try and keep the proposal under
this size limit. However, if you need to exceed 10MB, please break
the proposal up into two sections and e-mail in two separate
messages clearly indicating the solicitation number on the subject
line and denoting Part 1 and Part 2 response. We will be unable to
accept any hard copies of the proposal so please e-mail the
response as noted above.
3.
Quote Questionnaire
X
4.
Pricing Section
X
5.
Signed Addenda (if applicable)
6.
Supplier Sustainability Questionnaire
X
Alert – If you received this solicitation via a third-party plan-holder company and did not
directly download it from the City of Tempe’s Procurement home page you might not
have received any addendums that were published during the bidding period. To ensure
you are notified of addendums it is critical that you download this solicitation from the
City’s web site per the below link:
https://ww2.tempe.gov/bids/

RFQ# 22-014 INDEPENDENT MEDICAL EVALUATIONS
14 | Page
Scope of Work
The City of Tempe is seeking proposals from qualified firms to provide Independent Medical Evaluations (IME) and Fitness
for Duty examinations for our employees that are members of the Public Safety Personnel Retirement System (PSPRS)
and/or Arizona State Retirement System (ASRS).
EXHIBIT B

EXHIBIT C