Current Contract Information Form - Washington



State of Washington

Current Contract Information - Pricing and Ordering Information

Updated: January 06, 2016

Effective: January 06, 2016

|Contract number: |06910 |Commodity code: |9764 |

|Contract title: |Medical Physicals |

|Purpose: |To extend contract for an additional one year term. |

|Original award date: |January 7, 2011 |

|Current Contract period: |1/24/2011 |through: |1/07/2017 |

|Contract term: |Not to exceed SIX years or 1/7/2017 |

|Contract type: |This contract is designated as MANDATORY use. |

|Scope of contract |This contract is to obtain MEDICAL PHYSICAL examinations and fitness for duty evaluations for law enforcement officers |

| |and other prospective employees. These examinations shall be for a variety of purposes, included but not limited to: new |

| |hires, promotions, specialty positions, fitness for duty and limited duty assignments. Although some physical |

| |examinations will be for industrial insurance claims, the majority will be to determine an individual’s fitness to |

| |perform certain duties against agency standards. |

|Primary user agency: |Washington State Patrol (WSP) & Washington Dept. of Fish and Wildlife (WDFW) |

|For use by: |All members of the Washington State Purchasing Cooperative (WSPC) including where applicable: State Agencies, |

| |Institutions of Higher Education, Political Subdivisions, and Non-Profit Corporations may utilize this contract. |

|Primary Contractor: |Group Health Cooperative, Occupational Health |See Page 3 | |

| |Services | | |

|Services available: |Medical Physicals and Fitness for Duty Evaluations |

|Ordering information: |See page 2 Note III |

|Ordering procedures: |See page 2 Note II |

|Contract pricing: |See pages 4 & 5 |

|Term worth: |$200,000.00 |

|Current participation: |$0.00 MBE |$0.00 WBE |$450,000.00 OTHER |$0.00 EXEMPT |

| |MBE 0% |WBE 0% |OTHER 100% |Exempt 0% |

This page contains key contract features. Find detailed information on succeeding pages. For more information on this contract, or if you have any questions, please contact your local agency Purchasing Office, or you may contact our office at the numbers listed below.

|Contracts Specialist: |Tim L. Shay |Customer Service | |

|Phone Number: |(360) 407-9410 |Phone Number: |(360) 407-2210 |

|Fax Number: |(360) 586-2426 |Fax Number: |(360) 586-2426 |

|Email: |tim.shay@des. | | |

Visit our Internet site:

Notes:

I. Best Buy: The following provision applies to mandatory use contracts only. This contract is subject to RCW 43.19.190(2) & RCW 43.19.1905(7): which authorizes state agencies to purchase materials, supplies, services, and equipment of equal quantity and quality to those on state contract from non-contract suppliers. Provided that an agency subsequently notifies Department of Enterprise Services (MCC) that the pricing is less costly for such goods or services than the price from the state contractor.

If the non-contract supplier’s pricing is less, the state contractor shall be given the opportunity by the state agency to at least meet the non-contractor’s price. If the state contractor cannot meet the price, then the state agency may purchase the item(s) from the non-contract supplier, document the transactions on the appropriate form developed by DES and forwarded to the contract specialist administering the state contract. (Reference General Authorities document)

If a lower price can be identified on a repeated basis, the state reserves the right to renegotiate the pricing structure of this agreement. In the event such negotiations fail, the state reserves the right to delete such item(s) from the contract.

II. State Agencies: Submit Order directly to Contractor for processing. Political Subdivisions: Submit orders directly to Contractor referencing State of Washington contract number. If you are unsure of your status in the State Purchasing Cooperative call (360) 902-7415.

III. Only authorized purchasers included in the State of Washington Purchasing Cooperative (WSPC) listings published and updated periodically by DES may purchase from this contract. It is the contractor’s responsibility to verify membership of these organizations prior to processing orders received under this contract. A list of Washington members is available on the Internet , contractors shall not process state contract orders from unauthorized users.

IV. Contract Terms: This Document includes by reference all terms and conditions published in the original IFB, including Standard Terms and Conditions, and Definitions, included in the Competitive Procurement Standards published by DES (as Amended).

Primary COntractor Information

|Contractor: |Group Health Cooperative, Occupational Health Services |

| |12400 East Marginal Way South, AMB-1 |

| |Tukwila, WA 98106 |

|Contract Administration: |Jody Mahoney |

| |Daniel Perrow |

|Phone: |206-612-4367 |

| |206-901-7482 |

|Fax: |206-901-7485 |

|Email: |Mahoney.j@ |

| |Perrow.d@ |

|Appointment Scheduling: |Daniel Perrow |

|Phone: |206-901-7482 |

|Fax: |206-901-7485 |

|Email: |Perrow.d@ |

|Customer Service/Assigned Coordinator: |Jan Schumann |

| |Daniel Perrow |

| |Jody Mahoney |

|Phone: |206-229-1182 |

| |206-901-7482 |

| |206-612-4367 |

|Fax: |206-901-7485 |

|Email: |Schumann.j@ |

| |Perrow.d@ |

| |Mahoney.j@ |

|Technical Support: |Tim Gilmore, MD |

| |Jan Schumann |

|Phone: |206-229-1182 |

|Email: |Gilmore.t@ |

| |Schumann.j@ |

|Federal ID No.: |91-0511770 |

|Order placement address: |Group Health Cooperative, Occupational Health Services |

| |12400 East Marginal Way South, AMB-1 |

| |Tukwila, WA 98106 |

|Payment address: |Group Health Cooperative, Occupational Health Services |

| |ATTN: Cash Desk |

| |P.O. Box 34581 |

| |Seattle, WA 98121-0581 |

|Delivery time : |10 Calendar Days |

|Payment terms: |Net 30 Days |

|Shipping destination: |FOB destination |

Group Health Occupational Price Sheet 10/1/15

Trooper Cadet

Comprehensive Physical Exam $175.00

Physician’s Interpretation

Medical report

File prep and storage of records

Transcribing and Editing Included

Lab Panel (per contract) $75.00

Routine Venipuncture $7.00

Drug and Alcohol Screen $26.00

Audiogram (puretone air) $36.00

Pulmonary Function Test (Spirometry) $76.00

EKG $30.00

EKG Interpretation $31.00

Total $456.00

Ancillary Trooper Cadet

Stress Treadmill with EKG (pre-approval by WSP required) $174.00

Chest X-ray 2 views with interpretation $93

Lead Blood Test $52 (done if the Cadet has a history of military service or regular firearms usage.)

Zinc protoporphyrin/heme ratio $62 (done if the Cadet has a history of military service or regular firearms usage.)

X ray thoracic 1 view $72

X ray lumbar 1 view $72

Supplemental report $137/15 min (pre-approval needed if more than one hour)

CVEO

Comprehensive Physical Exam $175.00

Physician’s Interpretation

Medical report

File prep and storage of records

Transcribing and Editing Included

Lab Panel (per contract) $75.00

Routine Venipuncture $7.00

Drug and Alcohol Screen $26.00

Audiogram (puretone air) $36.00

Pulmonary Function Test (Spirometry) $76.00

EKG $30.00

EKG Interpretation $31.00

Total $456.00

Ancillary CVEO

Stress Treadmill with EKG (pre-approval required by WSP) $174.00

X-ray 2 views with interpretation $93

Lead Blood Test $52 (done if the CVEO has a history of military service or regular firearms usage.)

Zinc protoporphyrin/heme ratio $62 (done if the CVEO has a history of military service or regular firearms usage.)

X ray thoracic 1 view $72

X ray lumbar 1 view $72

Supplemental report $137/15 min (pre- approval if over one hour)

Promotional Physical

Comprehensive Physical Exam $175.00

Physician’s Interpretation

Medical report

File prep and storage of records

Transcribing and Editing Included

Lab Panel (per contract) $75.00

Routine Venipuncture $7.00

Total $257.00

Ancillary Promotional Physical

Supplemental Report $137/15 min (pre-approval needed if more than one hour)

SWAT Annual

Comprehensive Physical Exam $175.00

Physician’s Interpretation

Medical report

File prep and storage of records

Transcribing and Editing Included

Lab Panel (per contract) $75.00

Routine Venipuncture $7.00

Audiogram (puretone air) $36.00

Pulmonary Function Test (Spirometry) $76.00

EKG $30.00

EKG Interpretation $31.00

X-ray - Chest 2 views $93.00

TB-Testing/read $24.00

Respiratory questionnaire $40.00

Urinalysis lab $9.00

Total $596.00

Ancillary SWAT

UA microscopic (if UA positive) $12.00

Culture, bacteria urine $34.00

Stress EKG (pre-approval required by WSP) $174.00

Supplemental report $137/15 min (pre-approval needed if more than one hour)

SWAT EXIT- FULL

Comprehensive Physical Exam $175.00

Physician’s Interpretation

Medical report

File prep and storage of records

Transcribing and Editing Included

Lab Panel (per contract) $75.00

Routine Venipuncture $7.00

Audiogram (puretone air) $36.00

Pulmonary Function Test (Spirometry) $76.00

EKG $30.00

EKG Interpretation $31.00

X-ray - Chest 2 views $93.00

TB-Testing/read $24.00

Respiratory questionnaire $40.00

Urinalysis lab $9.00

Lead, Blood $52.00

Zinc protoporphyrin/heme ratio $62

Exit Exam total $710.00

Ancillary SWAT

UA microscopic (if UA positive) $12.00

Culture, bacteria urine $34.00

Stress EKG (pre-approval required by WSP) $174.00

Supplemental report $137/15 min (pre-approval needed if more than one hour)

SWAT EXIT PARTIAL

Lead, Blood $52.00

Zinc protoporphyrin/heme ratio $62

Routine Venipuncture $7.00

Total $121

BOMB

Comprehensive Physical Exam $175.00

Physician’s Interpretation

Medical report

File prep and storage of records

Transcribing and Editing Included

Lab Panel (per contract) $75.00

Urinalysis lab $9.00

Routine Venipuncture $7.00

Audiogram (puretone air) $36.00

Pulmonary Function Test (Spirometry) $76.00

EKG $30.00

EKG Interpretation $31.00

TB – Test/Read $24.00

Respiratory questionnaire $40.00

Total $503.00

Ancillary Bomb

U/A Microscopic (if UA Abnormal) $12.00

Culture, bacteria urine (if UA micro is positive) $34.00

Chest X ray 2 view $93.00

Supplemental report $137/15 min (pre-approval needed if over one hour)

Respiratory Clearance- Non WSP

Respiratory questionnaire $40.00

Ancillary Respiratory- Non WSP

Moderate Physical Exam $120.00

Pulmonary Function Test $76.00

Chest x-ray 1 view $71.00

EKG $30.00

EKG Interpretation $31.00

Total $328.00

Fit For Duty

Fit for Duty 1 Physician Panel                                       $595

Fit for Duty 2 Physician Panel                                       $1.090

Fit for Duty 3 Physician Panel                        $1,585

Fit for Duty 1 Physician Panel W/Psych                      $1,050

Fit for Duty 2 Physician Panel W/Psych                     $1,585

Fit for Duty 3 Physician Panel W/Psych                    $2,040

• Exams requiring TB skin test will not meet the required timeframe to submit results due to the TB skin test read is 3 business days after the initial skin test. No exams can be scheduled on a Thursday that includes the TB skin test.

Examination Site Locations

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