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EXHIBIT B <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS FOR MEDICAL SERVICES REVIEW PROGRAM <br />SAMPLE AGREEMENT <br />THIS AGREEMENT, made and entered into this day of 2018 by and between <br />NAME, a professional corporation (hereinafter "Consultant"), and the City of Santa Ana, a charter city and <br />municipal corporation organized and existing under the Constitution and laws of the State of California <br />(hereinafter "City"). 1 1 <br />RECITALS <br />A. The City desires to retain a medical consultant having special skill, knowledge and expertise in the field <br />of medical services to provide a fully comprehensive and legally -defensible medical services review <br />program as an essential part of the City's objective to provide and maintain a qualified work force. <br />B. Consultant represents that Consultant is able and willing to provide such services to the City. <br />C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its <br />field and that any services performed by Consultant under this Agreement will be performed in <br />compliance with such standards as may reasonably be expected from a professional consulting firm in <br />the field. <br />NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and <br />conditions hereinafter set forth, the parties agree as follows: <br />SCOPE OF SERVICES <br />Consultant shall organize, schedule, manage, and/or evaluate a comprehensive range of medical <br />services and examinations, including but not limited to: <br />A. For prospective and current City employees to perform the duties of the position for which they are <br />being considered (pre-employment assessments), using pre -determined medical protocols for each <br />job classification; such protocols may be modified by the physician, in consultation with the City's <br />Executive Director of the Human Resources Department, or his/her designee, as is necessary to <br />make a determination as to suitability for employment; <br />B. For current City employees being considered for employment in Department of Transportation (DOT) <br />and non -DOT positions requiring pre -placement or pre -assignment drug screens; <br />C. Return -to -work and Fitness for Duty examinations (industrial and non -industrial), and provide reports <br />and recommendations regarding the suitability of current employees to continue to perform their <br />duties; <br />D. Urine and breath specimen collection, appropriate chain of custody protocol, laboratory analysis and <br />Medical Review Officer (MRO) responsibilities; <br />E. Department of Motor Vehicles (DMV) Commercial Classification Driver's License physical <br />examinations; <br />F. DOT -mandated drug and alcohol testing of employees considered 'safety sensitive' as defined under <br />DOT regulations and City policy. Consultant shall ensure all such testing complies with DOT testing <br />procedures as per 49 CFR, Part 40; such testing to include pre-employment, pre -assignment and <br />random screening. <br />City shall be responsible for the organization, scheduling, and management of DOT and non -DOT "reasonable <br />City of Santa Ana Human Resources Department <br />RFP for Medical Services Review—August 27, 2018 <br />2'8E118 <br />