2025 Bid Form.docx
DOCX document 21 KB Posted
- Solicitation number
- SRC0000019823
- Issued by
- Ohio
About this file
This document is a bid form for the Ohio Air National Guard Firefighter Medical Evaluations project. The Adjutant General's Department of the State of Ohio is seeking a professional medical organization to provide candidate firefighter and member firefighter annual medical evaluations for Mansfield, Toledo, and Rickenbacker Air National Guard Bases. The evaluations will be conducted in accordance with the National Fire Protection Association (NFPA) 1582-2022 edition and the associated U.S. Air Force Technical Implementation Guide 1582 2022 edition. The required services include comprehensive physical exams, lab tests, imaging, and other assessments as outlined in the 17 line items on the bid form.
The bid form provides unit prices and total amounts for the various medical evaluation components, including blood tests, hearing exams, pulmonary function tests, electrocardiograms, immunizations, and a written report. Bidders must also provide pricing for respirator fit testing and PFOS/PFOA testing. The total bid amount is to be provided, and the contract term is not specified.
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Text version
STATE OF OHIO
ADJUTANT GENERAL'S DEPARTMENT
ATTN: DIMR-PC
2825 WEST DUBLIN GRANVILLE ROAD
COLUMBUS, OHIO 43235-2789
BID FORM
Project Title: Ohio Air National Guard Firefighter Medical Evaluations
Location: One service location for Rickenbacker ANGB Columbus Ohio, Mansfield ANGB Mansfield Ohio and Toledo ANGB Swanton Ohio
Bid Submitted by:
Having read and examined the Specifications, prepared by the State of Ohio, Adjutant General’s Department, 2825 West Dublin Granville Road, Columbus, Ohio 43235 for the above-referenced Project, and the following Addenda:
Addendum No. Date of Receipt
The undersigned proposes to perform all work in accordance with the Specification entitled "Ohio Air National Guard Firefighter Medical Evaluations ", for the following sums:
Base Bid:
1. Blood test (cmpl metabolic panel with lipid and cbc) $ x 102 = $ _
2. Alanine (alanine aminotransferase lab draw if not in cbc) $ x 102 = $
3. Urine Lab (complete urinalysis) $ x 102 = $
4. Audiogram (hearing exam) $ x 102 = $
5. Spirometry (pulmonary function test) $ x 102 = $
6. Chest Radiographs (2 view chest x-ray) $ x 3 = $
7. Electrocardiograms (resting EKG) $ x 3 = $
8. Exercise/Treadmill/EKG $ x 102 = $
9. Immunizations (TB test via T-spot) $ x 3 = $
10. TDAP (tetanus diphtheria pertussis immunization) $ x 3 = $
11. Hop B Titer (immunization) $ x 3 = $
12. Medical Evaluation (comprehensive physical exam) $ x 102 = $
13. Written report (dictated letter provided by physician) $ x 102 = $
14. Respirator Q (questionnaire form reviewed by MD) $ x 102 = $
15. Return to Work Exam (15 minute increments) $ x 32 increments (8 exams) =$ One (1) Hour Exam based on 15-minute increments.
16. Respirator Fit Testing (Quantitative) $____________ per test to include:
| Fee includes education on donning and doffing the respirator, care and maintenance, and successful | completion of the fit test. |
| Employee must bring his/her respirator. | |
| Employee being fit tested must be clean shaven. | |
| Employee must not have smoked a minimum of 30 minutes prior to being fit tested. | |
| Fit testing is performed at all WorkHealth Center | |
| If an individual has the need to be fitted for more than one mask, each additional fit is $__________. | |
| Each fit test takes approximately 15-20 minutes. |
17. PFOS/PFOA testing per lab draw $______________ This is a baseline blood test that includes:
(1) Perfluorobutanesulfonic acid
(2) Perfluoroheptanoic acid
(3) Perfluorohexanesulfonic acid
(4) Perfluoronanoic acid
(5) Perfluorooctane sulfonate
(6) Perfluorooctanoic acid
Total Amount $___________________
Sum In Words
File details come from the government source that posted it. Updated .