Bid Invitation (11)029
Physical & Health Assessments
Issue Date:8/3/2021
Questions Deadline:8/6/2021 05:00 PM (CT)
Response Deadline:8/13/2021 11:00 AM (CT)
Denton - Purchasing
Contact Information
Contact:Ginny Brummett
Address:Buyer
901-B Texas Street
Denton, TX 76209
Phone:(940) 349-7100 x7226
Email:ginny.brummett@cityofdenton.com
Page 1 of 8 pages Deadline: 8/13/2021 11:00 AM (CT)029
Event Information
Number:029
Title:Physical & Health Assessments
Type:Informal Request for Quote
Issue Date:8/3/2021
Question Deadline:8/6/2021 05:00 PM (CT)
Response Deadline:8/13/2021 11:00 AM (CT)
Notes:The City of Denton (the City) is requesting quotes with an individual or business with
considerable experience in providing Physical and Health Assessments.
The awarded individual or business shall possess a proven track record of using
innovative approaches to providing goods and services that represent the best value
to their clients. The awarded individual or business shall have the ability to
accomplish all aspects of the requested services. The selected individual or firm
should be able to provide innovative methods to deal with municipal challenges, and
cost effective solutions.
Billing Information
Contact:City of Denton
Address:Accounts Payable
215 E McKinney St
Denton, TX 76201-4299
Bid Attachments
IRQ 029 Physical and Health Assessments Scope of Work.pdf Download
Physical and Health Assessments Scope of Work
Conflict_of_Interest_Questionaire.docx Download
Conflict of Interest Questionnaire
TCOLE L2 and L3 rules.pdf Download
TCOLE L2 and L3 rules
Requested Attachments
Conflict of Interest Questionnaire
(Attachment required)
The individual or business must disclose any business relationship that would have an effect, of a conflict of interest.
Please attach a signed copy of the conflict of interest questionnaire.
Invoice sample
(Attachment required)
Page 2 of 8 pages Deadline: 8/13/2021 11:00 AM (CT)029
Bid Attributes
1 Firm's Legal Name
(Required: Maximum 1000 characters allowed)
2 Address Line 1
(Required: Maximum 1000 characters allowed)
3 Address Line 2
(Optional: Maximum 1000 characters allowed)
4 City
(Required: Maximum 1000 characters allowed)
5 State
(Optional: Maximum 1000 characters allowed)
6 Zip Code
(Required: Numbers only)
7 Agent Authorized to sign contract
The agents name and email who is authorized to sign the contract
(Required: Maximum 1000 characters allowed)
8 Subsidiary of:
(Optional: Maximum 1000 characters allowed)
Page 3 of 8 pages Deadline: 8/13/2021 11:00 AM (CT)029
9 Organization Class
Partnership Corporation Individual Association
(Required: Check only one)
1
0
Tax Payer ID
(Required: Maximum 1000 characters allowed)
1
1
Date Established
__ __ / __ __ / __ __ __ __
(Required)
1
2
Historically Underutilized Business
Yes, We are a registered HUB.
(Optional: Check if applicable)
1
3
Please provide a detailed listing of all products and/or services that your company provides.
(Required: Maximum 4000 characters allowed)
1
4
Invoices
A. The Contractor shall submit separate invoices in duplicate on each purchase order or purchase release after
each delivery. If partial shipments or deliveries are authorized by the City, a separate invoice must be sent for each
shipment or delivery made.
B. Proper Invoices must include a unique invoice number, the purchase order or delivery order number and the
master agreement number if applicable, the Department’s Name, and the name of the point of contact for the
Department. Invoices shall be itemized and transportation charges, if any, shall be listed separately. A
copy of the bill of lading and the freight waybill, when applicable, shall be attached to the invoice. The Contractor’s
name, remittance address and, if applicable, the tax identification number on the invoice must exactly match the
information in the Vendor’s registration with the City. Unless otherwise instructed in writing, the City may rely on the
remittance address specified on the Contractor’s invoice.
C. Invoices for labor shall include a copy of all time-sheets with trade labor rate and deliverables order number
clearly identified. Invoices shall also include a tabulation of work-hours at the appropriate rates and grouped by
work order number. Time billed for labor shall be limited to hours actually worked at the work site.
D. Unless otherwise expressly authorized in the Contract, the Contractor shall pass through all Subcontract and
other authorized expenses at actual cost without markup.
E. Federal excise taxes, State taxes, or City sales taxes must not be included in the invoiced amount. The City will
furnish a tax exemption certificate upon request.
A sample invoice must be submitted with this IRQ.
Acknowledge
(Required: Check if applicable)
Page 4 of 8 pages Deadline: 8/13/2021 11:00 AM (CT)029
1
5
Has your company filed or been named in any litigation involving your company and the Owner on a
contract within the last five years under your current company name or any other company name?
If so provide details of the issues and resolution if available. Include lawsuits where Owner was involved. (Notice:
Failure to disclose this information during proposal submission, and later discovered, may result in contract
termination at the Owner’s option.)
(Optional: Maximum 4000 characters allowed)
1
6
Have you ever defaulted on or failed to complete a contract under your current company name or any
other company name? If so, where and why? Give name and telephone number of Owner.
(Required: Maximum 4000 characters allowed)
1
7
Have you ever had a contract terminated by the Owner? If so, where and why? Give name and
telephone number (s) of Owner (s).
(Required: Maximum 4000 characters allowed)
1
8
Has your company implemented an Employee Health and Safety Program compliant with 29 CFR 1910
“General Industry Standards” and/or 29 CFR 1926 “General Construction Standards” as they apply to
your Company’s customary activities?
http://www.osha.gov/pls/oshaweb/owasrch.search_form?
p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1926
(Required: Maximum 4000 characters allowed)
Page 5 of 8 pages Deadline: 8/13/2021 11:00 AM (CT)029
1
9
Resident/Non-Resident Bidder Determination
Texas Government Code Section 2252.002: Non-resident bidders. Texas law prohibits cities and other
governmental units from awarding contracts to a non-resident firm unless the amount of such a bid is lower than the
lowest bid by a Texas resident by the amount the Texas resident would be required to underbid in the non-resident
bidders’ state. In order to make this determination, please provide the name, address and phone number of:
a. Responding firms principle place of business:
b. Company's majority owner principal place of business
c. Ultimate Parent Company's principle place of business
(Required: Maximum 4000 characters allowed)
2
0
Prohibition on Contracts with Companies Boycotting Israel
Pursuant to Section 2270.002 of the Texas Government Code, Respondent certifies that either (i) it meets an
exemption criteria under Section 2270.002; or (ii) it does not boycott Israel and will not boycott Israel during the term
of the contract resulting from this solicitation. Respondent shall state any facts and provide documentation that
make it exempt from the boycott certification in its Response.
Exemption criteria includes the following:
1. Company is a sole proprietorship;
2. Company employs less than 10 full-time employees;
3. Value of the contract is less than $100,000
“Boycott Israel” is defined to mean refusing to deal with, terminating business activities with, or otherwise taking any
action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or
with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action
made for ordinary business purposes. “Company” is defined to mean a for-profit sole proprietorship, organization,
association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability
company, including a wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of those
entities or business associations that exists to make a profit.
Sole proprietorship Employs less than 10 Full time employees
Value of the contract is less than $100,000 Does not Boycott Israel
(Required: Check only one)
Bid Lines
1 PHYSICAL ASSESSMENT SERVICES
(Line excluded from response total)
2 Pre-Employment Physical Assessment
Total Price:$Total:$
Item Notes:Pricing shall be based per examinee and to include cost of all services and
deliverable as outlined within the Scope of Work. No bid
Page 6 of 8 pages Deadline: 8/13/2021 11:00 AM (CT)029
3 Annual Physical Assessment
Total Price:$Total:$
Item Notes:Pricing shall be based per examinee and to include cost of all services and
deliverable as outlined within the Scope of Work. No bid
4 Pre-Employment Drug Screen Assessment
Total Price:$Total:$
Item Notes:Pricing shall be based per examinee and to include cost of all services and
deliverable as outlined within the Scope of Work. No bid
5 ADDITIONAL SERVICES
(Line excluded from response total)
6 X-Ray
(Response required)
Quantity:1 UOM:EA Price:$Total:$
Item Notes:Pricing shall be based per examinee and to include cost of all services
and deliverable as outlined within the Scope of Work.
Supplier Notes:
No bid
Additional notes
(Attach separate sheet)
7 Tuberculosis testing
(Response required)
Quantity:1 UOM:EA Price:$Total:$
Item Notes:Pricing shall be based per examinee and to include cost of all services
and deliverable as outlined within the Scope of Work.
Supplier Notes:
No bid
Additional notes
(Attach separate sheet)
Page 7 of 8 pages Deadline: 8/13/2021 11:00 AM (CT)029
Supplier Information
Company Name:
Contact Name:
Address:
Phone:
Fax:
Email:
Supplier Notes
By submitting your response, you certify that you are authorized to represent and bind your company.
Print Name Signature
Page 8 of 8 pages Deadline: 8/13/2021 11:00 AM (CT)029