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Submitted URL: https://app.pandadoc.com/document/a5a66811cb4a8528887cc66b663bda2d0ade57d3
Effective URL: https://app.pandadoc.com/p/a5a66811cb4a8528887cc66b663bda2d0ade57d3
Submission: On April 27 via manual from US — Scanned from DE
Effective URL: https://app.pandadoc.com/p/a5a66811cb4a8528887cc66b663bda2d0ade57d3
Submission: On April 27 via manual from US — Scanned from DE
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Öffnet in einem neuen Fenster Öffnet eine externe Website Öffnet eine externe Website in einem neuen Fenster <!---->Schließen Sie diesen Dialog<!----> Auf dieser Website werden Daten wie Cookies gespeichert, um wichtige Funktionen der Website sowie Marketing, Personalisierung und Analyse zu ermöglichen. Sie können Ihre Einstellungen jederzeit ändern oder die Standardeinstellungen übernehmen. Sie können dieses Banner schließen, um nur mit essenziellen Cookies fortzufahren. Datenschutzerklärung Einstellungen verwalten Alle akzeptieren Alles ablehnen <!---->Schließen Sie die Cookie-Einstellungen<!----> RevisionsCreated with Sketch.ImgReviewCreated with Sketch. COVID-19 Testing Options- OXY BY KAILEY HENDERSON EXPIRES ON APR 27, 2022 KH KS +6 Other actions Please fill in 2 required fields. Start 1 of 1 document COVID-19 Testing Options * OXY Chemical Prepared for: Dr. Marina Mathew Chief Medical Officer OXY Chemical marina_mathew@oxy.com Prepared by: Kailey Henderson Regional Sales Manager Prime Occupational Medicine hendersonk@primeoccmed.com COVID-19 OSHA Mandate Testing Program Company: OXY Chemical Attention: Dr. Marina Mathew Prime Occupational Medicine 15481 Airline Hwy Baton Rouge, LA 70817 Prime Occupational Medicine is prepared to provide this proposal for Covid-19 support services, in response to the COVID-19 Action Plan recently announced by the White House administration. The Occupational Safety and Health Administration (OSHA) will be issuing an Emergency Temporary Standard (ETS) that requires vaccination or weekly testing. The new standard will apply to all private sector employers with more than 100 employees. Upon successful execution, Prime Occupational Medicine shall furnish and supply OXY Chemical with the following: Option #1 (Supply Only) * Supply Rapid Antigen Testing Kit(s) - Testing facilitated by employer or employee self-administration Option #2 (On-Site) * Supply Rapid Antigen Testing Kits(s) * Provide Medical Tech to administer test(s) * Perform On-Site administration of test(s) Option #3 (In-Clinic) * Supply Rapid Antigen Testing Kits(s) * Provide "In-Clinic" administration of test(s) * Data-Management - Electronic delivery, storage and maintenance of records. Note*: For service requests of PRIME medical staff to administer testing onsite, OXY Chemicalwill be subject to additional fees as illustrated in the on-site pricing index below. Due to the high demand of COVID-19 services, Prime will not begin dispensing testing options until an executed purchase order has been issued and is received. Thank you for your interest in PRIME's services. If you would like more information regarding this quote or additional services provided by PRIME, please direct your questions to the following contact: Kailey Henderson Regional Sales Manager 713.725.5319 hendersonk@primeoccmed.com Administrative Office: 15481 Airline Highway Baton Rouge, Louisiana 70817 | 225.408.5902 | Clinics: 225.749.5750 www.primeoccmed.com PDF page break EXHIBIT A OSHA COVID-19 BUNDLE OPTION PRICE SUMMARY Service Description Unit Cost OSHA Covid-19 Individual Test Kit - per test (1) FDA-EUA Approved Rapid Antigen Test Kit $39.00 Shipping *To be billed at cost(s) ON-SITE SERVICES OPTION PRICE SUMMARY Service Description Unit Cost On-site Setup $75.00 Medical Technician Hourly Rate 7:30am - 4:29pm (Monday - Friday) Four (4) Hour Minimum Required $35.00 Medical Technician - After Hours - Hourly Rate 4:30pm - 7:29am (Monday - Friday) 24 Hours per day on Weekends & Holidays Minimum of four (4) hours per shift required, per medical technician - Mileage and per diem will be charged at the current GSA rates for any technician traveling 50 miles or more from the location of the site. $52.50 Fuel Surcharge-Small Unit (per mile) Calculated by distance from nearest Prime clinic location. $0.65 OSHA Covid-19 Individual Test Kit - per test (1) FDA-EUA Approved Rapid Antigen Test Kit $29.00 To bring a Mobile Testing Unit On-Site If Needed Mobile Unit Daily Rate Fee $150.00 Fuel Surcharge-Mobile Unit (per mile) Calculated by distance from nearest Prime clinic location. $2.00 Administrative Office: 15481 Airline Highway Baton Rouge, Louisiana 70817 | 225.408.5902 | Clinics: 225.749.5750 www.primeoccmed.com In-Clinic Option Price Summary 4404 North Main Street Baytown, TX, 77521 Clinical Testing Unit Cost OSHA Covid-19 Individual Test Kit w/ Data Management - per visit (1) FDA-EUA Approved Rapid Antigen Test Kit Electronic delivery, storage and maintenance of records $34.00 PCR COVID-19 Lab Test $100.00 Telemedicine Return to Work Fees Price Per Call Telemedicine RTW Fee 7:30a-4:30p $95.00 Telemedicine- RTW Afterhours Fee $195.00 ACCEPTANCE: By providing my signature below, I verify that I accept the pricing and terms set forth in this agreement. ______________________________ _______________ Authorized Company Representative Date Date Signature Administrative Office: 15481 Airline Highway Baton Rouge, Louisiana 70817 | 225.408.5902 | Clinics: 225.749.5750 www.primeoccmed.com Download latest revision All revisions uploaded back into PandaDoc are stored here to view and download. 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