Pulp Log Purchasing Contract by hje12949


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									   HARRIS COUNTY
REQUEST FOR PROPOSAL                                                                JOB #01/0093
                                                                          Date Due: Tuesday, April 17, 2001
      Cover Sheet                                                         DUE NO LATER THAN 1:00 P.M.

                                                                        Proposals received later than the date
                                                                        and time above will not be considered.

                                 OPERATION of DENTAL FACILITIES
                                  for Harris County Hospital District’s
                                      Community Health Program

                                             OFFERORS NOTE!!
Carefully read all instructions, requirements and                 Please return proposal in the envelope provided or in a
specifications.  Fill out all forms properly and                  comparable size envelope. Be sure that return envelope
completely. Submit your proposal with all appropriate             shows the Job Number, Description and is marked
supplements and/or samples.                                       "SEALED PROPOSAL."

                                           RETURN PROPOSAL TO:
                                   HARRIS COUNTY PURCHASING AGENT
                                     1001 PRESTON AVENUE, SUITE 670
                                           HOUSTON, TEXAS 77002

   For additional information, contact Dan Thweatt at 713.755.5982 or Don Wilson at 713.755.5898.

   You must sign below in INK; failure to sign WILL disqualify the offer. All prices must be typewritten or
   written in ink.
                      Total Amount of Proposal: $____________________________

   Company Name:          _________________________________________________________
   Company Address:       _________________________________________________________
   Taxpayer Identification Number (T.I.N.): _____________________________________

   Telephone No. ________________            FAX No. ________________ E-Mail: ______________________

   Print Name: ____________________________________________________________________

   Signature: ______________________________________________________________________

   [Your signature attests to your offer to provide the goods and/or services in this proposal according to the published
   provisions of this Job. When an award letter is issued, it becomes a part of this contract. Contract is not valid until
   Purchase Order is issued.]

                                                                                                                  Page 1 of 33
                                                TABLE OF CONTENTS
Items checked below represent components which comprise this bid/proposal package. If the item IS NOT checked, it is NOT
APPLICABLE to this bid/proposal. Offerors are asked to review the package to be sure that all applicable parts are included. If
any portion of the package is missing, notify the Purchasing Department immediately.

It is the Offeror's responsibility to be thoroughly familiar with all Requirements and Specifications. Be sure you understand the
following before you return your bid packet.

__X__ 1.          Cover Sheet
                  Your company name, address, the total amount of the bid/proposal, and your signature (IN INK) should appear
                  on this page.

__X__ 2.          Table of Contents
                  This page is the Table of Contents.

__X__ 3.          General Requirements
                  You should be familiar with all of the General Requirements.

__X__ 4.          Special Requirements/Instructions
                  This section provides information you must know in order to make an offer properly.

__X__ 5.          Specifications
                  This section contains the detailed description of the product/service sought by the County.

__X__ 6.          Pricing/Delivery Information
                  This form is used to solicit exact pricing of goods/services and delivery costs.

__X__ 7.          Attachments
                  __X__ a.           Residence Certification
                                     Be sure to complete this form and return with packet.

                  _____    b.        Bid Guaranty & Performance Bond Information & Requirements
                                     This form applies only to certain bids/proposals. Please read carefully and fill out

                  _____    c.        Bid Check Return Authorization Form
                                     This form applies only to certain forms. Please read carefully and fill out completely.

                  _____    d.        Vehicle Delivery Instructions
                                     Included only when purchasing vehicles.

                  __X__ e.           Minimum Insurance Requirements
                                     Included when applicable (does not supersede "Hold Harmless" section of General

                  __X__ f.           Workers' Compensation Insurance Coverage Rule 110.110
                                     This requirement is applicable for a building or construction contract.

                  _____    g.        Financial Statement
                                     When this information is required, you must use this form.

                  _____    h.        Reference Sheet

                  __X__ i.           Other
                                     From time to time other attachments may be included.
Revised 09/00
                                       GENERAL REQUIREMENTS
                                                                                                                      Page 2 of 33
                                                 FOR PROPOSALS


General Requirements apply to all advertised requests for proposals; however, these may be superseded, whole or in part, by
Contents. Be sure your proposal package is complete.

This request for proposals is governed by the competitive bidding requirements of the County Purchasing Act, Texas Local
Government Code, §262.021 et seq., as amended. Offerors shall comply with all applicable federal, state and local laws and
regulations. Offeror is further advised that these requirements shall be fully governed by the laws of the State of Texas and
that Harris County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County
Attorney concerning any portion of these requirements.

Fill out and return to Purchasing, ONE (1) complete proposal form, using the envelope provided. An authorized company
representative should sign the Cover Sheet. Completion of these forms is intended to verify that the offeror has submitted the
proposal, is familiar with its contents and has submitted the material in accordance with all requirements.

Offerors must return all completed proposals to the office of the Harris County Purchasing Agent reception desk at 1001
Preston Avenue, Suite 670, Houston, Texas before 1:00 P.M. on the date specified. Late proposals will not be accepted.

In the event of any conflict between the terms and provisions of these requirements and the specifications, the specifications
shall govern. In the event of any conflict of interpretation of any part of this overall document, Harris County's interpretation
shall govern.

When specifications are revised, the Harris County Purchasing Agent will issue an addendum addressing the nature of the
change. Offerors must sign it and include it in the returned proposal package.

Contractor, the successful offeror, shall indemnify and hold Harris County harmless from all claims for personal injury, death
and/or property damage resulting directly or indirectly from contractor's performance. Contractor shall procure and maintain,
with respect to the subject matter of this proposal, appropriate insurance coverage including, as a minimum, public liability
and property damage with adequate limits to cover contractor's liability as may arise directly or indirectly from work
performed under terms of this proposal. Certification of such coverage must be provided to the County upon request.

Offeror and offeror's insurance carrier waive any and all rights whatsoever with regard to subrogation against Harris County
as an indirect party to any suit arising out of personal or property damages resulting from offeror's performance under this

If any section, subsection, paragraph, sentence, clause, phrase or word of these requirements or the specifications shall be held
invalid, such holding shall not affect the remaining portions of these requirements and the specifications and it is hereby
declared that such remaining portions would have been included in these requirements and the specifications as though the
invalid portion had been omitted.

If this proposal requires submission of proposal guarantee and performance bond, there will be a separate page explaining
those requirements. Offers submitted without the required proposal bond or Cashier's Check are not acceptable.

                                                                                                                   Page 3 of 33
Harris County is exempt from all federal excise, state and local taxes unless otherwise stated in this document. Harris County
claims exemption from all sales and/or use taxes under Texas Tax Code §151.309, as amended. Texas Limited Sales Tax
Exemption Certificates will be furnished upon written request to the Harris County Purchasing Agent.

A multi-year lease or lease/purchase arrangement (if requested by the specifications), or any contract continuing as a result of
an extension option, must include fiscal funding out. If, for any reason, funds are not appropriated to continue the lease or
contract, said lease or contract shall become null and void on the last day of the current appropriation of funds. After
expiration of the lease, leased equipment shall be removed by the contractor from the using department without penalty of any
kind or form to Harris County. All charges and physical activity related to delivery, installation, removal and redelivery shall
be the responsibility of the offeror.

Prices for all goods and/or services shall be negotiated to a firm amount for the duration of this contract or as agreed to in
terms of time frame. All prices must be written in ink or typewritten. Where unit pricing and extended pricing differ, unit
pricing prevails.

The apparent silence of specifications as to any detail, or the apparent omission from it of a detailed description concerning
any point, shall be regarded as meaning that only the best commercial practice is to prevail and that only material and
workmanship of the finest quality are to be used. All interpretations of specifications shall be made on the basis of this
statement. The items furnished under this contract shall be new, unused of the latest product in production to commercial
trade and shall be of the highest quality as to materials used and workmanship. Manufacturer furnishing these items shall be
experienced in design and construction of such items and shall be an established supplier of the item proposed.

Offerors are responsible for including all pertinent product data in the returned proposal package. Literature, brochures, data
sheets, specification information, completed forms requested as part of the proposal package and any other facts which may
affect the evaluation and subsequent contract award should be included. Materials such as legal documents and contractual
agreements, which the offeror wishes to include as a condition of the proposal, must also be in the returned proposal package.
Failure to include all necessary and proper supplemental materials may be cause to reject the entire proposal.

Under the "Hazardous Communication Act", commonly known as the "Texas Right To Know Act", an offeror must provide
to the County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act.
Failure of the offeror to furnish this documentation will be cause to reject any bid applying thereto.

Evaluation shall be used as a determinant as to which proposed items or services are the most efficient and/or most
economical for the County. It shall be based on all factors which have a bearing on price and performance of the items in the
user environment. All proposals are subject to negotiations by the Purchasing Agent and other appropriate departments, with
recommendation to Commissioners Court. Compliance with all requirements, delivery and needs of the using department are
considerations in evaluating proposals. Pricing is NOT the only criteria for making a recommendation. A preliminary
evaluation by Harris County will be held and appropriate proposals will be subjected to the negotiating process. Upon
completion of the negotiations, Harris County will make an award. All proposals that have been submitted shall be available
and open for public inspection after the contract is awarded except for trade secrets or confidential information contained in
the proposals and identified as such.

Harris County reserves the right to inspect any item(s) or service location for compliance with specifications and requirements
and needs of the using department. If an offeror cannot furnish a sample of a proposed item, where applicable, for review, or
fails to satisfactorily show an ability to perform, the County can reject the offer as inadequate.


                                                                                                                  Page 4 of 33
Harris County reserves the right to test equipment, supplies, material and goods proposed for quality, compliance with
specifications and ability to meet the needs of the user. Demonstration units must be available for review. Should the goods
or services fail to meet requirements and/or be unavailable for evaluation, the offer is subject to rejection.

Upon signing this proposal document, an offeror offering to sell supplies, materials, services, or equipment to Harris County
certifies that the offeror has not violated the antitrust laws of this state codified in §15.01, et seq., Business & Commerce
Code, or the federal antitrust laws, and has not communicated directly or indirectly the offer made to any competitor or any
other person engaged in such line of business. Any or all proposals may be rejected if the County believes that collusion
exists among the offerors. Proposals in which the prices are obviously unbalanced may be rejected. If multiple proposals are
submitted by an offeror and after the proposals are opened, one of the proposals is withdrawn, the result will be that all of the
proposals submitted by that offeror will be withdrawn; however, nothing herein prohibits a vendor from submitting multiple
offers for different products or services.

Harris County reserves the right to award this contract on the basis of LOWEST AND BEST OFFER in accordance with the
laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one offeror, to reject any or all
proposals. In the event the lowest dollar offeror meeting specifications is not awarded a contract, the offeror may appear
before the Commissioners Court and present evidence concerning his responsibility after officially notifying the Office of the
Purchasing Agent of his intent to appear.

The successful offeror may not assign, sell or otherwise transfer this contract without written permission of Harris County
Commissioners Court.

If the contract is intended to cover a specific time period, the term will be given in the specifications under SCOPE.

Maintenance required for equipment proposed should be available in Harris County by a manufacturer-authorized
maintenance facility. Costs for this service shall be shown on the Pricing/Delivery Information. If Harris County opts to
include maintenance, it shall be so stated in the purchase order and said cost will be included. Service will commence only
upon expiration of applicable warranties and should be priced accordingly.

Harris County Commissioners Court must award the contract and the County Judge or other person authorized by the Harris
County Commissioners Court must sign the contract before it becomes binding on Harris County or the offeror. Department
heads are NOT authorized to sign agreements for Harris County. Binding agreements shall remain in effect until all products
and/or services covered by this purchase have been satisfactorily delivered and accepted.

Title and Risk of Loss of goods shall not pass to Harris County until Harris County actually receives and takes possession of
the goods at the point or points of delivery. Receiving times may vary with the using department. Generally, deliveries may
be made between 8:30 a.m. and 4:00 p.m., Monday through Friday. Offerors are advised to consult the using department for
instructions. The place of delivery shall be shown under the "Special Requirements/Instructions" section of this proposal
and/or on the Purchase Order as a "Deliver To:" address.

Offerors shall furnish all data pertinent to warranties or guarantees which may apply to items in the proposal. Offerors may
not limit or exclude any implied warranties. Offeror warrants that product sold to the County shall conform to the standards
established by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970. In the event product
does not conform to OSHA Standards, where applicable, Harris County may return the product for correction or replacement
at the offeror's expense. If offeror fails to make the appropriate correction within a reasonable time, Harris County may
correct at the offeror's expense.

                                                                                                                   Page 5 of 33
The successful offeror shall not deliver products or provide services without a Harris County Purchase Order, signed by an
authorized agent of the Harris County Purchasing Agent. The fastest, most reasonable delivery time shall be indicated by the
offeror in the proper place on the proposal document. Any special information concerning delivery should also be included,
on a separate sheet, if necessary. All items shall be shipped F.O.B. INSIDE DELIVERY unless otherwise stated in the
specifications. This shall be understood to include bringing merchandise to the appropriate room or place designated by the
using department. Every tender or delivery of goods must fully comply with all provisions of these requirements and the
specifications including time, delivery and quality. Nonconformance shall constitute a breach which must be rectified prior to
expiration of the time for performance. Failure to rectify within the performance period will be considered cause to reject
future deliveries and cancellation of the contract by Harris County without prejudice to other remedies provided by law.
Where delivery times are critical, Harris County reserves the right to award accordingly.

Renewals may be made ONLY by written agreement between Harris County and the offeror. Any price escalations are
limited to those stated by the offeror in the original proposal.

Offerors shall submit an original invoice on each purchase order or purchase release after each delivery, indicating the purchase order
number. Invoices must be itemized. Any invoice which cannot be verified by the contract price and/or is otherwise incorrect, will be
returned to the offeror for correction. Under term contracts, when multiple deliveries and/or services are required, the offeror may
invoice following each delivery and the County will pay on invoice. Contracts providing for a monthly charge will be billed and paid
on a monthly basis only. Prior to any and all payments made for good and/or services provided under this contract, the offeror should
provide his Taxpayer Identification Number or social security number as applicable. This information must be on file with the Harris
County Auditor’s office. Failure to provide this information may result in a delay in payment and/or back-up withholding as required
by the Internal Revenue Service.

Harris County reserves the right to terminate the contract for default if Seller breaches any of the terms therein, including
warranties of offeror or if the offeror becomes insolvent or commits acts of bankruptcy. Such right of termination is in
addition to and not in lieu of any other remedies which Harris County may have in law or equity. Default may be construed
as, but not limited to, failure to deliver the proper goods and/or services within the proper amount of time, and/or to properly
perform any and all services required to Harris County's satisfaction and/or to meet all other obligations and requirements.
Harris County may terminate the contract without cause upon thirty (30) days written notice.

Harris County encourages the use of products made of recycled materials and shall give preference in purchasing to products
made of recycled materials if the products meet applicable specifications as to quantity and quality. Harris County will be the
sole judge in determining product preference application.

If in its response, offeror either electronically scans, re-types, or in some way reproduces the County's published proposal
package, then in the event of any conflict between the terms and provisions of the County's published proposal package, or
any portion thereof, and the terms and provisions of the response made by offeror, the County's proposal package as
published shall control. Furthermore, if an alteration of any kind to the County's published proposal package is only
discovered after the contract is executed and is or is not being performed, the contract is subject to immediate cancellation.

If offeror obtained the specifications on a floppy disk in order to prepare a response, the proposal must be submitted in hard
copy according to the instructions contained in this Request-for-Proposals package. If, in its response, offeror makes any
changes whatsoever to the County's published specifications, the County's specifications as published shall control.
Furthermore, if an alteration of any kind to the County's published specifications is only discovered after the contract is
executed and is or is not being performed, the contract is subject to immediate cancellation.

All products and/or services furnished as part of this contract must be year 2000 compliant. This applies to all computers
including hardware and software as well as all other commodities with date sensitive embedded chips.

Revised 01/00
                                                                                                                         Page 6 of 33

  The following requirements and instructions supersede General Requirements where
  applicable. the term “Harris County” is understood to include the Harris County Hospital
  District (District or HCHD).

                           OPERATION of DENTAL FACILITIES
                            for Harris County Hospital District’s
                                Community Health Program

  1.0 SPECIAL REQUIREMENTS - Vendor Instructions
  Proposals shall be formatted as follows:
  All proposals must be typed on standard 8 1/2 x 11 paper, indexed and placed in a binder or
  folder. One original, clearly marked “original”, and five (5) copies, clearly marked
  “copy”, must be submitted. The complete proposal should be sealed in an envelope or box
  for delivery to the Office of the Harris County Purchasing Agent per instructions in the
  general requirements (see returning the proposal and proposal completion). All documents
  included in the proposal and the outside of the package must be labeled with the vendor's
  name and the job number that corresponds to this RFP.

  Each proposal shall be organized as follows:
    Section 1:     Bid Cover Sheet (completed) and Residency Certificate (completed)
    Section 2:     Pricing
    Section 3:     Any standard agreement(s) and/or contract(s) associated with your response
    Section 4:     Proposer’s listing of references
    Section 5:     Proposer’s Information (License Information, Certifications, etc.)
    Section 6:     Statement of Objectives and Scope as described in subsection 3.3 of this
    Section 7:     “Work Plan and Methodology” as described in subsection 3.4 of this
    Section 8:     “Organization and Staffing” as described in subsection 3.5 of this proposal
    Section 9:     “Budget” as described in subsection 3.6 of this proposal
    Section 10:    “Candidate Profile and Capabilities” as described in subsection 3.7 of
                   this proposal
    Section 11:    “Critical Operational Documents” as described in subsection 3.8 of
                   this porposal

  The proposal response may be incorporated into any contract, which results from this RFP.
  Vendors are cautioned not to make claims or statements to which they are not prepared to
  commit contractually. Failure by the vendor to meet such claims will result in a requirement
  that the vendor provide resources necessary to meet submitted claims.

  The vendor is expected to examine all documents, forms, specifications and instructions.
  Failure to do so will be at vendor’s risk.

                                                                                         Page 7 of 33
Harris County will not be liable for any costs incurred by the vendor in preparing a response
to this RFP. Vendors submit proposals at their own risk and expense. Harris County makes
no guarantee that any product or service will be purchased as a result of this request for
proposal, and reserves the right to reject any and all proposals. All proposals and their
accompanying documents will become the property of Harris County. All proposals are open
to negotiation.

All documents will be held by the County and are NOT subject to public review until an
award is made. Under the Request for Proposal process, sealed offers will be received and
opened in the Office of the Purchasing Agent. At and after opening, proposals will NOT be
part of the public record and subject to disclosure, but will be kept confidential until time of
award. When such award is completed, proposals will be available for public
inspection, including those portions marked confidential and/or proprietary.

All proposals will be examined by an evaluation committee consisting of representatives
from various departments and clinics within Harris County Hospital District as well as
members from Harris County Purchasing. Members may be added as needed.

Proposals which do not conform to the instructions given or which do not address all the
questions and/or services specified may be eliminated from consideration. Harris County,
however, reserves the right to accept such a proposal if it is determined to be in the County’s
best interest to do so.

Harris County may initiate discussions with vendors. Proposals will be accepted during this
period but only from vendors who responded to the original request. Discussions may not
be initiated by vendors. Harris County expects to conduct discussions with vendor
personnel authorized to contractually obligate the vendor with an offer.

Proposals, vendor interviews and/or evaluations will develop into negotiating sessions with
the successful vendor as selected by the evaluation committee. If Harris County is unable to
agree to contract terms, Harris County reserves the right to terminate contact negotiations
with that vendor and initiate negotiations with another vendor.

All correspondence relating to this RFP, from advertisement to award, shall be sent to
the Office of the Harris County Purchasing Agent. All presentations and/or meetings
between Harris County and the vendor relating to this RFP shall be coordinated by the
Office of the Harris County Purchasing Agent. All correspondence, written and/or
verbal, shall be through the Office of the Harris County Purchasing Agent.

Before, during or after award, Harris County will not be obligated to the vendor for products
and/or services until the completion of a signed purchase order from Harris County Hospital
District. Progress toward this end is solely at the discretion of Harris County and may be
terminated at any time prior to the issuance of a purchase order.

Submission of a proposal implies the vendor’s acceptance of the evaluation criteria and
vendor recognition that subjective judgements must be made by the evaluating committee.

                                                                                          Page 8 of 33
Award of the proposal shall be made to the responsible vendor whose proposal is determined
to be the best evaluated offer resulting from negotiations, taking into consideration
compliance with instructions, specifications and quality of the services proposed which best
meet the needs of the using department. Harris County may use references to make
judgements directly affecting the award of this proposal.

                                                                                      Page 9 of 33
                               OPERATION of DENTAL FACILITIES
                                for Harris County Hospital District’s
                                    Community Health Program


Harris County Hospital District invites qualified vendors to submit proposals for the OPERATION
OF DENTAL FACILITIES FOR HCHD. The awarded vendor(s) will have the responsibility of the
staffing of dentists and ancillary personnel (dental assistants, hygienists, etc.) as well as other
obligations as outlined within the RFP to carry on the day to day operations of the dental clinics,
those currently operational as well as those proposed in the future, under the umbrella of the District.
Questions should be directed to the Office of the Harris County Purchasing Agent, Dan Thweatt @
713.755.5982 (E-mail: dan_thweatt@co.harris.tx.us) or Don Wilson @ 713.755.5898 (E-mail:

A bid bond or cashier’s check in the amount of 5% of the total proposal amount will be required with
your submittal.

There will be a PRE-PROPOSAL CONFERENCE on Tuesday, April 10, 2001 at 9:30 a.m. at
the Harris County Hospital District’s Administration Building, 2525 Holly Hall, Board Room,
Houston, Texas 77025. Vendors are STRONGLY URGED TO ATTEND. At the same
conference, site visits will be scheduled for vendors if necessary. Persons with disabilities requiring
special accommodations should contact Dan Thweatt at 713.755.5982 or Don Wilson at
713.755.5898 at least two (2) days prior to the Pre-Proposal Conference or the site visits.


The Harris County Hospital District is a tax-supported public authority providing hospital care and
health services to the general public as well as to qualified medically indigent persons who are legal
residents of Harris County.

   The Hospital District was established as a result of a referendum in 1965 and became operative in
   January 1966. The governing body, the Board of Managers, is composed of nine members appointed
   by Harris County’s Commissioners Court. The District consists of three hospitals and eleven outlying
   Community Health Centers. Ben Taub General Hospital located at 1504 Taub Loop and Lyndon B.
   Johnson located at 5656 Kelley are general hospital facilities. Quentin Mease Community Hospital
   located at 3601 N. MacGregor Way has the primary responsibility for the care of the District’s
   Physical Medicine, Rehabilitation. The Community Health Program Health Centers are strategically
   located throughout Harris County.


                                                                                            Page 10 of 33
       *Acres Home Health Center                   Baytown Health Center
       818 Ringold                                 1602 Garth Road
       Houston, TX                                 Baytown, TX
       Mon – Fri 8:00am – 5:00pm             Mon – Fri 7:30am – 4:00pm

       Casa de Amigos Health Center                 **Dental Center
       1615 North Main                              1612 Fannin
       Houston, TX                                  Houston, TX
       Mon – Fri 7:00am –4:30pm                     Mon – Fri 8:00am – 5:00pm

       E.A. Squatty Lyons Health Center             *Gulfgate Health Center
       1712 First Street                            7550 Office City Drive
       Humble, TX                                   Houston, TX
       Mon – Fri 8:00am –4:30pm                     Mon – Fri 8:00am – 5:00pm

       Martin Luther King Health Center             *People’s Health Center
       3601 North MacGregor Way                     6630 DeMoss
       Houston, TX                                  Houston, TX
       Mon – Fri 8:00am –5:00pm                     Tues – Fri 7:45am – 5:00pm
                                                    Saturday 6:45am – 3:30pm

       *Settegast Health Center                     *Aldine Health Center
       9105 North Wayside                           4755 Aldine Mail Route
       Houston, TX                                  Houston, TX
       Mon – Fri 7:30am – 5:15pm                    Tues – Fri 8:00am – 5:00pm
                                                    Saturday 6:45am – 3:30pm

       *Strawberry Health Center
       927 East Shaw
       Pasadena, TX
       Mon – Fri 7:30am - 4:30pm

*Dental Satellite Sites
** Specialty Service – Oral Surgery, Denture, Emergency Care

In addition to these health centers, the District operates the Thomas Street HIV/AIDS Clinic located
at 2015 Thomas Street.


       1.1    OBJECTIVES
                                                                                          Page 11 of 33
    The District envisions the program to provide access to cost-effective, quality dental care and
    to maximize the accessibility of facilities to the greatest extent possible for the indigent of
    Harris County. Through an agreement, the City of Houston Health Department and the Harris
    County Hospital District maximizes resources by delivering dental care to targeted age

The plan to serve the eligible population of Houston/Harris County, Texas is:

          a. Children and young adults under the age of 16 years are to be referred to the City Health
             Department for dental services. The District will concentrate on patients 16 and older.

          b. Each new patient will be evaluated and prioritized. The dental services delivery system
             employed by the District will provide the patient with appropriate level(s) of care.

          c. Each dental provider is expected to provide care for a minimum of sixteen (16) patients
             per business day.

          d. Operation policies and procedures will be determined through a collaborative effort
             between the Harris County Hospital District and the contractor.

In its effort to insure quality care is rendered to the community, the Harris County Hospital District
will secure an independent auditor to perform an annual utilization review.

                               APPROPRIATE LEVELS OF CARE

                i. Urgent Care
    Urgent Care – that level of care which is required to alleviate acute dental pain and/or
    dental infections which may result in pain. (Examples: Abscessed tooth, acute
    periodontal infection, etc.). Patients will be seen by appointment. Every effort will be
    made to ensure same day availability of urgent appointment slots.

               ii. Episodic Care
    Episodic Care – that level of care which might be required to prevent an existing
    dental problem from becoming acute or urgent.(Example: Broken tooth or filling).
    These patients would receive dental services on an “as needed” basis.

               iii. Preventive Care:
    Preventive Care – the level of care that may be required to restore and maintain the
    patient’s oral health status to an acceptable condition.


             2.2.1 Clinical facility includes:
             Central Location (Specialty Service, etc.) @ 1612 Fannin, Houston, TX
                                                                                            Page 12 of 33
                      a. (6) Chair Operatory (to accommodate sit-down 4-handed dentistry)

                      b. (2) X-ray Rooms (1 panorex)

                     c. Dispensary Area and Sterilization Area

                      d. Waiting rooms (with area for registration, appointment and billing

                      e. Records Room

                      f. Storage Area

                      g. Patient Education Room

                      h. Office Space

                      i. Dental Instruments

       Satellite Sites:

              Peoples Health Center, Settegast Health Center, Aldine Health Center, Strawberry
              Health Center, Acres Home Health Center, Gulfgate Health Center

                      a. (4) Chair Operatory (to accommodate sit-down, 4-handed dentistry)

                      b. X-Ray (1 Panorex)

                      c. Dispensary Area and Sterilization Area

                      d. Waiting Room

                      e. Dental Instruments

                      f. Storage Area

                      g. Office Space

                      h. Medical Records – space allocated in Health Information Management

Total number of chairs for Dental Services (Central Location and Satellite Sites) is 30, with 15.25
Dentist FTE’s and Support Staff.


           1.3.1      Clinical Program to include:

                      a. Screening and Examination
                                                                                         Page 13 of 33
                   b. Patient Education for Preventing Dental and Oral Disease

                   c. Prophylaxis

                   d. Fluoride Treatment

                   e. X-ray

                   f. Class I, II, III, IV, and V restorations

                   g. Endodontia

                   h. Exodontia

                   i. Periodontia

                   j. Pedodontia

                  k. Fixed Multiple Restorations – Crowns Only
               (Non-Precious Metals and Acrylic Only)

                   l. Complete Dentures and Partial Dentures (Chrome or Acrylic Only)

                   m. Consultation

                   n. Orthodontics, impactions, and bone surgery services are not

     1.3.2 Patients entering and receiving care in this program will be screened for eligibility by
       the Harris Count Hospital District in one of its facilities.

     1.3.3 Patients will be seen by appointment; however, every effort shall be made to see drop-
       in patients with urgent care needs.

     1.3.4 A mechanism to address broken appointments should be provided.

1.3.5 For calendar year 2001, the Dental Clinics will observe:
          New Year’s Day        MLK Day                President’s Day
                 Good Friday           Memorial Day            Independence Day
                 Labor Day             Thanksgiving Day        Day After Thanksgiving
                 Christmas Eve         Christmas Day
    The awarded vendor will observe designated Community Health Program holidays.

       1.4.1       To Provide For:

          a. A management team responsible for monitoring quality of service, budget, patient
             relations and compliance.

                                                                                        Page 14 of 33
b. Physical Facility

c. Security Service

d. Janitorial Service

e. All Utilities and Telephone

f. Building Equipment Maintenance

g. Medical Records Maintenance

h. Linen Service – No Uniforms

i. Clerical Staff

j. Replacement of capital equipment.

k. Replacement of instruments that have reached their life expectancy

l. Supplies:
      i. tubing (peel), sterile
     ii. gloves
   iii. cover, shoe
    iv. cap, kaycel fabric surgeon
     v. cleaners, scope metrozyme
    vi. barrier, multi-use
   vii. cap, bouffant
  viii. integrator sterilization
    ix. label, sterilization
     x. sharps container
    xi. gowns, surgical – disposable XL
   xii. tape, autoclave steam
  xiii. face mask, disposable
  xiv. indicator, attest steam
   xv. surgeon cap, blue

                                                                        Page 15 of 33

     2.5.1 To staff the necessary dentists, and ancillary personnel (dental assistants, dental
           hygienists, etc.) to carry out the program.

     2.5.2   The contractor shall comply with the requirements of the Texas Department of
             Health regarding immunization requirements for staff which will involve direct
             patient contact with blood or body fluids in dental or medical facilities (Title 25,
             Chapter 97 of the Texas Administrative Code, as amended). Additionally, staff
             assigned to District facilities shall meet the following testing and immunization
             a. Tuberlin (PPD) Skin Test - The contractor shall require PPD testing yearly on
             their staff who have not previously tested positive. For any staff member whose
             test becomes positive, the Contractor must present documentation of treatment
             status. For staff with previous known positive skin tests, the Contractor will
             present a yearly screening of clinical symptoms for active tuberculosis.
             b. Hepatitis B - The contractor shall maintain information as to whether their
             staff have received a Hepatitis B vaccination or has been offered the vaccination
             and declined.
             c. Chicken Pox (Varicella) - The Contractor shall ensure that their staff know
             their immune status to Varicella by providing acceptable documentation of
             varicella vaccination, serologic testing for the presence of varicella antibodies, or
             a positive medical history for Varicella. Non-immune individuals are strongly
             encouraged to be vaccinated prior to working in HCHD.
             d. Rubella\Rubeola – Immunizations are strongly recommended for non-immune
             individuals who work in HCHD. Non-immune Healthcare workers who refuse
             vaccination will not be cleared to work in certain areas.

  The contractor agrees to provide documentation to the Employee Health Clinic that each staff
  member has met the above requirements prior to assignment to a District facility (EXHIBIT
  “B”). Both parties agree that release of a staff member’s health information shall be subject to
  proper written authorization from staff. The contractor understands and agrees that those
  failing to meet the above requirements for testing or immunization shall not be eligible for
  assignment to District facilities.

  The contractor will insure that staff is knowledgeable of the Harris County Hospital District’s
  staff educational requirements:

                 General Safety (Life Safety, Electrical, Fire, Back, Infection Control)
                 Blood borne Pathogens (HIV/HBV)
                 Standard Precautions
                 Hazard Communications
                 Advanced Directives
                 Substance Abuse
                 Performance Improvement
                 Emergency Preparedness (i.e., disaster plan, bomb threat)
                                                                                      Page 16 of 33
           Age-Specific Criteria
           CPR (where applicable)
           Corporate Compliance

Other educational classes required by the education department of the Harris County
Hospital District.

2.5.3   To insure that all dentists qualify as members of the Medical and Dental Staff of
        the Harris County Hospital District by meeting the qualifications below:

   2.5.3.a Qualifications for Membership
        Only those practitioners licensed to practice in the State of Texas and registered in
        Harris County, who can document their background, experience, training and
        demonstrate competence, their adherence to the ethics of their profession, their
        good reputation and their ability to work with other, shall be qualified for
        membership on the Medical and Dental Staff of the Harris County Hospital

2.5.4   To develop and maintain a method of quality control in accordance with the
        standards of the Harris County Hospital District.

2.5.5   To insure that all medical care is documented accurately and timely.

2.5.6   To maintain an inventory control system.

2.5.7   To Provide For:

   a. Replacement of Dental Instruments that result from misuse or abuse
   b. Repair of Dental Units
   c. Repair of Handpieces
   d. Laboratory Fees
   e. Supplies which are not included in the District’s supply list (see section 1.4.1)
2.5.8   To establish a working plan for providing after hour alternatives for all dental
        patients that are actively in the process of receiving dental care.

2.5.9   To submit for reimbursement an itemized monthly statement of operating expenses
        by Salaries, Supplies, and Services. Reimbursement will be limited to the total
        amount of the contract.

2.5.10 To procure and submit a bid bond or cashier’s check in the amount of 5% of the
       total proposal. A performance bond in an amount agreed upon prior to award may
       also be required.

                                                                                  Page 17 of 33
           2.5.11 To obtain and/or maintain during the term of the contract, minimum insurance
                  coverage as follows:

           2.5.12 Professional Liability
                      Per Person              Per Occurrence
                      $500,000                $1,000.000

           2.5.12 Texas Worker’s Compensation

               The contractor will provide the District with a certificate of insurance for the above
               coverage prior to execution of the contract.


      The contractor will provide compassionate, timely, and cost effective care to a minimum of 16
      patients per provider per business day. Patient care encounters will be defined as:

           2.6.1      Dental Visit – A face-to-face contact between the patient and the dentist in
               which a service is rendered. This visit generates a patient charge.

           2.6.2       Dental Follow-up Visit – A face-to-face contact between the patient and the
               dentist in which the primary purpose of the visit is a post-operative check or a suture
               removal. This visit does not generate a patient charge.

           2.6.3    Procedure – A unit of dental service rendered (fillings, extractions, etc.) (see
               EXHIBIT “A”)

           2.6.3.a    examinations
           2.6.3.b    radiographic survey
           2.6.3.c    laboratory tests
           2.6.3.d    prevention
           2.6.3.e    peridontics
           2.6.3.f    restorative dentistry
           2.6.3.g    oral surgery
           2.6.3.h    endodontics
           2.6.3.i    complete dentures
           2.6.3.j    removal partial dentures
           2.6.3.k    repair, refine, adjustments
           2.6.3.l    crowns


2.8    TERM

                                                                                             Page 18 of 33
      The initial term of the contract shall be for one (1) year from date of execution of the
      agreement with options to renew for four (4) additional years, one year at a time, upon mutual
      agreement by each party. Any annual increase/decrease shall be agreed upon mutually by both
      parties, however, the selected vendor will guarantee that any annual increase shall not exceed
      the Regional Medical Consumer Price Index.


      3.1    Proposals must be returned in the format                   indicated   in   the      “Special
             Requirements/Instructions” Section of this document.

      3.2   Each part of the proposal must consider relevant information provided by section 2.0 of
            this document, directly addressing any significant difference between what is
            described in 2.0 and what is proposed and expressing all appropriate qualifications or
            significant concerns the candidate may have.

      3.3    Statement of Objectives and Scope (returned in Section 6 of your response)
             Provide a statement of objectives and scope that demonstrates understanding of the
             intent and requirements of the program.

      3.4    Work Plan and Methodology (returned in Section 7 of your response)
             Describing the technical plan and methods proposed for accomplishing program in
             existing facilities and/or contract facilities.

      3.5    Organization and Staffing (returned in Section 8 of your response)
             Describe the organization and staffing proposed for the program. This description
             must explain the types and roles of the candidate’s personnel.

      3.6    Budget (returned in Section 9 of your response)
             This part of the proposal must include:

             3.6.1   The cost for the program as a whole.
             3.6.2   The cost for staffing, services, supplies, etc. detailed by each group.

             3.6.3   The example of the methods used in pricing each segment.

      3.7    Candidate Profile and Capabilities (returned in Section 10 of your response)
             This part must include:

             3.7.1   A short history and current profile of the candidate. Include organizational
                     structure, names and addresses of key management personnel, parent company
                     and division(if applicable).

             3.7.2   A description of all recently completed projects that are of similar nature to this
                     project, stating the name of institution and location.
                                                                                               Page 19 of 33
      3.7.3   Names and resumes of “key” on-site personnel for the project.

3.8   Critical Operational Documents (returned in Section 11 of your response)

      3.8.1   Provide a copy of your organization’s OSHA manual.

      3.8.2   Provide a copy of Performance Improvement Plan developed by your
              organization, including policies, evaluation documents and procedures that
              will be used by your organization to document quality assurance. Give the
              original date of implementation and date of last revision, if applicable.

      3.8.3   Describe the Information Management System that your organization, will use,
              including report format, sample copies, types of data analyzed, etc.

      3.8.4   Provide PROOF of JCAHO certification for your organization, including last
              certification date, type of certification given and expiration date. Please
              explain any deficiencies given and how they were resolved.

      3.8.5   Describe how nosocomial infections will be tracked, trended and resolved by
              your organization. When was protocol trial tested for accuracy? What is the
              nosocomial rate in your existing facilities.

      3.8.6   Describe how your organization will obtain medical data on medically
              compromised patients requiring dental services.

      3.8.7   Recap the Policies and Procedures Manual developed by your
              organization which will be used to run the day to day operation of dental
              centers. Submit a copy of the manual.

                                                                                  Page 20 of 33
                             (returned in Section 4 of your response)

Location or Clinic: ______________________________________
Address:       ______________________________________
Contact Name:         _______________________________________
Contact Telephone: _______________________________________

Location or Clinic: ______________________________________
Address:       ______________________________________
Contact Name:         _______________________________________
Contact Telephone: _______________________________________

Location or Clinic: ______________________________________
Address:       ______________________________________
Contact Name:         _______________________________________
Contact Telephone: _______________________________________

Location or Clinic: ______________________________________
Address:       ______________________________________
Contact Name:         _______________________________________
Contact Telephone: _______________________________________

Location or Clinic: ______________________________________
Address:       ______________________________________
Contact Name:         _______________________________________
Contact Telephone: _______________________________________

                                                                        Page 21 of 33
                                PRICING & DELIVERY
                            (Return in Section 2 of your Response)


Year 1: $_______________________
Year 2: $ _______________________
Year 3: $ _______________________
Year 4: $ _______________________
Year 5: $ _______________________

                                                                     Page 22 of 33

              Page 23 of 33
                                        RESIDENCE CERTIFICATION
                                       (Return in Section I of your response)

Pursuant to Texas Government Code §2252.001 et seq., as amended, Harris County requests Residence
Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of
governmental contracts; pertinent provisions of §2252.001 are stated below:

   (3)   "Nonresident bidder" refers to a person who is not a resident.

   (4)   "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor
         whose ultimate parent company or majority owner has its principal place of business in this state.

        I certify that __________________________________ is a Resident Bidder of Texas as defined in
                                     [Company Name]
   Government Code §2252.001.

 I certify that ______________________________________ is a Nonresident Bidder as defined in
                           [Company Name]
   Government Code §2252.001 and our principal place of business is _____________________________.
                                                                              [City and State]

                                                                                                             Page 24 of 33
                                Minimum Insurance Requirements

•        The contractor shall, at all times during the term of this contract, maintain insurance coverage with
         not less than the type and requirements shown below. Such insurance is to be provided at the sole
         cost of the contractor. These requirements do not establish limits of the contractor's liability.

•        All policies of insurance shall waive all rights of subrogation against the County, its officers,
         employees and agents.

•        Upon request, certified copies of original insurance policies shall be furnished to Harris County.

•        The County reserves the right to require additional insurance should it be deemed necessary.

A.       Workers' Compensation (with Waiver of subrogation to Harris County) Employer's Liability,
         including all states, U.S. Longshoremen, Harbor Workers and other endorsements, if applicable to
         the Project.

         Statutory, and Bodily Injury by Accident: $100,000 each employee. Bodily Injury by Disease:
         $500,000 policy limit $100,000 each employee.

B.       Commercial General Liability Occurrence Form including, but not limited to, Premises and
         Operations, Products Liability Broad Form Property Damage, Contractual Liability, Personal and
         Advertising Injury Liability and where the exposure exists, coverage for watercraft, blasting
         collapse, and explosions, blowout, cratering and underground damage.

         $300,000 each occurrence Limit Bodily Injury and Property Damage Combined $300,000 Products-
         Completed Operations Aggregate Limit $500,000 Per Job Aggregate $300,000 Personal and
         Advertising Injury Limit. Harris County shall be named as "additional insured" on commercial
         general liability policy.

C.       Automobile Liability Coverage:

         $300,000 Combined Liability Limits. Bodily Injury and Property Damage Combined. Harris
         County shall be named as "additional insured" on automobile policy.

Revised 12/00

                                                                                                   Page 25 of 33

If this bid/proposal package is for a building or construction contract, all of the provisions of this
rule as shown below apply. Since this is a mandatory requirement, cost increases should not be
experienced because of the need to comply with the Texas Workers' Compensation Law. For
additional information contact the Texas Workers' Compensation Commission, Southfield Building,
400 S. IH-35, Austin, Texas 78704-7491, (512) 440-3618.

A.     Definitions:

              Certificate of coverage ("Certificate") - A copy of a certificate of insurance, a certificate of
              authority to self-insure issued by the commission, or a coverage agreement, TWCC-81,
              TWCC-82, TWCC-83, or TWCC-84 showing statutory workers' compensation insurance
              coverage for the person's or entity's employees providing services on a project, for the
              duration of the project.

              Duration of the project - Includes the time from the beginning of the work on the project
              until the contractor's/person's work on the project has been completed and accepted by the
              governmental entity.

              Persons providing services on the project ("subcontractor" in §406.096) - Includes all
              persons or entities performing all or part of the services the contractor has undertaken to
              perform on the project, regardless of whether that person contracted directly with the
              contractor and regardless of whether that person has employees. This includes, without
              limitation, independent contractors, subcontractors, leasing companies, motor carriers,
              owner-operators, employees of any such entity, or employees of any entity which furnishes
              persons to provide services on the project. "Services" include, without limitation,
              providing, hauling or delivering equipment or materials, or providing labor, transportation,
              or other service related to a project. "Services" does not include activities unrelated to the
              project, such as food/beverage vendors, office supply deliveries, and delivery of portable

B.     The Contractor shall provide coverage, based on proper reporting of classification codes and payroll
       amounts and filing of any coverage agreements, which meets the statutory requirements of Texas
       Labor Code, Section 401.011(44) for all employees of the contractor providing services on the
       project, for the duration of the project.

C.     The Contractor must provide a certificate of coverage to the governmental entity prior to being
       awarded the contract.

D.     If the coverage period shown on the Contractor's current certificate of coverage ends during the
       duration of the project, the Contractor must, prior to the end of the coverage period, file a new
       certificate of coverage with the governmental entity showing that coverage has been extended.

E.     The Contractor shall obtain from each person providing services on a project, and provide to the
       governmental entity:

                                                                                                 Page 26 of 33
     (1)    A certificate of coverage, prior to that person beginning work on the project, so the
            governmental entity will have on file certificates of coverage showing coverage for all
            persons providing services on the project; and

     (2)    No later than seven (7) days after receipt by the Contractor, a new certificate of coverage
            showing extension of coverage, if the coverage period shown on the current certificate of
            coverage ends during the duration of the project.

F.   The Contractor shall retain all required certificates of coverage for the duration of the project and
     for one (1) year thereafter.

G.   The Contractor shall notify the governmental entity in writing by certified mail or personal delivery,
     within ten (10) days after the contractor knew or should have known, of any change that materially
     affects the provision of coverage of any person providing services on the project.

H.   The Contractor shall post on each project site a notice, in the text, form and manner prescribed by
     the Texas Workers' Compensation Commission, informing all persons providing services on the
     project that they are required to be covered, and stating how a person may verify coverage and
     report lack of coverage.

I.   The Contractor shall contractually require each person with whom it contracts to provide services
     on a project to:

     (1)    Provide coverage, based on reporting of classification codes and payroll amounts and filing
            of any coverage agreements, which meets the statutory requirements of Texas Labor Code,
            Section 401.011(44) for all its employees providing services on the project, for the duration
            of the project.

     (2)    Provide to the Contractor, prior to that person beginning work on the project a certificate of
            coverage showing that coverage is being provided for all employees of the person providing
            services on the project, for the duration of the project.

     (3)    Provide the Contractor, prior to the end of coverage period, a new certificate of coverage
            showing extension of coverage, if the coverage period shown on the current certificate of
            coverage ends during the duration of the project.

     (4)    Obtain from each other person with whom it contracts, and provide to the Contractor:

            (a)     A certificate of coverage, prior to the other person beginning work on the project,

            (b)     a new certificate of coverage showing extension of coverage, prior to the end of the
                    coverage period, if the coverage period shown on the current certificate of coverage
                    ends during the duration of the project;

                                                                                              Page 27 of 33
     (5)    Retain all required certificates of coverage on file for the duration of the project and for one
            (1) year thereafter.

     (6)    Notify the government entity in writing by certified mail or personal delivery, within ten
            (10) days after the person knew or should have known, of any change that materially affects
            the provision of coverage of any person providing services on the project; and

     (7)    Contractually require each person with whom it contracts, to perform as required by
            paragraphs (1) - (7), with the certificates of coverage to be provided to the person for whom
            they are providing services.

J.   By signing this contract or providing or causing to be provided a certificate of coverage, the
     Contractor is representing to the governmental entity that all employees of the contractor who will
     provide services on the project will be covered by workers' compensation coverage for the duration
     of the project, that the coverage will be based on proper reporting of classification codes and payroll
     amounts, and that all coverage agreements will be filed with the appropriate insurance carrier or, in
     the case of a self-insured, with the commission's Division of Self-Insurance Regulation. Providing
     false or misleading information may subject the contractor to administrative penalties, criminal
     penalties, civil penalties, or other civil actions.

K.   The Contractor's failure to comply with any of these provisions is a breach of contract by the
     contractor which entitles the governmental entity to declare the contract void if the Contractor does
     not remedy the breach within ten (10) days after receipt of notice of breach from the governmental

                                                                                               Page 28 of 33

              Page 29 of 33
                                       EXHIBIT A
EXAMINATIONS                             PERIODONTICS
Complete Dental Exam            14,204 Sublgingival Scaling                5,761
Emergency Dental Exam           15,687 Curettrage-Per Quad.                  24
Dental Visit Follow-up          47,485 Gingivec-Gingivopl/Quad                2
2nd Phy. Encounter                193    Retromolar Tissue Reduction          3
3rd Phy. Encounter                  6    Periodontal Recall                   1
Adjustment & Check Visit           28                                      5,791
Surgery Follow-up Visit            42
Blood Pressure                    101
Referral to Ben Taub              371    RESTORATIVE DENTISTRY
Referral to Outpatient Clinic     271    Amalgam-One Surface-Perm           5,103
                                78,388 Amalgam-Two Surfaces-Perm            2,720
                                         Amalgam-Three Surfaces-Perm         660
RADIOGRAPHIC SURVEY                      Amalgam-Four Surfaces-Perm          113
Regional Periapical              2,824   Amalgam-Five Surfaces-Perm            6
Bite Winds(each)                 6,998   Amalgam-One Surface-Decidu            3
Occlusal                           45    Amalgam-Two Surfaces-Decidu           2
Panogram                        12,735 Amalgam-Three Surfaces-Decidu           3
Special Views                      68    Pin Retention                        15
                                22,670 Palliative Base                       350
                                         Composite-One Surface              1,275
DOCUMENTATION                            Composite-Two Survaces              584
Diagnostic Casts                    3    Composite-Three Surfaces            471
                                         Composite-Four Surface              238
LABORATORY TEST                          Acid Etch                          2,454
Biopsy                              1    Stainless Steel Crown                33
                                         Poly Carbonate Crown                  9
PREVENTION                               Pulp Cap Direct                     360
Prevention Program 1             7,343   Pulp Cap Indirect                  6,483
Prevention Program 2             7,286   Pulpotomy                            27
Prevention Program 3               72    Crown Band Loop                       2
Toothbrush                        962    Space Maintainer                      1
Floss                             796    Cementation of Restorative Matl      18
Prophylaxis                      5,695   Copal (Varnish)                    7,477
Fluoride Treatment               5,807   Temporary Filling                  1,601
Mouth Protector                    64    Post-N-Core                          32
Pit & Fissure Sealant               2    Gelfoam                            2,149
                                28,027                                     32,189

                                                                            Page 30 of 33
                                     COMPLETE DENTURE
ORAL SURGERY                         Full Denture-Delv. Each            795
Prescription                22,075   Initial Impression                1,009
Tooth Removal Perm           9,913   Full Impression                    708
Tooth Removal Prim             50    Wax Bite                          1,527
Tooth Removal Impacted          7    Try-In                            1,634
Tooth Removal Surgical        607                                      5,673
Residual Root Removal        1,890
Bone Trim Minor               408    REMOVABLE PARTIAL DENTURE
Alveoplasty                   354    Part. Den-Del. Ea.                 753
Frenoplasty                     9    Initial Impression                 833
Frenoctomy                      1    Full Impression                    115
Reduction of Tuberosity        16    Try-In & Adjustment               1,634
Soft Tissue Surgery            31    Steel's Facing                      22
Incision + Drainage            24    Trans. Part. Dent-Wire + Acryli      8
Preprosthetic Surgery           6                                      3,365
Post Operative Treatment       97
Other Oral Surgery             40    REPAIR, REFINE, ADJUSTMEN
Suture/Removal               3,500   Partial Denture Repair Simple      32
Occlusal Adjustment            22    Partial Denture Repair Complex     98
                            39,050   Full Denture Repair Simple         20
                                     Full Denture Repair Complex        62
ENDODONTICS                          Partial Denture Reline (Each)       8
Root Canal-1 Completion      10      Full Denture Reline (Each)         90
Pulpectomy                   17      Full or Partial Denture Adjust.   502
Instrumentation              11      Occ/Adjustment/Reduction           22
Root Canal 2 - Completion     1                                        834
Pulpectomy                    3
Instrumentation               3      CROWNS
Root Canal 3 - Completion            Prep. + Temporization              2
Pulpectomy                    3      Impression
Instrumentation                      Crown Build-up                      1
Root Canal 4 - Completion     1      Re-Cement Bridge or Crown          26
Pulpectomy                    1      Re-Cement Facing                    1
Instrumentation               1      Re-Cement Stainless Steel Cro       6
Endodontic Surgery            1                                         36
Pulp Test                     1

                                                                       Page 31 of 33

              Page 32 of 33
                                                                   EXHIBIT “B”
Date Submitted
                                                               VACCINATION LOG
NAME                                                                                                           RUBEOLA/            MMR
                    TD     PPD   HB           VARICELLA                                  RUBELLA                                  DATE (S)
                    DATE         VAC*

                                                                                         Dz. Hist Sero(+)
                                              Dz. Hist         Sero(+) Vac                                  Dz. Hist   Sero(+)
                                 ----------   seY ‫ٱ‬            seY ‫ٱ‬                     seY ‫ٱ‬     seY ‫ٱ‬    seY ‫ٱ‬      seY ‫ٱ‬
                                              oN ‫ٱ‬             oN ‫ٱ‬                      oN ‫ٱ‬      oN ‫ٱ‬     oN ‫ٱ‬       oN ‫ٱ‬
                                              knU ‫ٱ‬            knU ‫ٱ‬                     knU ‫ٱ‬     knU ‫ٱ‬    knU ‫ٱ‬      knU ‫ٱ‬
                                 ----------   seY ‫ٱ‬            seY ‫ٱ‬                     seY ‫ٱ‬     seY ‫ٱ‬    seY ‫ٱ‬      seY ‫ٱ‬
                                              oN ‫ٱ‬             oN ‫ٱ‬                      oN ‫ٱ‬      oN ‫ٱ‬     oN ‫ٱ‬       oN ‫ٱ‬
                                              knU ‫ٱ‬            knU ‫ٱ‬                     knU ‫ٱ‬     knU ‫ٱ‬    knU ‫ٱ‬      knU ‫ٱ‬
                                 ----------   seY ‫ٱ‬            seY ‫ٱ‬                     seY ‫ٱ‬     seY ‫ٱ‬    seY ‫ٱ‬      seY ‫ٱ‬
                                              oN ‫ٱ‬             oN ‫ٱ‬                      oN ‫ٱ‬      oN ‫ٱ‬     oN ‫ٱ‬       oN ‫ٱ‬
                                              nU ‫ٱ‬k            knU ‫ٱ‬                     knU ‫ٱ‬     knU ‫ٱ‬    knU ‫ٱ‬      knU ‫ٱ‬
                                 ----------   seY ‫ٱ‬            seY ‫ٱ‬                     seY ‫ٱ‬     seY ‫ٱ‬    seY ‫ٱ‬      seY ‫ٱ‬
                                              oN ‫ٱ‬             oN ‫ٱ‬                      oN ‫ٱ‬      oN ‫ٱ‬     oN ‫ٱ‬       oN ‫ٱ‬
                                              knU ‫ٱ‬            knU ‫ٱ‬                     knU ‫ٱ‬     knU ‫ٱ‬    knU ‫ٱ‬      knU ‫ٱ‬
                                 ----------   seY ‫ٱ‬            seY ‫ٱ‬                     seY ‫ٱ‬     seY ‫ٱ‬    seY ‫ٱ‬      seY ‫ٱ‬
                                              oN ‫ٱ‬             oN ‫ٱ‬                      oN ‫ٱ‬      oN ‫ٱ‬     oN ‫ٱ‬       oN ‫ٱ‬
                                              knU ‫ٱ‬            U ‫ٱ‬nk                     knU ‫ٱ‬     knU ‫ٱ‬    knU ‫ٱ‬      knU ‫ٱ‬
                                 ----------   seY ‫ٱ‬            seY ‫ٱ‬                     seY ‫ٱ‬     seY ‫ٱ‬    seY ‫ٱ‬      seY ‫ٱ‬
                                              oN ‫ٱ‬             oN ‫ٱ‬                      oN ‫ٱ‬      oN ‫ٱ‬     oN ‫ٱ‬       oN ‫ٱ‬
                                              knU ‫ٱ‬            knU ‫ٱ‬                     knU ‫ٱ‬     knU ‫ٱ‬    knU ‫ٱ‬      knU ‫ٱ‬
# of doses rec             For waiver----->       0-Waiver
date of last dose                                   10/97
or waiver
                           For vaccinated               4 __      or   3 doses in 80’s
                                                      10/97            boosted 1997
                                                                                                       PREPARED BY INFECTION CONTROL – BEN TAUB

                                                                                                                                          Page 33 of 33

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