Purchassing Departm
ment
525 Buena
B
Vista SE
Albuqueerque, NM 877106
R
REQUEST FO
OR PROPOSAL
LS NO.: P-336
D
DUE DATE AN
ND TIME:
S
SUBMITTAL TYPE:
T
N
NUMBER OF RESPONSES
R
REQUIRED:
R
B
BUYER: Gil Rivera
R
P
Phone: 505-224
4-4546
Fax
x: 505-224-454
48
E
E-mail address:
griv
[email protected]
F
FREIGHT TER
RMS:
P
PAYMENT TE
ERMS:
TIT
TLE: Drug Screeening Services
On Or
O Before: A
April 4, 2013
44:00 PM LOCA
AL TIME (MS
ST)
Sealled Response
Resp
ponses sent by fax or email w
will not and CA
ANNOT be connsidered for
awarrd.
Onee (1) Original annd Five (5) Copiies
FOB
B Destination Frreight Included
Net 30 Days
T
TABLE OF CO
ONTENTS:
SECTION A:
SECTION C:
SECTION D:
SECTION E:
SECTION F:
SECTION G:
EXHIBIT A:
EXHIBIT B:
EXHIBIT D:
EXHIBIT E:
EXHIBIT F:
EXHIBIT G:
Proposal Su
ubmission Requ
uirements, Form
mat and Content
Submittal Instructions
Standard Prroposal Terms and
a Conditions
CNM Geneeral Terms and Conditions
C
Scope of Seervices, Specificcations, and Evaaluation Criteriaa
Signature of
o Firm’s Authorrized Representtative
Debarment//Suspension Staatus & Non-Colllusion Affidavitt Form
Resident Veterans Preferen
nce Certification
n
Insurance Requirements
R
UPON
U
REQUES
ST BY CNM
Campaign Contribution
C
Diisclosure Form
Sample Non-Disclosure Ag
greement
Sample Serrvices Agreemen
nt
CNM AUT
THORIZATION
N FORM
Sample Clinical Education
n Agreement
R
RFP # P-336, Advertised March
M
14, 201
13
C
Copyright CNM 2013. All rights
r
reserve
ed.
PA
AGE #:
2
3–4
5–8
9
110 – 14
15
16
17
18
119 – 20
221 – 25
226 – 36
1 page
118 pages
P
Page 1 of 36
PROPOSAL SUBMISSION REQUIREMENTS, FORMAT AND CONTENT:
Central New Mexico Community College (CNM) invites you to submit a proposal for the services specified in this
Request for Proposals. Please read carefully all instructions, specifications, terms and conditions. Failure to
comply with the instructions, specifications, terms and conditions of this Request for Proposals may result in your
proposal being declared non-responsive. The purchase of materials and or services awarded under this Request is
subject to CNM's General Terms and Conditions as well as all statements contained in this Request for Proposals.
All terms and conditions of the Request for Proposals shall remain unchanged for the duration of any resultant
agreement(s) and shall supersede and take precedence over any vendor agreement forms. Additional or different
terms proposed by the vendor are hereby rejected unless agreed to in writing by CNM. The New Mexico criminal
law prohibits bribes, gratuities and kickbacks (13-1-28 through 13-1-199, NMSA 1978).
Any and all clarifications of instructions, specifications, scope, requirements, terms and conditions, insurance,
bonds, or proposal preparation, etc. shall be made only by the Buyer listed above. All requests for clarification or
exception to instructions, terms and conditions, specifications, requirements, scope, insurance, bonds, or proposal
preparation, etc. must be made in writing, addressed to the Buyer listed above, and submitted no later than five (5)
days prior to the proposal due date. Technical questions concerning scope of work, CNM's requirements, needs or
expectations and the vendor's requirements, needs or expectations must be directed to the technical clarification
contact listed above. If a technical clarification contact is not listed above, then all such questions must be directed
to the Buyer listed above. If appropriate in CNM's sole judgement, CNM Purchasing may issue a written
Amendment or addendum which shall thereafter become part of this Request for Proposals. No oral interpretations
shall be binding upon CNM unless reduced to a written amendment issued by CNM Purchasing prior to the
proposal due date and time. Your reliance on any such oral interpretations shall be deemed to be unreasonable.
Each respondent, by submitting a response, represents that the respondent has read and completely understands the
request for qualifications documents and agrees to abide by the terms of this RFP and any resulting agreement.
Failure of the selected contractor to fulfill the provisions of this request for qualifications shall in no way relieve
the obligation of the Contractor to furnish all services necessary to carry out the provisions of the agreement.
The contents of this RFP, as revised and/or supplemented, and the successful Offeror’s proposal will be
incorporated into and become part of the awarded Price Agreement.
Should an Offeror object to any of the terms and conditions of this RFP, the Offeror must expressly identify any
and all exceptions to this proposal’s scope of work, terms and conditions in their proposal response to receive
consideration, and propose specific alternative language. CNM may or may not accept the alternative language.
General references to the Offeror’s terms and conditions or attempts at complete substitutions are not acceptable to
CNM and will result in disqualification of the Offeror’s proposal. The final terms and conditions of any resultant
contract may differ from those provided herein.
CNM is not responsible for representations made by any of its officers or employees prior to the execution of the
Agreement(s) unless such understanding or representation is included in the RFP or in subsequent written addenda
or responses provided to all proposers by CNM’s Purchasing Department. CNM is responsible only for that which
is expressly stated in the solicitation document and any authorized addenda thereto. Any cost incurred by the
Respondent in preparation, transmittal or presentation of any proposal or material submitted in response to the RFP
shall be borne solely by the Respondent.
Contractor shall not be an employee of CNM and is responsible for federal and state payroll and service taxes such
as social security, unemployment and gross receipts taxes. Service required by this RFP for which the Successful
Offeror does not identify cost will be borne at the Offeror’s expense and will not be charged to CNM.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 2 of 36
PROPOSAL SUBMISSION REQUIREMENTS, FORMAT AND CONTENT:
SUBMITTAL INSTRUCTIONS:
To submit a proposal, provide a type written document responding to the scope of work/services, specifications,
and evaluation criteria contained herein. Complete the forms labeled “SECTION E: Signature of Firm’s
Authorized Representative,” “SECTION F: Debarment/Suspension Status & Non-Collusion Affidavit Form,”
“EXHIBIT B: Campaign Contribution Disclosure Form,” signed by the firm’s authorized representative, and
submit these forms with your proposal’s response to Section D, Evaluation Criteria. Responses shall be signed by
a legally authorized representative of the Respondent. Unsigned responses to SECTION E: Signature of Firm’s
Authorized Representative and Section F: Debarment/Suspension Status & Non-Collusion Affidavit Form will be
rejected as a material failure.
CNM does not desire responses with fancy binders, binding, or sales literature. Instead, vendors' proposals should
be organized in a format that promotes the easy and clear evaluation of your proposal. To this end, the
organization of your proposal should generally follow the Request for Proposals' organization so that the Request
and your proposal can be cross-referenced during the evaluation process. Likewise, information in your proposal
should be presented in same order as the pertinent provisions of the Request for Proposals, referencing sections of
the Request on any and all attachments that you include with your proposal. Each original proposal must be
signed in ink by an authorized representative of your firm; all corrections shall be initialed in ink by person
signing the proposal. The contents of the selected proposal may become part of any resultant award. If you wish
to offer more than one proposal, clearly label the top as an alternate proposal and submit all responses in the same
envelope as the original proposal. Submit the number of copies of your proposal as specified above. Each copy
shall include all supporting documentation. Failure to submit the required number of copies may result in your
proposal being considered non-responsive.
1. REQUIRED SUBMITTAL DOCUMENTS NEEDED WITH YOUR SEALED RESPONSE:
a. OFFEROR’S point-by-point response to SECTION D, EVALUATION CRITERIA, paragraphs 3.3.1
THROUGH 3.3.4.
b. SECTION E: Signature of Firm’s Authorized Representative
c. SECTION F: Debarment/Suspension Status & Non-Collusion Affidavit Form
d. EXHIBIT B: Campaign Contribution Disclosure Form
e. Table of Contents to include section names, section numbers and page numbers
f. Letter of Transmittal. The letter of transmittal will fairly and briefly depict the respondent’s proficiency,
experience and capability to serve CNM and why the respondent believes they should be selected.
g. Response length and font size: Proposal responses should be limited to 10 double spaced pages no smaller
than 10 point font.
h. Submit one (1) original and five (5) copies of your response to this RFP with your SEALED response.
NOTE: Failure to submit items 1.a – 1.d. noted above will render the offer as being non-responsive.
Non-responsive offers CANNOT be considered for award. Items 1.b., 1.c., and 1.d. MUST be signed by
a legally authorized representative of the Respondent.
2. SUBMITTAL DEADLINE AND LOCATION
All responses must be received in a SEALED envelope by CNM no later than 4:00 PM MDT, April 4, 2013.
Responses are to be submitted via MAIL, COURIER, or HAND DELIVERED to:
Central New Mexico Community College
Purchasing Department
525 Buena Vista Drive SE
Albuquerque, NM 87106
Attn:
RFP # P-336, Due on or before 4:00 PM MDT, April 4, 2013
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 3 of 36
PROPOSAL SUBMISSION REQUIREMENTS, FORMAT AND CONTENT:
PLEASE ENSURE THAT YOUR SEALED ENVELOPE IS LABELED WITH YOUR FIRM’S NAME,
ADDRESS, RFP NUMBER, AND OPENING DATE AND TIME. Failure to properly identify this RFP #,
Due Date and Time on the lower left outside corner of your sealed proposal envelope may result in either
premature opening of your proposal or failure to open it upon the correct closing date and time.
a. Faxed or electronically mailed responses will NOT be accepted and CANNOT be considered for
award.
b. Late submissions of proposals will not be considered unless it is determined by CNM that the late
receipt was due solely to mishandling by CNM or if the proposal is the only one received. All other
late submissions will be returned unopened.
c. Responses will not be publicly opened.
d. Responses may be withdrawn at any time prior to the time and date set for RFP closing.
e. CNM reserves the right to accept or reject any or all responses and to waive technical irregularities.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 4 of 36
SECTION A: STANDARD PROPOSAL TERMS AND CONDITIONS FOR RFP # P-336
1.
ACKNOWLEDGMENT
OF
AMENDMENT
/
ADDENDUM. Vendors shall acknowledge receipt of any
amendments/addenda to this Request for Proposals by
identifying the amendment/addendum number and date in the
space provided on the form labeled “Signature of Firm’s
Authorized Representative”.
2.
ADDRESSES FOR NOTICES. Any notice required to be
given or which may be given under this Request for Proposals or
the resultant price agreement shall be in writing and delivered in
person or via first class mail to Central New Mexico Community
College, Purchasing Department, 525 Buena Vista, SE,
Albuquerque, NM 87106.
3.
AWARD OF PROPOSALS. CNM reserves the right to award
this proposal based on price and any other evaluation criteria
contained herein; to reject any and all proposals or any part
thereof, and to accept the proposal that is most advantageous to
CNM, taking into consideration the evaluation factors set forth in
this Request for Proposals.
4.
CANCELLATION. CNM reserves the right to cancel without
penalty this Request for Proposals, the resultant price agreement
or any portion thereof for unsatisfactory performance,
unavailability of funds, or when it is in the best interest of
CNM.
5.
CHANGES/ALTERATIONS AFTER AWARD. Changes or
alterations after the award can only be made if agreed to in
writing by CNM.
6.
CONFIDENTIALITY. Any information provided to or
developed by the successful vendor in the performance of the
resultant agreement shall be kept confidential and shall not be
made available to any other individual or organization by the
successful vendor without prior written approval of CNM.
7.
8.
DAMAGE AND SECURITY OF CNM PROPERTY. The
successful offeror shall be responsible for all damage to persons
or property that occurs as a result of his/her fault or negligence,
or that of any of his/her employees, agents and or
subcontractors. He/she shall save and keep harmless CNM
against all loss, cost, damage, claims, expense or liability in
connection with the performance of the resultant price
agreement. Any equipment or facilities damaged by the
successful vendor's operations shall be repaired and or restored
to their original condition at the vendor's expense, including but
not limited to cleaning and painting. The successful vendor
shall be responsible for security of all his/her equipment and for
the protection of work done under the resultant price agreement
until final acceptance of the work.
DELIVERY. Delivery is an important consideration and may
be a factor in determining the award. Please state your earliest
delivery date in the space provided on the response form.
Delivery to be made to Receiving/Warehousing, Central New
Mexico Community College, 901 Buena Vista SE,
Albuquerque, NM 87106, unless otherwise specified.
9.
DELIVERY DELAYS. If after award, the contractor becomes
aware of possible problems that could result in delay in the
agreed-to delivery schedule, the contractor must immediately
notify the Buyer or the designated representative. The initial
notification of the delay may be verbal with a written
confirmation, giving the probable cause and effect, with
recommendations for alternate action.
Nothing in this
paragraph will be interpreted as relieving the vendor of his/her
contractual obligations. However, failure to notify CNM
promptly will be a basis for determining vendor responsibility
in an otherwise excusable delay.
10. DISCREPANCIES.
Should any interested vendor find
discrepancies in any part of the listed specifications or the terms
and conditions, or find any part of the listed specification or the
terms and conditions to be incomplete or otherwise questionable
in any respect, such vendor shall immediately call such matters
to the attention of the Buyer, in writing, prior to the established
opening date.
11. DISRUPTION OF NORMAL ACTIVITY. All work shall be
performed so as not to interfere with normal CNM activities.
When it is necessary to disrupt normal activities, the schedule of
work and the areas to be affected must be approved by CNM's
authorized representative prior to commencement of the work.
12. EMPLOYEE CERTIFICATION.
The vendor and all
vendor's employees utilized on the work to be performed under
this Request for Proposals must have the proper certification(s)
and license(s) to comply with State and local requirements
connected to this Request for Proposals. The contractor shall
use only fully qualified and approved service technicians to
perform inspections, service and or repairs under this Request
for Proposals.
13. EQUIPMENT REQUIRED. The vendor shall be responsible
for supplying and maintaining all equipment and materials
necessary to complete the work under this Request for
Proposals except as otherwise noted in the Specifications.
14. ERRORS.
CNM is not liable for any errors or
misinterpretations made by the vendor responding to this
Request for Proposals. No advantage shall be taken by Vendors
in the omission of any details. Any misstatements of fact,
misrepresentations or errors in the Vendor’s proposal may, at
the sole discretion of CNM, be cause for disqualification. Each
vendor is responsible for ensuring that all information provided
in its proposal is accurate and complete in its entirety.
15. FORCE MAJEURE. Neither party to the resultant agreement
will be liable to the other for any failure or delay in
performance under the resultant agreement due to
circumstances beyond its reasonable control including, but not
limited to, acts of God, accidents, labor disputes, acts or
omissions and defaults of third parties, and official, government
or judicial action not the result of negligence of the party failing
or late in performing.
16. GENERAL TERMS AND CONDITIONS. CNM's General
Terms and Conditions are an equal and integral part of this
Request for Proposals.
17. GOVERNING LAW. This Request for Proposals and all
resultant price agreements shall be interpreted and governed by
the Laws of the State of New Mexico.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 5 of 36
SECTION A: STANDARD PROPOSAL TERMS AND CONDITIONS FOR RFP # P-336
18. INSURANCE REQUIREMENTS. The successful vendors
may be required to carry insurance meeting the requirements in
the Exhibit labeled "INSURANCE REQUIREMENTS" or as
noted in the specifications. The successful vendors shall submit
ONLY UPON REQUEST BY CNM the Certificate of
Insurance to the appropriate Buyer prior to commencing work
under the resultant price agreement. Insurance must remain in
effect for the entire term of the resultant price agreement and
must be extended to coincide with any future price agreement
extension. This Request for Proposals Number must appear on
the Certificate of Insurance. Note: The successful vendor
shall agree to comply with state laws and rules pertaining to
workers’ compensation insurance for its employees. If the
successful vendor fails to comply with the Workers’
Compensation Act and applicable rules when required to do
so, the resultant contract may be canceled effective
immediately.
27. PERIOD FOR PROPOSAL ACCEPTANCE. The Vendor
agrees, if its proposal is accepted within ninety (90) calendar
days of the closing date, to furnish the goods and services at the
prices set forth in its proposal, delivered to the designated
point(s) within the specified time in the delivery schedule.
Failure to comply may result in removal from the bid list. An
additional time period may be requested elsewhere in this
Request for Proposals.
19. INVITATION TERMS PART OF CONTRACT. This
Request for Proposals along with its attachments will be
considered to be part of the resultant price agreement and or
purchase order and is to be incorporated by reference.
29. PROPOSAL NEGOTIATION. Vendors submitting proposals
may be afforded an opportunity for discussion and revision of
proposals. Revisions may be permitted after opening and prior
to award for the purpose of obtaining best and final offer.
Negotiations may be conducted with responsible vendors who
submit offers found reasonably likely to be selected for award.
20. LATE SUBMISSIONS. Late submissions of proposals will
not be considered unless it is determined by CNM that the late
receipt was due solely to mishandling by CNM or if the
proposal is the only one received. All other late submissions
will be returned unopened.
21. MODIFICATIONS. Only modifications received prior to the
time specified for the closing will be accepted.
No
modifications will be accepted following the opening. The
Buyer may request technical clarifications of the proposal
following the opening.
22. NUMBER FOR PROPOSAL CLARIFICATION. The
Vendor should include a local or toll-free number for proposal
clarifications. Failure to do so may result in the proposal being
declared non-responsive.
23. OFFEROR’S TERMS AND CONDITIONS. Offerors must
submit with the proposal a complete set of any additional terms
and conditions they expect to have included in a contract
negotiated with the agency.
24. OPTION TO RENEW. CNM reserves the option to renew the
resultant agreement, contingent upon fiscal funding, as provided
for within Section 13-1-150 NMSA 1978, if such renewal is
found to be in the best interests of CNM. Renewal options will
be exercised in increments of one-year terms unless otherwise
agreed to by both parties.
25. OWNERSHIP OF MATERIAL. During the term of the
resultant agreement, ownership of all data, material, and
documentation originated and prepared by the successful
vendor for CNM shall belong exclusively to CNM.
26. PAYMENT DISCOUNTS. CNM will take advantage of
payment discounts offered whenever possible; however,
payment discounts will not be used as a means to determine the
highest evaluated offer.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
28. POTENTIAL COSTS UNSPECIFIED. The Vendor shall
include in its proposal all goods, material and labor costs that it
knows or should know will be required to complete the work
under this Request for Proposals including any goods, materials,
labor or other costs that are not specifically identified in the
specifications of this Request for Proposals. All such costs shall
be identified in the proposal and separately stated in the price or
pricing proposed in the proposal.
30. PROPOSAL OPENING. Proposals will be opened on the due
date and time specified on the proposal cover sheet in the
Purchasing Department Office. This is not a public opening
and contractors are not invited to attend.
31. PUBLIC INFORMATION. All information, except that
marked as confidential, will become public information at the
time that the Proposal is awarded. Confidential information
must be marked "CONFIDENTIAL" in red letters in the upper
right hand corner of the sheets containing the confidential
information.
Price and information concerning the
specifications cannot be considered confidential.
32. REFERENCES REQUIRED. Vendor must furnish the
minimum number of reference requested herein. Failure to
submit the information may result in your proposal being
considered non-responsive.
Vendor, by furnishing these
references, agrees to allow CNM to contact any person or
organization listed, and to utilize information obtained in the
evaluation of the offer.
33. RELEASES. Upon final payment of the amount due under the
terms of the resultant agreement, the successful vendor shall
release CNM, its Governing Board, officers and employees from
all liabilities, claims and obligations arising from or under the
terms of the resultant agreement. The successful vendor agrees
not to purport to bind CNM to any obligation not assumed herein
by CNM unless CNM has expressly authorized the successful
vendor to do so and then only within the strict limits of that
authority.
34. REPORTS AND INFORMATION. At such times and in such
forms as CNM may require, there shall be furnished to CNM
such statements, records, reports, data and information, as CNM
may request pertaining to matters covered by all resultant
agreements to this Request For Proposals.
Page 6 of 36
SECTION A: STANDARD PROPOSAL TERMS AND CONDITIONS FOR RFP # P-336
35. RESPONSIBLE VENDOR. CNM reserves the right to
conduct any investigations deemed necessary to determine the
responsibility of a vendor (i.e., prove that its financial resources,
production or service facilities, personnel, service reputation
and experience are adequate to make satisfactory delivery of the
services, construction or items of tangible personal property
described in the Request for Proposals). Vendor shall provide
audited financial statements if requested by CNM.
36. RESPONSIVENESS OF PROPOSALS. Vendors are hereby
expressly instructed that all proposals in response to this
solicitation shall meet all specifications and requirements of this
solicitation.
37. SEVERABILITY. If any provision of the resultant agreement
is found invalid or unenforceable, the remainder of the resultant
price agreement will be enforced to the maximum extent
permissible and the legality and enforceability of the other
provisions of the resultant agreement will not be affected.
38. SIGNATURE. The response must be signed by an authorized
representative in order for proposal to be considered responsive.
Compete and return the form labeled “Signature of Firm’s
Authorized Representative” with proposal response.
39. STATE AND LOCAL ORDINANCES. The successful
vendor shall perform work under the resultant price agreement
in strict accordance with the latest version of all State and local
codes, ordinances, and regulations governing the work
involved. All materials and labor necessary to comply with the
rules, regulations and ordinances shall be provided by the
vendor. Where the drawings and or specifications indicate
materials or construction in excess of the code requirements, the
drawings and or specifications shall govern. The vendor shall
be responsible for the final execution of the work to meet these
requirements. In the event of a conflict between various codes
and standards, the more stringent shall apply.
40. STATUS OF VENDOR. The successful vendor is an
independent contractor performing services for CNM and neither
he/she nor his/her agents or employees shall, as a result of the
resultant agreement, accrue leave, retirement, insurance, bonding
authority, use of CNM vehicles, or any other benefits,
prerequisites or allowances normally afforded only to employees
of CNM. The successful vendor acknowledges that all sums
received under the resultant agreement are personally reportable
by him/her/her for income, self-employment and other
applicable taxes.
41. SUBCONTRACTORS. Any work subcontracted by the
successful vendor shall require the prior written approval of the
subcontractor by CNM.
All submittals must be in a SEALED envelope, received at
CNM’s Purchasing Office on or before the due date and
time. Faxed or electronically mailed responses will NOT be
accepted.
The sealed envelope should be marked on the lower left
outside corner to identify this RFP #, the RFP Due Date and
Opening Time, and the respondent firm’s company name,
contact person, phone and email.
Note, if you wish to offer more than one proposal, clearly label
each additional offer as an alternate proposal and submit all
responses in the same envelope/package as the original
proposal.
43. TAXES. CNM is exempt from Federal excise taxes and from
New Mexico gross receipts taxes on materials, except
construction materials used by a contractor. Services are not
exempt from gross receipts taxes. Taxes, if any, on services
must be included as a separate line item and not included in
your base price proposed. Applicable taxes are excluded from
the evaluation of the proposal.
44. TECHNICALITIES. CNM reserves the right to waive any
technical irregularities in the form of the proposal of the highest
evaluated vendor which do not alter price, quality or quantity of
the services, construction or items of tangible personal property
offered.
45. TELEGRAPHIC/FACSIMILE SUBMITTALS. Telegraphic
/ Facsimile proposal submittals will not be considered.
However, proposals may be modified by telegraphic/facsimile
notice, provided that the notice is received by the time and date
specified for the closing.
46. TERMINATION. Termination for cause. If the contractor,
for any cause, fails or omits to carry out the work in an
acceptable manner, CNM may give notice in writing of such
failure or omission and of a reasonable time within which to
cure the deficiency. Contractor shall be required to take
corrective measures within such time. Contractor's failure to
comply with such notice and to cure the deficiency as provided
in the notice shall subject the Agreement to immediate
termination by CNM. In the event of a for-cause termination,
CNM shall terminate the Agreement by delivering to the
Contractor a written notice of termination. The effective date
of termination shall be the date stated in the notice or, if no
date is stated, then the date of delivery of the notice. Upon
delivery of such notice, Contractor shall have the right to
receive payment for services performed prior to termination
date, including reimbursement then due.
42. SUBMITTALS. To submit an offer on the goods or services
specified, provide a type written proposal responding to the
scope of work/services, specifications, and evaluation criteria
contained herein. Vendors are to submit responses as required
for easy and clear evaluation with information presented in the
order it appears herein referencing sections on all attachments.
Each original proposal must be signed in ink by an authorized
representative; all corrections shall be initialed in ink by person
signing the proposal.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 7 of 36
SECTION A: STANDARD PROPOSAL TERMS AND CONDITIONS FOR RFP # P-336
Termination for convenience of CNM. On fifteen (15)
business days written notice to Contractor, CNM may
terminate the Agreement in whole or in part for its own
convenience in the absence of any default by Contractor. In
the event of a no-cause termination, CNM shall terminate the
Agreement by delivering to Contractor notice of termination
without cause specifying the extent to which performance of
work under the Agreement is terminated and the date upon
which such termination becomes effective. The effective date
of ter5mination shall be the date stated in the notice or, if no
date is stated, then the fifteenth (15) business day after delivery
of the notice. Within ten (10) calendar days of the effective
date of termination, Contractor shall deliver to CNM all
documents and any other materials developed under the
Agreement. Upon delivery of such notice, the Contractor shall
have the right to receive payment for services performed to
termination date, including reimbursement then due.
47. VENDOR GUARANTEE. The vendor shall guarantee all
materials, equipment and workmanship furnished and or
installed to be free of defects and shall agree to replace solely at
his/her expense any and all defective equipment, parts, etc.
within a one year period after the date of acceptance of the items
and or installation by CNM, unless otherwise agreed to in
writing at the time of award.
48. VENDOR SCHEDULE REQUIRED. The vendor shall
include a proposed schedule for completion of work under this
Request for Proposals. It should contain an itemized break down
of all items and projects, including testing dates if applicable.
49. WITHDRAWAL OF PROPOSALS. Proposals may be
withdrawn by written notice, telegram or in person by an
vendor or an authorized representative any time prior to the
award. Proposals requiring proposal security may result in
forfeiture of the security if the proposal is withdrawn following
the opening.
50. WORKMANSHIP/COOPERATION. All work shall be done
in a neat, workman-like manner using acceptable equipment and
methods. The successful vendor will cooperate with CNM and
other contractors and coordinate his/her work involving other
contractors through CNM's authorized representative.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 8 of 36
SECTION C: GENERAL TERMS AND CONDITIONS
1. Inspection and Audit. a. CNM may inspect, at any reasonable time, any part of Seller's plant or
place of business which is related to performance of this Purchase Order. Acceptance of delivery shall
not be considered acceptance of the materials, supplies or services furnished. Final inspection of
product and services will be made at the destination. Any testing or inspection procedures required
by the specification are in addition to CNM's rights under this paragraph.
b. The Contractor shall maintain detailed time records which indicate the date, time and nature of
services rendered. Contractor shall maintain detailed records of all materials or supplies delivered to
CNM under this Purchase Order, including serial numbers and other appropriate identifiers. These
records shall be subject to internal and external audit. CNM shall have the right to audit billings both
before and after payment. Payment under the resultant Agreement shall not preclude CNM from
recovering excessive, erroneous or illegal payments previously made to the Contractor.
2 Warranties. Seller warrants the materials, supplies or services furnished to be exactly as specified
in this order, free from defects in Seller's design, labor, materials and manufacture, and to be in
compliance with any drawings or specifications incorporated herein and with any samples furnished
by Seller. All applicable UCC warranties, express and implied, are incorporated herein.
3. Acceptance and Rejection. If prior to final acceptance, any materials, supplies or service are found
to be defective or not as specified, or, if CNM is entitled to revoke acceptance of them, CNM may
reject or revoke acceptance, require Seller to correct without charge within a reasonable time, or
require delivery at an equitable reduction in price at CNM's option. Seller shall reimburse CNM for
all incidental and consequential costs related to unaccepted materials, supplies or service.
Notwithstanding final acceptance and payment. Seller shall be liable for latent defects, fraud, or such
gross mistakes as amount to fraud. Acceptance of performance shall not waive CNM's right to claim
damages for breach.
4. Assignment. This order is assignable by CNM. Except as to any payment due hereunder, this
order is not assignable by Seller without written approval of CNM.
5. Changes. CNM may make changes within the general scope of this order by giving notice to
Seller and subsequently confirming such changes in writing. If such changes affect the cost of, or the
time required for performance of this order, an appropriate equitable adjustment shall be made. No
change by Seller shall be recognized without written approval of CNM. Any claim of Seller for an
adjustment under this paragraph must be made in writing within thirty (30) days from the date of
receipt of Seller of notification of such change, unless CNM waives this condition. Nothing in this
paragraph shall excuse Seller from proceeding with performance of the order as changed hereunder.
6. Termination and Delays. CNM, by written notice stating the extent and effective date may
terminate this order for convenience in whole or in part, at any time. CNM shall pay Seller as full
compensation for performance until such termination: (1) the unit or pro rata order price for the
delivered and accepted portion; and (2) a reasonable amount to be approved by CNM, and not
otherwise recoverable from other sources by Seller, with respect to the undelivered or unaccepted
portion of this order. Provided, however, compensation hereunder shall in no event exceed the total
order price. Such amount will be limited to Seller's actual cost and may not include anticipated
profits.
CNM may terminate this order by written notice in whole or in part for Seller's default if Seller
refuses or fails to comply with the provision of this order, or fails to make progress so as to endanger
performance and does not cure such failure within a reasonable period of time. In such event, CNM
may otherwise secure the materials, supplies or services ordered, and Seller shall be liable for
damages suffered by CNM, including incidental and consequential damages.
If, after notice of termination, CNM determines Seller was not in default, or if Seller's default is due
to failure of CNM, termination shall be deemed for the convenience of CNM.
The rights and remedies of CNM provided in this article shall not be exclusive and are in addition to
any other rights and remedies provided by law or under this order.
As used in this paragraph, the word "Seller" includes Seller and its subsuppliers at any tier.
9. Patent and Copyright Indemnity. Seller shall pay all royalty and license fees relating to
deliverables and other items covered hereby. In the event any third party shall claim that the
reproduction, manufacture, use, or sale of goods or items covered hereby infringes any copyright,
trademark, patent, or other intellectual property rights, Seller shall indemnify and hold CNM harmless
from any cost, expense, damage, or loss resulting therefrom.
10. Discounts. Any discount time will not begin until the materials, supplies, or services have been
received and accepted and correct invoice received by CNM's Purchasing Department. In the event
testing is required, the discount time shall begin upon the completion of the tests.
11. Penalties. The Procurement Code, Section 13-1-28 et seq., imposes civil and criminal penalties
for its violation. In addition, the New Mexico criminal statutes impose felony penalties for bribes,
gratuities and kickbacks.
12. Title and Delivery.
Title to the materials and supplies passed hereunder shall pass to CNM at
the F.O.B. point specified subject to the right of CNM to reject upon inspection. For any exception to
the delivery date specified, Seller shall give prior notification and obtain approval from CNM's
Purchasing Department. Time is of the essence and the order is subject to termination for failure to
deliver on time.
13. Payment Charges. Late payment charges shall be paid in the amount and under the conditions
stated in Section 13-1-158, NMSA 1978.
14. Other Applicable Laws. Any provision required to be included in a contract of this type by any
applicable and valid Executive order, federal, state or local law, ordinance, rule or regulation shall be
deemed to be incorporated herein.
15. OSHA Regulations. The contractor shall abide by Federal Occupational Safety and Health
Administration (OSHA) regulations and the State of New Mexico Environmental Improvement Board
occupational health and safety regulations that apply to the work performed under this Invitation.
ALL PRODUCTS CONTAINING HAZARDOUS SUBSTANCES MUST BE PROPERLY
LABELED AND ACCOMPANIED BY MATERIAL SAFETY DATA SHEETS. The contractor
shall defend, indemnify and hold CNM free and harmless against any and all claims, loss, liability
and expense resulting from any alleged violations of said regulations including but not limited to
fines, penalties, judgments, court costs and attorney fees.
16. Debarment/Suspension. In performing the services and/or furnishing the goods specified within
this purchase order, the vendor/contractor certifies that it is not suspended, debarred or declared
ineligible from entering into contracts with the Executive Branch of the Federal Government, any
State agency or local public body; nor is in receipt of a notice of proposed debarment or suspension
from the Executive Branch of the federal Government, any State agency or local public body.
17. Applicable Law. Each party acknowledges that the New Mexico Procurement Code, NMSA
1978 13-1-28 through -199, as amended, applies to every CNM purchase or contract agreement of
tangible personal property, services and construction, including participation made pursuant to this
purchase order. Further, each party acknowledges that it will be responsible for claims or damages
arising from personal injury or damage to persons or property to the extent they result from
negligence of its employees or agents and that the liability of CNM shall be subject in all cases to the
immunities and limitation of the New Mexico Tort Claims Act, NMSA 1978 41-4-1 through -2 7, as
amended.
SECTION 2
GOVERNMENT SUBCONTRACT PROVISIONS
7. Affirmative Action.
Seller shall not discriminate with regard to hiring, termination or other
incidents of employment on the basis of race, sex, national origin, religion, age or handicap. Seller
agrees to: a) adhere to the principles set forth in Executive Order 11246 and 11375, and to undertake
specifically to maintain employment policies and practices that affirmatively promote equality of
opportunity for handicapped persons, minority group persons and women; b) take affirmative steps to
hire and promote women and minority group persons at all job levels and in all aspects of
employment; c) communicate this policy in both English and Spanish to all persons concerned within
the company, with outside recruiting services and the minority community at large; d) provide CNM
on request a breakdown of labor force by ethnic group, sex, and job category; and e) discuss with
CNM its policies and practices relating to its affirmative action program.
If this order is subcontract under a U.S. Government Prime Contract, the applicable
clauses listed below are incorporated into, and form a part of, the terms and conditions of this order.
In the event of any conflict between the terms and condition of Section 2 and any other provisions of
this order the terms and conditions of Section 2 shall prevail. The clauses contained in the following
paragraphs of the Federal Acquisition Regulations are incorporated herein by reference. For purposes
of this Purchase Order, in the following clauses, the term "contract" shall mean "this order", the term
"contractor" shall mean "Seller" and the term "Government" and "Contracting Officer" shall mean
"Albuquerque CNM" and the "Director of Purchasing," respectively.
The following provisions of the Federal Acquisition Regulations (FAR) apply
regardless of the amount of this order:
8. Indemnification and Insurance Seller assumes the entire responsibility and liability for losses,
expenses, damages, demands and claims in connection with or arising out of any actual or alleged
personal injury (including death) and/or damage or destruction to property sustained or alleged to
have been sustained in connection with or arising out of the performance of the work by Seller, its
agents, employees, subcontractors or consultants, except to the extent of liability arising out of the
negligent performance of the work by or willful misconduct of CNM. In any event, CNM's liability
shall be subject to the limitations of the New Mexico Tort Claims Act. Seller shall indemnify and
hold harmless CNM, its officers, agents, and employees from any and all liability for such losses,
expenses, damages, demands, and claims and shall defend any suit or action brought against any or all
of them based on any actual or alleged personal injury or damage and shall pay any damage costs and
expenses including attorneys fees, in connection with or resulting from such suit or action.
Seller agrees that it and its subcontractors will maintain public liability and property damage
insurance in reasonable amounts covering the above obligation and will maintain workers'
compensation coverage covering all employees performing this order.
* Anti-kickback Procedures:
52.203-7
Buy American Act and Balance of Payments Program
52.225-7001
* Contract Work Hours and Safety Standards Act-Overtime Comp. 52.222-4
* Equal Employment Opportunity
52.222-26
Integrity of Unit Prices
52.215-26(a)(b)
Notice to the Government of Labor Disputes
52.222-1
Preference for U.S. Flag Air Carriers (For internal air travel)
52.247-63
Restriction on Subcontractor Sales to the Government
52.203-6
Service Contract Act of 1965 (Reserved)
52.222-41
* Termination for Convenience of Government
(Education and other Nonprofit Institutions)
52.249-5(a)(f)
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
CNM reserves all administrative, contractual, and legal remedies against Seller in case of any
breaches of the contract.
* On contracts funded by federal grants, only the Special Terms and Conditions clauses identified
by the asterisk (*) are incorporated into this contract.
Page 9 of 36
SECTION D: SCOPE OF SERVICES & EVALUATION CRITERIA FOR RFP # P-336
1.
SCOPE OF REQUEST:
Central New Mexico Community College (CNM) is seeking proposals from qualified, experienced firms
with expertise and resources to perform forensic drug screening tests collected from Health Wellness and
Public Safety (HWPS) students and faculty on an as-needed basis. Screenings shall be performed at the
beginning of each instructional term. CNM’s HWPS department anticipates approximately 3,000
screenings will be needed per year.
1.1
CNM INSTITUTIONAL INFORMATION:
CNM is the largest community college in the State of New Mexico providing year round instruction.
CNM has an enrollment of approximately 30,000 students in both the fall and spring semesters with
approximately 15,000 students enrolled in the summer term. The current Full Time Enrollment (FTE) is
approximately 20,000 students. CNM serves its students at multiple campuses and locations: Main,
Joseph M. Montoya (JMMC), South Valley, Technology Annex, Westside, Workforce Training Center
(WTC), Rio Rancho, and Alameda Business Center as well as through online distance learning and hybrid
instruction. The college offers associate degrees and certificates in a variety of subject areas.
2.
SCOPE OF WORK
2.1
It is CNM’s intent to make one or more awards to this RFP. Each awarded vendor shall receive an
indefinite quantity price agreement. The initial term of the resultant Price Agreements arising from this
Request for Proposals shall be for a one (1) year term. CNM reserves the option to renew resultant price
agreements in accordance with New Mexico Statutes Annotated (NMSA), Section 13-1-150, 1978,
contingent upon fiscal funding, contractor performance, if such renewal is found to be in the best interests
of CNM. Renewal options, if exercised, shall be exercised in one (1) year increments. The maximum
term including all exercised renewals shall not to exceed a total of eight (8) years. Purchases shall be made
to any of the awarded vendors based on various factors including but not limited to experience, resources,
availability, price, proposed solution, etc.; whatever is in the best interest of CNM.
Any resultant Price Agreement(s) may be made available for use by other Institutions of Higher Education
and Central Purchasing Offices within the State of New Mexico. An Awardee of an Indefinite Quantity
Price Agreement established with CNM has the opportunity to market the resultant Price Agreement to
other local public bodies and state agencies under the State of New Mexico Public Purchases and Property
Act, NMSA 1978, Article 1, Procurement, Section 13-1-129, “Procurement under existing contracts.” Any
purchases and transactions that take place under this allowance shall be between the Awardee and the
respective Agency and in no way shall be the responsibility of CNM. Any institution of higher education
and central purchasing office within the state of New Mexico other than Central New Mexico Community
College utilizing this price Agreement will be required to administer its own contract documents.
The awarded Price Agreement holder(s) shall be required to perform forensic urine drug testing on an asneeded basis for up to approximately 3,000 HWPS students, faculty and/or staff per year, and shall adhere
to all laws and regulations applicable to forensic urine testing within the state of New Mexico including
but not limited to DOT Certified Laboratory & Collection Protocols, DEA Permit, CAP Accredited, and
FDA Blood & Tissue Permit.
The awarded Price Agreement holder(s) should also be able to offer hands on training at your facility(ies)
to CNM’s Phlebotomy and Medical Lab Sciences students.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 10 of 36
SECTION D: SCOPE OF SERVICES & EVALUATION CRITERIA FOR RFP # P-336
2.1.1
PANEL TEST
The following panel test comprising 2.1.1A through 2.1.1J shall be provided by the awarded Contractor:
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
FUHR9
Marijana
Cocaine
Amphetamines
Opiates
Barbiturates
Benzodiazepines
Methadone
Propoxyphene
Meperidine (Demerol)
2.2
PROCESS REQUIREMENTS
Successful vendors should meet the following process requirements:
2.2.1
Only Students/Faculty with a signed authorization form shall be tested. See CNM Authorization form per
Exhibit F.
2.2.2
The awarded Contractor shall include the CNM Program Identity code as provided on the CNM
Authorization form on all testing reports (see 2.2.5 and 2.2.6 below).
2.2.3
Students are required to show valid picture ID (driver's license) with the signed authorization form.
2.2.4
The awarded Vendor shall provide receipts to students with tracking information including their name,
date sample taken, and specimen number.
2.2.5
Negative results should be accessible electronically with 48 hours of collection.
2.2.6
Positive & Dilute results shall be reviewed by a Medical Review Officer (MRO). Test results are relayed
to a MRO where a medical physician reviews the results. If the result of the screen is negative, the MRO
informs the College that the student/employee has no detectable drug in the urine. However, if the test
results are non-negative and show a concentration level of parent drug or metabolite above the established
limit, the MRO contacts the student/employee to determine if there is any legitimate reason such as a
medical treatment or prescription. If the student/employee has no legitimate reason, the results are
reported as positive. The MRO assures:
1. respect for personal confidentiality and dignity of the donor
2. maintenance of the confidentiality of medical information, except when public safety is jeopardized
3. maintenance of high scientific and medical standards
2.2.7
Positive & Dilute results shall be accessible electronically within five (5) business days.
2.2.8
Billing by CNM HWPS Instructional program shall be sent directly to CNM's Compliance & Accounts
Payable Departments.
2.2.9
PERSONNEL
Contractor shall hire all employees necessary for the performance of the resultant contract. All persons
employed by the Contractor shall be employees of Contractor and not of CNM.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 11 of 36
SECTION D: SCOPE OF SERVICES & EVALUATION CRITERIA FOR RFP # P-336
The Contractor must agree and warrant that it will not discriminate or permit discrimination in its
operation or employment practices relative to the premises against any person or group of persons on
grounds of race, color, religion, national origin, sex, age, or sexual orientation, or any manner prohibited
by the laws of the United States, the State of New Mexico, or policies of Central New Mexico Community
College (CNM).
Contractor shall be solely responsible for its own labor relations with any trade or union representative and
shall negotiate and adjust all disputes between itself and its employees or any union representing its
employees. Contractor shall comply fully with all applicable federal laws and state laws, rules, and
regulations concerning employment and labor relations. Whenever the Contractor has knowledge that any
actual or potential labor dispute is delaying or threatens to delay the timely performance of work under the
resultant contract, the Contractor shall immediately give notice thereof including all relevant information
with respect to the agreement to CNM’s designated representative.
2.3
MINIMUM QUALIFICATIONS
2.3.1
The awarded Contractor shall have several testing locations within the Albuquerque metro area with hours
of operation Monday through Saturday, and shall adhere to all laws and regulations applicable to forensic
urine testing within the state of New Mexico including but not limited to DOT Certified Laboratory, DEA
Permit, CAP Accredited, and FDA Blood & Tissue Permit
2.3.2
The awarded Contractor should have the ability to offer hands on training at your facility for CNM’s
Phlebotomy,Medical Lab Sciences and Patient Care Tech students.
2.3.3
The awarded Contractor shall have the capacity to handle approximately 3,000 drug screenings per year.
Screenings will be needed at the beginning of each CNM instructional term; approximately 1,300 at the
beginning of the Spring Term, approximately 500 at the beginning of the Summer Term, and
approximately 1,200 at the beginning of the Fall Term.
3.
EVALUATION CRITERIA
3.1
STEP 1:
Written proposals shall be reviewed and evaluated in accordance with the evaluation criteria established
below per 3.5.3.1 Section I. through 3.5.3.4 Section IV. CNM reserves the right to reject all offers and
issue a new RFP if necessary. An evaluation committee shall evaluate written proposals based on the
weighted evaluation criteria. Rankings will be based upon an average tabulation of all individual
committee member scores. If interviews are not conducted, then the score based ranking shall be the basis
for awarding the top scored Offeror.
3.2
STEP 2 (optional):
If interviews are to be conducted, then the score based rankings of the written offers shall be used as the
basis to create a short list of those top ranked firms. Interviews shall be scored in accordance with the
evaluation criteria taking into account the information provided in the written response and any additional
questions related to the scope of the RFP. Additional questions related to the scope of this RFP may be
submitted to shortlist in advance or during interviews. Information and/or factors gathered during
interviews, negotiations, and any reference checks, in addition to the evaluation criteria rankings, may be
utilized in the final award decisions. References may or may not be reviewed at the discretion of CNM.
CNM reserves the right to contact references other than, or in addition to, those furnished by a
Respondent. Final rankings will be based upon an average tabulation of all individual committee member
scores after interviews and will not be averaged with STEP 1 scores.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 12 of 36
SECTION D: SCOPE OF SERVICES & EVALUATION CRITERIA FOR RFP # P-336
3.3
CRITERIA
3.3.1
SECTION I. CAPACITY, CAPABILITY, KNOWLEDGE, BACKGROUND AND
EXPERIENCE - 30 POINTS POSSIBLE
3.3.1.1
Provide a brief narrative describing the history of your firm. Identify the number of employees in your
firm, the ownership and if the company has ever filed bankruptcy, been in loan default, or if there are any
pending liens, claims or lawsuits against the firm.
3.3.1.2
Provide demonstrated experience that supports your firms’ ability to perform the services identified in the
goals and intent of this RFP. State any other experience that indicates the qualifications of your firm for
the performance of the services as requested in this RFP.
3.3.1.2.1
MINIMUM REQUIREMENT – Identify by location (street address) and operational hours per location all
testing locations that are available to CNM students and staff for forensic urine drug testing.
3.3.1.2.2
MINIMUM REQUIREMENT – Confirm your firm’s adherence and compliance to all laws and
regulations governing drug screening service providers including but not limited to DOT Certified
Laboratory & Collection Protocols, DEA Permit, CAP Accredited, and FDA Blood & Tissue Permit.
Include copies of all permits and certifications as applicable with your response to this RFP. Identify the
internal policy(ies) in place to conform to these laws and regulations. NOTE: CNM reserves the right to
perform a site survey to verify compliance.
3.3.1.2.3
MINIMUM REQUIREMENT – Confirm your firm’s ability to perform drug screening for approximately
3,000 CNM students and staff per year (approximately 1,300 screenings at the beginning of CNM’s Spring
Term, 500 screenings at the beginning of the Summer Term, and approximately 1,200 screenings at the
beginning of the Fall Term).
3.3.1.2.4
Describe whether your firm offers any hands on training at your facility(ies) to CNM students currently
enrolled in CNM’s Phlebotomy, Medical Lab Sciences and Patient Care Tech programs. Please note that
CNM and CNM’s students do not pay for this type of community service training.
3.3.1.3
Describe the proposed project staffing/organization and internal controls to be used during the course of
the project services.
3.3.1.4
State the name, title or position, telephone number and e-mail address of the individual who would have
primary responsibility for the potential project services resulting from this RFP.
3.3.1.5
Identify names, responsibilities, qualifications and location(s) of staff who will be assigned to projects.
All changes to staff assigned to projects must be mutually agreed to by the parties.
3.3.1.6
Provide an organizational chart of your firm indicating lines of authority for personnel involved in
performance of this potential contract and relationships of this staff to other programs or functions of the
firm. This chart must also show lines of authority to the next senior level management.
3.3.1.7
Describe if your firm has had a contract terminated for default in the last five (5) years. Termination for
default is defined as notice to stop performance due to the Offeror's non-performance or poor performance
or if the issue of performance was either (a) not litigated due to inaction on the part of the Proposer, or (b)
litigated and such litigation determined that the proposer was in default. Submit full details of their terms
for default including the other parties’ name, address, and telephone number. Present the Offeror’s
position on the matter. CNM will evaluate the facts and may, at its sole discretion, reject the proposal on
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 13 of 36
SECTION D: SCOPE OF SERVICES & EVALUATION CRITERIA FOR RFP # P-336
the grounds of the past experience. Indicate if no such termination for default has been experienced by the
Offeror in the past five (5) years.
3.3.2
SECTION II. PROPOSED IMPLEMENTATION PLAN - 30 POINTS POSSIBLE
3.3.2.1
Confirm your firm’s adherence to and describe your process for testing only those CNM Students and/or
Faculty with a signed authorization form.
3.3.2.2
Confirm that your firm shall provide CNM’s Program Identification code together with the student/staff
test information on all test results accessed electronically.
3.3.2.2.1
Confirm your firm’s adherence to and describe your process for validating Students valid picture ID
(driver's license) with the signed authorization form.
3.3.2.3
Confirm your firm’s adherence to and describe your process for providing receipts to students with
tracking information including their name, date sample taken, and specimen number.
3.3.2.4
Confirm whether negative results are accessible electronically with 48 hours of collection, and if so,
identify how this information is accessible (e.g., website).
3.3.2.5
Confirm that Positive & Dilute results are reviewed by a third party Medical Review Officer (MRO).
3.3.2.6
Discuss the information and support that would be required from CNM.
3.3.2.7
Identify any subcontractors which would be used during this project and describe their role(s).
3.3.3
SECTION III. REFERENCES - 15 POINTS POSSIBLE
List a minimum of three (3) references the Offeror may have had with institutes of higher education, or
institutions of similar size during the last three (3) years that relate to the Offeror’s ability to perform the
service(s) as requested in this RFP. List references by company, address, contract period of performance,
contact person’s name, E-mail address and web address. The Offeror must grant permission to CNM to
contact the references. CNM WILL CONTACT REFERENCES VIA EMAIL, SO BE SURE TO
INCLUDE THE EMAIL ADDRESS FOR EACH REFERENCE. NOTE: Do not include CNM as a
reference.
3.3.4
SECTION IV. ECONOMY AND PRICE - 25 POINTS POSSIBLE
Proposals should include all charges associated for services requested.
CNM’s students pay for drug testing services through their student fees. Student fees can only be updated
yearly in February, but any changes will not go into effect until August of the same year. CNM’s goal is
to keep costs down for our students. As such, we strongly desire the awarded Contractor to keep pricing
the same for at least 3 years. Thereafter, we would prefer that pricing increase by no more than 3% per
year or by CPI, whichever is lowest.
CNM prefers to pay the below standardized rate for forensic drug testing inclusive of review by a Medical
Review Officer (MRO) and electronic access to test results.
$17.65 per test. Retests, if requested by the student/staff should also be at this rate.
Confirm your firm’s agreement to the above standardized rate, or identify your proposed per test rate.
Include details on how long your firm’s proposed rate will be valid for (e.g., 3 years) and the maximum
escalation per year for a total term not to exceed eight (8) years.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 14 of 36
SECTION E: SIGNATURE OF FIRM'S AUTHORIZED REPRESENTATIVE
By signing below, contractor acknowledges that it is a competent firm capable of providing the items and/or services
requested, is properly licensed for providing the items or services specified, has read this Invitation to Bid,
understands it, and agrees to be bound by its terms and conditions. Contractor hereby agrees to furnish items and/or
services, at the prices quoted, pursuant to all requirements and specifications contained in this document, upon
receipt of an authorized purchase order from the purchasing department, and further agree that the language of this
document shall govern in the event of a conflict with its bid. The undersigned, being duly authorized to sign bidding
documents and act on behalf of the contractor in an official capacity, certifies that the items and/or services offered
on this Invitation to Bid meets or exceeds all specifications, terms and conditions as described in this Invitation to
Bid without exceptions. I understand that items and/or services not meeting all specifications, terms and conditions
will be rejected and all costs shall be borne by the contractor.
Please fill in all spaces below:
Legal Company Name
Address
City, State, Zip
Phone Number
FAX Number
Email
Contact Person for Clarification of Bid Response
NM Tax ID
Federal Tax ID
Applicable NM License Numbers
ALL NEW MEXICO LICENSE NUMBERS LISTED HEREIN OR PURPORTED BY THE VENDOR MUST BE
ISSUED IN THE OFFERING FIRM’S LEGAL COMPANY NAME. LICENSE NUMBERS LISTED UNDER A
NAME OTHER THAN THE LEGAL COMPANY NAME MAY RENDER THE OFFER AS BEING NONRESPONSIVE. NON-RESPONSIVE OFFERS WILL NOT BE CONSIDERED FOR AWARD.
OFFERORS WISHING TO RECEIVE THE RESIDENTIAL PREFERENCE AS APPLICABLE PER NMSA 131-21 MUST SUBMIT A VALID RESIDENTIAL PREFERENCE CERTIFICATE WITH THEIR SEALED
RESPONSE.
OFFERORS WISHING TO RECEIVE THE VETERAN RESIDENT BUSINESS PREFERENCE AS
APPLICABLE PER NMSA 13-1-22 MUST SUBMIT A VALID RESIDENT VETERAN’S PREFERENCE
CERTIFICATE WITH THEIR SEALED RESPONSE.
Acknowledgment of Amendment/Addendum
Specify Number(s) and Date(s)
#
date
#
date
#
date
#
date
#
date
Signature of Member Authorized to Sign for Firm
Printed/Typed Name and Title of Individual Signing
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 15 of 36
SECTION F: DEBARMENT/SUSPENSION STATUS & NON-COLLUSION AFFIDAVIT FORM
DEBARMENT/SUSPENSION STATUS
1. The vendor/contractor certifies that it is not suspended, debarred or ineligible from entering into
contracts with the Executive Branch of the Federal Government, or in receipt of a notice of proposed
debarment from any State agency or local public body.
2. The vendor/contractor agrees to provide immediate notice to CNM's Purchasing Department in the
event of being suspended, debarred or declared ineligible by any State or Federal department or
agency, or upon receipt of a notice of proposed debarment that is received after the submission of this
bid but prior to the award of the purchase order/contract.
NON-COLLUSION AFFIDAVIT
The undersigned, duly authorized to represent the persons, firm and/or corporation joining and
participating in the submission of the foregoing bid (such persons, firm and/or corporation hereinafter
being referred to as the vendor/contractor), being duly sworn, on his/her oath, states that to the best of
his/her belief and knowledge no person, firm, or corporation, nor any person duly representing the same
joining and participating in the submission or the foregoing bid/proposal, has directly or indirectly entered
into any agreement or arrangement with any other vendor/contractors, or with any employee of CNM, or
any person, firm or corporation under contract with CNM whereby the contractor, in order to induce the
acceptance of the foregoing bid by CNM has paid or is to pay any other vendor/contractor or to the
aforementioned persons anything of value whatsoever, and that the vendor/contractor has not directly or
indirectly entered into any agreement or arrangement with any other vendor/contractor which tends to or
does lessen or destroy free competition in the letting of the contract sought for by the foregoing bid.
CERTIFICATION
The undersigned hereby certifies that he/she has read the above Non-Collusion Affidavit and
Debarment/Suspension Disclosure Statement and that he/she understands and will comply with these
requirements. The undersigned further certifies that he/she have the authority to certify compliance for the
vendor/contractor named below.
Signature
Printed/Typed Name
Title
Date
Legal Company Name
Address
City/State/Zip
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 16 of 36
SECTION G: RESIDENT VETERANS PREFERENCE CERTIFICATION
__________________________________________ (NAME OF CONTRACTOR) hereby certifies the following in
regard to application of the resident veterans' preference to this procurement:
PLEASE CHECK ONLY ONE BOX FROM THE FOUR (4) CHECK BOXES LISTED BELOW:
 I declare that my firm is ineligible to receive New Mexico Resident Veterans Preference.
The following three (3) checkboxes are applicable to ONLY those vendors eligible to receive New Mexico
Resident Veterans Preference AND who have included a valid New Mexico Resident Veterans Preference
certificate with their sealed response. No preference will be extended unless a valid certificate is included in
your sealed response. Submitted certificates shall be validated by CNM with New Mexico Tax & Revenue.
 I declare under penalty of perjury that my business prior year revenue starting January 1 ending December 31 is
less than $1M allowing me the 10% preference discount on this solicitation. I understand that knowingly giving false
or misleading information about this fact constitutes a crime.
 I declare under penalty of perjury that my business prior year revenue starting January 1 ending December 31 is
more than $1M but less than $5M allowing me the 8% preference discount on this bid or proposal. I understand that
knowingly giving false or misleading information about this fact constitutes a crime.
 I declare under penalty of perjury that my business prior year revenue starting January 1 ending December 31 is
more than $5M allowing me the 7% preference discount on this bid or proposal. I understand that knowingly giving
false or misleading information about this fact constitutes a crime.
"I agree to submit a report, or reports, to the State Purchasing Division of the General Services Department
declaring under penalty of perjury that during the last calendar year starting January 1 and ending on December 31,
the following to be true and accurate:
"In conjunction with this procurement and the requirements of this business' application for a Resident
Veteran Business Preference/Resident Veteran Contractor Preference under Sections 13-1-21 or 13-1-22 NMSA
1978, when awarded a contract which was on the basis of having such veterans preference, I agree to report to the
State Purchasing Division of the General Services Department the awarded amount involved. I will indicate in the
report the award amount as a purchase from a public body or as a public works contract from a public body as the
case may be.
"I understand that knowingly giving false or misleading information on this report constitutes a crime."
I declare under penalty of perjury that this statement is true to the best of my knowledge. I understand that giving false
or misleading statements about material fact regarding this matter constitutes a crime.
______________________________________________________________________________
(Signature of Business Representative)*
(Date)
*Must be an authorized signatory for the Business.
The representations made in checking the boxes constitutes a material representation by the
business that is subject to protest and may result in denial of an award or unaward of the
procurement involved if the statements are proven to be incorrect.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 17 of 36
EXHIBIT A: INSURANCE REQUIREMENTS
CERTIFICATES OF INSURANCE
The AWARDED Contractor(s) shall furnish UPON REQUEST, one copy each of Certificates of insurance herein required for each copy of
the resultant Agreement, showing the coverage, limits of liability, covered operation, effective dates of expiration of policies of Insurance
carried by the Contractor. The Contractor shall furnish to the Owner copies of limits. The Certificates of Insurance shall be in the form of
AIA Document G-705 or similar format acceptable to the Owner. Such certificates shall be filed with the Owner and shall also contain the
following statements:
1.
The Governing Board of Central New Mexico Community College, Central New Mexico Community College, its agents,
servants and employees are held as additional insured.
2.
"The insurance coverage certified herein shall not be canceled or materially changed except after forty five (45) days
written notice has been provided to the Owner."
COMPENSATION INSURANCE:
The Contractor shall procure and shall maintain during the life of any resultant agreement Worker's Compensation insurance as required by
applicable State law for all of the Contractor's employees to be engaged at the site referred to in this solicitation in case of any such work
sublet, the Contractor's Worker's Compensation insurance. In case any class of employee engaged in work on the project under this contract
is not protected under a Worker's Compensation Statute, the Contractor shall provide and shall cause each subcontractor or sub-subcontractor
to provide Employer's Insurance in an amount of not less than $500,000.
CONTRACTOR'S PUBLIC LIABILITY INSURANCE:
The Contractor shall maintain insurance coverage "equal to the maximum liability amounts set forth in the New Mexico Tort Claims Act
Section 41-4-1 et.seq. NMSA 1978". The insurance must remain in force for the life of the contract including all contract extension or
renewals. The limits effective July 1, 1992 are:
$400,000 per person/$750,000 per occurrence plus $300,000 for medical and $100,000 for property damage for a total maximum
liability of $1,150,000 per occurrence.
CONTRACTOR'S VEHICLE LIABILITY INSURANCE:
The Contractor shall procure and shall maintain during the life of this contact Vehicle Liability Insurance coverage "equal to the maximum
liability amounts set forth in the New Mexico Tort Claims Act Section 41-1-1 et. seq. NMSA 1978". The insurance must remain in force for
the life of the contract including all contract extensions or renewals. The limits effective July 1, 1992 are:
Bodily Injury:
Property Damage:
$750,000. Each Occurrence
$100,000. Each Occurrence
SUBCONTRACTOR'S AND SUB-SUBCONTRACTOR'S PUBLIC AND VEHICLE LIABILITY INSURANCE:
The Contractor shall either:
(1)
Require each subcontractor or sub-subcontractor to procure and maintain during the life of the subcontract or sub- subcontract
Public Liability Insurance of the types and amounts specified above or,
(2)
Insure the activities of the subcontractors or sub-subcontractors in the Contractor's policy as required under this Article.
GENERAL:
All insurance policies are to be issued by companies authorized to do business under the laws of the state in which the work is to be done and
acceptable to Owner.
The Contractor shall not violate, or permit to be violated, any conditions of any said policies, and shall at all times satisfy the requirements of
the insurance companies writing said policies.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 18 of 36
EXHIBIT B: CAMPAIGN CONTRIBUTION FORM
Pursuant to the Procurement Code, Sections 13-1-28, et seq., NMSA 1978 and NMSA 1978, § 13-1-191.1 (2006),
as amended by Laws of 2007, Chapter 234, any prospective contractor seeking to enter into a contract with any
state agency or local public body for professional services, a design and build project delivery system, or the
design and installation of measures the primary purpose of which is to conserve natural resources must file
this form with that state agency or local public body. This form must be filed even if the contract qualifies as a small
purchase or a sole source contract. The prospective contractor must disclose whether they, a family member or a
representative of the prospective contractor has made a campaign contribution to an applicable public official of the
state or a local public body during the two years prior to the date on which the contractor submits a proposal or, in
the case of a sole source or small purchase contract, the two years prior to the date the contractor signs the
contract, if the aggregate total of contributions given by the prospective contractor, a family member or a
representative of the prospective contractor to the public official exceeds two hundred and fifty dollars ($250) over
the two year period.
Furthermore, the state agency or local public body may cancel a solicitation or proposed award for a proposed
contract pursuant to Section 13-1-181 NMSA 1978 or a contract that is executed may be ratified or terminated
pursuant to Section 13-1-182 NMSA 1978 of the Procurement Code if: 1) a prospective contractor, a family member
of the prospective contractor, or a representative of the prospective contractor gives a campaign contribution or
other thing of value to an applicable public official or the applicable public official’s employees during the pendency
of the procurement process or 2) a prospective contractor fails to submit a fully completed disclosure statement
pursuant to the law.
The state agency or local public body that procures the services or items of tangible personal property shall indicate
on the form the name or names of every applicable public official, if any, for which disclosure is required by a
prospective contractor.
THIS FORM MUST BE INCLUDED IN THE REQUEST FOR PROPOSALS AND MUST BE FILED BY ANY
PROSPECTIVE CONTRACTOR WHETHER OR NOT THEY, THEIR FAMILY MEMBER, OR THEIR
REPRESENTATIVE HAS MADE ANY CONTRIBUTIONS SUBJECT TO DISCLOSURE.
The following definitions apply:
“Applicable public official” means a person elected to an office or a person appointed to complete a term of an
elected office, who has the authority to award or influence the award of the contract for which the prospective
contractor is submitting a competitive sealed proposal or who has the authority to negotiate a sole source or small
purchase contract that may be awarded without submission of a sealed competitive proposal.
“Campaign Contribution” means a gift, subscription, loan, advance or deposit of money or other thing of value,
including the estimated value of an in-kind contribution, that is made to or received by an applicable public official or
any person authorized to raise, collect or expend contributions on that official’s behalf for the purpose of electing the
official to either statewide or local office. “Campaign Contribution” includes the payment of a debt incurred in an
election campaign, but does not include the value of services provided without compensation or unreimbursed travel
or other personal expenses of individuals who volunteer a portion or all of their time on behalf of a candidate or
political committee, nor does it include the administrative or solicitation expenses of a political committee that are
paid by an organization that sponsors the committee.
“Family member” means spouse, father, mother, hild, father-in-law, mother-in-law, daughter-in-law or son-in-law.
“Pendency of the procurement process” means the time period commencing with the public notice of the request
for proposals and ending with the award of the contract or the cancellation of the request for proposals.
“Person” means any corporation, partnership, individual, joint venture, association or any other private legal entity.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 19 of 36
EXHIBIT B: CAMPAIGN CONTRIBUTION FORM
“Prospective contractor” means a person who is subject to the competitive sealed proposal process set forth in the
Procurement Code or is not required to submit a competitive sealed proposal because that person qualifies for a
sole source or a small purchase contract.
“Representative of a prospective contractor” means an officer or director of a corporation, a member or manager
of a limited liability corporation, a partner of a partnership or a trustee of a trust of the prospective contractor.
Name(s) of Applicable Public Official(s) if any:
CNM's Governing Board including, District 1 Ms. Pauline J. Garcia, District 2 Mr. Robert P. Matteucci Jr.,
District 3 Ms. Deborah Moore, District 4 Mr. Mark Armijo, District 5 Mr. Blair L. Kaufman, District 6 Ms.
Penelope S. Holbrook, and District 7 Mr. Michael DeWitte.
DISCLOSURE OF CONTRIBUTIONS BY PROSPECTIVE CONTRACTOR:
Contribution Made By:
______________________________________________________
Relation to Prospective Contractor:
______________________________________________________
Date Contribution(s) Made:
______________________________________________________
Amount(s) of Contribution(s)
______________________________________________________
Nature of Contribution(s)
______________________________________________________
Purpose of Contribution(s)
______________________________________________________
____________________________
Signature
_______________________
Date
____________________________
Title (position)
--OR—
NO CONTRIBUTIONS IN THE AGGREGATE TOTAL OVER TWO HUNDRED FIFTY DOLLARS ($250) WERE
MADE to an applicable public official by me, a family member or representative.
______________________________
Signature
_______________________
Date
______________________________
Title (Position)
(Attach extra pages if necessary)
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 20 of 36
EXHIB
BIT D: SAM
MPLE NON
N-DISCLOS
SURE AGR
REEMENT
T
Non-Disclosure Agreeement – forr Contractoors
This is an Agre
eement betw
ween Centra
al New Me
exico Comm
munity Colle
ege (“CNM”) and
Contractor/V
Vendor name
e] (“Contracttor”) concern
ning the conffidentiality an
nd nondisclossure of inform
mation
[C
re
elating to CN
NM, its students and em
mployees.
References in this Agre
eement to “C
CNM” mean CNM
to
ogether with its students and
a employees.
WITN
NESSETH:
WHER
REAS, Contra
actor has con
ntracted with
h CNM to pro
ovide ______
___________
________ services,
ass described in Request fo
or Proposal(s
s) No. _____
_ and related
d documents (the “Contra
act”), the term
ms and
co
onditions of which
w
Contra
act are incorp
porated herein by referencce; and
WHER
REAS, Contra
actor acknow
wledges and recognizes tthat in perforrming the Co
ontract it mayy have
acccess to data
a and informa
ation contained within or about CNM’ss resources a
and systems; and
WHER
REAS, Contra
actor acknow
wledges and recognizes tthat in perforrming the Co
ontract it mayy have
acccess to sensitive and/or proprietary and/or
a
nonpu
ublic data an
nd information
n which is orr may be sub
bject to
sttate and/or fe
ederal laws and
a regulatio
ons, including
g but not lim
mited to privaccy laws and regulations, which
m
must be kept confidential
c
pursuant
p
to th
hose laws an
nd/or regulati ons; and
WHER
REAS, Contra
actor recognizes that CNM has a com
mpelling need
d to maintain confidentialiity and
prrohibit disclo
osure of data
a and information contain
ned within C
CNM’s resources and systems, and further
re
ecognizes tha
at its Contrac
ct with CNM places Conttractor in a p
position of sp
pecial trust and confidencce with
re
espect to data
a and information concerning CNM an
nd its operatiions; and
WHER
REAS, Contrractor recogn
nizes and acknowledgess that a bre
each of this Agreement would
ause substan
ntial, grave and irreparablle harm to CNM and its in
nterests; and
d
ca
WHER
REAS, Contra
actor agrees to the terms
s and conditio
ons set forth below.
RFP # P-336, Advertised
A
March 14, 2013
3
opyright CNM
M 2013. All rig
ghts reserved
d.
Co
Pag
ge 21 of 36
EXHIBIT D: SAMPLE NON-DISCLOSURE AGREEMENT
NOW, THEREFORE, for the reasons stated above, Contractor, as a precondition to its Contract
with CNM and in partial consideration thereof, agrees and covenants with CNM as follows:
1.
Contractor agrees to perform services under the Contract pursuant to any
and all privacy and confidentiality requirements contained in state and federal laws and
regulations applicable to CNM, as well as those state and federal laws and regulations
applicable to Contractor.
2.
Contractor agrees that it will keep in strictest confidence all CNM data
and information to which it may have access in performing its duties under the
Contract, in computerized form or otherwise, and that neither it nor anyone operating
on its behalf will disclose or use, in any manner, CNM data and information, except to
the extent necessary to carry out the Scope of Work in the Contract. No other use of
the data and information by Contractor is permissible.
3.
Contractor agrees to indemnify and hold harmless CNM from any and
all liability, injury and damages resulting or arising from any intentional or
unintentional disclosure of data and/or information stored on or contained within CNM
resources and systems by Contractor, its agents and representatives.
4.
Contractor agrees and acknowledges that at all times during the Contract
it is operating and shall operate as an independent contractor and not as an agent or
employee of CNM.
5.
Contractor agrees that information contained within CNM resources and
systems shall be accessed, if at all, only as may be necessary to carry out the Contract.
Contractor agrees to reasonably limit access to information contained within CNM
resources and systems to those among its employees, officers or directors for whom
disclosure is necessary to further the purpose of the Contract.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 22 of 36
EXHIBIT D: SAMPLE NON-DISCLOSURE AGREEMENT
6.
Contractor agrees that, upon the termination or conclusion of the
Contract, it will deliver promptly to CNM all data, information, documentary and other
materials relating to CNM, and any and all copies of electronic records thereof, within
its custody or control or within the custody or control of its agents or representatives,
that it or anyone operating on its behalf created, produced or obtained in the course of
Contractor’s Contract with CNM.
7.
Contractor agrees that if any person or entity requests, subpoenas, or
otherwise attempts to obtain any data, information or material relating to CNM within
Contractor’s custody or control, or within the custody or control of anyone operating on
its behalf, it will notify CNM immediately and will cooperate fully in any legal action
by CNM seeking protection against disclosure of such data, information or material.
8.
If Contractor knows or has reason to believe that there has been an
improper use or any disclosure of CNM’s data or information, Contractor shall orally
notify CNM as soon as practicable and shall send written notice within five (5) business
days of discovery. Such notification shall set forth in detail the known or suspected use
or disclosure.
9.
Contractor acknowledges and agrees that if it breaches this Agreement,
CNM, in addition to terminating the Contract and taking other action available to it,
may obtain preliminary and permanent court injunctions to stop the breach, and may
also sue to recover from Contractor an amount equal to the damages caused by the
breach and the revenues Contractor or anyone operating on its behalf derived from the
breach, together with all costs and expenses, including attorneys’ fees, incurred by
CNM in taking such actions.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 23 of 36
EXHIBIT D: SAMPLE NON-DISCLOSURE AGREEMENT
10.
Contractor agrees that the terms of this Confidentiality Agreement will
survive the expiration or termination of the Contract.
11.
This Agreement and obligations hereunder shall be binding on the
representatives, assigns, and successors of the Contractor and shall inure to the benefit
of the assigns and successors of CNM.
12.
If any of the provisions of this Agreement are not enforceable, in whole
or in part, the remaining provisions set forth in this Agreement shall nonetheless remain
in full force and effect.
13.
This Agreement constitutes the entire understanding of the parties about
the subject matter hereof and may not be amended or modified except in writing signed
by each of the parties to the Agreement.
IN WITNESS WHEREOF, each of the undersigned has caused this Confidentiality Agreement
to be executed by their duly authorized representatives.
Central New Mexico Community College
[Contractor/Vendor Name]
Print Name: _________________________
Pint Name: ____________________
Signature: __________________________
Signature: _____________________
Title: ______________________________
Title: _________________________
Date: ______________________________
Date: _________________________
Contractor Employees who will have access:
Print Name: _____________________
Signature: _______________________
Title: ___________________________
Date: ____________________________
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 24 of 36
EXHIBIT D: SAMPLE NON-DISCLOSURE AGREEMENT
Print Name: ______________________
Signature: _______________________
Title: ___________________________
Date: ____________________________
Print Name: ______________________
Signature: _______________________
Title: ___________________________
Date: ____________________________
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 25 of 36
EXHIBIT E: SAMPLE SERVICES AGREEMENT
ENTER DESCRIPTION OF SERVICES
THIS AGREEMENT, including all exhibits thereto (“Agreement”), made this ENTER DAY of
ENTER MONTH, ENTER YEAR, by and between Central New Mexico Community College ("CNM"
or “Owner”) and ENTER NAME ("Vendor").
Recitals:
WHEREAS with CNM’s Request for certain related services in connection with ENTER
TYPE OF SERVICES, “ENTER TYPE OF SERVICES” Services (the “Project” or “Services”);
WHEREAS CNM selected Vendor’s proposal as being the most advantageous and awarded
the work to Vendor;
WHEREAS CNM and Vendor desire to enter into a written agreement for ENTER TYPE OF
SERVICES related services;
NOW, THEREFORE, the parties agree as follows:
ARTICLE ONE
STATEMENT OF WORK
1.0
ENTER DESCRIPTION SERVICES SCOPE OF WORK
1.1
ENTER DESCRIPTION SERVICES
Provide expertise and resources and consulting services to ENTER DESCRIPTION.
Lead and assist the college in the redesign and implementation of a new website for cnm.edu.
1.2 SCOPE OF WORK
ENTER SCOPE OF SERVFICES
ARTICLE TWO
CNM’S RESPONSIBILITIES
2.0
CNM agrees to contract with and does hereby contract with the Vendor, under the
terms and conditions of this Agreement, to perform for CNM ENTER DESCRIPTION and related
services as described in this Agreement.
2.1
CNM shall designate representative(s) (“HWPS Representative” or “HR
Representatvie) to act on its behalf in accordance with the limited authority described in this Section
2.1. The HWPS or HR Representative shall have limited authority to give general direction to the
Vendor, to answer questions with respect to the Work, to approve pay applications subject to other
required approvals, and to initiate the change order process. CNM shall administer this Agreement
and shall have the authority to 1) modify or interpret this Agreement, 2) to approve change orders; all
of which are decisions which are reserved to be made by CNM’s HWPS and/or HR Departments,
Business Office, and Purchasing Department. No action, representation, or conduct by the HWPS
and/or HR Representative shall relieve the Vendor of its responsibilities to carry out its duties and
obligations under this Agreement. Any notice given or modification may only be issued as a signed
change order or amendment to this agreement issued by the Purchasing Department.
2.2
CNM shall provide reasonable assistance to Vendor as Vendor may reasonably
request for the purpose of rendering the Services, including but not limited to the following: (a)
access, on an as-needed basis, to CNM personnel, and to data processing, hardware and software
CNM PO # TBD
Copyright CNM, 2013. All rights reserved.
Page 26 of 36
EXHIBIT E: SAMPLE SERVICES AGREEMENT
systems utilized by CNM, all provided and maintained at CNM’s expense in good working order and
in actual operation at all times at which Vendor reasonably requests operation for the purpose of
rendering the Services; (b) reasonable use of office equipment and services such as desks, chairs,
word processors, telephone, copying and other equipment and services reasonably appropriate to
accommodate Vendor’s personnel; and (c) a reasonable amount of space on CNM’s premises,
including parking spaces, for Vendor’s personnel.
ARTICLE THREE
VENDOR’S SERVICES
3.0
Vendor shall be capable of performing the Scope of Work and have experience in all
phases of ENTER DESCRIPTION and Drug Screening Services;
3.1
Vendor shall render all Services to fulfill the Statement of Work as defined in Article
One in a professional and workmanlike manner and will use reasonable commercial efforts to render
such Services in a manner that will not unreasonably interfere with CNM’s normal business
operations. Any Services to be provided by Vendor hereunder shall be subject to the then-current
availability of appropriate Vendor’s resources.
3.2
When providing Services under this Agreement, Vendor shall comply with all
applicable federal, state and local laws. Vendor shall be qualified to conduct the business necessary
to the performance of this Agreement in the State of New Mexico throughout the term of this
Agreement. Vendor shall obtain (or has obtained), at its own cost and expense, all necessary
licenses, professional certifications and permits and shall assume the responsibility for and pay all
applicable fees and all applicable taxes, which are now or may be imposed upon Vendor in the
future by any governmental authority arising out of such qualification to do business in the State of
New Mexico.
3.3
Upon prior written agreement by CNM, Vendor may subcontract Services to be
performed under this Agreement, provided that, in all such cases, Vendor shall be fully responsible
for the acts and omissions of its subcontractors, and shall be responsible for their performance in
accordance with the terms this Agreement. No contractual relationship shall exist between any
subcontractor and CNM, unless it is evidenced in a separate contract independent of this
Agreement.
3.4
Vendor shall retain and maintain records reasonably related to the Services provided
to CNM hereunder, sufficient to support and verify Vendor’s performance of such Services and the
fees charged to CNM therefor. Such records shall be available for examination by CNM or its
authorized representative(s) during Vendor’s regular business hours, within a reasonable period of
time following a written request by CNM to examine such records.
ARTICLE FOUR
SPECIAL SERVICES
4.0
CNM has the right to require, and Vendor agrees to perform, services related to the
Project other than the web redesign consulting Services described in Article Three of this Agreement
(“Special Services”). For services required by CNM, other than those described and required by
Article Three, Vendor will be compensated per the terms set forth in Exhibit B, Section II of this
Agreement.
4.1
Vendor shall submit a detailed written proposal for performing the Special Services
and a “not to exceed” fee proposal for such Special Services to CNM for its review and written
approval incorporating a declaration as to the suitability of performing work. The “not to exceed” fee
CNM PO # TBD
Copyright CNM, 2013. All rights reserved.
Page 27 of 36
EXHIBIT E: SAMPLE SERVICES AGREEMENT
proposal shall be broken down into specific hours and shall identify all subcontractor costs to
perform the services and accomplish the work. CNM’s approval of such proposal shall be in writing
and communicated through the issuance of an approved purchase order revision. No payment for
Special Services in connection with such Special Services shall be made except for such Special
Services performed in accordance with CNM’s advance written approval.
ARTICLE FIVE
TERM
5.0
The term of this Agreement begins immediately upon delivery to Vendor of a CNM
purchase order incorporating this Agreement, extends through approval of the final Services
performed by Vendor, and continues until both parties have fulfilled their respective obligations
under this Agreement.
ARTICLE SIX
EMPLOYMENT OF CONSULTANTS
6.0
Vendor agrees to employ competent web redesign consultants (New Mexico licensed
and registered, if applicable) not otherwise employed by CNM for the Project, as might be necessary
for the proper design and construction of the Project. Vendor shall furnish to CNM a list of these
consultants for prior approval before engaging them for the Project. Vendor represents that services
performed by the design professionals under this Agreement will be conducted in a manner
consistent with that level of care and skill ordinarily exercised by members of the profession currently
practicing under the same or similar conditions. Vendor represents that the performance of any
consultant assigned by Vendor to work on the Project shall be in accordance with sound
professional standards, and the requirements of this Agreement.
ARTICLE SEVEN
PROFESSIONAL LIABILITY INSURANCE
7.0
At its own expense, Vendor shall procure and maintain during the life of this
Agreement professional liability insurance in an amount not less than One Million Dollars
($1,000,000) for each claim and in the aggregate. Insurance coverage shall not be canceled or
materially changed except after thirty (30) days written notice has been provided to CNM. Vendor
shall furnish CNM copies of certificates of insurance showing the coverage, limits of liability, covered
operations, effective dates and dates of expiration of policies of insurance carried by Vendor.
ARTICLE EIGHT
INDEMNIFICATION AND INSURANCE
8.0
Vendor shall indemnify, defend and hold harmless CNM, its officers and employees
against all liability, claims, damages, losses or expenses (including attorney's fees) arising out of
bodily injury to persons or damage to property caused by, or resulting from, Vendor's and/or its
employees' acts or omissions. This hold-harmless and indemnification clause is subject to the
immunities, provisions and limitations of the New Mexico Tort Claims Act (Sections 41-4-1 et seq.
N.M.S.A. 1972) and Section 56-7-1, N.M.S.A. 1978 and any amendments thereto.
8.1
Vendor shall comply with all requirements of Exhibit C hereto. Copies of Insurance
certificates are required prior to release of CNM’s Purchase Order and signed Services Agreement.
CNM PO # TBD
Copyright CNM, 2013. All rights reserved.
Page 28 of 36
EXHIBIT E: SAMPLE SERVICES AGREEMENT
ARTICLE NINE
ASSIGNMENT AND SUCCESSORS
9.0
Vendor agrees not to sublet, sell or assign this Agreement or any portion of the Work
included herein, and not to enter into a partnership for the performance of the services and work
contemplated by this Agreement with any person or persons without the prior written permission of
CNM. Any approved successors or assignees shall be bound to and by the same terms and
conditions as Vendor, and shall accept in writing the delegation of Vendor’s duties and
responsibilities under this Agreement. Vendor remains responsible for completion of the Project and
warranties. Vendor remains responsible for design integrity. The following shall not be considered
“Assignment” for purposes of this Agreement: Vendor Firm’s Assignment of this Agreement or of
any Vendor rights under this Agreement to Vendor’s successor by merger or consolidation or to any
person or entity that acquires all or substantially all of its share capital or assets.
ARTICLE TEN
TIMELINESS OF PERFORMANCE
10.0 Vendor shall perform its duties and services under this Agreement with all
reasonable diligence and continuous effort, and shall not delay this Work in order to perform work
under other contracts entered into after this Agreement.
10.1 Vendor shall continue to perform the Work under this Agreement through all
disputes, with the Owner and/or the Contractor, including but not limited to payment disputes and
disputes regarding the scope of the Vendor’s obligations under the Agreement.
ARTICLE ELEVEN
OWNERSHIP OF INSTRUMENTS OF SERVICE
11.0 CNM shall be the exclusive owner of any and all right, title and/or other interest in
and to any and all work product created by Contractor as a result of any Services. The Contractor
may not use the work as a whole without CNM’s prior permission.
11.1 All written and oral information not in the public domain or not previously known, and
all information and data obtained, developed, or supplied by CNM will be kept confidential and the
Contractor will not disclose to any other party, directly or indirectly, without CNM's prior written
consent unless required by lawful order.
ARTICLE TWELVE
RECORDS AND AUDIT
12.0 Vendor shall maintain detailed time records that show the date, time and nature of
services rendered. These records shall be subject to inspection by the CNM, its representatives,
and the State Auditor. CNM, its representatives, and the State Auditor shall have the right to audit
billings both before and after payment. Payment under this Agreement shall not foreclose the right
of CNM to recover excessive and/or illegal payments. CNM, its representatives and the State
Auditor shall have access to and the right to examine and/or audit any directly pertinent records,
books, documents and papers of Vendor involving transactions related to this Agreement for a
period of three (3) years after final payment.
CNM PO # TBD
Copyright CNM, 2013. All rights reserved.
Page 29 of 36
EXHIBIT E: SAMPLE SERVICES AGREEMENT
ARTICLE THIRTEEN
APPLICABLE LAWS
13.0 Vendor shall endeavor to comply with all federal, state, and local laws and
ordinances applicable to the Work called for herein. Vendor further agrees to operate under and be
controlled by the Civil Rights Act of 1964, Title VI, and Executive Order No. 11246.
13.1 Vendor shall adhere to all State, Federal, local and CNM rules, laws, regulations,
guidelines, the New Mexico Procurement Code, CNM’s Procurement Regulations, New Mexico’s
Public Works Act (N.M. Stat. Ann. § 13-4-1, et. seq.), the New Mexico Prompt Payment Act, and all
other applicable laws, statutes, codes, regulations, and the like, the policies and procedures
associated with the Work to be performed.
ARTICLE FOURTEEN
TERMINATION
14.0 Termination for Cause. If Vendor, for any cause, fails or omits to carry out the Work
in an acceptable manner CNM may give notice in writing of such failure or omission and of a
reasonable time within which to cure the deficiency. Vendor shall take corrective measures within
such time. Vendor's failure to comply with such notice and to cure the deficiency as provided in the
notice shall subject this Agreement to immediate termination by CNM.
14.1 In the event of a for-cause termination, CNM shall terminate this Agreement by
delivering to Vendor a written notice of termination. The effective date of termination shall be the
date stated in the notice or, if no date is stated, then the date of delivery of the notice. Upon such
termination, the Vendor shall deliver to CNM all design plans, drawings, documents, and all other
materials developed under this Agreement.
CNM shall then have the right to retain the services of other design professionals to complete the
Vendor’s Work under this Agreement, and shall have no obligation to seek bids for that replacement
design professional(s). The cost of completing the Vendor’s Work under this Agreement shall be
paid for by applying the balance of the contract amount remaining on this Agreement at the time of
termination. If the cost to complete the Work under this Agreement is less than the remaining
contract amount, the remaining contract amount shall be paid to the Vendor. If the cost of
completing the Work under this Agreement exceeds the original or amended contract amount, then
the Vendor shall pay CNM for the difference between the contract amount and the cost to complete
the Vendor’s Work.
14.2 Termination for convenience of CNM. On fifteen (15) business days written notice to
Vendor, CNM may terminate this Agreement in whole or in part for its own convenience in the
absence of any default of Vendor.
14.3 In the event of a termination for convenience, CNM shall terminate this Agreement by
delivering to Vendor notice of termination without cause specifying the extent to which performance
of Work under this Agreement is terminated and the date upon which such termination becomes
effective. The effective date of termination shall be the date stated in the notice or, if no date is
stated, then the sixteenth (16th) business day after delivery of the notice. Within ten (10) calendar
days of the effective date of termination, Vendor shall deliver to CNM all design plans, construction
estimates, drawings, documents, survey books and any or all other materials developed under this
Agreement. Upon delivery of such notice, the Vendor shall have the right to receive payment for
services satisfactorily performed to termination date, including reimbursement then due.
CNM PO # TBD
Copyright CNM, 2013. All rights reserved.
Page 30 of 36
EXHIBIT E: SAMPLE SERVICES AGREEMENT
ARTICLE FIFTEEN
APPROPRIATIONS
15.0 The terms of this Agreement are contingent upon sufficient appropriations and
authorizations being made by the Legislature of the State of New Mexico and/or CNM for the
performance of this Agreement. If sufficient appropriations and authorizations are not made by the
Legislature and/or CNM, this Agreement shall terminate upon written notice being given by CNM to
Vendor. CNM's decision as to whether sufficient appropriations are available shall be accepted by
Vendor and shall be final.
ARTICLE SIXTEEN
RELEASE
16.0 Vendor, upon final payment to it of the amounts due for the Project, releases CNM,
its governors, officers and employees, and the State of New Mexico from all liabilities, claims and
obligations whatsoever arising from or under this Agreement as pertains to the Project.
16.1 Vendor agrees not to purport to bind CNM or the state of New Mexico to any
obligation not assumed herein by CNM or the State of New Mexico, unless Vendor has express
written authority to do so, and then only within the strict limits of that authority.
ARTICLE SEVENTEEN
CONFIDENTIALITY
17.0 Any confidential information provided to or developed by Vendor in the performance
of this Agreement shall be kept confidential and shall not be made available to any individual or
organization by Vendor without prior written approval of CNM.
ARTICLE EIGHTEEN
CONFLICT OF INTEREST
18.0 Vendor warrants that it presently has no interest and shall not acquire any interest,
direct or indirect, which would conflict in any manner or degree with the performance of services
required under this Agreement. Vendor shall comply with the provisions of Section 10-16-12
N.M.S.A. 1978 which requires disclosure in writing to the office of the Secretary of State of the State
of New Mexico amounts received under state contracts when and if such provisions become
applicable. With regard to performance under this Agreement, Vendor is an independent contractor,
and not an officer, agent, partner, joint venturer or employee of CNM. Neither party shall, at any
time or in any manner, represent that it or any of its agents or employees is in any manner agents or
employees of the other party.
ARTICLE NINETEEN
GOVERNING LAW/INTERPRETATION
19.0 The laws of the State of New Mexico shall govern this Agreement. In no event shall
any portion of this Agreement be interpreted against a party on the grounds that such party drafted
the provision in question. Both parties acknowledge having had ample opportunity for review and
comment by their attorneys and both parties having participated in drafting this Agreement as a
whole.
CNM PO # TBD
Copyright CNM, 2013. All rights reserved.
Page 31 of 36
EXHIBIT E: SAMPLE SERVICES AGREEMENT
ARTICLE TWENTY
AMENDMENT
20.0 This Agreement shall not be altered, changed, or amended except by an instrument
in writing executed by the parties. Only CNM’s Buyer or Purchasing Director is authorized to modify
this Agreement.
ARTICLE TWENTY-ONE
MERGER
21.0 This Agreement with its exhibits and schedules incorporates all of the agreements,
covenants and understandings between the parties thereto concerning the subject matter thereof.
No prior agreements or understanding, verbal or otherwise, of the parties or their agents shall be
valid or enforceable unless embodied in this Agreement.
ARTICLE TWENTY-TWO
CERTAIN PENALTIES
22.0 The State of New Mexico Procurement Code, Sections 13-128 through 13-1-199
N.M.S.A. 1978, imposes civil and criminal penalties for its violation. In addition the New Mexico
criminal statutes impose felony penalties for illegal bribes, gratuities and kickbacks.
ARTICLE TWENTY-THREE
FORCE MAJEURE
23.0 Neither party will be liable to the other for any failure or delay in performance under
this Agreement due to circumstances beyond its reasonable control, including Acts of God, acts of
war, accident, labor disruption, acts, omissions and defaults of third parties and official,
governmental and judicial action not the fault of the party failing or delaying in performance.:
ARTICLE TWENTY-FOUR
NOTICES
24.0 Any notice required to be given under this Agreement shall be deemed sufficient, if
given in writing and hand delivered to the following address or sent by first class mail, properly
franked and addressed as follows:
If to CNM:
Central New Mexico Community College
525 Buena Vista, SE
Albuquerque, NM 87106-4096
Attn: Gil Rivera, Buyer, Purchasing
If to Vendor:
ENTER VENDOR NAME
ENTER VENDOR ADDRESS
ENTER VENDOR CONTACT
CNM PO # TBD
Copyright CNM, 2013. All rights reserved.
Page 32 of 36
EXHIBIT E: SAMPLE SERVICES AGREEMENT
ARTICLE TWENTY-FIVE
MISCELLANEOUS
25.0 Attorney’s Fees. In the event of litigation with respect to or related to this Agreement
or the Project, such action shall be brought in the County of Bernalillo, State of New Mexico. The
prevailing party shall be entitled to recover reasonable attorney’s fees. The law of the State of New
Mexico shall govern these matters.
25.2
Insurance Requirements. The Vendor shall be required to carry insurance meeting the
requirements in the Exhibit C hereto labeled "INSURANCE REQUIREMENTS" and as noted in the
specifications. The Vendor will be required to submit the Certificates of Insurance to CNM’s
Purchasing Director prior to commencing Work under the Agreement. Insurance must remain in effect
for the entire term of the Agreement.
25.3 The General Conditions attached hereto as Exhibit A are hereby incorporated to the
extent they are not inconsistent with other provisions of this Agreement. In Exhibit A, “Seller” and
“Contractor” mean “Vendor.”
25.4 Entire Agreement.
Indefinite Quantity Price Agreement Purchase Order #
BO306XXX and this Agreement incorporates all the agreements, covenants, and understandings
between the Parties concerning the subject matter hereof, and all such covenants, agreements, and
understandings have been merged into the Indefinite Quantity Purchase Order BO306XXX including
its terms and conditions and this written Agreement. No prior agreement or understanding, verbal or
otherwise, of the parties or their agents shall be valid or enforceable unless embodied in the
Purchase Order with the attached agreement and any amendments
IN WITNESS THEREOF, the parties hereto have executed this Agreement the day and year last set
forth below.
CENTRAL NEW MEXICO COMMUNITY
COLLEGE
ENTER FIRM’S LEGAL NAME
OWNER (Signature)
FIRM (Signature)
GILBERT M. RIVERA, BUYER
(Printed name and title)
ENTER AUTHORIZED PERSON’S NAME
(Printed name and title)
Date: _____________________________________
Date: ______________________________________
CNM PO # TBD
Copyright CNM, 2013. All rights reserved.
Page 33 of 36
EXHIBIT E: SAMPLE SERVICES AGREEMENT
EXHIBIT A, GENERAL TERMS AND CONDITIONS
1. Inspection and Audit. a. CNM may inspect, at any reasonable time, any part of Seller's
plant or place of business which is related to performance of this Purchase Order. Acceptance
of delivery shall not be considered acceptance of the materials, supplies or services furnished.
Final inspection of product and services will be made at the destination. Any testing or
inspection procedures required by the specification are in addition to CNM's rights under this
paragraph.
b. The Contractor shall maintain detailed time records which indicate the date, time and nature of
services rendered. Contractor shall maintain detailed records of all materials or supplies delivered to
CNM under this Purchase Order, including serial numbers and other appropriate identifiers. These
records shall be subject to internal and external audit. CNM shall have the right to audit billings both
before and after payment. Payment under the resultant Agreement shall not preclude CNM from
recovering excessive, erroneous or illegal payments previously made to the Contractor.
2 Warranties. Seller warrants the materials, supplies or services furnished to be exactly as
specified in this order, free from defects in Seller's design, labor, materials and manufacture,
and to be in compliance with any drawings or specifications incorporated herein and with any
samples furnished by Seller. All applicable UCC warranties, express and implied, are
incorporated herein.
3. Acceptance and Rejection. If prior to final acceptance, any materials, supplies or service
are found to be defective or not as specified, or, if CNM is entitled to revoke acceptance of them,
CNM may reject or revoke acceptance, require Seller to correct without charge within a
reasonable time, or require delivery at an equitable reduction in price at CNM's option. Seller
shall reimburse CNM for all incidental and consequential costs related to unaccepted materials,
supplies or service. Notwithstanding final acceptance and payment. Seller shall be liable for
latent defects, fraud, or such gross mistakes as amount to fraud. Acceptance of performance
shall not waive CNM's right to claim damages for breach.
4. Assignment. This order is assignable by CNM. Except as to any payment due hereunder,
this order is not assignable by Seller without written approval of CNM.
5. Changes. CNM may make changes within the general scope of this order by giving notice to
Seller and subsequently confirming such changes in writing. If such changes affect the cost of,
or the time required for performance of this order, an appropriate equitable adjustment shall be
made. No change by Seller shall be recognized without written approval of CNM. Any claim of
Seller for an adjustment under this paragraph must be made in writing within thirty (30) days
from the date of receipt of Seller of notification of such change, unless CNM waives this
condition. Nothing in this paragraph shall excuse Seller from proceeding with performance of
the order as changed hereunder.
6. Termination and Delays. CNM, by written notice stating the extent and effective date may
terminate this order for convenience in whole or in part, at any time. CNM shall pay Seller as full
compensation for performance until such termination: (1) the unit or pro rata order price for the
delivered and accepted portion; and (2) a reasonable amount to be approved by CNM, and not
otherwise recoverable from other sources by Seller, with respect to the undelivered or
unaccepted portion of this order. Provided, however, compensation hereunder shall in no event
exceed the total order price. Such amount will be limited to Seller's actual cost and may not
include anticipated profits.
CNM may terminate this order by written notice in whole or in part for Seller's default if Seller
refuses or fails to comply with the provision of this order, or fails to make progress so as to
endanger performance and does not cure such failure within a reasonable period of time. In
such event, CNM may otherwise secure the materials, supplies or services ordered, and Seller
shall be liable for damages suffered by CNM, including incidental and consequential damages.
If, after notice of termination, CNM determines Seller was not in default, or if Seller's default is
due to failure of CNM, termination shall be deemed for the convenience of CNM.
The rights and remedies of CNM provided in this article shall not be exclusive and are in
addition to any other rights and remedies provided by law or under this order.
As used in this paragraph, the word "Seller" includes Seller and its subsuppliers at any tier.
7. Affirmative Action. Seller shall not discriminate with regard to hiring, termination or other
incidents of employment on the basis of race, sex, national origin, religion, age or handicap.
Seller agrees to: a) adhere to the principles set forth in Executive Order 11246 and 11375, and
to undertake specifically to maintain employment policies and practices that affirmatively
promote equality of opportunity for handicapped persons, minority group persons and women;
b) take affirmative steps to hire and promote women and minority group persons at all job levels
and in all aspects of employment; c) communicate this policy in both English and Spanish to all
persons concerned within the company, with outside recruiting services and the minority
community at large; d) provide CNM on request a breakdown of labor force by ethnic group,
sex, and job category; and e) discuss with CNM its policies and practices relating to its
affirmative action program.
8. Indemnification and Insurance Seller assumes the entire responsibility and liability for
losses, expenses, damages, demands and claims in connection with or arising out of any actual
or alleged personal injury (including death) and/or damage or destruction to property sustained
or alleged to have been sustained in connection with or arising out of the performance of the
work by Seller, its agents, employees, subcontractors or consultants, except to the extent of
liability arising out of the negligent performance of the work by or willful misconduct of CNM. In
any event, CNM's liability shall be subject to the limitations of the New Mexico Tort Claims Act.
Seller shall indemnify and hold harmless CNM, its officers, agents, and employees from any and
all liability for such losses, expenses, damages, demands, and claims and shall defend any suit
or action brought against any or all of them based on any actual or alleged personal injury or
damage and shall pay any damage costs and expenses including attorneys fees, in connection
with or resulting from such suit or action.
Seller agrees that it and its subcontractors will maintain public liability and property damage
insurance in reasonable amounts covering the above obligation and will maintain workers'
compensation coverage covering all employees performing this order.
CNM PO # TBD
Copyright CNM, 2013. All rights reserved.
9. Patent and Copyright Indemnity. Seller shall pay all royalty and license fees relating to
deliverables and other items covered hereby. In the event any third party shall claim that the
reproduction, manufacture, use, or sale of goods or items covered hereby infringes any
copyright, trademark, patent, or other intellectual property rights, Seller shall indemnify and hold
CNM harmless from any cost, expense, damage, or loss resulting therefrom.
10. Discounts. Any discount time will not begin until the materials, supplies, or services have
been received and accepted and correct invoice received by CNM's Purchasing Department. In
the event testing is required, the discount time shall begin upon the completion of the tests.
11. Penalties. The Procurement Code, Section 13-1-28 et seq., imposes civil and criminal
penalties for its violation. In addition, the New Mexico criminal statutes impose felony penalties
for bribes, gratuities and kickbacks.
12. Title and Delivery. Title to the materials and supplies passed hereunder shall pass to
CNM at the F.O.B. point specified subject to the right of CNM to reject upon inspection. For any
exception to the delivery date specified, Seller shall give prior notification and obtain approval
from CNM's Purchasing Department. Time is of the essence and the order is subject to
termination for failure to deliver on time.
13. Payment Charges. Late payment charges shall be paid in the amount and under the
conditions stated in Section 13-1-158, NMSA 1978.
14. Other Applicable Laws. Any provision required to be included in a contract of this type by
any applicable and valid Executive order, federal, state or local law, ordinance, rule or regulation
shall be deemed to be incorporated herein.
15. OSHA Regulations. The contractor shall abide by Federal Occupational Safety and Health
Administration (OSHA) regulations and the State of New Mexico Environmental Improvement
Board occupational health and safety regulations that apply to the work performed under this
Invitation.
ALL PRODUCTS CONTAINING HAZARDOUS SUBSTANCES MUST BE
PROPERLY LABELED AND ACCOMPANIED BY MATERIAL SAFETY DATA SHEETS. The
contractor shall defend, indemnify and hold CNM free and harmless against any and all claims,
loss, liability and expense resulting from any alleged violations of said regulations including but
not limited to fines, penalties, judgments, court costs and attorney fees.
16. Debarment/Suspension. In performing the services and/or furnishing the goods specified
within this purchase order, the vendor/contractor certifies that it is not suspended, debarred or
declared ineligible from entering into contracts with the Executive Branch of the Federal
Government, any State agency or local public body; nor is in receipt of a notice of proposed
debarment or suspension from the Executive Branch of the federal Government, any State
agency or local public body.
17. Applicable Law. Each party acknowledges that the New Mexico Procurement Code,
NMSA 1978 13-1-28 through -199, as amended, applies to every CNM purchase or contract
agreement of tangible personal property, services and construction, including participation made
pursuant to this purchase order. Further, each party acknowledges that it will be responsible for
claims or damages arising from personal injury or damage to persons or property to the extent
they result from negligence of its employees or agents and that the liability of CNM shall be
subject in all cases to the immunities and limitation of the New Mexico Tort Claims Act, NMSA
1978 41-4-1 through -2 7, as amended.
SECTION 2
GOVERNMENT SUBCONTRACT PROVISIONS
If this order is subcontract under a U.S. Government Prime Contract, the applicable
clauses listed below are incorporated into, and form a part of, the terms and conditions of this
order. In the event of any conflict between the terms and condition of Section 2 and any other
provisions of this order the terms and conditions of Section 2 shall prevail. The clauses
contained in the following paragraphs of the Federal Acquisition Regulations are incorporated
herein by reference. For purposes of this Purchase Order, in the following clauses, the term
"contract" shall mean "this order", the term "contractor" shall mean "Seller" and the term
"Government" and "Contracting Officer" shall mean "Albuquerque CNM" and the "Director of
Purchasing," respectively.
The following provisions of the Federal Acquisition Regulations (FAR) apply
regardless of the amount of this order:
* Anti-kickback Procedures:
52.203-7
Buy American Act and Balance of Payments Program
52.225-7001
* Contract Work Hours and Safety Standards Act-Overtime Comp.
52.222-4
* Equal Employment Opportunity
52.222-26
Integrity of Unit Prices
52.215-26(a)(b)
Notice to the Government of Labor Disputes
52.222-1
Preference for U.S. Flag Air Carriers (For internal air travel)
52.247-63
Restriction on Subcontractor Sales to the Government
52.203-6
Service Contract Act of 1965 (Reserved)
52.222-41
* Termination for Convenience of Government
(Education and other Nonprofit Institutions)
52.249-5(a)(f)
CNM reserves all administrative, contractual, and legal remedies against Seller in case of any
breaches of the contract.
* On contracts funded by federal grants, only the Special Terms and Conditions clauses
identified by the asterisk (*) are incorporated into this contract.
Page 34 of 36
EXHIBIT E: SAMPLE SERVICES AGREEMENT
EXHIBIT B
VENDOR’S COMPENSATION
SECTION I
For Drug Screening Services for the Scope of Work identified in Article Three of this Agreement,
compensation shall be based on a fixed, Not-to-Exceed fee. This fee as used in this Agreement,
shall mean the actual total amount paid by CNM to the Vendor for work prepared pursuant to this
Agreement, minus gross receipts taxes and other taxes, Costs are fixed fee amounts.
$17.65 per test. Retests, if requested by the student/staff should also be at this rate.
A.
Firm may add any applicable gross receipts tax to the fees and other payments payable
hereunder. Firm shall use and require the use of nontaxable transaction certificates by all
other parties with whom it does business in connection with performing its services under
this Agreement whenever allowed by law. In all events, Firm shall not include gross receipts
taxes paid to others as a part of the base dollar amount upon which Firm calculates gross receipts
taxes when billing its fees and expenses to CNM.
B.
Firm shall present detailed invoices and statement of the services rendered. Firm's invoices
shall reference the CNM purchase order number and be submitted in a format that has been
reviewed and approved in writing by CNM. Payments shall be made subject to CNM's approval of
the statement of the services rendered. For compensation, Firm shall issue monthly invoices for
services rendered and CNM shall make payments NET 30 days upon approved invoice per NMSA
13-1-158, based on the percent completion for milestones completed. CNM may or may not request
100% fulfillment of a final milestone prior to payment.
Firm shall issue a monthly status report detailing the estimated percent completion for work
performed on a milestone basis. The report shall include details of all work performed during the
invoice period, the estimated percentage of work performed during the invoice period and a total
percent of all work performed to date. Refer the below sample table shown below.
CNM PO # TBD
Copyright CNM, 2013. All rights reserved.
Page 35 of 36
EXHIBIT E: SAMPLE SERVICES AGREEMENT
EXHIBIT C, INSURANCE REQUIREMENTS
CERTIFICATES OF INSURANCE:
The Vendor shall furnish the Owner one copy each Certificates of Insurance herein required for each copy of the resultant
Agreement, showing the coverage, limits of liability, covered operation, effective dates of expiration of policies of insurance
carried by the Vendor. The Vendor shall furnish to the Owner copies of limits. The Certificates of Insurance shall be in the
form of AIA Document G-705 or similar format acceptable to the Owner. Such certificates shall be filed with the Owner and
shall also contain the following statements:
1.
The Governing Board of Central New Mexico Community College, Central New Mexico Community College, its
agents, servants and employees are held as additional insured.
2.
"The insurance coverage certified herein shall not be canceled or materially changed except after forty five (45) days
written notice has been provided to the Owner."
COMPENSATION INSURANCE:
The Vendor shall procure and shall maintain during the life of this Agreement Worker's Compensation insurance as required
by applicable State law for all of the Vendor’s employees , and in case of any such work being sublet, shall require the
subcontractors to maintain such Worker's Compensation insurance. In case any class of employee engaged in work on the
Project under this Agreement is not protected under a Worker's Compensation Statute, the Vendor shall provide and shall
cause each subcontractor or sub-subcontractor to provide Employer's Insurance in an amount of not less than $500,000.
VENDOR’S PROFESSIONAL LIABILITY INSURANCE:
The Vendor shall maintain professional liability insurance in the amount of at least $1,000,000.
VENDOR'S PUBLIC LIABILITY INSURANCE:
The Vendor shall maintain insurance coverage "equal to the maximum liability amounts set forth in the New Mexico Tort
Claims Act Section 41-4-1 et.seq. NMSA 1978". The insurance must remain in force for the life of the Agreement including
all extension or renewals. The limits effective July 1, 1992 are: $400,000 per person/$750,000 per occurrence plus
$300,000 for medical and $100,000 for property damage for a total maximum liability of $1,150,000 per occurrence.
VENDOR'S VEHICLE LIABILITY INSURANCE:
The Vendor shall procure and shall maintain during the life of this contact Vehicle Liability Insurance coverage "equal to the
maximum liability amounts set forth in the New Mexico Tort Claims Act Section 41-1-1 et. seq. NMSA 1978". The insurance
must remain in force for the life of the Agreement including all extensions or renewals. The limits effective July 1, 1992 are:
Bodily Injury
Property Damage
$750,000 Each Occurrence
$100,000 Each Occurrence
SUBCONTRACTORS’ AND SUB-SUBCONTRACTORS’ PUBLIC AND VEHICLE LIABILITY INSURANCE:
The Vendor shall either:
(1)
Require each subcontractor or sub-subcontractor to procure and maintain during the life of the subcontract or subsubcontract Public Liability Insurance of the types and amounts specified above or,
(2) Insure the activities of the subcontractors or sub-subcontractors in the Vendor's policy as required under this Article.
GENERAL:
All insurance policies are to be issued by companies authorized to do business under the laws of the state in which the Work
is to be done and acceptable to Owner.
The Vendor shall not violate, or permit to be violated, any conditions of any said policies, and shall at all times satisfy the
requirements of the insurance companies writing said policies.
RFP # P-336, Advertised March 14, 2013
Copyright CNM 2013. All rights reserved.
Page 36 of 36
EXHIBIT F: CNM AUTHORIZATION FORM
Authorization Form for Urine Drug Test
Company Name: Central NM Community College – Health, Wellness & Public Safety Account #TBD
Please Circle one of the following Programs:
Date:
PL
M
Student Name:
Program Name
Clinical Laboratory Assistant
Medical Laboratory Technician
Dental Assistant
Diagnostic Medical Sonography
Dietary Manager
Emergency Medical Technician Intermediate
Emergency Medical Technician Paramedic
Emergency Medical Technician Basic
Faculty
Medical Laboratory Assistant
Nurse Refresher
Nursing Assistant/Unit Coordinator
Nursing (PN & ADN)
Perioperative Nursing
Pharmacy Technician
Phlebotomy
Radiology Technician
Respiratory Technician
Surgical Technician
E
RD Numbers
35219
17080
17802
35224
92509
35220
17084
17083
92820
17088
17086
35226
35221
17087
17081
35222
35227
35228
35223
Faculty Name:
Time:
Category:
__X___ SAFE Panel 10 + Alcohol, Meperidine
Urine Drug Test :Test Code: #4968
Pre-employment / Post Offer ___X___
Post-Accident ________
Time of Accident ________
Random ________
Follow Up________
SA
Authorized Services:
Authorizing Person Signature: __________________________________
(If you have questions call Nichole Rogers at 505-224-4172)
***Attention Donor:
Tesing Agency requires photo ID at time of collection.***
Please bring this Authorization Form with you to the Collection Site. You can visit any location that offers
urine screening.
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
CL
LINICAL EDU
UCATION AG
GREEMENT
BY AN
ND BETWEEN
N
CENTRA
AL NEW MEX
XICO COMMU
UNITY COLLE
EGE
AND
This aagreement, efffective as of
through
, is made by
b and betweenn
New Mexico Comm
munity College School (herein
nafter called “S
School”).
Training Site”)) and Central
(hereinnafter called “T
EREAS, the Sch
hool has degreee/certificate prrograms in nursing and alliedd health professsions; and,
WHE
EREAS, clinicaal education is a required and
d integral comp
ponent of the cuurriculum for tthat degree; andd,
WHE
EREAS, the Sch
hool desires th
he assistance off Training Site in the developpment and impllementation off the clinical edducation
WHE
compponent of the cu
urriculum; and
d,
EREAS, Trainin
ng Site wishes to assist the School by proviiding clinical eexperience for sstudents assignned to it by thee School.
WHE
NOW
W THEREFORE, in consideraation of the mu
utual agreemen
nt set forth hereein, the School and Training S
Site agree as foollows:
1.
R
Responsibilities of the Schooll
aa. School shaall assume resp
ponsibility for planning
p
and im
mplementing thhe educational component off the student’s ttraining.
bb.
School shaall assume resp
ponsibility for assuring
a
contin
nuing compliannce with the edducational standdards establishhed by the
appropriatee accrediting organization.
cc.
School shaall appoint an individual as the Clinical Coordinator
C
forr each program
m who shall bbe the single ppoint of contacct
between th
he School and Training Site and who shalll be responsibble for the oveersight and connduct of studeents assigned to
Training Site.
dd.
When app
propriate, Scho
ool shall, in collaboration
c
with
w
Training Site, appoint a Preceptor w
who shall be rresponsible fo
or
planning an
nd implementiing each clinicaal education prrogram.
ee.
School shaall notify Train
ning Site of itts planned sch
hedule of studeent assignmennt at a time m
mutually agreedd upon by both
h
parties, an
nd shall provid
de Training Sitte with the naames of the stuudents, their level of academ
mic preparatioon, dates of the
clinical ed
ducation assign
nment for each
h student, and any required health reportss or informatioon. The Schoool shall obtain
n
written con
nsent from the student prior to forwarding any
a student reccord informatioon to Training S
Site.
ff.
School will, upon requeest, supply suffficient docum
mentation, suchh as curriculum
m vitae, Drug Enforcement Administration
n
plicable), curreent active New
w Mexico liceenses (if applicable), and otther applicablee certificates of
o
(DEA) cerrtificate (if app
competenccy, as well as necessary
n
docu
umentation of results of tubeerculosis testinng (within the past 24 monthhs), evidence of
o
current im
mmunization sttatus (including
g Hepatitis B antibody testting or proof oof vaccinationn or written prroof of Schoo
ol
refusal), caardiopulmonary
y resuscitation (CPR) training
g, and trainingg in infection coontrol (e.g. bloood-borne pathogens).
gg.
School shaall comply with
h and advise asssigned studen
nts of their obliigation to com
mply with all appplicable Schoool and Training
g
Site standaards, policies an
nd procedures,, rules and regu
ulations includding, but not lim
mited to, the Scchool’s suspeccted impairmen
nt
policy (Seee Exhibit A School of Heealth, Wellnesss, and Public Safety Suspeected Impairm
ment Policy), ddrug free work
k
1
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
environment and infection control, as well other standards of the Center of Medicare and Medicaid Services (CMS), the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO), the Occupational Safety and Health Act (OSHA), and
other regulatory, licensing, and accrediting organizations to which Training Site is bound to abide or to which Training Site
deems, it its sole discretion, to subscribe. The Training Site shall be responsible to furnish School with information and
documentation necessary for School to comply with this paragraph.
h.
School represents that neither School, nor any of School’s management or any other employees or independent contractors
who will have any involvement in the services or products supplied under this Agreement, have been excluded from
participation in any government healthcare program, debarred from or under any other federal program (including but not
limited to debarment under the Generic Drug Enforcement Act), or convicted of any offense defined in 42 U.S.C. Section
1320a-7, and that School, School’s employees, and independent contractors are not otherwise ineligible for participation in
federal healthcare programs. Further, School represents that School is not aware of any such pending action(s) (including
criminal actions) against School or School’s employees or independent contractors. School shall notify Training Site
immediately upon becoming aware of any pending or final action in any of these areas.
i.
School shall communicate, through its Clinical Coordinator, with Training Site on matters pertinent to clinical education.
Such communication will include, but not be limited to, on-site visits to Training Site while the School students are
participating in the clinical education program. All expenses related to such on-site visits shall be borne solely by the School.
j.
When appropriate, School shall supply Training Site with the forms to be used in evaluating student performance in Training
Site.
k.
School shall obtain and, at all times while this Agreement is in effect, maintain professional and general liability insurance as
necessary to insure the School and students against any liability, claim or claims, or judgments for damages including death,
bodily injury, and property damage arising directly or indirectly out of their activities during their clinical education with
Training Site. The amount of coverage shall be not less than what is stated in the Tort Claims Act (41-4-19 maximum
liability). Certificates of such insurance will be provided annually.
l.
School shall advise Training Site of changes in faculty, curriculum, and policy, which may affect this clinical education
program.
m. Confidentiality and Disclosure of Patient Information.
1) Confidential Information
For purposes of this Section, the term “Confidential Information” shall mean the non-public information of Training
Site, including, but not limited to, individual patient medical records or information related to the care of individual
patients, including billing and claims information, policies and procedures, any formulae, patterns, compilations,
programs, devices, methods, systems, techniques, processes, financial information, business strategy, or costing data that
(1) derives independent economic value (actual or potential) from not being generally known to , and not being readily
ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use, or (2) is the
subject of efforts that are reasonable under the circumstances to maintain its secrecy. The term “Confidential
Information” shall not include information which: (1) is known to the receiving party prior to receiving it form the other
party, (2) is generally know to the public, or (3) is disclosed to one party at any time by a third party who had the legal
right to disclose it, or (4) is independently developed by the other party in compliance with law.
2) Confidentiality
(a) School shall have access to Confidential Information and other information including information relating to
individual patients which shall be deemed to be confidential and School shall not, nor shall its employees and
agents, except as may be required by any lawful subpoena, curt order, or legal process, at any time without Training
Site’s prior written consent: (a) disclose any such information to any third party, or (b) reproduce or utilize any such
information in furtherance of any business venture other than the operation of Training Site. School further agrees
that its personnel, contractors, and subcontractors involved in the performance of Services under the terms of this
Agreement shall sign a Confidentiality Agreement, which is attached hereto as Exhibit B.
(b) If School is required by lawful subpoena, court order, or legal process to disclose any Confidential Information or
other related information, School shall provide notice thereof to Training Site to enable Training Site to seek a
protective order or other appropriate legal or equitable remedy to prevent such disclosure, should Training Site
determine it intends to do so.
2
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
3) Health Insurance Portability and Accountability Act
(a) Throughout the term of this Agreement School shall, at no cost to Training Site, comply with all applicable state,
federal and local laws, rules and regulations currently in effect, or which may become effective during the term of
this Agreement, including HIPAA and any related regulations, with regard to PHI, including, without limitation the
handling, storage, disclosure, security and maintenance of Health Information (referred to collectively as the
“Privacy Laws”).
(b) Further, in regard to HIPAA, School warrants that:
(i) School will not use or further disclose PHI other than as permitted by this Agreement or required by law.
(ii) School shall protect and safeguard from any oral and written disclosure all confidential information regardless
of the type of media on which it is stored (e.g., paper, fiche, electronic, etc.) with which it may come into
contact.
(iii) School shall implement and maintain appropriate policies and procedures to protect and safeguard PHI.
(iv) School shall use appropriate safeguards to prevent use or disclosure of PHI other than as permitted by this
Agreement or required by law.
(v) School shall ensure that all of its subcontractors and agents to which it provides PHI pursuant to the terms of
this Agreement shall agree to all of the same restrictions and conditions to which School is bound. Under such
agreement, the third party shall (a) provide reasonable assurances that such PHI will be held confidential as
provided pursuant to this Agreement, (b) provide reasonable assurance that such PHI will be disclosed only as
required by law or for the purposes for which it was disclosed to such third party, and (c) immediately notify
School of any breaches of the confidentiality of the PHI, to the extent it has obtained knowledge of such breach.
(vi) School shall, within five (5) days of becoming aware of a loss, a suspected loss, or disclosure of PHI in
violation of this Agreement by School, its officers, directors, employees, contractors or agents or by a third
party to which School disclosed PHI pursuant to this Agreement, report any such disclosure to Training Site’s
Privacy and Security Officers. This requirement will also apply to any loss, or suspected loss of PHI and
Confidential Information.
(vii)School shall, within five (5) business days of receipt of a request from Training Site, make available PHI in
accordance with 45 CFR § 164.524. In the event any individual requests access to his or her PHI directly from
School, School may not deny access to the PHI requested. However, School shall, within two (2) business
days, forward such request to Training Site.
(viii)School shall, within ten (10) business days of receipt of a request from Training Site for and amendment of an
individual’s PHI, make available PHI for amendment and incorporate any amendments to PHI in accordance
with 45 CFR § 164.526. In the event any individual requests an amendment to his or her PHI directly to
School, School may not deny the amendment to the PHI requested. However, School shall, within two (2)
business days, forward such request to Training Site.
(ix) School shall, within ten (10) business days of notice by Training Site, make available the information required
to provide an accounting of disclosures in accordance with 45 CFR § 164.528. At a minimum, School shall
provide Training Site with the following information: (i) the date of the disclosure, (ii) the name of the entity
or person who received the PHI, and if known, the address of such entity or person, (iii) a brief description of
the PHI disclosed, and (iv) a brief statement of the purpose of such disclosure that includes an explanation of
the basis for such disclosure. In the event the request for an accounting is delivered directly to School, School
shall within two (2) business days forward such request to Training Site. It shall be Training Site’s
responsibility to prepare and deliver any such accounting requested. School hereby agrees to implement an
appropriate record keeping process to enable it to comply with the requirements of this paragraph.
(x) School shall make its internal practices, books and records relating to the use and disclosure of PHI received
from, or created or received by one party on behalf of the other available to the Secretary of Health and Human
Services, governmental officers and agencies, and Training Site for purposes of determining compliance with
45 CFR §§ 164.500—534.
(xi) Upon termination of this Agreement, for whatever reason, School will return or destroy all PHI, if feasible,
received from, or created or received by it on behalf of Training Site which School maintains in any form, and
retain no copies of such information, or if such return or destruction is not feasible, to extend the precautions of
this Agreement to the information and limit further uses and disclosures to those purposes that make the return
or destruction of the information infeasible;
3
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
(xii)School recognizes that any breach of confidentiality or misuse of information found in and/or obtained from
records may result in the termination of this Agreement and/or legal action. Unauthorized disclosure may give
rise to irreparable injury to the patient or to the owner of such information and accordingly the patient or owner
of such information may seek legal remedies against School.
(c) Survivability
The obligations of this section shall survive the termination of this Agreement.
2.
3.
Responsibilities of The Training Site:
a. Upon request from School, Training Site shall provide a Preceptor with adequate time to plan and implement this clinical
education program and, when feasible, to attend relevant faculty meetings and conferences.
b.
As appropriate, Training Site shall evaluate the performance of the assigned students as often as is mutually agreed,
using the evaluation forms supplied by the School. The completed evaluation will be forwarded to the School within one
week following the conclusion of a student’s clinical education assignment.
c.
Training Site shall provide the physical facilities and equipment necessary to conduct this clinical education program,
including, wherever possible, the use of library, study, locker and cafeteria facilities.
d.
Training Site shall provide each assigned student with orientation relevant to Training Site facilities and policies and
procedures.
e.
Training Site shall advise the School at the earliest possible time of any serious deficit noted on the ability of an assigned
student to progress toward achievement of the stated objectives of this clinical education program. Training Site reserves
the right to dismiss any student from Training Site premises when it is deemed in Training Site sole discretion that the
student’s health or performance is a detriment to the well-being any Training Site patient or employee.
f.
Training Site shall inform the School of any changes in its operation or policies, which may materially affect this clinical
education program.
Mutual Responsibilities
a. School and Training Site mutually agree that students who are assigned to Training Site shall not receive any
compensation from the parties for such assignment, and they shall not be considered employees of the parties while
participating in the program that is the subject of the Agreement, nor shall students be eligible for employee benefits
provided by the parties including but not limited to worker’s compensation benefits in the event of injury of the student
while assigned to Training Site.
b.
School and Training Site shall work together to determine the number of students to receive clinical education at
Training Site and the length of rotation required to achieve the stated clinical education objectives.
c.
School, in collaboration with Training Site, will establish the clinical education objectives for the affiliation, devised
methods for their implementation, and evaluate their effectiveness.
d.
School and Training Site agree that each will exchange all necessary data and information for each to comply with
business objectives as well as any appropriate certification and/or accreditation organizations and requirements of
federal, state, or local regulations. Any request for data or information shall be given with reasonable advance notice and
shall be in writing.
e.
School and Training Site agree that they will comply with all federal and local laws including the provisions of the Civil
Rights Act of 1964, which are applicable to activities carried out under this Agreement. The parties agree not to engage
in unlawful discrimination on the basis of race, color, national origin, gender, religion, family responsibilities, disability,
political affiliation, age, or sexual orientation.
f.
This Agreement shall be effective for
and shall remain in effect until
. Either party
may terminate this Agreement by giving the other party written notice not less than ninety (90) days prior to the effective
date of the termination. In any event, the termination will not be effective until the end of the then-current academic
term.
4
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
g.
This Agreement shall not be assigned in whole or in part without the prior written consent of both parties.
h.
All notices and other communications which may be or are required to be given by the parties to this Agreement shall be
in writing and shall be mailed by first-class, certified mail, return receipt requested, postage prepaid, addressed to the
addresses appearing below. Each party may designate by notice in writing a new address to which any notice and other
communication may thereafter be so sent. Each notice and communication shall be deemed received only at such time as
the return receipt is signed by the recipient. Notices shall be addressed to the parties as follows:
1) If to the School:
Nichole Rogers, External Compliance Coordinator
School of Health, Wellness, & Public Safety
Central New Mexico Community College
525 Buena Vista SE
Albuquerque, NM 87106
505-224-4172 Direct Line
505-224-4120 Fax Line
2) If to the Training Site:
i.
This Agreement shall be governed by the Laws of the State of New Mexico.
j.
No revision or modification of this Agreement shall be effective unless it is in writing and is signed by both parties.
5
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
WITNESS WHE
EREOF, the paarties hereto haave executed th
his Agreement aas of the day aand year first abbove written.
IN W
Centrral New Mexicco Community College
Tamrra Mason, Dean
n
Schoool of Health, Wellness,
W
& Pub
blic Safety
Date :
Date:
Lorettta Montoya, Comptroller
C
Date :
Date:
6
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
CLINIICAL EDUC
CATION A
AGREEMEN
NT
Supportting Docum
ments
Exhibit
Doccument Nam
me
P
Purpose
Exhibit A
Policy
y and Proced
dures for stu
udents suspeccted
of impairm
ment during clinicals.
c
T
To provide cclear guideliines and
coonsistent proocedures for handling
inciddents of studeent use/abuse of alcohol,
drugs or conntrolled subsstances.
Exhibit B
Confiden
ntiality Agreeement
Exhibit C
Perform
mance Expecttations
7
To ensure studdents are awaare of their
respponsibilities
To provide clear perforrmance
exppectations foor faculty andd students.
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
EXHIBIT A
CENTRAL NEW MEXICO COMMUNITY COLLEGE (CNM)
SCHOOL OF HEALTH, WELLNESS, & PUBLIC SAFETY (HWPS)
POLICY AND PROCEDURES FOR STUDENT SUSPECTED OF IMPAIRMENT
ADOPTED 2003
Revisions for minors added July 27, 2006
1.
Policy: Although CNM enforces a policy regarding substance abuse, the special needs of the Health, Wellness, & Public Safety
(HWPS) programs require additional procedures for handling the suspected drug/alcohol impairment of students enrolled in
HWPS coursework designated as theory/clinical, practical or laboratory courses. Due to the nature of the course of study,
students enrolled in such HWPS theory/clinical/practical/laboratory courses must not be under the influence of any substance
(regardless of whether the use of the substance is legal or illegal), which impairs or is likely to impair their clinical judgment
while in the patient care, clinical, practical or laboratory setting. This policy demonstrates the HWPS commitment to safeguard
the health of the students and the public and provides a safe place for students to learn.
2.
Purpose: Drug or alcohol use, either while on-campus or in a clinical, practical or laboratory setting, can seriously endanger the
safety of patients and students, as well as render it impossible to provide safe healthcare and service. Impairment or potential
impairment of judgment in the clinical, practical or laboratory setting places the safety of students, patients, faculty and the
general public at unacceptable risk.
The purpose of this policy is to:
a. Provide clear guidelines and consistent procedures for handling incidents of student use/abuse of alcohol, drugs or controlled
substances that affect or are likely to affect judgment in the classroom, clinical, practical or laboratory setting.
b. Inform students of their responsibility to conform to all state and federal laws and regulations and CNM policies, rules and
regulations regarding alcohol, drugs or controlled substances.
c. Provide substance abuse prevention/detection education for all faculty regarding problem recognition and implementation of
this policy.
d. Balance the need to safeguard the public with the student’s rights.
3.
Definitions:
a. Legal Drugs: Legal drugs include medications prescribed by a physician for a specific individual and over-the-counter
medications. The HWPS prohibits the use/abuse of such drugs to the extent that behavior or judgment is adversely affected.
b. Illegal Drugs: Illegal drugs include those controlled substances (certain drugs or substances that are subject to or have a
potential for abuse or physiological dependence) under federal or state law that are not authorized for sale, possession or
use/abuse (in confirmed, detectable levels), and legal drugs which are obtained or distributed illegally. Manufacture,
use/abuse, possession, sale, purchase or transfer of illegal drugs is prohibited. The CNM Student Code of Conduct further
elaborates on this policy.
c. Impairment: A chemically impaired person is one who is under the influence of a substance that interferes with mood,
perception or consciousness resulting in physical and/or behavioral characteristics which affect the individual’s ability to
meet standards of performance, behavior and/or safety in clinical, practical or laboratory course settings.
4.
Legal Use of Substance under Direction of Physician: A student taking legal drugs must be able to provide documentation of a
medical reason for such in the event of a positive drug screen. This student may not participate in any clinical, practical or
laboratory setting if impaired. All attendance policies remain in place and the student remains responsible for completing all
requirements of the course or program.
5.
Factors Suggesting Impairment: Current students while in the patient care, clinical, practical or laboratory setting may be asked to
submit to a drug test, if cause or reasonable suspicion of substance use exists. Factors which COULD establish cause/reasonable
suspicion include, but are not limited to:
 Unsteady gait
 Unusual sleepiness or drowsiness
 Slurred speech or change in the student’s usual speech pattern
 Blood shot eyes
 Unusually disheveled appearance
 Aggressive tone
 Physical aggression
 Odor of alcohol or marijuana
8
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT











6.
Residual odor peculiar to some chemical or controlled substances
Unexplained and/or frequent absenteeism during a scheduled class or clinical laboratory
Personality changes or disorientation
Inappropriate behavior which suggests that the student is under the influence of a chemical substance that impairs or could
impair clinical, practical or laboratory judgment
Repeated failure to follow instructions or operating procedures
Violation of clinical, practical or laboratory facility or CNM safety policies
Involvement in an accident or near-accident
Marked decrease in manual dexterity and/or coordination in body movement
Discovery of or presence of drugs/drug paraphernalia in student’s possession
Alcohol in a student’s possession
Theft or absence of narcotics from the student’s clinical or practical site
Substance Use Testing Procedures:
a. The student will be removed from the classroom or clinical laboratory without delay and will be given an opportunity to
explain his/her behavior. If the instructor/preceptor reasonably suspects impairment, the student shall be sent for a drug
screen to a suitable laboratory designated by CNM. The student will not be able to return to class or clinical laboratory until
the Director of the Program, the Dean of HWPS, the Dean of Students or identified designees deem it appropriate. The
student remains responsible for all course or program requirements during such period.
b. Students suspected of impairment will be sent for a 10+alcohol forensic urine drug screen with split specimen and proper
chain of custody. In addition, the student is to have a breath analyzer test for alcohol that is certified by the Substance Abuse
Mental Health Services Administration (formerly NIDA) for DHHS/DOT testing and accredited in Forensic Urine Drug
Testing by the College of American Pathologists (CAP-FUDT). The preceding requirements regarding custody and
certification apply to a retest. A facility that is licensed in compliance with the law will be used for the testing.
c. The student will be given a Drug Screening Referral Form and will take the Drug Screening Referral Form to the testing site
immediately. The student must report to the testing site within one hour from the time the Drug Screening Referral Form is
completed. The student shall provide the instructor with the student’s current phone number.
d. The student shall take a government issued picture identification card, such as a driver’s license or high school picture
identification, with them to the testing facility.
e. The student may not drive him/herself to the testing facility. The instructor will arrange for transportation from the clinical or
practical laboratory to the designated testing site through the HWPS. If the student is a dual credit student, the high school
principal must be notified and written parental/legal guardian permission (obtained at the time of course enrollment) must be
in place to send via a cab or parent/legal guardian will transport within the acceptable time frame.
f. CNM will pay for drug/alcohol screening whether the results are positive or negative. The student shall be informed of the
test result. If the test result is positive, a student may request and pay for a retest of the collected urine specimen at the
designated laboratory or another certified laboratory. Results of the test and contents of the Impaired Behavior Form shall
remain confidential and may be released only to the Dean of HWPS and Dean of Students Office or the deans’ designee and
to those with a legitimate need to know. In the event of the screening of a high school student, the high school principal and
parents/legal guardians will be notified.
7.
Consequences:
a. If the test results are negative the student will meet with the instructor and the director of the HWPS program within two
working days, not including Saturday or Sunday, of the receipt of the test results. During this meeting with the instructor and
the director the student will have an opportunity to present information regarding the matter. Behavioral issues that prompted
the drug/alcohol screen will be discussed and a decision will be made whether disciplinary action will be taken. If
disciplinary action is indicated, the matter will be referred to the Dean of Students Office. The outcome of the decision
(whether or not disciplinary action is needed) will be sent to the Dean of HWPS.
b. If the drug or alcohol screen is positive, the following actions will occur:
 The student will be notified by the Director of the program, the Dean of HWPS, or identified designee of the results of
the test and that they cannot return to the classroom, clinical, practical or laboratory setting until approved to do so by the
Dean of Students Office.
 All documentation will be sent to the Dean of Students Office for further action.
 The student shall contact the Dean of Students Office by the next working day after being notified of the test results.
 The student may request a retest of the split specimen at their own expense at another certified laboratory as described
above.
9
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
c.
d.
e.
f.
g.
h.
If a student admits to being impaired by drugs or alcohol they will be removed from the clinical, practical or laboratory site
and treated as for a positive drug screen. All documentation will be forwarded to the Dean of Students Office for further
action.
If a student fails to report to the testing site within the time required or refuses to have a drug screen completed, such failure
or refusal shall be treated as for a positive drug screen. All documentation will be forwarded to the Dean of Students Office
for further action.
In the event that a disciplinary action includes suspension or dismissal from a HWPS program and/or CNM and the student
thereafter requests and is allowed to return to any HWPS program, the following steps will be required prior to re-entry:
 All CNM and HWPS requirements associated with the suspension or dismissal must be met.

The student must provide a clean drug and alcohol screen prior to re-entry.
 The student must submit to random urine screens as long as the student remains enrolled in a clinical, practical or
laboratory program within the HWPS. An outside agency will be used, such as the Monitored Treatment Program. A
positive test will result in referral to the Dean of Students Office for further action, with a recommendation from the
Dean of HWPS for permanent dismissal from the HWPS.
Students testing positive for drugs and/or alcohol will be strongly advised to complete a Drug/Alcohol Rehabilitation
Program.
Conviction of a criminal drug statute while enrolled in a HWPS program will result in referral to the CNM Dean of
Students Office for possible further action.
Consequences imposed on dual credit students by this Policy may be in addition to and not in lieu of consequences imposed
by policies in effect in the public school district in which the student is also enrolled.
10
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
GUIDELINES FOR INSTRUCTOR/PRECEPTOR
If an instructor or preceptor reasonably suspects a student is under the influence of a substance that impairs or could impair
clinical judgment, they should follow these steps:
INSTRUCTOR:
1.
The instructor shall remove the student from the clinical, practical and/or laboratory setting without delay. The instructor shall
give the student an opportunity to explain his/her behavior. If instructor reasonably suspects impairment, the instructor shall send
the student for a drug screen, and the student will not be allowed to return to the classroom, clinical, practical or laboratory setting
until the Director of the program, the Dean of HWPS, the Dean of Students or identified designees deems it appropriate.
2.
The instructor shall document the behavior observed on the Impaired Behavior Form. The category marked “other” can include
any type of inappropriate behavior not otherwise listed that reasonably suggests that the student is under the influence of a
substance that impairs or could impair judgment in the particular clinical, practical or laboratory setting.
3.
The Impaired Behavior Form shall be fully completed even if the student:
a. refuses or is unable to sign the document (in which case the instructor/preceptor should note the reason (s).)
b. admits to being under the influence of a specific substance (in which case the student shall sign the statement)
4.
The instructor shall document on the form any witnesses to the behavior and the actions taken. Where possible, the instructor will
have a witness verify the observations and sign the form.
5.
The instructor shall complete the Drug Screening Referral Form and retain a copy and send the original form with the student for
testing without delay. The student shall be advised as follows:
a. Take a government issued picture identification card, such as a driver’s license or school issued picture identification card,
with them to the testing facility.
b. They may not drive themselves. The instructor will arrange for two-way transportation from the clinical or practical
laboratory to the drug-testing site through the HWPS. The instructor should contact the HWPS office for the purchase order
number and phone number of an approved taxicab company to transport the student. Alternatively, the student may arrange
for someone else to give him/her a ride to the testing facility, to arrive within one hour of the time the Drug Screening
Referral Form is completed.
c. A split specimen shall be requested and the student shall have an opportunity to request and pay for a retest of the collected
specimen.
d. The student must report to the testing facility within one hour of being sent for a drug screen.
6.
The student shall provide the instructor with the student’s current phone number.
7.
The instructor shall notify the director of the classroom/clinical/practical/laboratory program in which The student is enrolled and
the Dean of HWPS (in person, via pager, or telephone; detailed messages should not be left on voice mail) of the action taken as
soon as practical, and shall provide the completed Impaired Behavior Form and a copy of the Drug Screening Referral Form to
the director and the Dean of HWPS.
PRECEPTOR:
1.
A preceptor shall remove the student from the clinical, practical or laboratory setting without delay and inform them that they are
being sent for a drug screen. They will be told that they will not be allowed to return to the clinical, practical or laboratory setting
until the Dean of HWPS deems it appropriate.
2.
The preceptor should then immediately contact the CNM instructor with whom he/she is working to report this action and any
explanation provided by the student. If the instructor is available on site the instructor may take over. If the instructor is
unavailable, the preceptor shall proceed with the process for instructors, above.
11
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
CNM SCHOOL OF HEALTH, WELLNESS, & PUBLIC SAFETY (HWPS)
SUSPECTED IMPAIRMENT FORM
__________________________ (date & time) at ___________________________________ (place)
________________________________ (student) _________________________________ (course #)
This student was removed from the clinical, practical or laboratory setting, based on the factors indicated below. This student
may not return to the clinical laboratory or classroom until they meet with the director of the program and the Dean of HWPS and/or
Dean of Students Office.


















Unsteady gait
Blood shot eyes
Unusual sleepiness or drowsiness
Unusually disheveled appearance
Slurred speech or in a different pattern from the student’s usual pattern
Aggressive tone (describe)____________________________________________________________
Physical aggression (describe)_________________________________________________________
Odor of alcohol or marijuana (Circle)
Residual odor peculiar to some chemical or controlled substance (Describe)_____________________
Unexplained and/or frequent absenteeism during a scheduled class or clinical laboratory session
Personality changes or disorientation
Discovery or presence of drugs/drug paraphernalia and/or alcohol in a student’s possession (Circle)
Repeated failure to follow instructions or operating procedures
Violation of safety policies of the clinical, practical or laboratory facility or CNM
Involvement in an accident or a near accident
Marked decrease in manual dexterity and/or coordination in body movement
Theft or absence of narcotics from the student’s clinical or practical site
Other behaviors ___________________________________________________________________

Other comments (Include length of time observed, distance from student, and how student responded when confronted):
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
______________________________________________________________________________
The following witness (es) also observed the behavior(s) noted (Please print and sign name):
________________________________________________________________________________
_______ A preceptor, the time of notification and name of the instructor_________________________
12
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
CNM SCHOOL OF HEALTH, WELLNESS, & PUBLIC SAFETY (HWPS)
SUSPECTED IMPAIRMENT FORM
Page 2
THE ACTIONS TAKEN WERE: (Choose one of the following and initial):
I. _______ sent for a drug/alcohol test at ______________________ (Time).






The student may not return to the clinical, practical or laboratory setting until results are known and approved to do so.
The student must take a government or school issued picture identification to the drug testing site.
The student may arrange for transportation to the drug testing site. They may not drive themselves. If they cannot
arrange transportation, CNM will provide a one-way trip from the clinical, practical or laboratory site to the drug testing
site. Transportation provided by:
______________________________________________________________________
The student must arrange for transportation from the drug testing site.
The student has a maximum of one hour to report to the drug testing site from the time at which the Drug Screening
Referral Form is completed.
A split specimen may be collected in the event the student will want another lab to test the specimen.
II. ________The student admits to being impaired by __________________________ and shall be treated as having a positive
drug/alcohol test (Student MUST sign this form).
III. _______The student refused to go for a drug/alcohol test as described and shall be treated as having a positive drug/alcohol test.
A positive drug or alcohol test will result in immediate referral to the Dean of Students Office for disciplinary action. Self-admission
of drug or alcohol impairment or refusal to go for a test will also result in immediate referral to the Dean of Students Office. All
information is to be kept confidential.
_____________________________________
Instructor/Preceptor Print name
_________________________________________
Signature
Date
Time
_____________________________________
Student
Print name
_________________________________________
Signature
Date
Time
_____________________________________
Witness if student refuses to sign. Print name
_________________________________________
Signature
Date
Time
If student would/could not sign, please indicate reason or reasons given:
_____________________________________________________________________________________
Notification to _________________________ occurred on __________________________ (time & day).
Director, Dean, or Dean Designee
(Copies of this form shall be given to: student, Dean of HWPS, Program Director, instructor, student file)
(Revised 11/12/03; 8/2010)
13
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
DRUG SCREENING REFERRAL FORM
TO: CONCENTRA:
Commons
3811 Commons Ave NE
Albuquerque, NM 87109
(505) 244-3804
Encino
801 Encino Pl E-1
Alb, NM 87102
(505) 842-5151
North Pointe
5700 Harper NE Ste. 110
Albuquerque, NM 87109
(505) 823-9166
Outside Albuquerque:______________________________________________________
After hours in Albuquerque: ________________________________________________
FROM:
________________________________________ (name of student) is to obtain a 10+alcohol forensic urine drug screen with a split
specimen and proper chain of custody. In addition, the student is to have a breath analyzer test for alcohol. Results of both tests
are to be clearly marked “CONFIDENTIAL” and sent in a sealed envelope clearly marked “CONFIDENTIAL” to Nichole Rogers the
External Compliance Coordinator for HWPS, at the above address.
I, _____________________________________________________ (Printed student name) give permission for Concentra to release
the results of this drug screen to the External Compliance Coordinator and/or the person named below at CNM.
Immediate results will be called to _________________________at_______________________.
Director of Program/Designee
Phone number
_______________________________
Student’s signature
PRINT CNM representative/Preceptor
__________________________
Date
____________________________
Signature
_____________
Date
(Revised 11/12/03; 8/2010)
14
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
EXHIBIT B
CENTRAL NEW MEXICO COMMUNITY COLLEGE
THE SCHOOL OF HEALTH, WELLNESS, & PUBLIC SAFETY
Confidentiality Agreement
Any individual requiring access to patient, or business information at any clinical site must sign this agreement in order to receive
access. This includes access to written as well as electronically stored information. The terms of this agreement apply to oral, written
and electronic information. Violations of the terms of this agreement are grounds for immediate legal and/or disciplinary action. This
agreement supersedes all prior agreements related to confidentiality or proprietary information. Please read the terms of this
agreement carefully.
I agree to and understand the following conditions:
1) I will not disclose, release, or discuss any patient information, including clinical information of any kind, such as treatment
protocols, medical conditions, financial/social information or patient demographic information, for any purpose except to
complete duties assigned. I understand that this includes all patients--even ones that I may know personally. In addition, I
understand that state and federal law also require me to keep all patient information confidential.
2) I will not disclose, release, or discuss business (e.g., financial, legal, operational, marketing) or employee information with any
third party without first receiving written authorization from an appropriate clinical site manager who has authority to grant such
authorization.
3) I will not seek information about patients, employees, or business operations for my own personal use by accessing electronic or
written records or through oral communications. I understand that my access to such information is strictly limited to only to that
information that I need to know in order to carry out duties assigned.
4) I will not transmit confidential information about patients, employees, or business operations via unsecured networks. I
understand that this includes sending unencrypted clinical information on the Internet and the utilization of unsecured cellular
phone networks.
5) I will not at any time, share or disclose USERNAMES, PASSWORDS, or other authorizations that I use to access information. I
understand that this includes posting or writing this information where other individuals can view it. I accept responsibility for all
activities undertaken using my access codes or other authorizations.
6) I will not attempt to gain unauthorized access to computer hardware/software/firmware that is owned by owned by any clinical
site or disclose procedures (in whole or in part) to others so that they might do so.
7) I will take reasonable care to prevent the unauthorized use, disclosure, or availability of confidential and/or proprietary
information including through unattended screen displays and/or unsecured written documents. I understand that business and
employee information is confidential and proprietary and should not be made available to persons or entities outside of the
clinical site. I further agree, upon the conclusion of my clinical rotation, to return all business, patient information in my
possession or control to my clinical preceptor/instructor.
8) I acknowledge that the clinical site retains the right to monitor and/or review my access to information at any time for evidence of
tampering or misuse, and may, at its own discretion, suspend or terminate my access privileges pending administrative review.
9) I will immediately report any violations of these rules that I know of or suspect to the appropriate authorities.
10) The rules of confidentiality and ethical behavior at the clinical site are available to me for review. I agree to follow these rules
and behave in a professional, ethical manner at all times. I understand that misconduct and/or breaches of confidentiality will be
grounds for legal and/or disciplinary action.
Student Signature
Individual’s Full Name (Printed)
Date
12/02
15
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
EXHIBIT C
Performance Expectations
1.
General
a. School’s faculty and students must comply with Training Site’s student and employee policies in addition to the appropriate
regulatory agencies for their profession.
b.
School’s faculty and students MUST OBTAIN VERBAL CONSENT from the patient and/or the patient’s family to provide
care or observe procedures, surgeries, etc.
c.
School’s faculty and students must comply with Training Site’s policies regarding confidentiality.
1) School’s faculty and students WILL NOT photocopy or otherwise reproduce any portion of the medical record for
personal use.
2) Photocopy and facsimile machines are intended for use by Training Site’s employees and staff in the execution of their
jobs, and are not intended for personal use of School’s faculty or students.
3) School must have proof of a current Clinical Education Agreement BEFORE the student(s) begin their clinical rotations
within Training Site.
d.
Representatives of the School may schedule meetings with the Director, Manager or Preceptor to discuss and evaluate the
student program.
e.
Training Site acknowledges that some Schools request students to participate in independent clinical rotations.
1) School MUST arrange student preceptorship with the Director, Manager, or Preceptor of the precepting unit/area before
the student arrives on the unit/area.
2) No student will work on a unit/area without the approval of the Director, Manager or Preceptor and an identified
preceptor who can be present on the unit.
f.
Training Site WILL NOT ASSUME responsibility for medical bills if a student or faculty member is injured or exposed to a
health hazard while on clinical rotation.
1) Training Site will assume financial responsibility for testing of a patient if there is a suspected exposure, to a student or
faculty member, to a communicable disease has occurred. The test results will be reported to the student, faculty, the
School and the patient.
2) Students and faculty members are financially responsible for testing and/or medical treatment they receive at Training
Site while on clinical rotation.
2.
Supporting Documentation
a. At the time any student(s) is/are assigned to Training Site, School will have the following documentation available for review
by Training Site upon request:
1) Verification and documentation that each faculty member and student have:
a) Current CPR course completion (if applicable); and,
b) Immunity for rubella and rubeola; and,
c) Negative TB test within the last 24 months; and,
d) Hepatitis B vaccination series, if given (Hepatitis B series is highly recommended).
b.
c.
School will have available documentation that each faculty member and student have had basic safety training which may
include the following:
1) Safety (Fire, Electrical, Security, Hazmat, Emergency Preparedness, Equipment, Utility Systems); and,
2) Tuberculosis (TB) precautions; and,
3) Ergonomic Safety; and,
4) Infection Control/Universal Precautions, and
5) OSHA Blood borne Pathogens (IDS & Hepatitis B)
School will have available documentation for each faculty member regarding:
16
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
1) Current licensure or certification in the State of New Mexico by the appropriate licensing board; and,
2) Appropriate qualifications for their positions as a faculty member; and,
3) A list of faculty members including full name, professional title, and telephone numbers.
3.
Orientation
a. Clinical Students and Faculty Involved In Direct Patient Care
1) The Director/Manager of the Division the students will be doing clinical in or rotating through, will arrange for the
orientation of student instructors/faculty.
2) The Division Director/Manager will orient instructors/faculty to the physical layout of the unit/area, patient care routines,
and documentations forms.
3) New student instructors/faculty MUST be oriented to the unit/area on which they will have students PRIOR to assuming
full accountability for student clinical rotation.
4) The student instructor/faculty will orient students to the organization and the clinical unit/area.
a) The faculty will orient students on their first day of clinical rotation, before they report to their assigned units, and
provide the Director, Manager or designee with a work schedule for each student on the unit/area.
b) A complete list of students with their names and home phone numbers must be presented to the Charge Nurse and/or
preceptor on the first day of a clinical rotation.
b.
Observational Preceptorship Programs
1) The Training Site preceptor will provide an orientation for students and/or faculty appropriate to the site or Divisions
involved.
c.
Clinical Rotations (Only For Students And Faculty Involved in Direct Patient Care)
1) Once a contract is completed, School will submit requests for clinical rotations to the appropriate Division
Director/Manager and/or Preceptor who will be responsible for coordination of clinical rotation programs for students
within their units/areas.
2) If students are injured during their clinical rotation, School is responsible to ensure that the following occurrence reports
are completed by the injured individual:
a) Accident Report for a physical injury (can be obtained from the unit).
b) Exposure Report for exposure to a health hazard (can be obtained from the unit),
i. Needle punctures, scalpel cuts, etc.
ii. Improper handling of specimens
iii. Hazardous agents
iv. Excessive radiation
c) These reports are forwarded to the unit/area Director and then processed as per current policy.
d.
Faculty Guidelines (Only For Faculty Directly Supervising Students Involved In Direct Patient Care)
1) The School will supply sufficient staff to insure the effective supervision of students and implementation of the Health,
Wellness, & Public Safety program.
2) School is responsible for the actions of students at all times.
3) School faculty as well as staff will assist, encourage, and promote the learning process for students.
4) School faculty, in collaboration with Training Site department Director/Manager, will make student assignments on the
unit/area. Training Site STAFF WILL RETAIN ULTIMATE RESPONSIBILITY FOR ALL PATIENTS ASSIGNED
TO STUDENTS.
5) School faculty and students are encouraged to attend unit/area report, when appropriate, to obtain current patient status
information and to identify student learning opportunities.
17
EXHIBIT G: SAMPLE CLINICAL EDUCATIONAL AGREEEMENT
e.
Student Guidelines
1) Training Site staff may interrupt or stop students from performing procedures which may be detrimental to the patient or
when the patient refuses to allow a student to perform the procedure.
2) School students will report to work at the designated time and receive a report on their assignment.
3) Students must contact the appropriate faculty member, Preceptor, or designee to report an illness and expected absence.
4) School students may independently perform ONLY those tasks or procedures for which they have been previously taught
and have the knowledge and skills to perform competently.
5) A School faculty member or appropriate Training Site staff member, must be present when students are performing new
tasks or procedures for which they have not been determined to be competent or for which they do not feel competent.
a) When a physician is willing to be present and assume clinical responsibility, certain tasks maybe performed in
accordance with the New Mexico Practice Act.
b) These tasks cannot be performed until after formal education for the task is documented by the student in
accordance with the New Mexico Medical Practice Act.
6) Students may take verbal or telephone orders ONLY under direct supervision and with the validation of the appropriate
School faculty or Training Site staff member.
a) All student orders must be co-signed by the appropriate authority (faculty, preceptor, etc.).
7) Students may administer routine medications ONLY under the direct supervision of School faculty or authorized
Training Site staff member and in accordance with rules and regulations of appropriate agencies.
a) The student’s knowledge of the medication should be verbally assessed concerning:
i. Actions
ii. Adverse effects
iii. Implications
iv. Normal dosage
b) Sterile water is considered a medication because it has undergone the approval process through the Food and Drug
Administration.
8) Student nurses may administer IV push medications ONLY under the supervision of a Training Site staff or School
faculty who have been IV certified.
9) Because students are not licensed personnel they may not:
a) Have narcotic keys assigned to them. (They may use the keys to obtain medications for IM, oral, or subcutaneous
administration under the direct supervision of their faculty or assigned staff nurse. They will return the keys
promptly to the accountable/assigned Training Site licensed staff member.)
b) Be placed in charge of a code or administration of code medications. (They should notify the nursing staff of a lifethreatening situation and begin CPR.)
10) All entries made by a student on a patient chart or any medical record from must:
a) Have prior approval and co-signature from School faculty or authorized Training Site staff member.
b) Nursing students will sign their names on the chart followed by S.N. (student nurse) or SPN (student practical
nurse), as appropriate.
i. School Faculty or authorized Training Site staff will co-sign where the student has signed.
ii. School faculty or authorized Training Site staff will cosign the student’s assessment on the chart and record in
the Nursing Progress Notes whether there is agreement or disagreement with the student’s assessment.
c) All other students will sign their names with the appropriate title as outlined by their regulatory agencies.
18