Loading...
11/22/2016 AgreementCONTRACT BETWEEN THE BOARD OF COUNTY COMMISSIONERS AND THE BOARD GOVERNORS FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FLORIDA AND BOUND TREE MEDICAL, LLC FOR THE PURCHASE OF MEDICAL SUPPLIES AND PHARMACEUTICALS THIS CONTRACT, hereinafter "CONTRACT" or "AGREEMENT ", is made and entered into this 1 St day of December, 2016 by and between the Monroe County Board of County Commissioners and Board of Governors Fire and Ambulance District 1 of Monroe County, Florida, hereinafter referred to as "COUNTY ", and Bound Tree Medical, LLC, hereinafter referred to as "CONTRACTOR ". WITNESSETH: WHEREAS, the COUNTY advertised a notice of request for proposals for medical supplies and pharmaceuticals. WHEREAS, the successful Proposer was Bound Tree Medical, LLC, and; WHEREAS, this CONTRACTOR represents that it is capable and prepared to provide such services, and; WHEREAS, the COUNTY intends to enter into an agreement to furnish medical supplies and pharmaceuticals at set pricing and; WHEREAS, this contract is an "Agreement" between both parties, NOW, THEREFORE, in consideration of the promises contained herein, the parties agree as follows: 1. CONTRACT DOCUMENTS — This contract consists of the Agreement, the CONTRACTOR'S response to the Request for Proposals (RFP), and the documents referred to in the Agreement as a part of this Agreement. In the event of any conflict between any of the contract documents, the one imposing the greater burden on the CONTRACTOR will control. 2. CONTRACT PERIOD AND RENEWAL - The effective date of this Agreement shall be December 1, 2016 through November 30, 2019, with two one -year options for renewal, subject to the approval of the Monroe County Board of County Commissioners and the Board of Governors of Fire and Ambulance District 1. 3. CONTRACT TERMINATION - This Agreement may be terminated for any reason by either party on 30 -day written notice without cause. If the CONTRACTOR fails to fulfill the terms of this Agreement, or attachments, properly or on time, or otherwise violates the provisions of the agreement or of applicable laws or regulations governing the use of funds, the County may terminate the contract immediately by written notice. The notice shall specify cause. All finished or unfinished supplies or services shall, at the option of the County, become property of the County. The County shall pay the CONTRACTOR fair and equitable compensation for expenses incurred prior to termination of the agreement, less any amount or damages caused by the CONTRACTOR'S breach. If the damages are more than compensation payable, the CONTRACTOR will remain liable after termination and the County shall pursue collection for damages. 4. SUBJECT MATTER OF CONTRACT - This Agreement is to furnish medical supplies and pharmaceuticals at set pricing to Monroe County Fire Rescue. PRICING — is set forth in the Medical Supply Discount Off List and Pricing Worksheet (Attachment A). This will be inserted in the contract, which outlines both a discount in the form of a percentage off list, and pricing on specified numbered items. 6. QUALITY INSURANCE PROVISIONS A. Quality and Quality Control. A system of test inspections shall be used to insure receipt of the quality and quantity of material(s) /service(s) purchased. Material(s)/Service(s) will be promptly inspected any discrepancies from the purchase order and /or the supplier's invoice shall be reported immediately by the Monroe County Logistics Specialist. B. Material Safety Data Sheet (MSDS). Any items delivered must be accompanied by a MSDS. The MSDS must be maintained by the user agency and must include the following information: 1) The Chemical name and the common name of the toxic substance. 2) The hazards or other risks in the use of the toxic substance, including: a) The potential for fire, explosion, corrosively and reactivity; b) The known acute and chronic health effects of risk from exposure, including the medical conditions which are generally recognized as being aggravated by exposure to the toxic substance; and c) The primary routes of entry and symptoms of overexposure. 3) The proper precautions, handling practices, necessary personnel protective equipment, and other safety precautions in the use of, or exposure to, the toxic substances, including appropriate emergency treatment in the case of overexposure. 4) The emergency procedure for spills, fires, disposal and first aid. 5) A description, in lay terms, of the known specific potential health risks posed by the toxic substance intended to alert any person reading this information. 6) The year and month, if available, that the information was compiled and the name, address, and emergency telephone number of the manufacturer responsible for preparing the information. C. CONTRACTOR must be able to supply contracted requested supplies within a three (3) business day time frame of normal request of supplies when the County has made that request within normal working hours of 8 am to 5 pm Monday through Friday. During emergency (natural or man -made emergencies) situations CONTRACTOR must be able to supply requested supplies on a next day basis, twenty -four (24) hours a day seven (7) days a week. 7. CONTRACTOR'S LIABILITY A. Warranty. It shall be the CONTRACTOR'S responsibility to submit at the time of shipment the original manufacturer's warranty for the materials supplied. CONTRACTORS shall follow procedure(s) to accomplish supplying a replacement product, if warranted. Replacements shall be finalized within five working days of reporting the defect. B. Guarantee. The material(s) supplied shall be guaranteed to be free from defect of composition, conception and workmanship for a minimum period of 120 days from the date of acceptance by the County. Any parts or portions found not in accordance with this specification will be rejected by the County and returned to the CONTRACTOR at the CONTRACTORS expense for immediate replacement. 8. SPECIFICATIONS: A. Substitutions. Items supplied shall be as ordered and specified. When substitutions are recommended or necessary, the determination as to whether any proposed substitution is or is not equal to the product specified as a standard shall be made by the COUNTY, and such determination shall be final and binding. B. Quality. The materials to be furnished shall be currently in production and shall be of the manufacturer's standard or better quality. C. Quantities. The quantities listed on the Medical Supply Discount Off List and Pricing Worksheet (Attachment A) are estimated quantities for one (1) year. The COUNTY shall not be required to purchase any minimum or maximum quantities during the term of any award resulting from this specification. The COUNTY may purchase as little as zero percent (0 %) or exceed as much as one hundred percent (100 %) of the forecasted or estimated quantities. D. Packaging. Only materials that are packaged in the original factory fresh packaging shall be accepted. No materials that have been re- packaged or that are in the adulterated or damaged packages shall be accepted at the receiving location, nor shall after - market materials be accepted at the receiving location. Any attempts by the CONTRACTOR to furnish the COUNTY with other than first quality materials shall constitute default as outlined in this specification. E. Refrigeration. Maintaining a specific temperature range throughout the shipping process is essential to the quality of healthcare products. Only materials which have been properly shipped in a temperature- controlled environment shall be accepted by the COUNTY. F. Expiration Dates. All merchandise shall have a minimum expiration date of 18 months from date of shipment, and date must be displayed on the package. 9. CONDITIONS: A. Authorization. All orders shall be placed via Monroe County by individual Purchase Orders generated by the County's electronic ordering software, Operative IQ, or as "Open" Purchase orders, at the County's election. B. Furnishing Items. Contract items are to be furnished on an "as needed, when needed basis" during the life of the contract. C. Delivery. Materials ordered shall be delivered within three (3) business days after receipt of order. Failure to do same shall be considered breach of contract or default, and the COUNTY shall utilize its options as stated within the proposal specification. D. Backorders. In the event an item is not immediately available at the time of an order, or is not able to be delivered within three (3) days, the County shall have the option of purchasing the item from another vendor. E. Penalties. The COUNTY reserves the right to increase or decrease quantities shown without penalty. F. Addition/Deletion. The COUNTY reserves the right to add or delete any item from this proposal or resulting contract when deemed to be in the interest of the COUNTY. G. Samples. When required, samples shall be labeled with the CONTRACTORS' name and item number and shall be furnished free of charge. Samples not destroyed will be returned upon request at the CONTRACTOR'S expense. H. Substitution. The CONTRACTOR shall not substitute items for like items without the approval of the COUNTY. Any violation of such procedure may result in a possible cancellation of the contract. All approved substitutes shall be annotated as such on the CONTRACTOR'S shipping document(s). I. Contract Prices. Contract prices from Medical Supply Discount Off List and Pricing Worksheet (Attachment A) shall be firm and shall not be amended after the contract is executed. Any attempt by the CONTRACTOR to amend said prices unilaterally shall constitute default as outlined in the contract. Prices quoted shall include all shipping costs, shipped F.O.B Marathon, Florida or to the facility location specified by the requestor or the purchase order. All taxes of any kind and character payable on account of the work done and materials furnished under the award shall be paid by the CONTRACTOR and shall be deemed to have been included in the price. The COUNTY is exempt from all state and federal sales, use, transportation, and excise taxes. Contract prices shall include all royalties and costs arising from patents, trademarks, and copyrights in any way involved in the work. Whenever the CONTRACTOR is required or desires to use any design, device, material or process covered by letters of patent or copyright, the CONTRACTOR shall indemnify and save harmless the COUNTY, its officers, agents, and employees from any and all claims of infringement by reason of the use of any such patented design, toll, material, equipment or process, to be performed under the contract, and shall indemnify the said COUNTY, its officers, agents and employees for any costs, expenses and damage which may be incurred by reason of any infringement at any time during the prosecution or after the completion of the work. J. Contract Provisional Prices off List Price. Contract pricing for items not included on Medical Supply Discount Off List and Pricing Worksheet (Attachment A) and sold to the County at a discounted percentage rate off the list price issued by CONTRACTOR shall be firm and shall not be amended after the contract is executed. Any attempt by the CONTRACTOR to amend said prices shall constitute default as outlined in the contract. COUNTY will verify items by a printout from the CONTRACTOR's online catalog showing both the "list price" and "your price ", the latter being the COUNTY'S price. K. Contract Changes. No changes, over the contract period, shall be permitted unless prior written approval is given by the Monroe County Board of Commissioners and the Board of Governors of Fire and Ambulance District 1. No CONTRACTOR shall assign the contract or any rights or obligations there under to a subcontractor without the prior written approval of the Monroe County Board of Commissioners and the Board of Governors of Fire and Ambulance District 1. L. Price Escalation. The County will allow a price escalation provision for items on the Medical Supply Discount Off List and Pricing Worksheet (Attachment A) with this award. The original CONTRACTOR prices on Medical Supply List Pricing Worksheet (Attachment A) shall be firm for a one (1) year minimum period. A price escalation /de- escalation will be allowed one (1) year after the beginning of the award period and at one (1) year intervals thereafter, provided the CONTRACTOR notifies the COUNTY, in writing of any requested price changes at least sixty (60) days prior to those changes taking effect. This request must be accompanied by a certified letter from the CONTRACTOR'S supplier showing the price increase to the contractor. The price increase to the County shall be limited to the percentage increase to the CONTRACTOR as stated in this letter. If, at the point of exercising the price escalation provision, market media indicators show that the prices have decreased, and that the CONTRACTOR has not passed the decrease on to the COUNTY, the COUNTY reserves the right to place the CONTRACTOR in default, cancel the contract, and remove the CONTRACTOR from the COUNTY's CONTRACTOR list for a period of time deemed suitable to the COUNTY. M. Invoicing. The CONTRACTOR shall furnish the COUNTY complete itemized invoices for the goods received. Invoices are to reflect the prices stipulated on the purchase order, and as outlined on the Medical Supply Discount Off List and Pricing Worksheet (Attachment A). Invoices are also to reflect the provisional price discount in the form of a percentage at which the CONTRACTOR will sell these items off its list price. The COUNTY will not accept an aggregate invoice. As part of the award process, the COUNTY may request a sample invoice. Invoices shall contain, but not limited to the following information: • Invoice number • Company name • Purchase order number • Location and dates of delivery • Cost of items as stated on the contract and extended price to reflect total cost for number of items received. N. Payment. Full payment will be made by the COUNTY after receipt and acceptance of materials /services and proper invoices in accordance with the Florida Local Government Prompt Payment Act, Section 218.70 et al. O. Ordering. CONTRACTOR will provide web -based online ordering website designed specifically for service. P. Disaster Recovery. CONTRACTOR must have a proven Disaster Support Program in place and shall provide the COUNTY with emergency numbers for these situations. These numbers will be updated immediately if the contact number changes. 10. INDEMNIFICATION — CONTRACTOR shall indemnify and hold the COUNTY and Monroe County and Monroe County Fire and Ambulance District 1 harmless for any negligence on its part or faulty or improper workmanship, for all work performed under this contract, including all costs of collection, reasonable attorney fees, claim costs, and as per "Attachment I ". All property or equipment being directly maintained or repaired by CONTRACTOR shall be considered in its care, custody, and control while such work is in progress and until physical control of such property or equipment is restored to the COUNTY. 11. INSURANCE — The Proposer will comply with the insurance requirements listed in Attachment I to the RFP. 12. ADDITIONAL REQUIRED STATEMENTS / VERIFICATIONS / AFFIDAVITS. Attached hereto in Attachments 13. Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners of Monroe County, Florida. 14. Venue for any litigation arising under this contract must be in a court of competent jurisdiction in Monroe County, Florida. This Agreement is not subject to arbitration. ESS WHEREOF, each party hereto has caused this contract to be executed by its duly k representative. MADOK BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA B y: Clerk of Court BOUND TREE MEDICAL, LLC: B Nice President Print Name and Title Date: 01/13/2017 4 de- ° " '� By: 5 Mayor BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FL L Mayor / Chairperson CCU -- r, cc!, r_ Attachment A — Medical Supply Discount Off List and Pricing Worksheet = Attachment B — Submission Proposal Response Form - Attachment C — Non - Collusion Affidavit I Attachment D —Lobbying and Conflict of Interest cn ZD Attachment E — Drug Free Workplace -' Attachment F — Public Entity Crime Statement - co -� Attachment G — Local Preference (if applicable) c ,a Attachment H — Scope of Services Response Form 1W Attachment I — Request for Waiver of Insurance Requirements (if applicable) 13. Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners of Monroe County, Florida. 14. Venue for any litigation arising under this contract must be in a court of competent jurisdiction in Monroe County, Florida. This Agreement is not subject to arbitration. ESS WHEREOF, each party hereto has caused this contract to be executed by its duly k representative. MADOK BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA B y: Clerk of Court BOUND TREE MEDICAL, LLC: B Nice President Print Name and Title Date: 01/13/2017 4 de- ° " '� By: 5 Mayor BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FL L Mayor / Chairperson CCU -- r, cc!, r_ SECTION FOUR: ATTACHMENTS AND FORMS Attachment A Medical Supply Discount Off List and Pricing Worksheet Attachment B Submission Proposal Response Form Attachment C Non - Collusion Affidavit Attachment D Lobbying and Conflict of Interest Attachment E Drug Free Workplace Attachment F Public Entity Crime Statement Attachment G Local Preference Attachment H Scope of Services Response Form Attachment I Insurance Requirements, Indemnification/Hold Harmless, and Request for Waiver of Insurance Requirements Q C N V a Q � s 3 111 N 7 cc O. N 3 LL t7 VI d .0 Y d C 'v a a c N N O O N 0 a CL N d �-- Pu 4 7 SR EM; V7 M 4/ M M M N Yfl 4'a H1 A N N 117 � /f! N Iff Yi N ^ � N M M M N M M M 12 M M H9 I��R M M F► ei► fi N ' Z.. x m x m x m x m x m x m x x m m a W x m x m x m x m x¢¢¢ m W W W x m x m ¢ W W W so t m Y W q O O W N J � W Q d' U Q v y O V y0 � J v o � 0 0 J 0 4J J W J W W Z W W Z Z Z J W Z Z O ¢ J J J G 3 333 Z W w Z Z W W W W K w W W w W G °C o VI y to W Vt Vi W y W Vl lU y W W W W W d' C cc ~ N v U U u W X W J LL X W J LL X W J LL X W J LL X W J LL X W J LL X W J LL X W J LL L X m LL X m LL X m LL X m LL X X S m (J Z Z Z N a a y c ¢ C J Q a 6 J J Ca c J c C J X M \ O X m \ O x m \\ O x m \ O x m \ O x m \ x m \ O X m \ , � , 4 , ,. W m l7 m U' m C7 W J a � W V W W 1; 1 y vt W H W t; O y y y y O O n y N O O m IA OJ O O m � O to W O W y W O W UI W d Y Y Y Q O Q W J W N J J �n w J �n N J W W w�.. w w W W W W W � W r W { W H O S 0 0 2 Z Z Z z Z } 4 1- 1 i- x LA 2 x 2 x o o S W W y r y y F y U y U y y y y y y y ' t_ 3 3 t 3 3 t F 3 y W W J W to W m W d O d d o 0 a 0 d 0 t_ ►_2- w w w w w w m v u>, p o V m i m w w m m ° ; m ° W` m a LL W a L LL a LL LL a LL LL a LL LL a LL LL a LL {L a LL LL W a J LL > u LL > U LL LL > U LL > U LL m > U W N y N N N y y 0 y 0 LL d y 4. LL d a y LL s W d U � V � 4 7 u � u � u � U � u O 2 Z D z > Z > z D z U =) u f• J H J f- J Z > K Z y a y a a y a y a Z W m M W m n W Co D W CO W m W no W co W m W to W m > W m > W m W m W O m O °C O Q a a¢ a 3 3 O W m W W m m W m W m O f J 1 J r J r J J F J t J 1 J t- J Q F J Q ►- J Q 1 J ¢ 1 F J Q J ¢ ¢ d Q¢ a d _a _a W w W W W W S U W S V W S U W 2 U W W 2 u W 2 u W 2 u W S u w 2 u W 2 V W 2 u W S v W a 2 u y � W y > W y > W `! 0 7 0 d 0 d d O 0 H d 0 d 0 N 4f a q d cr d a a� a K d a, a d' a w a cc a cr. a¢ 2 a w a w W a m ac O 0 y 0 0 O O O o O f- 0 a i- 0 s h- ♦ a a F o a F 0 a 0 0 0 0 a a o� N o N 0 N 0 0 0 7 0 U' W W W W W W a W O W a W O w W O W W a h W W � 2D 2 Y Y Q¢ a a d a¢ a a a¢ a a a¢ a a a¢ a a a a a a 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 m a m a m¢¢ a a a z a m a cc a az a ¢ a m a ar a x E 'a a z a a a oc a` =¢ a Q m a = Q 5 ac a a s¢ a a O N N M y l0 h - O ei :7 .-1 rl wi N ey N N M N N O N y N .. IV 4' s .Y O S v . CL +I.s N N .J 4 0 c O U N_ 0 G. CL 3 H V �a d t n Gots .9 9 ��{{ �{ �.{ e0 �a f Or e!n A A d► Of A �.y ONi Z d z W W W W W fC Q Y3 W W W W W m m m m m to m CO CO m W W W W W Q tJ L o y� !� t o O H N N N M e . N N N �N1 N N N N N N N N N N N N M M N N N j � l l ul w + + a+ w w r r. Y r z r x , Y � �: r .G � a• :�+ s+» a+ a+ ;04 _W fG m N N Z J z W W Z J Z W W Z J Z W W Z J Z W W w O ty Y U Q a x V x Ln S N x N x In S Ln 2 1 S 1/1 2 � x h to 0 a o 0 g a Z > > > >> ri N M d LL; J m m m m m m m m V W W W ix W O O O O O O O O O O O O J J = u W J O ✓� u z W u z W u z W v Z W u z W u z W u z W u z W u z W u Z W N z W W W W W µy,11 ~ J W Q a' W K LL C LL fY LL d' LL C LL a' LL K W K LL a' LL W F H t-- to F- NI f- N Z W N V tD oD O N tp f10 O M W M W N W N W a V J a > d d 1 d d a? LD Z Q¢ Z ? d¢ Z 6 O W w W W of W W oc W W W W z¢ W W W W W W z W W a W W Y W W u a a a U a m ( a W Z W Z W Z W Z W Z W Z W Q W W W W J W W W w W Z Z Z Z Z Q CL O h W O W w O W a' O a' W O W W W z J > 0 W J j> W J W J J J > W J a 3 a a J Q a Q J a a J a a m m N Q C' C a d a S ¢ G a' K W O W K Q m tL to lL m W m 11. z W LL x N S N 2 V/ S N x N x N a z s Z a z a. Z 6 Z a Z a Z d Z a Z A Z W O W m W m W m m +� W m W a to O n to w a to O a to 0 W (!� a LL o�c oc LL ¢ oc W z ¢ LL c W rc o LL > d 3 > Q 3 > ¢ 3 > ¢ 3 > Q 3 > ¢ 3 > ¢ 3 > ¢ > Q > Q z O a cc rt u x 3 W W O W ¢ y a a = 0 Q o 5 O 3 J o z N o0 o o .w fv v a a a Q a a a a 'a Q m c� > to a t 3 .} w a } m = _ ® _ _ m = J d W J a W J J a W J Q W J Q au J Q W ,J au 8 J Q W . 6 iu p O ' y O M O r1 0 O Op R fh w W w. W W a O W a Q W a O W a 0 W a 0 t l7 u } u H u F u u } u 0 Z 0 z 0 z 0 z 0 z 0 Z 0 Z !9 z Q(D z Z >> > > >> LA Z y z V o v 0 � o 0 u 0 z Q : oc ~~ `� ,� r } ac Q x } a s > ¢ a s > z a x > z a x } rc a x > a x } z a x >} oc a x ac d x 3 3 3 3 r 3 S z S z n a� l7 z 0 z 0 z 0 z z U 0 0 0 0 0 0 a 0 a 0 a 0 a g a O a O a O a O a O 6¢ Q Q 0 Q 0 0¢ O _ O_ > a 5 � 3 >->. g? m z z z z z z z z z z z LA z LA z z z z 0 01010 o o O t7 > a > a } a > a r a r a¢ r r d > a > a > a > Q > a > a > a r a r a r Q > a } a¢ > } a r a r a r a r a > a > Q r Q r a 3 a 5 S5 5 ge¢ le L= e5 25 15 Le LC !E LZ Le 5 5 55 Lx a s a p o a�� 'a a c� ¢ a '¢ a a a '¢ 'd a a a a a a a a a a a a a a a a a a¢ a a w N h N co N O1 N O M N M N M M M ��{{ M 1f1 M tD M f` M W M 01 M O 'Q — V N < M < V 'V' V7 R tD •i f, ? pp of O� V O t+l N t!1 N t!9 M to V to LM Vi 0 a.. v u a OR Y 41 s 0 3 m z a -a m f9 0 C f.� Q CL CL OA dl Z N MU M M N M N Oi M N N M N N' N N 6 p a a � y a y � � � y ° 1 + p i c O S � � { a P m v M� ° N + u m n z , 4 * fi b 1 ta! m a t M t a w a 9 r, � A 4/li N y N! N M N N M� YY d H z ¢ W a W a W Q W a¢ W W a W a� a W x m x m x m ¢ W ¢¢ W W a W tg 0 m x m Q m x m 0 m < W m x m .7 t i Y n N N N N ry N 1'� ei N O V1 00 e-i n M to O O O N O N N O N Q tp tL t0 t0 a 6 m y J � t I � � Yom• :.. L� r.. :.. �.. :�. , G^� :.� :.. r. r. �.. :-, Y. :.. ;.� .. �,-. y. ... � r. :.. ;,. ;,, :.. ;,, .• r a { 4 F a F a Z z cc o cc `o in in N N F- F Q U t K M OC K W W W a Z O m a 2 Y Z Y Z Y Z ][ x Y x Y ? m C N a Q LL La Q W. U; a¢ LL La W U Q U Q W "'� \ O O h = C x 5 N Q W t7 m Y CL N 4A H N N OC > OC > W N Q Q \\ ? m -J m \ W W W D D F- Zzi W `-' �byy W t Fyn Vf V w f 00 W ° On ("` LL m x ILL-, . X m s N -1 LL LL LL LL a W LL LL O Z Q ? O M X Z �- O V y in N N a O W W > W > >¢¢ D W D W 2 p C7 >. p Q x 2 n a ? .-� M X z u't N x D Qd z et Z O x 1 -4 Z x Z X m \ X m D D D O > > 2 \ to q m Y VI W M LU d H N Z x Z X N C l7 C 0 z at O 3 m d z x x a 2 Z t0 2? a ru z W r �• N Q O W -' N Y Z v w aY 4Y O O O ynj D �' ~ tb X 2 J O LL ,�, j ? W O � K x Z x z x Z Z � 6 Q Z Z O w ¢ W a 2 N > O Y O _J O U _J O U _J O U _J O U O O m = Z O Z n W J W w S h D ry J a J m J m J LL J x o Z In n J O Z V O l0 X X LL LL LL LL U u m GC a N d a ? m W LL tX C Q c ¢ K OC K W K X Z Z to Q¢ m S J 1-- O W m 4A M Z 'i Z N N N it rt t0 rl m .-� LL 40 LL 00 W > -j z z 2 O g 2 Z LL W ~ g D O H Q h- Q F- Q t{oL i- Q F- a 0 tO 1!1 �- U ,�+, a ? Z U 2 W D 2 O 2 O W ' W a 0 Z z ti W u Z7� F J 3 O 3 C7 3 C7 3 C7 3 C7 ^� a F N 8 z w o u u iE Y m © r4 O F W S� Li a W n 2 Z 2 2 2 m z U' go 0 0 w >> a C 'j n W z W D W W W W W W W W W V a S w z to ti O v W (7 S n 2 D O O O O O O O O O C G f" W n g a q D q° a Z D Z n Z o Z n Z N Z a 0 0 N N N w W W 4A 4A lA h 4A 4A to I {A m W LL m m m m m m m m m m U U 4A , DO 2 N Z 4A C7 N 0 Z to 0 Z to U' Z H U' Z 4A V' i to V' 9 to U` to C)OL9 4!1 Z to Z 4A Z N U Z 1/7 l7 H C7 Z N Q N U' 2 4 6AA W vZ_ 4Af to (A W CAA W N W N W V1 W {A N W Vt V1 V{ V1 H H W 'A W V Z _ yy N tA V { Z _ Af N W t{ _AA N W C n d' n W CC D C O K D OC n � O � n K O W OC n W OC D W C O K D W LC a CC O W � n W OC O K D W OC n N W N W H W N W N W h W N W VI W N W H W N W H W N W N W H W h W N W N W a ¢ ¢ Q ¢ ¢ ¢ ¢ Q 4 ¢ ¢ Q ¢ ¢ ¢ ¢ Q Q ¢ 4 ¢ Q Q a a < Q Q Q ¢ 3 3 3 3 3 3 3 3 3 3 3 z ° z z z ° z ° z ° z ° z ° z ° z ° z zz ° z ° ° z ° z ° z z ° z S a a a a a a a a a a a m m m m m m m c8 m m m m m m � t�A 'm 4 o p t0 D t0 t0 QQ tD to ID t0 pppp tD t00 On r h n n n M1 n co n 0 m W M M 00 Q v V Q d 01 t �L 3 C �L a C m 4. J 0 C 3 Q u O Q. G. u aj h D ►' : 1` M !~/* �! M M► �^/!' tlIF Ct tlT r pi M Cf O/R r't CT t .. fJ f1� tl 6 Q W X < CG W ¢ W ¢ W Q uJ Q w Q W Q W Q W a W Q W Q w Q N ll X m X X X Y X X X Q Q Q Q a W In m m d m ['C t0 W W W W W N O N N p S po O t t0 t0 V tf O N M N V .�-1 V t Q ry O O N {YYYii N Q W_ W = W z N 5 Z W to J Q } z ui d h W J N W � W J z a m a E a 3 N o a m J Ln A LL O _+ _ m Q 0 Z O a Q In _ Q a g CC CL Ln g W X oc O � a Z �w d w 'o U � J vl a Z m W a o a Z o F o F Y `^ o u Z 'n h Z Z Q a to W W LL J O t_ O Y dW W 4 1 h O O Y Y LL J d Y Z d O O b J u1 �[ h _Q O u> h O g W w V - ' ,� W ui O W OD OL d kn 3 d W W Q Y Q d 2 �- 2 h W a \ d `� z of W g Q d In O Ln O Q d LL w LL LL 3 3 Z p U Z O a 3 w w Y U uj Z z Ob o Q d O U S W O t0 2 (= J = ~ 3 H N m O U J Z L 'n > J n y N Z LL a J M H N ac v Q (-: U W co 3 ft O of a m m U o ° K Y O v V a l Z Q In W W 4 p a \ j a H O >> 0 Y = a x S` N W JO �" O° a oc ¢ O O J oW WW o d Q X O h p r 3 OL c X u Z '� h w F = d d Z a d 0 O Y 3 00 O O 2 ~ F Y m U to O Z a0 F t0 F g m 2 Q O w d V U ll w Y V d l J l7 Z vl O In O d vl O of O sn O l Q a ul .Ni \ 'a Q M X Co p N Y w X Q O W a W m j j h VI Z Z O g J U 2 U� O N LL LL LL LL LL LL LL LL LL LL O Q O Q O VT u lJ N 0 W J vt h W O m h m O Q O a �p a W U w\ z 3 O u p Z S C U h >>> U U U >> U U d 0 d d w o[ � Q �n st .- a J m a z O tJ Z o O w of Q S cc _ N t/ a V tYt//�� = ~ W W J U pC _� K C C w K U W \ u W N \ O W OZ H h cr H W N ei O d es{{ X d� d Z W a d Q J O J O J O V m g a Q Q W LL U Z U Z O H O N O N O N O \ lA d h 0 Z d U N ¢ A ' Z m LL w N U U U C W h z ¢ W > w > W > DL m h z O �„ O ti. W of N W or W ¢ N W x N W ac Z U Z U N W O N W O ti. �-1 ., O In w (� tA O O Z O Z O Z O W g a¢¢¢ S . > >> In p> d w a ¢ J F= S d O O a O O d O d O O d O O a m a m 0 0 H vi p x 2 p a O K ► Q = S t tJ a h t7 4 d ¢ ¢ O Q Q d W W W O J Q j J �" u z z w ui � w 5� ¢ h (^ 00 w 00 U 2 >} m J m J m J m J m W O W O W J W J (7 a d W d ¢ 2 OC h ? W h OC W CC u Vi Vl z a W W K o: Z O Z O 2 O Z O Z O ~ssss N Vl to N {QJ F F F F F F h Z 0 Z 0 z Z z z z Z z 0 0 Z 2 z Z Z Z Z 00 0 m m Z Z Z w w w w w w w to l? 0 O C9 0 Q l7 t7 O U O t9 t7 U' U' g 0 °C ¢ Li �d[ m Ci m m m m m m m Q C Q D ¢ Q O ¢ D ¢ OG Q Q O ¢ O Q < O O Q G d Q Q O Q � � ��� � l0 f� 00 00 00 00 01 O0 O Q1 r1 QI N 0 M m V 0 If1 m �O Ql r " OD O/ 01 Ol O r1 O e-1 -- O O 2 - O e ' O 2-1 - O QQ A O O ,- ed Q N r .-1 r rt • rl ti e1 e� r1 Y 47 d .L Y 3 Op {.� a` m Q �o dJ N u b V C Q � H G. Ln C/1 A IV g- e•t H N N y q N ( ��" - eA N N y� �➢11 C�! 4'Y �/I 6� M Q W C d N - W Q W Y [L m h x m X m X m X m V1 U tt[[ W 1/� V Q W Q W X m X m LA V (A V X m cA U Ln U 47 X m X m X m X m {y/�� U X m N ^ H 8 8 8 8 d m M R v d c°a M d d d N M N N Yf fOOV N 0 W D us ,� N. � i/� i+' i++ i+'I �`."� i/� i++ i.'� i+'I i►+ in :n � 8^ in iJ'+ Y+ n r i^ r � ✓+ i� i^ i++ �+ iM+ :n i� U w u W O u u � w m LL {/y 1„) 0 O W O W IA W Q X W m K LL h W K LL X O ?? Y Z (7 c LL m Z W a 4o s H _p O W J x m m N x m N H K p z a > o h° W m o H o H p p 8 ( Q � T tv3 p 2 X co o n w co Ln co C ^ w W Z a N u a u tt Z C4 o Z W — a a w >> H rJ � \ M H '+ z Q > H w m w N Z O g w 0 L F- ,n w W w z m z ry x OC OC G LL' a z } Y ` Y ZA r H z U O N Ln Z Z ip z z F z z N u u O H w H w N = 2 O m Y t> H ? X N p H X Cl M m LL LL LL U LL d N C G 3 CC LL JW K LL J ? W = O tc U Ln H O Y U Q S U O w U p W U a W u p W O M M 0 U` W W w Q a W m LL Z 3 W - � Z , O [C w CO p p *1/ X V1 W a w Z h w J I LL U U - c J C X W F - cc C . �W/ w 3 O W a n � 2�� W W W t W Q m to m a Vf t`� X w W to W In - a p It J O N O m m m° 2 w W LL O C W CL n h V1 W W W W W = N R Z ` S �y O _O - Q F iU u Z p J W o O O F Y O x W f Q ' - y y m J { Y t�l. LL LL O N 7 h V01 p O cc Fes.. rn LL Z W V U ? V J� O N C g 8 a 0 0 0 0 l7 to h OV Zq w H z z z O u a to O w W 'G, Q t7 IhA w 3 o 3 O 3 O 3? o g g O d a m �- o c w z 2 ,'^„ w z¢$ W x o 0 u he 0 U o u w LL '^ 0 p O LL p a m z a W W W W W Q W a N z p a a Q m p r W h H H ' 'J Ln x Z _ � O C, W W p m F- g Q Z S Y G J 0. p oc 1/� Q m ID w W 3 J W g W g W W a z Q z 0> W O Q �o y a W a I w = O o S 0 S 0 z o A z; w 2 J 2 O J Z O J 2 O 2 m 4i O O w F U d v� 2 Z z Z w W W W W c W m m W U N N W N U p a W y as m O O U J > > > > W U W z M-- i Z Q Q W U Q Q O O mC C OC W O .J O J O J O �.i N W W J S a J W p z a z z> W w ? Q K tlC GC 0 1 S S> m m w U' t9 l7 l7 U x cc IA h 3 Q m a IA to IA IA h 2 z z J O Q h O 0 K rr 0 O K 0 O [G 0 O tC 0 O !L o 0 K o 0 C o 0 d o 0 OC o 0 K o 0 m o 0 K 2 O 1 Z O 1= Z o h Z 0 M Z 0 F- 2 0 F= z 0 F- Z 0 Z 0 F= Z 0 = Z 0 = Z 0 - f a 2 0 t- 0 0 o z 0 0 z 0 c a z z a z z 0 z a 0 z z 0 z z 0 z z 0 z z a z z 0 z z 0 Q a a a a r< a != a a t a F ! a a u u u v u u v u u u u u u h N Vf IA t N IA n t; H H N } C J m M m J m z O a O_ Z _O Z O z O Z O Z O_ z O 2 O Z O z o 2 O_ z O 2 2 2 2 a '2 a a Z _ 2 a Z a 2 W LV7 S� ii W i w �i W W W W �i W �i W W W W �i W F, W f p 2 2 p �' 2 m p 2 p 2 p g p p p p LL z w z_ LL LL LL LL LL LL LL LL z LL _a LL z_ LL _z a > a > a > a > 'Q > a > a ? Q > Q > Q > Q > Q > a > > S IO H N H W H 01 H O H H H N H M H d H u1 H t0 H n H W H QI H O H .+ H N H M H d H t!1 N l0 H r` H 00 H CA H O H H H N H M H � H R H ki V R Q d s Y 3 Cho V a c t6 i+ V1 Q C 3 O Y CL Q 3 N . a 2 p rl ri n rS n ev n 1n r p 4 ti P. A n rp n r'i r. ri I n n w r•1 fp��^�l rD /!! WI e•r w~ i 1+1 r, rti n ty n r ♦p rp n r� CQQjj1 �A M A r� n �y !! P� e1 +► a v 12 ^ a o ^ » { s ^ o i. N r' M U! a do a e. �R + • TA a r4 st a ; D m m �► a 9 1 �J � {{ •n M irf 7�f N 9 C Z x m x m x m x to W u to -I( X ¢ ¢ W m W W X no F ¢ m Q W Q W X ¢ C1 W ¢ W ¢ W d Q ¢ d ¢ ut W W W W W U x m N N N N N N � Q 1 N O Q 0�0 V M opW .0 w :3 N n N N m M Q N n >' P� � P• P• P• P• F• � P• P• P• P� P* P• P' P• P• P• P• P• P• P• P• P' P� P• P• P• P• P• W F a a a w 0 J 0 5 a .. _..,,... > > > cr F Z F 0 cz w F W O d x co a x m 0 c a x a x co a w q r Vl Z N Z ion Z J m \ Z d ? W N X N X Z X N X c-4 m M m O Q a Q cr w Z U 0 0 0 U u ~ z u t7 oo t:t N 0 N t? M ¢ t0 X j. i F 0 Q J K C Z �L O J Ir 0 s � W W LL W W LL W W LL W w LL J J d u W J\ Q7 w Z W J Ol t'1 Q W W z J _Z Vf K Z 'z Q Q W w Vf Q \ N J LL! LL Q O Z " Z VI 'a N y N C' lA Y N 0. V1 w K O LL W Z Q W _ O w '-1 J N O O J S? 7 J � Q Q c J c C JJ S 4r JJ J m t > M W 2 K J C7 awl J Q L �y m > > 7 O N O N ZA z .al \ Q C 'C N U' 0 cQ } O N G J ~ a O Z W O Z W O Z W O z W 3 0 W 0 W 0 W a l7 N N �-. \ Q O F Z u N c G " W JJ N G J 0 d 1n w C �` th 0 _g D z c` z Y d p 0 a 0 ac r O m 0 2 c Q t! z w\ o o o 2 ut O \ O Z 2. O �. r .� ut vZi O w { r / j� �. U Z z' z Z Y = _ = 0 O W 0 t Z 7C ? O N O S "i U �O 2 o N p �S N iL' �} !C O S Ln W W �7 J d Q Z z C t p W rii W �ii W L W F w "4 O u V V V Q C) O a O \ d . 63 W F Q O d o Q Z 0 W z V z W Z a W N Q 0 n W N E Z Z _ z 0:) S = �` N O J Z l7 C d w N F p > a >> a O w 1 w m 2 a f= = a a a z Z g Q u u t� tr1 to ° o N ° ¢ ° a a a a Q a d a o a a a ° o w W LL LL H y C n f[ 1. Ln F d' W z N Z 0 V1 z 0 H Z 0 LA Z 0 V1 N N V1 Z Z Z Z 0 0 0 0 V1 Z 0 V1 Z 0 4A Z 0 N Z 0 VI Z 0 VI VI Z Z 0 0 V1 Z 0 V1 Z 0 V1 z 0 V1 V1 o V1 N 11 Z Z Z Z Z Z 0 0 0 0 0 0 V1 Z 0 W W d 0 F p F e Q�Q Q�Q QFQ Q F F aFQ� Q F Q F a F a FQ- 1 Q - Q . i Q - a aFa Q� Q a�d{ F F F a � a s 0 N 0 V1 0 V1 a W p a a a W W W W a W a W o 0 a o a a O D o a G o a 0 a W W W W W W W W w W W w W W W y� i:. � •D r/ h •"I 9G •-1 O� a-1 O LA �-/ in in el N V1 ei m Vf N Q ul e9 V1 1D h 110 to V1 in u1 e-1 rl r1 e1 Ql l/1 ri o t0 "'1 .i �O e-1 N t0 rl m t0 i4 a VT tD la rl !"I t0 t0 vl f� tD e'1 00 tD rti Q1 o e-1 ry m Q t0 t� h h h h "'1 r1 rl �-1 e1 �-i to h r1 Q L `. N u 0 Q Cl 4) Z N Y 3 IA v �L a c R ♦+ O M C 3 U CL CL N d �q m �nla g e e = a a e le , g r, 5 0 1 ep losiR of of Tw M vi ([yy pp iJ I Z .. Q ui X CC X m Q W Q W Q W Q W Q W Q Q Q X Q W W W 6] W y Y U G. rn N K h p V' M N N N 00 w G 0 W O Ln U X W 'A Ln U Z W a Ln W (y� Ln 2 z J (D t� m z ? ~ n n Co F a in Q Y c n O\ n m W _...... NN F m Z "• n O Q z w U \ w Ln w - a a N O} w F F ru V Q Z W Q Y J a = Z O n 0 7 Z F m W Q W p LL t0 Q OC o\ i d ? N w J W U V Z h W Z J u V p F Z J `-� X N \ m Z O j Z F > m N �- O -i -' o ., F 07 '(D' � w a o a o m z w a 2° > 0 W = 2 o C J N J N j s tL n W U J m W N > ? cc � �OJ c J V1 a O > = W Z Q w 2 J N O Z l9 p F F \ Z Z N LL J H O J Z C 0 N (� o O u7 0[ J o< v 0 ./ 2 U. 0 w o o . of o co Q 0 p p .� N W W W z m m Z O ac C 2 p O Q= _Z Z 0 OJ J G O J U' Z Q p j v U W Z W O 2 > U W 2 0 Z Z Z ., 1 F. W 2 p 2 O 2 Q~ Z Z Z Z O Q d W CY > Z O O O O Q w cn 0 N Ln > n W F Z O O }� Z O Z O Z O Z O V7 Z N Z 0 Z O to Z O of Z O N N N of of Z Z Z Z Z O > > > > m J J J W W W w V U _O _O U _O _O _O _O Q F F Q F F O n O z w W W W ,w F F o W V S W a W V o W Ci 0 W o W U n W l3 a W U o w U C.1 V V V 0 0 0 0 0 W W W W W U 0 0 0 0 2 2 2 2 2 2 2 2 2 2 wM M N rl n ri n �! 00 0 N 0�o ei a ri N w w w 0 ow N H N N N rn m rn m 14 1-4 H N Attachment B SUBMISSION PROPOSAL RESPONSE FORM SET PRICING FOR MEDICAL SUPPLIES AND PHARMACEUTICALS Proposer's Name and Mailing Address: Bound Tree Medic L LC 5000 Tuttle Crossinq Blvd Dublin, OH 43016 Telephone and Fax Numbers: I have included: r • Proposal/Tabbed Sections y • Medical Supply Discount Off List and Pricing Worksheet (Attachment A) • Submission Proposal Response Form (Attachment B) V • Non - Collusion Affidavit (Attachment C) ,/ • Lobbying and Conflict of Interest Clause Form (Attachment D) • Drug Free Workplace Form (Attachment E) • Public Entity Crime Statement (Attachment F) • Local Preference Form (Attachment G) �r • Scope of Services Response Form (Attachment H) • Insurance Requirements, Indemnification /Hold Harmless, f and Request for Waiver of Insurance Requirements (Attachment i) d (Check mark items above, as a reminder that they are included). I state that I am authorized to submit this proposal. � STATE OF Ohio Signature of Proposers) COUNTY OF Franklin Vice Presid Date 9/06/2016 PERSONALLY APPEARED BEFORE ME, the undersigned authority, k h ; t_ yl 4 a G r � h p who, after first being sworn by me, (name of individual signing) affi Mature in the space provided above on this 6th day of 20 16 David M90 II My commission e" $ Ii"P^1Wdit NOTARY PUBLI Attachment C NON - COLLUSION AFFIDAVIT 1, Rhiannon Greene according to law, on my oath, and under penalty of perjury, depose and say that: 1. lam Vice President , ofthe firmof Bound Tree Medical, LLC the bidder /responder making the proposal for the project described in the Notice of Request for Competitive Solicitations for: Medical Supplies and Pharmaceuticals and I executed the said proposal with full authority to do so. 2. The prices in this proposal have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder /responder or with any competitor. 3. Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the bidder/responder and will not knowingly be disclosed by the bidder /responder prior to the opening of the responses, directly or indirectly, to any other bidder /responder or to any competitor. 4. No attempt has been made or will be made by the bidder /responder to induce any other person, partnership or corporation to submit, or not to submit, a proposal for the purpose of restricting competition. 5. Th ents contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon e truth oft statements contained in this affidavit in awarding contracts for said project. j . n 7 09/06/2016 (Signature ofBidder /Responder) (Date) Rhiannon Greene, V ice President PrintName/Title STATE OF: COUNTY OF Ohio Franklin PERSONALLY APPEARED BEFORE ME, the undersigned authority, rt''' + t.`' ^ (name of individual signing Affidavit), who, after first being sworn by me, affixed his/her signature in the space provided above on this 6th day of S eptember 20 16 , My David Mello H CatUh" B0Wft*14= Oti f P -s� NOTARY BLIC Attachment D LOBBYING AND CONFLICT OF INTEREST FORM SWORN STATEMENT UNDER ORDINANCE NQ, 10 -1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE Rhiannon Greene, vice President warrants that he/it has not employed, retained or otherwise had act on his /its behalf any former County officer or employee in violation of Section 2 of Ordinance No. 10- 1990 or any County officer or employee in violation of Section 3 of Ordinance 11W 10 -1990. For breach or violation of this provision, the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee. (Signature) Date: 9/06/2016 STATE OF: Ohio COUNTY OF: Franklin PERSONALLY APPEARED BEFORE ME, the undersigned authority, (name of individual signing Affidavit), who, after first being sworn by me, affixed his/her signature in the space provided above on this 6th day of September 20 16 My Commission Expires: `4 ` David ZitellO II lbgrypubk Core jWM&0W# l t: NoTtkRY PUBLIC Attachment E DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: Bound Tree Medical LLC (Name of Business) 1. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terns of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contenders to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Imposes a sanction on, or requires the satisfactory participation in, a drug abuse assistance or rehabilitation program if such is available in the employee's community, for any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug -free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. i Bidder's Signature Rhiannon Greene, vice President 9/06/2016 Date David Mello II *"Plt*8ftd0N5 Attachment F PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." I have read the above and state that neither sound Tree Medical, LL,c (Proposer's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (Signature) Rhiannon Greene, Vice President Date: _ 9/06/2016 STATE OF: Ohio COUNTY OF: Franklin Subscribed and sworn to (or affirmed) before me on the 6th day of September , 20 I's , by !* _' C` �, '<�`t 1'' ? (name of individual signing Affidavit). He/She is personally known to me or has produc ed (type of identification) as identification. My Commission Expires: David Rello H W"Puble,a1 mdOW X= NOTARY LIC Attachment G "Not Applicable LOCAL PREFERENCE FORM ** A. Vendors claiming a local preference according to Ordinance 023 -2009 must complete this form. Name of Bidder/Responder Date: 1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at least one year prior to the notice or request for bid or proposal? (Please famish copy.) 2. Does the vendor have a physical business address located within Monroe County from which the vendor operates or performs business on a day to day basis that is a substantial component of the goods or services being offered to Monroe County? List Address: Telephone Number: B. Does the vendor /prime contractor intend to subcontract 50% or more of the goods, services or construction to local businesses meeting the criteria above as to licensing and location? If yes, please provide: 1 Copy of Receipt ofthe business tax paid to the Monroe County Tax Collector by the subcontractor dated at least one year prior to the notice or request for bid or proposal. 2. Subcontractor Address within Monroe County from which the subcontractor operates: Telephone Number Address Address Print Name Signature and Title of Authorized Signatory for Bidder/Responder STATE OF _ COUNTY OF On this day of , 20 , before me, the undersigned notary public, personally appeared , known to me to be the person whose name is subscribed above or who produced as identification, and acknowledged that he/she is the person who executed the above Local Preference Form for the purposes therein contained. My commission expires: Notary Public (Seal) Print Name ** This Form is only required if Local Preference is applicable pursuant to Sec. 2 -349, Monroe County Code. Attachment H - Scope of Services Response Form 12016 The Proposer will be evaluated on compliance with the below service requirements. By submitting a proposal, the Proposer agrees that these provisions will be part of the agreement between the parties. YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) CiZUAI.ETY A;SF,IGE PAQi1/IS1O�4$ Ordered Supplies / Receiving: A system of test inspections shall be used to assure quality and quantity of materials received by County. Materials will be promptly inspected and any discrepancies from the purchase order and /or the supplier's invoice shall be reported immediately by the Monroe County Logistics Specialist to the Supplier and X shall be corrected within a two (2) business day time frame when the County has made that report within normal working hours of 8 am to S pm Monday through Friday. Material Safety Data Sheet (MSDS): Any items delivered must be accompanied by a MSDS. The MSDS will be maintained by the County and must Include the following information: 1. The Chemical name and the common name of the X toxic substance. 2. The hazards or other risks in the use of the toxic X substance, including: a) The potential for fire, explosion, corrosively X and reactivity; b) The known acute and chronic health effects of risk from exposure, including the medical X conditions which are generally recognized as being aggravated by exposure to the toxic substance; and c) The primary routes of entry and symptoms of overexposure. X 3. The proper precautions, handling practices, — necessary personnel protective equipment, and x Attachment H - Scope of Services R esponse Form 1 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, but with specified deviations comply comply (please detoll deviations below) other safety precautions in the use of, or exposure to, the toxic substances, including appropriate emergency treatment in the case of overexposure. 4. The emergency procedure for spills, fires, disposal x and first aid. 5. A description, in lay terms, of the known specific potential health risks posed by the toxic x substance intended to alert any person reading this information. 6. The year and month, if available, that the Information was compiled and the name, x address, and emergency telephone number of the manufacturer responsible for preparing the information. Supply Time: - - " ^ ^ Proposers must be able to supply contracted requested supplies within a three (3) business day time frame of normal request of supplies when the County has made x that request within normal working hours of 8 am to 5 pm Monday through Friday. Natural or Man -Made Emergencies: During emergency (natural or man -made emergencies) situations, Proposers must be able to supply requested supplies on a next day basis, twenty -four (24) hours a " day seven (7) days a week. PROPOSEWS'ij _ jQTY - Warranty: It shall be the Proposer's responsibility to submit at the time of shipment the original manufacturer's warranty x for the materials supplied. Attachment H - Scope of Services Response Form 12016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Defects: Upon un- packaging and discovering defects to materials shipped by Supplier, any medical supplies and /or pharmaceuticals requiring replacement shall be x finalized within five (5) working days of reporting the defect. (See also information required behind Tab 2 regarding warranties and replacements.) Guarantee: The material(s) supplied shall be guaranteed to be free from defect of composition, conception and workmanship for a minimum period of 120 days from the date of acceptance by the County. Any parts or x portions found not In accordance with this specification will be rejected by the County and returned to the Proposer at the Proposer's expense for Immediate replacement. Quality: The materials to be furnished shall be currently in production and shall be of the manufacturer's standard x or better quality. Quantities: The quantities listed on the Medical Supply Discount Off List and Pricing Worksheet (Attachment A) are estimated quantities for one (1) year and are for cost comparison only. Any reference to forecasted or estimated quantities within the proposal documents is intended to inform the proposers of approximate x annual requirements. The County shall not be required to purchase any minimum or maximum quantities during the term of any award resulting from this specification. The County may purchase as little as zero percent (0%) or exceed as much as one hundred percent (100%) of the forecasted or estimated quantities. Attachment H - Scope of Services Response Form 12016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Packaging: Only materials that are packaged in the original factory fresh packaging shall be accepted. No materials that have been re- packaged or that are in the adulterated or damaged packages shall be accepted at the receiving location, nor shall after market materials be accepted x at the receiving location. Any attempts by the Proposers to furnish the County with other than first quality materials shall constitute default as outlined in this specification. Refrigeration: Maintaining a specific temperature range throughout the shipping process is essential to the quality of healthcare products. Proposer has the ability to ship products in a proper temperature - controlled x environment. Only materials which have been properly shipped in a temperature - controlled environment shall be accepted by the COUNTY. Expiration Dates: Where applicable, all merchandise shall have a minimum expiration date of 18 months from date of shipment, and date must be displayed on the package. coi�lemonis Authorization: Proposer has the ability to handle orders placed by the electronic ordering software Operative IQ. (All orders shall be placed via Monroe County by individual x Purchase Orders generated by the County's electronic ordering software, Operative IQ, or as "Open" Purchase orders.) Furnishing Proposal Items: Contract items are to be furnished on an "as needed, when needed basis" during the life of the contract. x Attachment H - Scope of Services Response Form 12016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Delivery: Materials ordered shall be delivered within three (3) business days after receipt of order. Failure to do same shall be considered breach of contract or default, and x the County shall utilize its options as stated within the contract. Backorders: In the event an item is not immediately available at the time of an order, and able to be delivered within three (3) days, the County shall have the option of purchasing x the item from another vendor. Penalties: The County reserves the right to increase or decrease quantities shown without penalty. X Samples (Medical Supplies only): From time to time, either at the stage of the Proposal or subsequently while the contract is In force, the Proposer may wish to recommend an alternative to an item listed on Medical Supply Discount Off List and Pricing Worksheet (Attachment A). In those situations, the County may require the Proposer or the Proposer may elect to submit a sample for inspection, to ensure x that the alternative is of similar quality. Such samples shall be labeled with the Proposer's name and item number and shall be furnished free of charge. The vendor can determine whether the sample should be returned or destroyed. Samples not destroyed will be returned upon request at the Proposer's expense within ten days following receipt of the sample. Substitution: No items will be substituted without the prior written approval of the County. Any violation of such procedure may result in a possible cancellation of the x contract. All approved substitutes shall be annotated as such on the Proposer's shipping document(s). Attachment H — Scope of S ervices Response Form' 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Proposal Prices: Proposal prices quoted on Medical Supply Discount Off List and Pricing Worksheet (Attachment A) shall be firm and shall not be amended after the dates and time of x the proposal opening. Any attempt by the Proposer to amend said proposal prices shall constitute default as outlined in this specification. Shipping Costs: Prices quoted in the Proposal and Proposal Response form shall include all shipping costs, shipped F.O.B x Marathon, Florida or to the facility location specified by the requestor or the purchase order. Taxes: All taxes of any kind and character payable on account of the word done and materials furnished under the award shall be paid by the Proposer and shall be x deemed to have been included in the proposal. The County is exempt from all state and federal sales, use, transportation, and excise taxes. Infringement: Proposal prices must include all royalties and costs arising from patents, trademarks, and copyrights in any way involved in the work. Whenever the Proposer is required or desires to use any design, device, material or process covered by letters of patent or copyright, the Proposer shall indemnify and save harmless the County, its officers, agents, and employees from any and all x claims of infringement by reason of the use of any such patented design, toll, material, equipment or process, to be performed under the contract, and shall indemnify the said County, its officers, agents and employees for any costs, expenses and damage which may be incurred by reason of any infringement at any time during the prosecution or after the completion of the work. Attachment H - Scope of Services Re F 1 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Award Changes: No changes, over the contract period, shall be permitted unless prior written approval is given b7the County and, where applicable, confirmed by the " Monroe County Board of Commissioners. Assignment: No Proposer shall assign the contract or any rights or obligations thereunder to a subcontractor without the x written consent of the County and approval of the Monroe County Board of Commissioners. Price Escalation: The County will allow a price escalation provision with this award. The original proposal prices quoted on Medical Supply Discount Off List and Pricing Worksheet (Attachment A) shall be firm for a one ;1) year minimum period. A price escalation /de- escalation will be allowed one (1) year after the beginning of the award period and at one (1) year intervals thereafter, provided the Proposer notifies the County, in writing of any requested price changes at least sixty (60) days prior to those changes taking effect. This request must be accompanied by a certified letter from the Proposer's supplier showing the price increase to the contractor. The price increase to the County shall be limited to the percentage increase to the Proposer as stated in this letter. If, at the point of exercising the price escalation provision, market media indicators show that the prices have decreased, and that the Proposer has not passed the decrease on to the County, the County reserves the right to place the Proposer in default, cancel the contract, and remove the Proposer from the County's proposer list for a period of time deemed suitable to the County. Attachment H - Scope of Services Response Form 12016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Invoicing: The Proposer shall furnish the County complete itemized invoices for the goods received. Invoices are to reflect the prices stipulated on the purchase order and as outlined on the Medical Supply Discount Off List and Pricing Worksheet (Attachment A). Invoices are also to reflect the provisional price discount in the form X of a percentage at which the Proposer will sell these items off its list price. The County will not accept an aggregate invoice. As part of the award process, the County may request a sample invoice. Invoices shall contain, but not limited to the following information: • Invoice number • Company name • Purchase order number • Location and dates of delivery • Cost of items as stated on Proposal Response and extended price to reflect total cost for number of items received. Prompt Payment Act: The Proposer agrees to accept payment per the terms of the Florida Local Government Prompt Payment Act. Normal processing time is approximately 30 days from X presentation of the invoice. Ordering: Proposers will provide web -based online ordering website designed specifically for service. X Disaster Recovery: Proposers have a proven Disaster Support Program in place and can demonstrate previous experience in disaster recovery supply chain management and shall X provide the County with emergency numbers for these situations. These numbers will be updated immediately if the contact number changes. Attachment H - Scope of Services Response Form 12016 ) YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Indemnification and Insurance Requirements: The Proposer can comply with the Insurance requirements outlined in Attachment 1 to the RFP, or has submitted a Request for Waiver (also found in x Attachment 1). Also, the Proposer can comply with the indemnification and hold harmless requirements (also found in Attachment 1). ) "`'t CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/13/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this °' certificate does not confer rights to the certificate holder in lieu of such endorsement(s). r PRODUCER CONTACT C Aon Risk Services Northeast, Inc. NAME: d Columbus OH Office PHONE (8 6) 283 -7122 FAX (A/C. No. Ext): 445 Hutchinson Avenue A/C. No.: (800) 363 -0105 d Suite 900 E -MAIL R ADDRESS: Columbus OH 43235 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Hartford Fire insurance Co. 19682 5 0D In Tree medi cal, LLC 5000 Tu ttl e C Blvd. INSURER B: Hartford Casualty Insurance Co 29424 C Dublin OH 43016 USA INSURER C: Sentinel insurance Company, Ltd 11000 INSURERD: Medmarc Casualty Ins Co 22241 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570065283042 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L TYPE OF INSURANCE Limits shown are as requested INSD WVD POLICYNUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY UUNVG 3435 1210112016 1z EACH OCCURRENCE 51, 000, 000 CLAIMS -MADE X❑OCCUR $300,000 PREMISES Ea occurrence MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY 51,000,000 GEMLAGGREGATE LIMIT APPLIES EACH 2017 2016 510,00 PER GENERALAGGREGATE 52,000,000 00 POLICY ❑X JE0. F1 LOC PRODUCTS - COMPlOPAGG Excluded � OTHER: 0 C AUTOMOBILE LIABILITY Y 33 UUN co VG3435 12/01/201612/01 /2017 COMBINED SINGLE LIMIT a aedd nt $1,000,000 X ANYAUTO BODILY INJURY (Per person) O AUTOS ONLY SCHEDULED Z OWNED AUTOS BODILY INJURY (Per accident) m HIREDAUTOS NON-OWNED PROPERTYDAMAGE ONLY AUTOS ONLY Per accident B 33RHUVG1892 12 O1 12 O1 d X UMBRELLA LIAB X OCCUR / / / / OCCURRENCE 0,000 U EXCESS LIAB CLAIMS -MADE AGGREGATE 510, 000, 000 DED X RETENTION $10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER STATUTE OTH- YIN R ANY PROPRIETOR / PARTNER !EXECUTIVE E.L. EACH ACCIDENT OF FICER/M E M BER Mandatory In EXCLUDED? N I A (Mandatory in NH) El 8 E.E.L. DISEASE-EA EMPLOYEE s, describe und er DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT D I Products Liab 1160H380015 12/01/2016 12/01/2017 Aggregate Limit $10,000,000 Claims Made SIR Aggregate $150,000 SIR applies per policy ter s & conditions Per Occ Limit 510,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space is required) Re: Account No. 104754. Monroe County BOCC is included as Additional Insured in accordance with the policy provisions of the General Liability and Auto Liability policies. AP GEMENTI .�/�a _ .L DA WAVER N /A( YES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County BOCC AUTHORIZED REPRESENTATIVE 1111 12th St. suite 408 - Key west FL 33040 USA /��//+jQ } y/� - ��GFdfi �� /GthLlAs c/ /OLNaA w e! L ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000037575 A � ® LOC #: ADDITIONAL REMARKS Sr.mmi ii F AGENCY INSURER(S) AFFORDING COVERAGE Aon Risk Services Northeast, Inc. NAMED INSURED INSURER Sarnova, Inc., Bound Tree Medical, LLC POLICY NUMBER See certificate Number: 570065283042 INSURER CARRIER NAIC CODE See Certificate Number: 570065283042 AnnI'rJf%k1A1 c�uwevc. EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TIDE OFINSLiR.4NCE ADDL SLBR WVD POLICY NUMBER POLICY EFFECTIVE EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPULATION DATE (M1[/DD/YM) LLNIITS OTHER D Products Liab 160H380015 claims Made SIR applies per policy to 12/01/2016 ms & conditions 1210112017 SIR Per Occurrence $50,000 I F] ACnRn 1M /innR /n11 ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORV' AGENCY CUSTOMER ID: SARNINC -01 LOC #: ADDITIONAL REMARKS SCHEDULE Paae 1 of i AGENCY NAMED INSURED T hompson Flanagan Executive Liability Group Sarnova, Inc. Bound Tree Medical, LLC 3. Tri -Anim Health Services, Inc. 5000 Tuttle Crossing Blvd. P.O. Box 8023 POLICY NUMBER EE PAGE 1 Dublin, OH 43016 CARRIER NAIL CODE EE PAGE 1 AnnITInMAI DCRAAOLIQ SEE P 1 FEIN: 751835412 EFFECTIVE DATE: E P 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Named Insureds 1. Sarnova, Inc. FEIN: 262386055 2. Bound Tree Medical Products, Inc. FEIN: 731646550 3. Tri -Anim Health Services, Inc. FEIN: 952959155 4. Bound Tree Medical, LLC FEIN: 311739487 5. Sarnova HC LLC FEIN: 262549813 6. Emergency Medical Products Inc. FEIN: 391164909 7. Cardiovascular Concepts, Inc. FEIN: 751835412 ACnRn 1n1 rgnnwmi BDICKSON W cuuo AL;UKU CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD