Item G11AGENDA ITEM SUMMARY
Meeting Date: November 20, 2013 Division: Emergency Services
Bulk Item: Yes X No — Department: Fire Rescue
Staff Contact Person: Holly Pfiester 289-6088
AGENDA ITEM WORDING: Approval to award proposal and enter into a Contract between the Monroe County
Board of County Commissioners, The Board of Governors Fire and Ambulance District I of Monroe County, Florida,
and Bound Tree Medical LLC furnishing specified medical supplies and pharmaceuticals at set contract pricing, and
provisional pricing on non -specified items reflected as a 25% discounted percentage rate off list.
ITEM BACKGROUND: On September 17,2013 at 3:00 pm, sealed proposals were opened to furnish medical supplies
and pharmaceuticals to Monroe County Fire Rescue for use at the Fire Stations and on the ground and air ambulances.
Per the RFP, the guidelines used for analyzing and evaluating the various proposals were as follows: Pricing (40 points),
Performance (30 points), Online Catalog/Ordering (20 points), and References (10 points). On October 22, 2013 a
selection committee of four (4) members held an advertised public meeting at 9:00 am to rank the proposals.
Attachment A of the RFP required set pricing on one -hundred -ninety-three (193) items.
From the six (6) proposers:
I . PH&S proposed eight (8) items — w/ 0% off list
2. Customed USA proposed sixty-seven (67) items — w/ 0% off list
3. QuadMed, Inc. proposed one -hundred -fifty-four (154) items - w/ multiple % off list - nothing over 20%
4. Moore Medical LLC, proposed one -hundred -fifty-eight (158) items — w/ 18% off list
5. Midwest Medical Supply, proposed one -hundred -fifty-seven (157) — w/ 25% off list
6. BoundTree Medical, proposed all one -hundred -ninety-three (193) items — w/ 25% off list
The aforementioned first four (4) companies were eliminated from the proposal process for 1) not bidding all items, 2)
not having the most competitive pricing on the items they did bid, or 3) not having the most competitive percentage off
list. In comparing the aforementioned company, Midwest Medical Supply, Bound Tree Medical LLC had more
competitive pricing on the most frequently purchased medical supplies. Staff recommends accepting the Bound Tree
Medical LLC proposal, and entering into a contract commencing on December 1, 2013 and ending November 30, 2016.
PREVIOUS RELEVANT BOCC ACTION: On November 17,2010, item F7, the Board approved the current contract
used for medical supplies between Monroe County Board of County Commissioners, The Board of Governors Fire and
Ambulance District I of Monroe County, Florida, and Bound Tree Medical LLC commencing December 1, 2010 thru
November 30, 2013 with no renewal options. On July 2, 2013, the Board of County Commissioners approved issuance of
a Request for Proposals (RFP).
CONTRACT/AGREEMENT CHANGES: N/A
STAFF RECOMMENDATIONS: Approval
TOTAL COST: $149,200 INDIRECT COST: — BUDGETED: Yes X No
DIFFERENTIAL OF LOCAL PREFERENCE: N/A on all proposals
COST TO COUNTY: see above SOURCE OFFUNDS: 141-13001-530520/512 and 101-11001-530520/512
REVENUE PRODUCING: Yes No X AMOUNT P7 MONTH Year
APPROVED BY: County Atty?Z�MMB/Purclfasing Risk Managernen
DOCUMENTATION: Included X Not Required
DISPOSITION: AGENDA ITEM #
CONTRACT SUMMARY
Contract with: Bound Tree Medical LLC Contract #
Effective Date: --1-2/01/2013
Expiration Date: 11/30/2016
Contract Purpose/Description:
Contract fumishing specified medical supplies and pharmaceuticals at set contract pricing, and provisional
pricing on non -specified items reflected as a 25% discounted percentage rate off list.
Contract Manager: Holly Pfiester 6088 Emergency Services /Stop 14
(Name) (Ext.) (Department/Stop #)
for BOCC meetinz on 11/20/2013 Agenda Deadline: 11/05/2013
welk"Ift "Wo
Total Dollar $149,200 Current $149,200
Value of Contract: 141-13001-530520 = $80,000 FY14 Portion:
530512 = $20,000
101-11001-530520 =$34,200
530512 = $15,000
Budgeted? Yes® No ❑
Grant: $
I County Match: $ 0
Account Codes: 141-13001-530520/512 and 101-11001-530520/512
Estimated Ongoing Costs FYI 5 forward:
(Not included in dollar value above)
ADDITIONAL COSTS
For:
(ea. maintenance, i
CONTRACT REVIEW
Changes
Date In Needed e
Division Director Yes El No !
Risk Management Yes[:] Noo
E310 I . �2
O.M.B./Purchasing 11 l -.)YesO No[�'
County Attorney Yes[:] NoR
I Conu-nents:
OMB Form Revised 2/27/01 MCP #2
salaries, etc.
FICTIMON
N
it— S-- -U (I
BUDGET AND FINANCE
PURCHASING DEPARTMENT
TABULATION SHEET
OPEN DATE: SEPTEMBER 17, 213 AT 3:00 PM,
TITLE: MEDICAL SUPPLIES AND PHARMACEUTICALS
RESPONDENT BID BOND BID AMOUNT
BOUND TREE MEDICAL, LLC-DUBLIN, OH.
N/A
MULTIPLE PRICING
CUSTOMER USA, LLC-ORLANDO, FL.
N/A
MULTIPLE PRICING
MIDWEST MEDICAL SUPPLY CO. LLC-
N/A
MULTIPLE PRICING
EARTH CITY, MO.
PH & S PRODUCTS LLC-MINERVA, OH.
N/A
MULTIPLE PRICING
QUADMED INC. EMERGENCY MEDICAL
N/A
MULTIPLE PRICING
PRO DUCTS-JACKSONVILLE, FL.
MOORE MEDICAL LLC-FARMINGTON, CT.
N/A
MULTIPLE PRICING
Bid Committee Present: Emie Coughlin - Purchasing Office
Members of the Public Present: None
I hereby certify that this is a true and dorrect copy of said bid opening and that all bidders listed above have been checked against the
State of Florida Convicted & Suspended Vendor listings. All bids listed above were received by the date and time specified.
Bid Opened By: Emie Coughlin - Purchasit q Manager
BOARD OF COUNTY COMMISSIONERS
County of Monroe Mayor George Neugent, District 2
Mayor Pro Tern, Heather Carruthers, District 3
Danny L. Kolhage, District I
The Florida Keys David Rice, District 4
Sylvia J. Murphy, District 5
Division of Emergency Services
Fire Rescue Departi-nent
490 63d Street Ocean
Marathon, FL 33050
Phone (305) 289-6088
MEMORANDUM
DATE: September 24, 2013
TO: Jim Callahan, Fire Chief/Division Director, Emergency Services
FROM: Holly Pfiester, Executive Assistant
RE: Request for Proposals (RFP), Medical Supplies and Pharmaceuticals, Selection Committee
Chief,
On September 17, 2013 at 3:00 pm, sealed proposals were opened to furnish medical supplies and
pharmaceuticals to Monroe County Fire Rescue for use at the Fire Stations and on the ground and air ambulances.
On October 22, 2013, a publicly advertised Selection Committee Meeting was held at the Marathon Annex
starting at 9:00 am. Present at the meeting were Deputy Chief of Operations, Gary Boswell, Chief of EMS & Air
Rescue, Chris Musser, Captain of EMS, Andrea Sutherland, Director of Emergency Management, Irene Toner,
and myself. There were no members of the public present.
Attachment A of the RFP required set contract pricing on one -hundred -ninety-three (193) items. Provisional
pricing, reflected as a discount off list price, was requested for items not specified on Attachment A. Per the
RFP, the guidelines used for analyzing and evaluating the various proposals were as follows: Pricing (40 points),
Performance (30 points), Online Catalog/Ordering (20 points), and References (10 points).
Six (6) proposers were ranked:
1. PH&S proposed eight (8) items — w/ 0% off list
2. Customed USA proposed sixty-seven (67) items — w/ 0% off list
3. QuadMed, Inc. proposed one -hundred -fifty-four (154) items - w/ multiple % off list - nothing over 20%
4. Moore Medical LLC, proposed one -hundred -fifty-eight (158) items — w/ 18% off list
5. Midwest Medical Supply, proposed one -hundred -fifty-seven (157) — w/ 25%® off list
6. BoundTree Medical, proposed all one -hundred -ninety-three (193) items — w/ 25% off list
Please see the selection committee's attached score and ranking sheet.
Page 1 of 2
The aforementioned first four (4) companies received low scores for 1) not bidding all items, 2) not having the
most competitive pricing on the items they did bid, and 3) not having the most competitive percentage off list.
In comparing the aforementioned company, Midwest Medical Supply, Bound Tree Medical LLC had more
competitive pricing on the most frequently purchased medical supplies.
The selection committee recommends accepting the Bound Tree Medical LLC proposal, and entering into a
contract commencing on December 1, 2013 and ending November 30, 2016.
Respectfully submitted,
#, t
d_
Holly Pfiester
Executive Assistant, Monroe County Emergency Services
Deputy Chief of Cerations, Gary Boswell
Chief of EMS & Air Rescue, Chris Musser
Captain of/EMS, Andrea Sutherland
A .....d d
'COMM
Selection Committe Ranking Request for Proposals on Medical Supplies and Pharmaceuticals
Tuesday, October 22, 2013, 9:00am Government Annex Conference Room as Advertised
PROPOSER
REVIEWER
G. BOSWELL
C. MUSSER
A. SUTHERLAND
I. TONER
1
Pricing
Out of 40 points
_.
0
4
_ 4
4
PROPOSER'S
BOUNDTREE MEDICAL,
2
Performance
Out of 30 points
25
25
35
OVERALL
LLC
3
Online
Out of 20 points
2
0
0
SCORE
— DUBLIN, OH
4
References
Out of 10 points
10
10
10
10
REVIEWER TOTAL
96
95
95
95
381
1
`Pricing
Out of 40 points
Z0
0
15
1S
PROPOSER'S
CUSTOMED USA LLC
'
2
Performance
Out of 30 points
-
0
0
_30
OVERALL
— ORLANDO, FL
_ 3
Online
Out of 20 points
__
0
20
SCORE
4
References
Out of 10 points
10
0
10
1
REVIEWER TOTAL
80
0
75
75
230
1
Pricing
Out of 40 points
5
301,30
35
PROPOSER'S
MIDWEST MEDICAL
2
Performance
Out of 30 points
30
20
220
25
OVERALL
SUPPLY CO., LLC 13
Online
Out of 20 points
20
20 1
20
SCORE
— EARTH CITY, MO
4
'References
Out of 10 points
10
10
110
REVIEWER TOTAL
85
80
80
90
335
1
Pricing
Out of 40 points
0
— _
PROPOSER'S
PH&S PRODUCTS, LLC
2
Performance
Out of 30 points
_
_
._
1
,.
OVERALL
— MINERVA, OH
3
Online
Out of 20 points
0
0
0
SCORE
4
References
Out of 10 points
10
0
10
m1-0
REVIEWER TOTAL
40
0
40
40
120
1
Pricing
Out of 40 points
25
25
20
2
PROPOSER'S
2
Performance
Out of 30 points
0
=�
�
0
OVERALL
QUADMED, INC.
3
Online
_
Out of 20 points
2 .
0
y
—JACKSONVILLE, FL
—
SCORE
4
References
Out of 10 points
1
1
1
REVIEWER TOTAL
85
75
80
85
325
1
"Pricing
Out of 40 points
25
15
25
PROPOSER'S
2
Performance
Out of 30 points
30
20
30
30OVERALL
MOORE MEDICAL LLC
3
Online
Out of 20 points
2[�
0
2
— FARMINGTON, CT
SCORE
4
References
;Out of 10 points
0
0
1.0
REVIEWER TOTAL
75
73
65
85
298
Selection Conu iaaittee Ranking Request for Proposals on Medical Suppiies and Pharm aeeutiea k Tuesday, October 22, 2013, 9e00aani Government
Annex Conference Room as Advertised - Criteria, as ou iaaed in adveilised request for proposak, below,
The following describes the general guidelines to be used for analyzing and evaluating the
various proposals. To decide the best qualified Proposers, Monroe County Fire Rescue reserves
the right to eliminate all factors it deems inappropriate, whether or not such factors have been
stated in this section. If a joint venture is proposed then each firm must include all of the
information required and the submittal shall be combined into a single document. This contract
shall be awarded on the following criteria:
• Pricing (40 points)
- Quoted price per item (Attachment A)
- Discount in the form of a percentage off list price
- Prices quoted will also be used to establish the extent of a Proposer's product
lines and services
Ability to Provide and Perform the Required Services for the Contract (30 points)
- Ability to accept and process orders for pharmaceuticals, including Schedule II
and IV drugs
- The qualification and financial stability of the Proposers
- Service turnaround time for delivery of supplies
- Location of nearest full time local representative, and nearest personnel on call
- Location of distribution center(s)
- Proposer's logistical and service support
• Technology for Supporting the Program (20 points)
- Electronic online catalog; online ordering and tracking; ease of order entry
- Quality of Proposer's online resources
- Online product and/or service specifications and features offered by Proposers
• References (10 points)
- A minimum of ten (10) customer references for product and/or services of similar
scope dating within past 3 years (with at least three (3) references preferably
being a Florida government entity)
NOTE: In performing the evaluation, only information contained within the Proposer's written
proposal will be considered.
Monroe County reserves the right to accept or reject any or all proposals. Monroe County also
reserves the right to (1) waive any non -substantive irregularities and technicalities; (2) reject the
proposal of any Proposer who has previously failed in the proper performance of a contract of a
similar nature, who has been suspended or debarred by another government entity, or who is not
in a position to perform under this award; and (3) inspect all facilities of Proposers in order to
make a determination as to its ability to perform.
Monroe County reserves the rights to reject any offer or proposal if the prices for any line items
or sub line items are materially unbalanced. An offer is materially unbalanced if it is
mathematically unbalanced, and if there is reason to believe that the offer would not result in the
lowest overall cost to the County, even though it is the lowest evaluated offer. An offer is
mathematically unbalanced if it is based on prices which are significantly less than fair market
price for some proposal line item and significantly greater than fair market price for other
proposal line items. Fair market price shall be determined based on industry standards,
comparable proposals or offers, existing contracts, or other means of establishing a range of
current prices for which the line items may be obtained in the market place. The Purchasing
Director, citing the basis for the determination, shall make the determination of whether a
particular offer or proposal is materially unbalanced in writing.
The County shall be the final authority in the award of this proposal.
A. The County reserves the right to reject any and all proposals, or any part of any
proposals; to award separate contracts for the services based on geographic area or other,
and to waive any informality in any response, or to re -advertise for all or part of the work
contemplated.
B. The County also reserves the right to reject the response of a Proposer who has
previously failed to perform properly or to complete contracts of a similar nature on time.
C. The recommendation of staff shall be presented to the Monroe County Board of County
Commissioners and the Board of Governors of Fire and Ambulance District 1 of Monroe
County, Florida, for final selection and award of contract. If proposal is found to be
acceptable to the County, written notice will be given to the selected Proposer of the
acceptance of the Proposer's proposal and the award of the contract to Proposer.
CONTRACTBETWEEN
1 , • ,1 1 1 1 1' •
.►1
THE i1..1 GOVERNORS
FIRE 1 AMBULANCE DISTRICT
OF MONROECOUNTY,1' 1
1
BOUND '"MEDICAL, LLC
THIS CONTRACT, hereinafter "CONTRACT" or "AGREEMENT", is made and entered into
this 1" day of December, 1 by • between the Monroe• .•. • of •'
Commissioners andBoard • • r and Ambulance District I of • •County,
referredFlorida, hereinafter referred to as "COUNTY", and Bound Tree Medical, LLC, hereinafter
to • O':
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:
CONTRACT DOCUMENTS — This contract consists of the Agreement, the
CONTRACTOR'S response to the Request for Proposals (RFP), the documents referred
to in the Agreement as a part of this Agreement and Bound Tree Medical, LLC. In the
event of • between any of the contract documents,one ••
greater burden on the CONTRACTOR will control.
2. CONTRACT PERIOD AND RENEWAL - The effective date of this Agreement shall be
December1through• • 1 2016.
3. CONTRACT TERMINATION - This Agreement may be terminated for any reason by
either party on 1 •ay written notice without• '' •' fails to fulfill
funds,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
•unty may terminate the contract immediatelyby •notice
specifyshall - + or r supplies or - 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.
5. PRICING — is set forth in Attachment A. This will be inserted in the contract from the
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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 from
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
M—raT.-Tem-
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.
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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
C. CONTRACTOR must be able to supply contracted requested supplies within
three (3) business day time frame of normal request of supplies when the Coun,1
has made that request within normal working hours of 8 am to 5 pm Mond
through Friday. During emergency (natural or man-made emergencies) situatio
CONTRACTOR must be able to supply requested supplies on a next day basi,
twenty-four (24) hours a day seven (7) days a week.
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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.
[I,. Guarantee. The material(s) supplied shall be guaranteed to be free from defect oT
composition, conception and workmanship for a minimum period of 120 da
from the date of acceptance by the County. Any parts or portions found not
accordance with this specification will be rejected by the County and returned
the CONTRACTOR at the CONTRACTORS expense for immedial
replacement.
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 List 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.
A. Authorization. All orders shall be placed via Monroe County by individual
Purchase Orders, or as "Open" Purchase orders.
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, and 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 List 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 shall
constitute default as outlined in the contract.
Prices quoted include all shipping costs, shipped F.0.13 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 word 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,
,gid COUNTY its officers agents and ern lo ees f
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J. Contract Provisional Prices off List Price. Contract pricing not included
Medical Supply List Pricing Worksheet (Attachment A), and sold to the CouwMnity
a discounted percentage rate off the list price issued by CONTRACTOR shall
firm and shall not be amended after the contract is executed. Any attempt by t
CONTRACTOR to amend said prices shall constitute default as outlined in t
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 written consent of the COUNTY and
approval of the Monroe County Board of Commissioners.
L. Price Escalation. The County will allow a price escalation provision 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 List 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. Normal processing time is
approximately 30 days in total. The COUNTY does not pay service charges on
late payments; however the COUNTY is subject to the Florida's Local
Government Prompt Payment Act.
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, ani
as per "Attachment G". All property or equipment being directly maintained or repaire.•
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 thiv,
COUNTY.
11. INSURANCE — No insurance is required for this contract.
12. ADDITIONAL REQUIRED STATEMENTS / VERIFICATIONS /
AFFIDAVITS. Attached hereto in Attachments A, B, C, D, E, F and G are Scope of
Work Supply List with Pricing, Submission Response Form, Non -Collusion Affidavit,
Public Entity Crime Statement, Drug -Free Workplace Form, Lobbying & Conflict of
Interest Clause, Indemnification & Hold Harmless, and the Local Preference Form (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.
IN WITNESS WHEREOF, each party hereto has caused this contract to be executed by its duly
authorized representative.
(SEAL)
ATTEST: AY HEAVILIN,
COUNTY CLERK
I R_5*1 2001104a-
LOmy: Mark Dougherty / Chief Financial officer
AMBULANCE DISTRICT I OF MONROE
COUNTY, FL
M.
Work Supply List with Pricing, Submission Response Form, Non -Collusion Affidavit,
Public Entity Crime Statement, Drug -Free Workplace Form, Lobbying & Conflict of
Interest Clause, Indemnification & Hold Harmless, and the Local Preference Form (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.
IN WITNESS WHEREOF, each party hereto has caused this contract to be executed by its duly
authorized representative.
(SEAL)
ATTEST: AMY HEAVILIN,
COUNTY CLERK
By:_ mark Dougherty / Chief Financial Officer.
Date: October 31, 2013
� III i'lli 111 111 141111 1! 11 go -a- swam
LO) NO LOW I ZRIJ DMIDEN QIIKIRAIIA��
IN
[40 Igo W."ViLl au g V u teal I I
M
Mayor / Chairman
Attachment A Medical Supply List Pricing Worksheet
Attachment B Submission Response Form
Attachment C Non -Collusion Affidavit
Attachment D Public Entity Crime Statement
Attachment E Drug Free Workplace Form
Attachment F Lobbying & Conflict of Interest Clause (Ethics Clause)
Attachment G Indemnification and Hold Harmless
Attachment H Local Preference Form
Attachment A
MEDICAL SUPPLY LIST PRICING WORKSHEET
CATEGORY ITEM DESCRIPTION
AIRWAY ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 5.0 lQlBX FLEXI-SET
Brand Specified
(Y/N) sQTY.
N
EST.
2
Units
--LX-
Unit price
15.20110EA
Extended
Price
30AOJWEA
AIRWAY ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 5.5 10 BX FLEXI-SET
N
2
BX
15.20/10EA
30.40J20EA
AIRWAY ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 6.5 10 BX FLEXI-SET
N
2
BX
15.20110EA
30A0L20EA
AIRWAY ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 7.0 30 BX FLEX] -SET
N
2
BX
S1510J10EA
$30.40120EA
AIRWAY ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 7.5 10 BX FLEXI-SET
N
2
BX
$15.2011DEA
530.40120EA
AIRWAY ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 8.0 10113X FLEXI-SET
N
2
1 BX
I S15.20/10EA
$30.40120EA
AIRWAY ENDOTRACHEAL TUBE CUFFED WITH STYLE17E B.S 10 BX FLEXI-SET
N
2
RX
S15.20/10EA
$30.40120EA
AIRWAY ENDOTRACHEAL TUBE CUFFED WITH MLE17E 9.0 10 FIX FLEXI-SET
N
2
BX
1510/10EA
30,40120EA
AIRWAY ENDOTRACHEAL TUBE HOLDER ADULT 100/CS THOMAS
Y
70
EA
S2.50JIEA
5176.40170EA
AIRWAY ENDOTRACHEAL TUBE UNCUFFED WITH STYLETTE 2.S 10 BX FLEXI-SET
N
1
RX
--jM.20Ll0lUk
SI5.20110EA
AIRWAY ENDOTRACHEAL TUBE UNCUFFED WITH STYLETTE 3.0 lQ/BX FLEXI-SET
N
I
BX
1510 10EA
15.20110EA
AIRWAY ENDOTRACHEAL TUBE UNCUFFED WITH STYLETTE 3.5 lQlBX FLEXI-SET
N
I
BX
15.20/10EA
15.20110EA
AIRWAY ENDOTRACHEAL TUBE UNCUFFED WITH STYLET7 E 4.0 lQlBX FLEXI-SET
N
I
BX
115.20/10EA
----j15.20 10EA,
AIRWAY ENDOTRACHEAL TUBE UNCUFFED WITH MLE17E 4.5 30 BX FLEXI-SET
N
I
BX
515.20/10EA
515.20110EA
AIRWAY-- ETTUBE DISP. INTRODUCER. BLUE STARIGHTTIP 15 FRENCH X 70CM. ADULT
y
50
EA
53.86/lEA
$193.0054EA
AIRWAY [GEL 02 RESUS PAK ADULT SIZE 3 YELLOW HOOK RING BY INTERSURGICAL -d is -,s &6 tl �125,39-
y
20
EA
20.90 �IEA
$417.97120EA
AIRWAY IGEL 02 RESUS PAK ADULT SIZE 4 YELLOW HOOK RING BY INTERSURGICAL 1.1e.- in case of'6, Lo ' 12S 39"
y
30
EA
--jRL90LSEA
$626.95130EA
AIRWAY IGEL 02 RESUS PAK ADULT SIZE 5 YELLOW HOOK RINGBYINTERSURGICAL aid in c,- cf 6 val `1253-
y
20
EA
520.90AEA
$417.97120EA
AIRWAY KING VISION VIDEO LARYNGOSCOPE BLADE. CHANNELED DISP. 18 MM W F11- LED D!Gstal rum CAMERAL
I
BX
283.20LIOEA
293.20 lQEA
AIRWAY KING VISION VIDEO LARYNGOSCOPE BLADE, STANDARD. DISP. 13 MM. WaHITE LED, DIGITAL CMOS CAMERAL 10E6L BK
y
I
BX
283.20JIOEA
283.20110EA
AIRWAY LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MAC # I GREENLINE
y
10
FA
3.8SAEA
S38.50110EA
AIRWAY LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MAC If 2 GREENLINE
y
10
EA
3.85AEA
$38.S0110EA
AIRWAY LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MAC # 3 GREENLINE
y
20
EA
53.85/lEA
$77.130/20FA
AIRWAY LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MAC 4 4 GREENLINE
y
20
EA
53.85/lEA
$77.00/20EA
AIRWAY LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MILLER N 0 GREENLINE
y --lo
EA
93.8511EA
S38.5011DEA
AIRWAY LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS
y
10
EA
3.85/IEA
$30.52agiE&_-
AIRWAY LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MILLER N 2 GREENLINE
y
10
EA
53.8511EA
$38.50110EA
AIRWAY LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MILLER # 3 GREENLINE
Y
20
EA
S18511EA
$77.00120EA
AIRWAY LARYNGOSCOPE- BLADE DISP. FIBEROPTIC STAINLESS STEEL MILLER N 4 GREENLINE
y
20
EA
$3.85AEA
77.DQ120FA
AIRWAY LARYNGOSCOPE HANDLE. GREENLINE FIBER OEOCPENLITE CHROME PLATED BRASS 2 AA BATTERIES
N
12
EA
30.88/lEA
370.56112EA
AIRWAY LUBRICATING JELLY 2.7 GRAM. FOIL PACK. STERILE. WATER SOLUBLE. MINI PACK 144/BX
N
L_
BX
k7.22L144EA
521.60/432EA
AIRWAY NASOGASTMCTUBE, 08FR RUSH LEVINE
N
12
EA
SS.75/lEA
69.00 12EA
AIRWAY NASOGASTRIC TUBE. IQFR RUSH LEVINE
N
12
EA
S1.7811EA
SUIELZEA--
AIRWAY NASOGASTRIC TUBE. 12FR RUSH LEVINE
y
12
EA
51.0211EA
S12.24112EA
AIRWAY NASOGASTRIC TUBE, 14FR RUSH LEVINE
y
12
FA
1.0211EA
$12.24A2EA
AIRWAY NASOGASTRIC TUBE. 16FR RUSH LEVINE
y
12
EA
$1.02!IEA
S12.24/12EA
AIRWAY NASOGASTRIC TUBE. 18FR RUSH LEVINE
Y
12
EA
--ILULIEA
S12.24L12LA_
AIRWAY NASOPHARYNGEAL AIRWAY - NPA -LATEX
N
2
BX
1230 10EA
S25A01201EA
AIRWAY NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 14 FRENCH IOJBX BUSCH
N
2
BX
$20.20110EA
$40.40/20EA
AIRWAY NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 16 FRENCH IQ BX BUSCH
N
2
BX
S20.20110EA
40.40/20EA
AIRWAY NASOPHARYNGEAL AIRWAY - NPA- LATEX FREE PVC 18 FRENCH 10 BX BUSCH
N
2
BX
20.20 10EA
540.40/20EA
AIRWAY NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 20 FRENCH 10 BX BUSCH
N
2
FIX
S20.20110EA
$40.40/20EA
AIRWAY NASOPHARYNGEAL AIRWAY - NPA -LATEX FREE PVC 22 FRENCH 10 BX RUSCH
N
2
BX
2M20110FA
540A0 24EA
AIRWAY NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 24 FRENCH 10 BX BUSCH
N
2
BX
S20.21311DEA
S40A0120EA,
CATEGORY ITEM DESCRIPTION
AIRWAY NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 26 FRENCH 10 BX BUSCH
Brand Specified
(Y/N)
N
EST.
CITY.
2
Units
BX
Unit price
S20.20110EA
Extended
Price
S40AQ/24EA
AIRWAY NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 28 FRENCH 30 BX RUSCH
N
2
BX
$20.20/1 EA
S40.40/20EA
AIRWAY AIRWAY - NPA- LATEX FREE PVC 30 FRENCH 10 BX BUSCH
N
2
BX
S20.2011DEA
$40.40120EA
-NASOPHARYNGEAL
AIRWAY ORAL AIRWAY ,100 MPURPLEBERMAN
y
---so
EA-
kjjjLlEA
57.22L50EA
AIRWAY ORAL AIRWAY, 50MM TURQUOISE BERMAN
y
10
FA
50,28/1EA
SSk0/20EA
AIRWAY ORAL AIRWAY, 60MM BLACK BERMAN
Y
20
EA
0.1411EA
52.80120EA
AIRWAY ORAL AIRWAY, 70MM WHITE BERMAN
Y
30
CA
---Jg!ALIEA
54.20AEA
AIRWAY ORAL AIRWAY, BOMM GREEN BERMAN
y
30
EA
50.1411 A
$414LIEA
AIRWAY ORAL AIRWAY. 90MM YELLOW BERMAN
y
so
EA
0.1411EA
57,QgISOEA
AIRWAY SUCTION CANISTER DISPOSABLE RED TOP 8c
Y
27
EA
S2.4411EA
65.88/27EA
AIRWAY SUCTION CANISTER WITH PREATTACHED 6 FT TUBING GREEN 1200- 48LCS
y
2
CS
$245.76148EA
491.52/96EA
AIRWAY SUCTION CATHETER. 12FR, COILED, GRADUATED, FROSTED SURFACE. KINK RESISTANT
N
24
EA
50.1711EA
54.08/24EA
AIRWAY SUCTION CATHETER, 14FR, COILED, GRADUATED, FROSTED SURFACE. KINK RESISTANT
N
24
EA
--I0.17LIEA
54.08124EA
AIRWAY SUCTION CATHETER, 16FR, COILED, GRADUATED, FROSTED SURFACE, KINK RESISTANT
N
24
EA
S0.17/lEA
4.QRJ24EA
AIRWAY SUCTION CATHETER, ISFR. COILED, GRADUATED, FROSTED SURFACE, KINK RESISTANT
N
24
EA
- S0.1711EA
�4.08/24EA
AIRWAY SUCTION CATHETER, 6FR, COILED, GRADUATED, FROSTED SURFACE, KINK RESISTANT
N
24
EA
10.17AEA
�24EA
AIRWAY I SUCTION CATHETER, 8FR, COILED, GRADUATED. FROSTED SURFACE. KINK RESISTANT
N
24
EA
0,1711EA
$4,00124EA
AIRWAY SUCTION TIP YANKAUER BULB TIP WITH CONTROL VENT STERILE CURAPLEX
y -
75
EA
50.41/3EA
30.75175EA
AIRWAY SUCTION TUBING ONLY 114 IN X 6 FT SO CS
N
I
CS
S36.50/SOEA
36.50 ILEA
AIRWAY BAAM AIR FLOW MONITOR
y
10
EA
$6.2411EA
562 40110EA
AIRWAY END TIDAL CO2 SMART CAPNOUNE PLUS OXYGEN _ORIDION ADULT/ INTERMEDIATE
v -
200
EA
$8.9411EA
1768.=200EA
AIRWAY FILTERUNE SET. NON HUMIDIFIED. INTUBATED, ADULT PEDIATRIC ORIDION MICROSTREAM
y -
so
EA
S7.09/lEA
S354.50150EA
BANDAGES/DRESSINGS l.h-.. ..d JohPwn
N
18
FIX
l 7q!IRY
31 'WIRRX
BANDAGES _DRESSINGS
BANDAGES DRESSINGS
BANDAGES/DRFSSINGS
BANDAGE ELASTIC LATEX FREE 6 IN X 5 YARU$ IUKLhtux
BANDAGE TRIANGULAR WITH TWO PINS 51 IN X 36 IN X 36 IN 12 BX
BANDAGE, MULTI-TRUAMA DRESSING 121N X 301N. STERILE2SEALCS
N
N
3
6
LX_
CS
$2.52/12EA
S21.25/2SEA
7.56136EA
$127.50J150EA
BANDAGES DRESSINGS
BURN DRESSING WATER JEL 2 IN X 6 IN
Y
_.LO
LA
2.54AEA
550.80120EA
BANDAGES 10RESSINGS
BURNDRESSINGWATERJEL41NX41N
N
10_
EA
SI.9011EA
$38.00120EA
BANDAGES DRESSINGS
BURN DRESSING WATER JEL 8 IN X 18 IN
N
20
EA
7.3811EA
$147.60120EA
BANDAGES DRESSINGS
BURN DRESSING WATER JEL BLANKET 3FT X 2.SFT
y
12
EA
---��IEA
571.69112EA
BANDAGES DRESSINGS
BURN DRESSING WATER JELFACIAL
y
To
EA
$11.5411FA
11SAOIIOEA
BANDAGES DRESSINGS
BURN SHEET, BLUE, 60IN X 96 IN, STERILE
N
12
EA
_jLZILlEA
S26.88112EA
BANDAGESIDRESSINGS
COLD PACK INSTANT 5.5 EN % 10 IN 24 L RAPID COLD
y
12
CS
924.90/1CS
S298.80/12CS
BANDAGES DRESSINGS
CONFORMING STRETCH BANDAGE, GAUZE, 4 IN STERILE, 12 RLJBG
..
N
40
BG
S2.82/IBG-
$112.80112BG
BANDAGES DRESSINGS
DRESSING ABDOMINAL PADS STERILE SIN X91N 2519X d i. 26!PK 51.80APK**
32
BX
2.25/25EA
$7100LBOGEA
BANDAGES DRESSINGS
GAUZE SPONGE NON STERILE 12 PLY 2 IN X 2 11
N
24
BG
�0.99118G
S 23.76/24BG
BANDAGES DRESSINGS
GAUZE SPONGE, BASIC ECONOMY, 4 IN x 4 IN, 12 PLY, STERILE, 2/PK. 25PKIBX
N
36
-
BX
51.51jim
�54.36136BX
FANDAGESIDRESSINGS
GAUZE CONFORMING STRETCH STERILE 41N X 4.1 YD 12RLSM
N
40
BG
$18211BG
5112.80L40BG
BANDAGES DRESSINGS
HYDROGEN PEROXIDE 3% 16 OZ
N
36
EA
50.8211EA
29.52136EA
BANDAGES _DRESSINGS
TAPE ADHESIVE CLOTH I IN X 10 YARDS 1218X
N
36
BX
57.60118X
5273.60/368X
BANDAGES DRESSINGS
TAPE ADHESIVE CLOTH 2 IN X 10 YARDS 6/BX
N
36
FIX
$7.6011BX
273.601366X
@ANDAGES DRESSINGS
TRAUMA EMS SHEARS, BLACK 7 114 In. SAFETY BANDAGE TIP, FULLY AUTOCLAVABLE. SURGICAL STAINLESS STEEL BLADES
N
32
EA
$0.82/lEA
$2G.24132EA
BANDAGES DRESSINGS
TRIPLE ANTIBIOTIC OINTMETN. UNIT DOSE 1/32 OZ 1441BX
6
BX
$10.0811BX
S&D.48/6BX
BREATHING
BAG VALVE MASK NEONATE INFANT RESUSCITATOR SPUR 11 WITH OXYGEN RESERVOIR TUBE
y
24
EA
S13-1211FA
$314.88/74FA
CATEGORY
BREATHING
ITEM DESCRIPTION
BAG VALVE MASK W1 MEDIUM ADULT MASK SPUR 11 DISP, INDIVIDUALLY BOXED
Brand Specified
(Y/N)
y
EST.
CITY.
48
Unib
EA
Unit price
S8.8011EA
Extended
Price
S422.40/48EA
BREATHING
BAG VALVE MASK COLLAPSED SPUR 11 PEDIATRIC nRqP WITH MAW AND AMID
Y
24
EA
$28.3911EA
5681.36124EA
BREATHING
CPAP CIS BREATHING CIRCUIT Wl MEDIUM MASK
y
26
EA
S35.95AEA
934.70 26EA
BREATHING
HERA VENT FILTER, HIGH EFFICIENCY Wl PORT, HYDROPHOBIC PAPER TIDAL VOLUME RANGE > 500 L
Y
100
FA
S2.20/lEA
$220.001100EA
VENTILATION CIRCUIT DISP KIT, Wj EXHAUST COLLECT / PEEP VALVE, FOR DEMAND VERSION OF PARAPACIVENTIPAC
v
10
EA
19.12 IEA
191.29110EA
_BREATHING
BREATHING
VENTILATION CIRUIT, SINGLE LIMB, PORTABLE , 6 FT PATIENT TUBE, 1/8 IN AND 114 IN ID FOR USE WITH EAGLE UNIVENT
N
100
EA
54.89jlEA
S489L00JID0EA
DIAGNOSTIC
BLOOD PRESSURE CUFF DISP ADULT FOR USE WITH LIFEPAK MONITORS
N
160
EA
3.47/SEA
555.20/160EA
DIAGNOSTIC
BLOOD PRESSURE CUFF DISP CHILD FOR USE WITH UQ`PAv MONITORS
N
6
EA
S2.2911EA
$13.7416EA
DIAGNOSTIC
BLOOD PRESSURE CUFF DISP INFANT FOR USE WITH LIFEPAK MONITORS
N
6
1 EA
51.95/IEA
511.7016EA
DIAGNOSTIC
BLOOD PRESSURE CUFF DISP LARGE ADULT FOR USE WITH LIFEPAK MONITORS
N
so
EA
S3 9515CEA
197.50150EA
DIAGNOSTIC
BLOOD PRESSURE CUFF DISP SMALL ADULT FOR USE WITH LIFEPAK MONITORS
N
so
EA
52.5611EA
128.00 50EA
p a I. s 0 ', 2 1. 14 11 R
y
40
EA
SI0.665AEA
5426.60L40EA
_DIAGNOSTIC
DIAGNOSTIC
DEFIB/PACINGIECG PADS PED! W/ QUIK-COMBO CONNECTOR FOR LlfePak 12 & LlfePak 10 & LlfePak 5 -s Id in eairs t�, '25.9811 PR-
y
20
EA
j12.99JlEA
S259.80120EA
ELECTRODES SISTRIP SOJSX 12BX&S
N
30
a_
$96.75/ICS
S2902.50130CS
_DIAGNOSTIC
DIAGNOSTIC
ELECTRODES PEDIATRIC 31PK l0PKjBX HUGGABLE
Y
2
FIX
$4.69118X
9.39/213X
DIAGNOSTIC
GLUCOSE TEST STRIPS, CAPILLARY. SO BX PRECISION XTRA
y
48
BX
22.2211BX
1066.56/4813X
DIAGNOSTIC
LANCETS. FINGERSTIX 200 BX
y
4
BX
S28.4011BX
5113.6014BX
DIAGNOSTIC
PAPER UPII.LP12. LPIS SIZE 109 MM X 21M ROLL. 5 ROLLS BX LIFEPAK
y
75
1 BX
SEL12ARX
S609.00jZ5BX
PENLIGHTS DISPOSABLE 6/PK sa'w I,, CA e- S0.6' �" EA-
N
18
1 PK
S3.6616EA
S65.881108EA
_DIAGNOSTIC
DIAGNOSTIC
RAZORS PREPARATION SO BX GALLANT
Y
BX
16.50/SOEA
S66.001200EA
THERMOSCAN PR04000 EAR THERMOMETER COVERS .
. . . . .Y
4
BX
S13.28/IBX
553.1214BX
_DIAGNOSTIC
DIAGNOSTIC
TINCTURE OF BENZOIN SWAMICKS INDIVIDUALLY WRAPPED SOPKJBX
y
is
--m-
8.94
$13410115EIX
IMMOBILIZATION
RESTRAINT DUAL LADDER LOCK 7 FT LOOPLOCK SAME LENGTH ORANGE PLASTIC DISP "r-. d by add -due. 2-
200
EA
N d
bid
No bid
IMMOBILIZATION
RESTRAINT STRAP SEAT BELT BUCKLE LOOP rmn 2 pirm q PT nigp
N
24
EA
56.9011EA
$165.60/24EA
IMMOBILIZATION
EXTRICATION COLLAR, BABY NO -NECK
y
10
EA
I S4.6911EA-
S46-90/10EA
IMMOBILIZATION
EXTRICATION COLLAR ADJUSTABLE PEDIATRIC STIFN
y
10
EA
S4.9011EA
549.00110EA
IMMOBILIZATION_
EXTRICATION COLLAR ADIUSTABUE,ADULT NASAL CANNULA HOOK STIFNECK SELECT LAERDAL
Y
250
_LA
4.9011EA
S1225.001250EA
IMMOBILIZATION
HAND-E HAND HOLD DEVICE YELLOW
y
20
LA
$14.5311EA
290.60/20EA
IMMOBILIZATION
HEAD BLOCKS STICKY
y
200
PR
�IP R
S718.001200PR
VACUUM SPLINT SET DISPOSABLE
N
--.I-
SETS
169.2511SET
846.251SSETS
_IMMOBILIZATION
INFECTION CONTROL
BIOHAZARD WASTE BAG, 1.2MIL, RED W1 BLACK PRINT, 23 IN X 23 IN , 7-10 GAL
N
Soo
EA
50.0811EA
$40I1001500EA
INFECTION CONTROL
BODY BAG BASIC VINYL STRAIGHT ZIPPER 6 GAUGE 36 IN X 90 IN 10 CS
N
75
EA
jLjZLlEA
S474.00nSEA
INFECTION CONTROL
EMBAGS, E AESIS BAG ISDO ml. SO/ok
N
I
PK
567.00/50EA
S67,00/SOEA
INFECTION CONTROL
y
100
TB
6.9111TUB
$691.001100TUB
INFECTION CONTROL
GLOVES LATEX FREE POWDER jBX l0BXjC-1 FREEFORM EC
y
400
BX
59.51111FIX
380CLOO4000X
INFECTION CONTROL
GLOVES LATEx FREE POWDER FREE EXPENDED CUFF NlTRICE LARGE 50 BX 108X CS FREEFORM EC
y
300
FIX
59.5011BX
S2850.01300BX
INFECTION CONTROL
GLOVES LATEX FREE POWDER FREE EXTENDED CUFF NITRILE MEDIUM 50 BX lOBX CS FREEFORM EC
y
2D0
BX
$9.SOIIBX
51900.0012008X
INFECTION CONTROL
GLOVES LATEX FREE POWDER FREE EXTENDED CUFF NITRILE SMALL SO BX IOBXJC-1 FREEFORM EC
y
10
FIX
9.50 18X
$95.00jl0QX
INFECTION
HAND CLEANSER FOAMING ALCOHOL BASED 9 OZ 24 CS ALCARE PLUS
y
4
CS
218.88 24EA
875.52196EA
_CONTROL
INFECTION CONTROL
RESPIRATOR N95 REGULAR SIZE 20 BX 6BX CS 3M ki I. Lox of ZQ 0 51812120,-A-
v
30
EA
50.90611EA
527.18130EA
INFECTION CONTROL
SLEEVE COVER 200 CS PPE Trauma sleeves
N
3
CS
S5100AC5
5156.DD/3CS
INFECTION CONTROL
TRANSPORTABLE SHARPS CONTAINER, SHUTTLE W/ LOCKING MECHANISM, 11/2 IN D X 6 112 IN L
Y
50
EA
51.6311EA
SBI.SO/SOEA
INFECTION CONTROL
WASH BASIN. 6 QUART. ROSE 50 EA CS
N
50
EA
�1E A
30.00/SOEA
IV ADMINISTRATION
ALCOHOL PREP PADS LARGE IDDIOX
N
4
FIX
1.68/1RX
56.77/48X
CATEGORY
IV ADMINISTRATION
ITEM DESCRIPTION
ECLIPSE SAFETY EEDLEISGIDOZBX
Brand Specified
(Y/N)
y
EST.
QTY.
4
Units
FIX
Unit price
S24.9711BX
Extended
Price
$99.88L4FIX
IV ADMINISTRATION
INT, AV NOUS JIV J ADMINISTRATION SET NEEDLE FREE 1 Y SITE 1 VALVE 10 DROP 83 IN SO CS
INTRAVENOUS
I
574.50150EA
$1490.0011000EA
IV ADMINISTRATION
INTRAVENOUS OVI ADMINISTRATION SET NEEDLE FREE 1 Y SITE 1 VALVE 60DROP 831N 50 CS
N
5
CS
82.50 SOEA
5412.50125DEA
IV ADMINISTRATION
INTRAVENOUS IV DRESSING TRANSPARENT ADULT IGO BX 5BX CS VENI-GARD
Y
10
BX
36.64 IBX
S36GAID110OX
IV ADMINISTRATION
INTRAVENOUS JIVI EXTENSION SET NEEDLE FREE WITH 2 Y SITES 43 IN 48 CS INTERLINK
Y
4
CS
$87.8411CS
351.36 4CS
IV ADMINISTRATION
IV EXTENSION set WITH AMSAFE NEEDLELESS INJECTION SITE 81N IOO CS
Y
4
CS
129.00 1CS
$516.00L4CS
IV ADMINISTRATION
PRESSURE INFUSOR IWO CC INFUSION CUFF WITH VALVE ANQ ANEROID GAUGE
Y
10
EA
10.89 LEA
208.90 IDEA
IV ADMINISTRATION
SALINE FLUSH 0.9% 10 ML PREFILLED 12 ML LUER LOCK SYRINGE 1DOEA BX
N
4
B%
S33.001100EA
132.D0 4OOEA
IV ADMINISTRATION
SYRINGE ONLY LUER LOCK IOCC IODEA BX
N
2
BX
8.00 100EA
16.00 200EA
IV ADMINISTRATION
SYRINGE ONLY LUER L OCK 6OCC 40 BX BECTON DICKINSON
Y
5
BY
19.63 IBX
598.151SBX
IV ADMINISTRATION
SYRINGE ONLY BD 5 CC LUER-LOK TIP STERILE 125 BX
N
2
BX
8.75 125EA
517.S0 2SOEA
IV ADMINISTRATION
TOURNIQUET, LATEX FREEE 1 IN X 18 IN PRE -ROLLED 250 BG IDOG CS -°=oi3 m I, -of 10auEA rl 59.CC,'l001A"
N
CS
225.00 2500EA
20250.00 2S EA
IV CATHETERS
CATHETER INTRAVENOUS IV LATEX FREE 16 GAUGE X 1.25 IN SO BX PROTECTIV
Y
BY
78.50 SOEA
157.00 1OOEA
IV CATHETERS
CATHETER INTRAVENOUS IV LATEX FREE 16 GAUGE X 1.25 IN SO BY PROTECTIV
Y
B%
78.50 SOEA
1570.00 1 EA
IV CATHETERS
CATHETER INTRAVENOUS IV LATEX FREE 20 GAUGE X 1.25 IN 50 BX PROTE -
Y
62q
B%
78.50 SOFA
1570.00 1 EA
IV CATHETERS
CATHETER INTRAVENOUS IV LATEX FREE 22 GAUGE X 1 IN 50 BX PROTECTIV
Y
BX
78.5050EA
1570.00 1 EA
IV CATHETERS
CATHETER INTRAVENOUS IV LATEX FREE 14 GAUGE X 1.25 IN S@ BX PROTECTIV
Y
RX
78.50 50EA
157.00 16OEA
IVCOMPONENTS
STOPCOCK WAY W' SWIVAL AND MALE LUER LOCK
N
EA
1.031EA
25.752SEA
IV SOLUTIONS
SODIUM CHLORIDE 0.9%1 ML 14EA CS
N
CS
513.44114EA
268.80 260EA
IV SOLUTIONS
SODIUM CHLORIDE 0.9%100ML SINGLES 96EA`CS
N
1
CS
$119.P4LWA
119.04 9GEA
IV SOLUTIONS
SODIUM CHLORIDE 0.9%SOOML 24EA CS BAXTER
Y
40
CS
19.68 24EA
787.20 960EA
MEDICATIONS
ADENOCARD 12MG 4ML ANSYR SYRINGE
Y
SO
EA
85.02 IEA
$4251.001SOEA
MEDICATIONS
ADENOCARD 6MG 2ML ANSYR SYRINGE
Y
25
EA
S419211FA
1073.00 2SEA
MEDICATIONS
ALBUTEROL 0.083%2.5MG 3ML 25VIAI % BX
Y
4
RX
3.8$ 2SEA
1552 100EA
MEDICATIONS
AM€DATE ETOMIDATE Lifeshleld Drefilled w,n 40MG'20 ML
Y
40
EA
536.5411EA
1461.60 40EA
MEDICATIONS
AMIODARONE 15OMG 3ML VIAL
Y
85
EA
1.69 IEA
S143.6518SEA
MEDICATIONS
AMMONIA INHALANTS 10 BX
N
10
BX
2.07 IBX
I S20.70/ICBX
MEDICATIONS
ANECTINE 200 MG 10 ML VIAL 'REFRIGERATE- IDEA/BX
Y
40
1 EA
3.75 IEA
150.00 40EA
MEDICATIONS
ASPIRIN CHILDREN`S CHEWABLE ORANGE FLAVOR B1MG 36 BT
N
30
BT
IT 76 1RT
22.80 308T
MEDICATIONS
ATROPINE !MG IOML ANSYR PREFILLED SYRN.
Y
80
EA
6.03 IEA
482.40180EA
MEDICATIONS
CALCIUM CHLORIDE 1GM IOML ANSYR SYRINGE
Y
60
EA
6.2R'IFL_
376.80 60EA
MEDICATIONS
DEXTROSE 50%SOW ANSYR SYRINGE
Y
44
EA
5.96 IEA
262.24 44EA
MEDICATIONS
DIAZEPAM SMG ML 2ML LUER LOCKING CARPUJECT 10 BX
Y
10
BX
101.40 10EA
1014.00 ICOEA
MEDICATIONS
DILTIAZEM 1MG ADD -VANTAGE VIAL NON-REFR€G ADD -VANTAGE DILUENT REQUIRED- SOLD SEPERATELY
Y
10
EA
8.85 lEA
88.50 1DEA
MEDICATIONS
DIPHENHYDRAMINE SOMG ML IML BENADRYL
Y
25
EA
0.96 IEA
24.00 2SEA
MEDICATIONS
DOPAMINE 400MG D5W 250ML 12 CS
N
62
EA
IO.47 IEA
649.14 62EA
MEDICATIONS
EPINEPHRINE 1:1 1MG 1ML AMPULE
Y
75
EA
2.62 IEA
196.50 SEA
MEDICATIONS
EPINEPHRINE 1:10000 1 MG 10 ML LIFESHIELD SYRINGE
Y
260
FA
S.R9 IEA
1178.00 200EA
MEDICATIONS
FENTANYL CLASS II O.OSMG ML 2ML VIAL ---� d l¢. 6cx o125E:A s2; ';2✓- C:3'2SEA#$
N
20
EA
40.9192 IEA
18.384 20EA
MEDICATIONS
FLUMAZENIL O.SMG SML VIAL SO VIALS BX ROMAZICON
Y
3
EA
1D.95 IEA
32.85 3EA
MEDICATIONS
HYDROMORPHONE DILAUDID CLASS II 2MG ML IML CARPUlECT*°s�lcl in h*�,:nf SOvA P:) S27.3i'10EA--
N
30
EA
2.7311EA
81.9330EA
MEDICATIONS
INSTA-GLUCOSE 31GM 12 CS
N
4
CS
38.88 12EA
155.52 48EA
MEDICATIONS
LORAZEPAM 2MG 1ML V➢AL 10 BOX *REFRIGERATE--
Y
2
BX
12.23 1BX
24.46 2BX
MEDICATIONS
METOPROLOL 5MG SML VIAL
Y
30
EA
1.34IEA
13.40 10EA
CATEGORY
MEDICATIONS
ITEM DESCRIPTION
MIDAZOLAM --VERSED-- 5MG ML 2ML VIAL IO BOX
Brand SpedNed
(Y/N)
Y
EST.
QTY.
6
Units
1 BX
Unit price
11.34 IBX
Extended
Price
68.04 6BX
MEDICATIONS
MORPHINE IONIGIMLIMLOarLyAlet EO BX
Y
10
BY
21.72 IBX
$217.201108X
MEDICATIONS
NALOXONE 2MG 2ML LUER JET
Y
70
EA
18.45 IEA
1291.50 7OEA
MEDICATIONS
NITROGLYCERIN 50MG DSW 250ML BTL
Y
30
EA
5.12 IEA
9153.60130EA
MEDICATIONS
NITROGLYCERIN LINGUAL SPRAY 4 MCG SPRAY 60 DOSES 12EA CS
N
20
EA
153.20 IEA
3064.00 20EA
MEDICATIONS
ONDANSETRON 4 MG 2ML VIAL 25 EA BX
Y
40
EA
SO.47JIEA
SIB. 60 40EA
MEDICATIONS
PANCURONIUM IMG IOML VIAL
Y
70
EA
5.16 IEA
361.20 JOEA
MEDICATIONS
QUELICIN 200MG IOML VIAL -REFRIGERATION REQUIRED-
Y
40
EA
9.54 IEA
S381.6014DEA
MEDICATIONS
SODIUM BICARBONATE 4.2% 10ML INFANT LIFESHIELD
Y
10
EA
$8.2511EA
82.50 10EA
MEDICATIONS
SODIUM BICARBONATE B.4-k LIFESHIELD SYRINGE
Y
35
1 EA
6.54 IEA
$228.9013SEA
MEDICATIONS
SOLU-MEDROL 125 MG 2ML VIAL 2SE61OX
Y
2S
EA
5.83 IEA
149.75 2SEA
MEDICATIONS
SALINE UNIT DOSE MODUDOSE 3ML 0.9%NACL INHALER EASY OPEN TWIST AND PULL IGO EA BX
I Y
10
BX
SlI.0OlIDOEA
I S110.00/1000EA
MEDICATIONS
VECURONIUM IOMG IOML VIAL IOEA BX
Y
40
EA
4.85 IEA
194.00 40EA
OXYGEN DELIVERY
TUBING CONNECTOR FITS TUBING FROM 7 32 TO 7119 IN DIAMETER 5 IN 1 SO PK
N
2
PK
65.26 SOFA
430.56 100EA
OXYGEN DELIVERY
NEBULIZER SMALL VOLUME HAND HELD WITH TEE MOUTHPIECE FLEXTUBE 7FT TUBING SOFA CS
N
2
CS
32.00 SOEA
64.00 106EA
OXYGEN DELIVERY
OXYGEN MASK ADULT ELONGATED HIGH CONCENTRATION PARTIAL NON-REBREATHING METAL NOSE CLIP 5@ EA CS
N
8
CS
49.5p SOEA
5396.GOL400EA
OXYGEN DELIVERY
OXYGEN NASAL CANNULA ADULT CONV.STYLE CLEAR FLARED NASAL PRONGES 7 FT TUBING 50E. CS _
N
_.. 6
CS
12.50 SOFA
$75,001300EA
BoundTree
medical
Making Precious Minutes Count...' -
To Whom It May Concern,
In response to your bid request, Bound Tree Medical is pleased to offer 25% off of the list
prices, for all items other than on the itemized list submitted in the 2012/2013 Bound Tree
Medical Emergency Medical Product current list price.
Our web site is,"ivw.boundtree.com
In order to provide a percentage off list discount, it is necessary for Bound Tree to exclude
certain product categories or manufacturer products. This is largely due to the cost
variability of these items as a result of market demand and raw material costs.
Products excluded from the percentage off bid include the following:
Manufacturers Excluded **
Product Categories Excluded**
Advanced Circulatory Systems
Backboards
CAS
Hot and Cold Packs
Junkin Safety
King Tubes (not kits) and Airways
Laerdal (Manikins and AHA items)
Gloves
Nasco
Pharmaceuticals _ m
Shock Doctor _
Rescue Buddies (Charitable item)m
Simulaids
IV Solutions
Stryker
TSG
We are pleased to provide you with a competitive bid for the emergency medical supplies
and equipment that you are seeking. Please contact our Bids and Contracts Department at
800-533-0523 with any questions. Thank you.
**Other than items included on itemized list submitted.
Sincerely,.
Valia Way
Manager, Contracts & Bids
Attachment B
SUBMISSION PROPOSAL RESPONSE FORM
SET PRICING FOR MEDICAL SUPPLIES AND PHARMACEUTICALS
Proposer's Name and Mailing Address:
Telephone and Fax Numbers:
All amounts must be written clearly.
I have included:
Bound Tree Medical, LLC
5000 Tuttle Crossing Blvd.
Dublin, Ohio 43016
800.533.0523 ext 5370 / 877.311.2437
•
Proposal/Tabbed Sections
X
•
Medical Supply List Pricing Worksheet
X
•
Discount in the form of a percentage off list price
X
•
Submission Response Form
X
•
Non Collusion Affidavit
X
•
Public Entity Crime Statement
•
Drug Free Workplace Form
X
•
Lobbying and Conflict of Interest Clause Form
X
•
Indemnification and Hold Harmless
X
•
Local Preference Form (Attachment H if applicable)
('heck mark items above, as a reminder that they are included).
I state that I am authorized to submit this proposal.
STATE OF AZI
ignature/Kroposerir'
—i!-
,
COUNTY OF Franklin e inc .cial Officer
Date 9/13/2013
PERSONALLY APPEARED BEFORE ME, the undersigned
authority, Mark Dougherty who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above O.MWA
September �,%
3 day of 20 13 ?,00T-&0,t
S
My commission expires: gj:
NOTARY PUBLIC 4.s
OF
Attachment C'
I'
Mark Dougherty , of the city of
Dublin according to law on my oath, and under
penalty of perjury, depose and say that;
1) 1 am Bound Tree Medical, LLC the respondent making the
Solicitation for the project described as follows:
Medical Supplies and Pharmaceuticals
2) The prices in this solicitation 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 respondent or with any competitor;
3) Unless otherwise required by law, the prices which have been quoted in this
solicitation have not been knowingly disclosed by the respondent and will not knowingly be
disclosed by the respondent prior to solicitation opening, directly or indirectly, to any other
respondent or to any competitor; and
4) No attempt has been made or will be made by the respondent to induce any other
person, partnership or corporation to submit, or not to submit, a solicitation for the purpose of
restricting competition; and
5) The statements contained in this affidavit are true and correct, and made with full
knowledge that Monroe County relies upon the truth of the statements contained in this affidavit
in awarding contracts for said project.
STATE OF
Ohio
1,1sign-atuWof Respondent)
COUNTY OF Franklin October 31,2013
Date
Mark Dougherty -- who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above on this
31 day of October 20 13
%
4 ROOT' NO
My�ccoi coo expires:
A M I I
NOTARY PUBLIC P
Z
OMB - MCP FORM k" I
A-
I IWO
Attachment D
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 solicitation on a contract to provide any goods or
services to a public entity,: may not submit a solicitation on a contract with a public entity for the
construction or repair of a public building or public work, may not submit solicitations on leases
of real property to public entity, may not be awarded or perform work as a proposers, supplier,
subproposers, RESPONDENT or subRespondents 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."
By executing this form, I acknowledge that I/my company is in compliance with the above.
STATE OF =n�
(Sign re of Res ndent)
September 13, 2013
Mark Dougherty who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above on this
13 day of September
My commission expires:
NOTARY PUBLIC
Attachment E
DRUG -FREE WORKPLACE FORM
The undersigned Respondent 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 solicitation 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 solicitation, the employee will
aproposale by the terms of the statement and will notify the employer of any conviction of, or
plea of guilty or nolo contendre 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 require the satisfactory participation in a drug abuse assistance or
rehabilitation program if such is available in the employee's community, or 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
Anve, rpnnirement.q
September 13, 2013
Fl=
Attachment F
mo wo mo) mg-811ja M 01 Im %-"A I oil
ETHICS CLAUSE
Bound Tree Medical, LLC 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 No. 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.
J'*
j�
._`
(Signature)
Date: October 31, 2013
STATE OF Ohio
COUNTY OF Franklin
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Mark Dougherty who, after first being sworn by me, affixed his/her
signature (name of individual signing) in the space provided above on this 31 day of
October , 20 13
NOTARY PUBLIC
```�ltlllp�dr�®
y commission expires: I) i
OMB - MCP FO 44
tftlfill%
Attachment G
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION
MANUAL
Indemnification and Hold Harmless
for
Other Respondents and subRespondents
The Responder covenants and agrees to indemnify and hold harmless Monroe County Board of
County Commissioners AND Board of Governors for District I, its servants, agents and
employees from any and all claims for bodily injury (including death), personal injury, and
property damage (including property owned by Monroe County) and any other losses, damages,
and expenses (including consultant's fees) which arise out of, in connection with, or by reason of
services provided by the Proposers or any of its subRespondents (s) in any tier, occasioned by
the negligence, errors, or other wrongful act or omission of The Responder or its sub -Responder
in any tier, their employees, or agents.
In the event the completion of the project (to include the work of others) is delayed or suspended
as a result of the Responder's failure to purchase or maintain the required insurance, the
Respondent shall indemnify the County from any and all increased expenses resulting from such
delay.
The first ten dollars ($10.00) of remuneration paid to the Respondent is for the indemnification
provided for above.
The extent of liability is in no way limited to reduced, or lessened by the insurance requirements
contained elsewhere within this agreement.
's Signature
September 13, 2013
l
Attachment H
LOCAL PREFERENCE FORM "Not Applicable**
&
Name of Proposers/Responder
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 proposal or solicitation? (Please furnish 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 Respondent 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 of the business tax paid to the Monroe County Tax Collector by the subRespondent dated at least
one year prior to the notice or request for proposal or solicitation.
2. SubRespondent Address within Monroe County from which the subRespondent operates:
Tel. Number
lam, Wrlm-
Signature and Title of Authorized Signatory for
Proposers/Responder
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.
104. ' �
10 MM200-
My commission expire Seal