Item K3VOARD OF GOVERNORS FIRE AND 1• DISTRICTJ
AGENDA 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, seated 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:
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
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 BOG 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 Governors approved issuance of a Request
for Proposals (RFP).
CONTRACT/AGREEMENT CHANGES: N/A
TOTAL COST:__JIA2,200 INDIRECT COST: — BUDGETED: Yes X No
DIFFERENTIAL OF LOCAL PREFERENCE: N/A on all proposals
COST TO COUNTY: see ..• SOURCE OF FUNDS:_ 141-13001-530520/512 and 10 1- 1100 1 -530520/512
REVENUE PRODUCING: Yes N AMOUNT PER MONTH Year,,8
APPROVED BY: County Atty���/Purchv;ing Risk Management.
DOCUMENTATION: Included -X
Not Required
AGENDA ITEM #
W9010111119is1JEWN
ONE
0111J6111111,
Contract with: Bound Tree,Medical LLC Contract #
Effective Date:
12/01/2013
Expiration Date: 11/30/2016
Contract Purpose/Description:
Contract fumishing specified medical supplies and pharmaceuticals at set contract pricing, and provisional
rns reflected as a 25% discounted i rcentage rate off list.
Contract Manager: Holly Pfiester 6088 Emergency Services / Stop 14
(Name) (Ext.) (Department/Stop #)
Lfor BOG meeting on 11/20/2013
Deadline: 11/05/2013
CONTRACT COSTS
Total Dollar $149,200 Current $149,200
Value of Contract: 141-13001-530520 = $80,000 FY14 Portion:
530512 = $20,000
10 1 - 1100 1 -530520 = $34,200
530512 = $15,000
Budgeted? Yes® NoEl Account Codes: 141-13001-530520/512 and 101-11001-530520/512
Grant: $
County Match: $ 0
ADDITIONAL COSTS
Estimated Ongoing Costs FY15 forward: For:
(Not included in dollar value above) - (eg. maintenance, utilities, janitorial, salaries, etc.
Date In Needed R
Division Director YesE] No
Risk Management Yes[ --I No
��,
O.M.B./Purka-sing U Q� �; Yeso Nod
County Attorney 13 YesF-] NoR[
Comments:
nMR Fnrm X4r-n un
Date Out
WWMA
BUDGET AND FINANCE
PURCHASING DEPARTMENT
TABULATION SHEET
OPEN DATE: SEPTEMBER 17, 2013 AT 3:00 PM,
TITLE: MEDICAL SUPPLIES AND PHARMACEUTICALS
RESPONDENT BID BOND BID AMOUNT
BOUND TREE MEDICAL, LLC-DUBLIN, OH. N/A MULTIPLE PRICING
CUSTOMED 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 - Purchasir 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 Department
490 63d Street Ocean
Marathon, FL 33050 � 411"
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,
of
1
Holly Pfesier
Executive Assistant, Monroe County Emergency Services
Deputy Chief of
•
Chief of EMS & Air Rescue, Chris Musser
............
Captain oEMS, Andrea Sutherland
s
5�
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 -4
G. BOSWELL
C. MUSSER
A. SUTHERLAND
I. TONER
1
Pricing
Out of 40 points
40
40
40
40
PROPOSER'S
BOUNDTREE MEDICAL,
2
Performance
Out of 30 points
20
25
25
25
OVERALL
LLC
3
Online
Out of 20 points
20
20
`
0_
SCORE
— DUBLIN, OH
4
References
Out of 10 points
1.0
10
1010
REVIEWER TOTAL
96
95
95
95
381
icing
Out of 40 points
2 0
0
21
�rz
PROPOSER's
2
Performance
Out of 30 points
30
0
30
30
CUSTOMED USA, LLC
OVERALL
— ORLANDO, FL
3
Online
Out of 20 paints
�0
_
SCORE
4
References
Out of 10 points
'10
10
REVIEWER TOTAL
80 _
0
75
75
230
1
Pricing
°Out of 40 points
30
30
35
PROPOSER'S
MIDWEST MEDICAL
2
Performance
=Out of 30 points
30
20
?0
05
OVERALL
SUPPLY CO., LLC
3
Online
Out of 20 points
20
no
10
`°
SCORE
— EARTH CITY, MO
4
References
Out of 10 points
10
10
10
10
REVIEWER TOTAL
85
80
80
90
335
1
Pricing
Out of 40 points
0
0
0
0
PROPOSER'S
PH&S PRODUCTS, LLC
2
Performance
Out of 30 points
1
v; �a,^
30
0 .
OVERALL
— MINERVA, OH
3
°'Online
Out of 20 points
0
0
0
SCORE
4
References
Out of 10 points
10
0
10
10
REVIEWER TOTAL
40
0
40
40
120
1
_
Pricing
.Out of 40 points
;�
� �
2
PROPOSER'S
2
Performance
Out of 30 points
1
�_
�`
0
- -
�,
n
OVERALL
QUADMED, INC.
3
Online
Out of 20 points
p
200
—JACKSONVILLE, FL
__0
SCORE
4
References
Out of 10 points
10
10
10
10
REVIEWER TOTAL
85
75
80
85
325
1
Pricing
Out of 40 points
2 51
25
15
25
PROPOSER'S
MOORE MEDICAL LLC
2
Performance
Out of 30 points
- —
30
20
30
30
OVERALL
— FARMINGTON, CT
3
Online
Out of 20 points
20
20
era
20
SCORE
4
References
Out of 10 points
0
8
0
10
REVIEWER TOTAL
75
73
65
85
298
Selection Conimittee Ranking Request for Proposals on Medical Supplies and Phar aceuticak Tuesday, Ocrober 22, 2013, 9�00am Gov rnnient
Annex Conference Room as Advertised ,- Criteria, as outlined in advertised request for proposals, 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
IWE
! • ' 1 ! ! ! !
1
THE BOARD ! . ! .
FIRE AND AMBULANCE DISTRICT
OF MONROE COUNTY,
1
BOUND TREE MEDICAL,
FOR THE PURCHASE OF MEDICAL SUPPLIES AND PHARMACEUTICALS
referred
THIS CONTRACT, hereinafter "CONTRACT" or "AGREEMENT", is made and entered ini
this I" day of December, 2013 by and between the Monroe County Board of County
Commissioners and Board of Governors Fire and Ambulance District I of Monroe County,
Florida, hereinafter referred to as "COUNTY", and Bound Tree Medical, LLC, hereinafte
to .s "CONTRACTOR
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,
•' ' •'consideration•' the promises containeZf-h-erein,parties
as • •
CONTRACT DOCUMENTS — This contract consists of the Agreement, the
CONTRACTOR'S response sthe Request forProposals the documents referred
to in the Agreement as a part of this Agreement and Bound Tree Medical, LLC. In the
event of • between of - contract documents,one •• the
greater burden on the CONTRACTOR will control.
2. CONTRACT PERIOD AND RENEWAL - The effective date of this Agreement shall be
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.
5. PRICING — is set forth in Attachment A. This will be inserted in the contract from the
,WIAM' nywalm-111-mul 101.0 •
A. Quality and Quality Control. A system of test inspections shall be used to insure
receipt of the quality and quantity of materials)/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 r• to the toxic • and
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 pin 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.
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.
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.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 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,
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 not included on
Medical Supply List 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 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 tim%
,Oiee
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.
• Ordering. CONTRACTOR will provide web -based online ordering websiv
designed specifically for service.
P. Disaster Recovery. CONTRACTOR must have a proven Disaster Suppom
Program in place and shall provide the COUNTY with emergency numbers f] these situations. These numbers will be updated immediately if the conta
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 G". 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 — No insurance is required for this contract.
lW All illlll,!� 1111111111111, 1111 IlIrl #1
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
1-r
41.
Print
By: mark Dougherty / Chief Financial Officer
1•' 1 1 111 1 1
Lei MLVA L11121• 1 1 1 1
0
Mayor, George Nugent
1;1"MI
1; 1 1 11 1
: 1 .
COUNTY,
MFA
ZMANIMMM
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
• T&i TOT, TmTrb I a
BY: Mark Dougherty / Chief Financial officer
Print Name and Title
Date: October 31, 2013
• oil wo an atiallia *A W al -1117,
M
132312MMEM
Xrl 0 1
512 1: 11 wgg ION u nJ V u u"
•
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
� / I
CATEGORY
AIRWAY
ITEM DESCRIPTION
ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 5.0 10JBX FLEXI-SET
Brand Specified
(Y/N)
N
EST.
QTY.
2
Units
BX
Unit price
515.20/10EA
Extended
Price
$30,40120EA
AIRWAY
ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 5.5 10 BX FLEXI-SET
N
2
BX
k15.20110EA,
$30.40J20EA,
AIRWAY
ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 6.5 SO BX FLEX! -SET
N
2
BX
SIS.20110EA
$30.40120EA
AIRWAY
ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 7.0 IQJBX FLEXI-SET
N
2 .
FIX
SIS.20110EA
$30.40120EA
AIRWAY
ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 7.5 30 BX FLEM-SET
N
2
FIX
15.2011OEA
$30.40120EA
ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 8.0 101RX FLEXI-SET
N
2 1
BX
SIS.20/10EA
S30 40/20EA
-AIRWAY
ENDOTRACHEAL TUBE CUFFED WITH STYLETTE 8.5 10 BX FLEX! -SET
N
2
ex
S15.20/10EA
$30.40120EA
_AIRWAY
AIRWAY
ENDOTRACHEAL TUBE CUFFED WITH S-FyL p7p a n I n/Ry n FXI-SFT
N
2
FIX
S15.20110EA
30.40/20EA
AIRWAY
FNWTRACHEAL TUBE HOLDER ADULT 1001CS THOMAS
Y
70
FA
S2.5011EA
$176.40LZOEA
AIRWAY
m66TRACHEAL TUBE UNCUFFED WITH STYLETTE 2.5 101BX FLEXI-SET
N
1
FIX
--j15.29j-10EA
S15.22JIL)EA
ENDOTRACHEAL TUBE UNCUFFED WITH STYLETTE 3.0 10 BX FLEXI-SET
N
I
RIK
15.20110EA
115.20110EA
_AIRWAY
AIRWAY
ENDOTRACHEAL TUBE UNCUFFED WITH STYLETTE 3.5 ID/BX FLEXI-SET
N
1
FIX
SI5.20110EA
15.29LIQEA
AIRWAY
ENDOTRACHEAL TUBE UNCUFFED WITH STYLETTE 4.010 FIX FLEXJAFT
N
I
BX
115.20/10EA
515.20110EA
AIRWAY-
ENDOTRACHEAL TUBE UNCUFFED STYLETTE 10 FIX FLEXIA�
N
I
BX .
q1S.20110FA
S15.20/10EA
_.LNDOTRACHEAL
AIRWAY
ETTUBE DISP. INTRODUCER. BLUE STARIGHT TIP 15 FRENCH X 70 CM, ADULT
y
so
EA
S3.8611EA
$1910015DEA
AIRWAY
IGEL 02 RESUS PAK ADULT SIZE 3 YELLOW HOOK RING @Y INTERSURGICAL"
y
20
EA
$20.9011EA
$417.97120EA
AIRWAY
IGEL 02 RESUS PAK ADULT SIZE 4 YELLOW HOOK RING BY INTERSURGICAL - S02 m c.se 0§ 6 0 12
y
30
EA
S20.90/lEA
626.95/30EA
AIRWAY
IGEL 02 RESUS PAK ADULT '12539*1
y
20
EA
420.90/lEA
417.97/20EA
KING VISION VIDEO LARYNGOSCOPE BLADE CHANNELED DISP. 18 MM W HITE LED DIGITAL CMOS CAMERAL IDEA BK
y
I
LX_
J283.20Ll0EA
j283.20 l0EA
_AIRWAY
AIRWAY
KING VISION VIDEO LARYNGOSCOPE BLADE, STANDARD DISP. 13 MM, WIWHITE LED, DIGITAL CMOS CAMERAL 10EAJ FIX
y
I
BX
S283.20110EA
$283.20110EA
LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MAC # I GREENLINE
y
10
EA
53.85/IEA
$38.50/10EA
_AIRWAY
AIRWAY
LARYNGOSCOPE BLADE DISP. FIREROPTIC STAINLESS STEEL MAC N 2 GREENLINE
y
10
EA
S3.SSIIEA_
S38.50/10FA
AIRWAY-
LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MAC # 3 GREENLINE
y
20
EA
53.8511EA
$77.00120EA
AIRWAY
LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MAC N 4 GREENLINE
y
20
EA
3.8511EA
77.00120EA
AIRWAY
LARYNGOSCOPE BLADE DISP, FIBEROPTIC STAINLESS STEEL MILLER # 0 GREENLINE
Y
20
EA
S3.8511EA
- 538.50110EA
AIRWAY
LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MILLER H I GREENLINE
Y
10
EA
53.85/lEA
538.50110EA
AIRWAY
LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESS STEEL MILLER If 2 GREENLINE
y
10
FA
q3,RS/IFA
138.50110EA
AIRWAY
LARYNGOSCOPE BLADE DISP. FIBEROPTIC STAINLESSY
20
EA
53.85AEA
$77.00120EA
AIRWAY
LARYNGOSCOPE BLADE DISP, EMERGE
y
20
LA-
�18SJIEA
�77.00/20EA
AIRWAY
LARYNGOSCOPE HANDLE. GREENLINE FIBER OPTIC. PENLITE CHROME PLATED BRASS 2 AA BATTERIES
N
01111
12
EA
S30.88/lEA
S370.56112EA
AIRWAY
LUBRICATING JELLY 2.7 GRAM, FOIL PACK STERILE. WATER SOLUBLE, MINI PACK 1441BX
N
3
BX
57 20/144EA
521.60L432EA
AIRWAY
NASOGASTRIC TUBE, 08F
12
FA
S9.7511FA
569.00112EA
AIRWAY
NASOGASTRIC TUBE. 10FR RUSH LEVINE
N
12
FA
el,7911FA
�21.36/12EA
AIRWAY
NASOGASTRIC TUBE, 12FR RUSH LEVINE
y
12
EA
$1.0211EA
��12EA
AIRWAY
NASOGASTRIC TUBE, 14FR RUSH LEVINE
y -
EA
51.9211EA
$12.24112EA
AIRWAY
NASOGASTRIC TUBE, 16FR RUSH LEVINE
...... )L_
12
EA
S1.0211EA
$12.24112EA
NASOGASTRIC TUBE. ISFR RUSH LEVINE
y
12
EA
J1.02LlEA
_ �12.24112EA
_AIRWAY
AIRWAY
AIRWAY - NPA- LATEX FREE PVC 12 FRENCH 1018X RUSCH
N
2
BX
S12.70110EA
S25 40/201EA
-.NASOPHARYNGEAL
AIRWAY
NASOPHARYNGEAL AIRWAY - NPA- LATEX FREE PVC 14 FRENCH
N
2
BX
I S20.20/10EA
40.40/20EA
AIRWAY
NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 16 FRENCH 10 BX BUSCH
N
2
BX
I $20.20110EA
140.40/20EA
AIRWAY
NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 18 FRENCH 10 BX BUSCH
N
2
BX
20.20 IDEA
540.40120EA
AIRWAY
NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 20 FRENCH 10 BX BUSCH
N
2
FIX
20.20110EA
$40.40120EA
NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 22 FRENCH i0 BX RUSCH
N
2
BX
520.20110EA
540.40120EA
_AIRWAY
AIRWAY
NASOPHARYNGEAL AIRWAY - NPA . LATEX FREE PVC 24 FRENCH l0/BX BUSCH
N _
2
FIX
$20.20110EA
40.40/20EA
CATEGORY
ITEM DESCRIPTION
NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 26 FRENCH 10 BX BUSCH
Brand Specified
(Y/N)
N
EST.
QTY.
2
Units
1 FIX
Unit price
$20.20110EA
Extended
Price
$40.40120EA
_AIRWAY
AIRWAY
NASOPHARYNGEAL AIRWAY - NPA- LATEX FREE PVC 28 FRENCH 10 BX BUSCH
N
2
FIX
520.2011GEA
540.40120EA
AIRWAY
NASOPHARYNGEAL AIRWAY - NPA - LATEX FREE PVC 30 FRENCH IQJBX BUSCH
N
2
BX
520.2011DEA
$40.40120FA
ORAL AIRWAY, 100MM PURPLE BERMAN
Y
50
EA
0.1411EA
7.00/SQEA
_AIRWAY
AIRWAY
ORAL AIRWAY, SOMM TURQUOISE BERMAN
y
20
EA
S0.2811EA
$5.60120EA
AIRWAY
ORAL AIRWAY. 601MM BLACK BERMAN
y
20
EA
0.1411EA
52.80/20EA
AIRWAY_ORAL
AIflWAY POMM WHITE BERMAN
Y
30
LA_
50.1411EA
54.20/lEA
AIRWAY
ORAL AIRWAY, SOMM GREEN BERMAN
y
30
EA
II14/-IEA
54.2011EA
ORAL AIRWAY. 90MM YELLOW BERMAN
y
so
EA
_ S0.14/lEA
S7.00/50EA
_AIRWAY
AIRWAY
SUCTION CANISTER DISPOSABLE RED TOP 800cc
y
27
EA
S2.44/lEA
$65.88127EA
AIRWAY
SUCTIONCANISTERWITH PREATTACHED 6 FT TUBING r.RFFN 1740c1 ARJ--
y
2
CS
$245.76/48EA
491.52196EA
AIRWAY
SUCTION CATHETER, 12FR. COILED, GRADUATED, FROSTED SURFACE. KINK RESISTANT
N
24
EA
S017/lEA
$4.09124EA
SUCTION CATHETER, 14FR, COILED, GRADUATED, FROSTED SURFACE. KINK RESISTANT
N
24
FA
0.1711EA
$4.08124EA
_AIRWAY
SUCTION CATHETER. IGFR. COILED. GRADUATED. FROSTED SURFACE. KINK RESISTANT
N
24
EA
lEA
4.08/24EA
S
_AIRWAY
AIRWAY
SUCTION CATHETER, 18FR, COILED, GRADUATED, FROSTED SURFACE, KINK RESISTANT
N
24
EA
0.1711EA
54.08124EA
AIRWAY
SUCTION CATHETER, 6FR, COILED, GRADUATED, FROSTED SURFACE
N
24
EA
0,17 ICA
S4.09124EA
AIRWAY
SUCTION CATHETER, 8FR, COILED, GRADUATED, FROSTED SURFACE, KINK RESISTANT
-N
24
EA
50.17/lEA
S4.09/24EA
AIRWAY
SUCTION TIP VANKAUER BULB TlP WHTH CONTROL VENT STERILE CURAPLEX
y
75
EA
1EA
�30.75/75EA
AIRWAY
SUCTION TUBING ONLY 1/4 IN X 6 FT SOICS
N
I
CS
6.50 50EA
S
36.50 SOEA
5
AIRWAY
BAAM AIR FLOW MONITOR
y
EA
10.41
6.24
.
=lEA2 4 EA
AIRWAY
END TIDAL CO2 SMARTINTERMEDIATE
EA
176&00 200EA
EB
FILTERLINE SET, NON HUMIDIFIED, INTUBATED, ADULT PEDIATRIC ORIDION MICROSTREAM
EA
354 S.EA
354.50 50EA
_AIRWAY
BANDAGE /DRESSINGS
LF 3001BX Johnson and Johnson
N
1 18
1 BX
S1,7511BX
I
531.50118ox
- -- I C- -;-
�BANDAGESQRESSINGS
BANDAGES DRESSINGS
BANDAGE ELASTIC LAI EX FREE b IN X s ---'l
BANDAGE TRIANGULAR WITH TWO PINS 51 IN X 36 IN X 36 IN 12 BX
N
3
BX
2.S2 Ll2EA
-
$756136EA
BANDAGES DRESSINGS
BANDAGE, MULTFTRUAMA DRESSING, 121N X 301N, STERILE. 2SEA/CS
N
6
CS
21.25125EA
5127.501150EA
BANDAGESIDRESSINGS
BURN DRESSING WATER JEL 2 IN X 6 IN
y
10_
EA
S2.5411EA
50.80120EA
RANDAGESiDRESSINGS
BURN DRESSING WATER AL 4 IN X 4 IN
20
EA
1.90AEA
538.00120EA
RANDAGESIDRESSINGS
BANDAGES DRESSINGS
BURN DRESSING WATER JEL 8 IN X 18 IN
BURN DRESSING WATER JEL BLANKET 3FT X 2.SFT
N
20
12
EA
EA
7.38AEA
5 47.64jlEA
5147.60j20EA
e571.68112E0.
BANDAGES DRESSINGS
BURNDRESSINGWATERIELFACIAL
y
10
EA
111.54/IEA
$115.40110EA
BANDAGES DRESSINGS
�
BURN SHEET. BLUE. 60IN X 96 IN, STERILE
N
12
EA
--jL2111FA
LUEA
---J2fiffl -
BANDAGES DRESSINGS
PACK INSTANTS.5 IN X 10 IN 24 CS RAPID COLD
y
12
CS
924.90/1CS
S298.80112CS
_COLD
BANDAGES DRESSINGS
CONFORMING STRETCH BANDAGE GAUZE 4 IN STERILE 17 RL Ar
N
40
BG
$2.82/IBG
112.90112BG
BANDAGES DRESSINGS
DRESSING, ABDOMINAL PADS STERILE SIN X PIN 25/BX -.Id =r, 2C°P% LM
N
32
BX
2.25125EA
572.001800FA
BANDAGES, DRESSINGS
GAUZE SPONGE NON STERILE 12 PLY 2 IN X 21N 200 BG
N
24
BG
M991113G
S23.76/24BG
BANDAGES DRESSINGS
GAUZE SPONGE, BASIC ECONOMY, 4 IN x 4 IN, 12 PLY, STERILE, 21PK, 25PKJBX
N
36 -
BX
51.5111BX
54.36136BX
BANDAGES DRESSINGS
GAUZE CONFORMING STRETCH STERILE 41N X 4.1 YD 12RLS BG .
. . . . . tL_
40
BG
2.82 16G
112.80L40643
BANDAGES DRESSINGS
HYDROGEN PEROXIDE 3% 16 OZ
N
36
EA
0.9211EA
$29.52136EA
BANDAGES DRESSINGS
N
36
BX
$7.6011BX
527160L36EN
BANDAGES DRESSINGS
TAPE ADHESIVE CLOTH 2 IN X 10 YARDS 618X
N
36
BX
57.60/113X
S27160136BX
BANDAGES ORES5JNG5
TRAUMA EMS SHEARS. BLACK 7 IL4 In, SAFETY BANDAGE TIP FULLY AUTOCLAVAM F SURGICAL STAINLESS STEEL BLADES
N
32
FA
50A2/lEA
_
_J&2jLZEABANDAGES
DRESSINGS
TRIPLE ANTIBIOTIC OINTMETN LNIT QOSE 1 32 OZ 44/RX
N
6
BX
510.0811BX
560.4816OX
BREATHING
BAG VALVE MASK NEONATE INFANT RESUSCITATOR SPUR 11 WITH OXYGEN RESERVOIR TUBE
Y
24
EA
513.1211EA
$314.88/24EA
CATEGORY
BREATHING
ITEM DESCRIPTION
BAG VALVE MASK W/ MEDIUM ADULT MASK SPUR 11 DISP. INDIVIDUALLY BOXED
Brand Specified
(Y/N)
y
EST
EST.
QTY.
V48
Units
EA
Unit price
S8.8011EA
Extended
Price
$422.4014SEA
BREATHING
BAG VALVE MASK COLLAPSED SPUR 11 PEDIATRIC, OISE, WITH MASK AND EXPIRATORY HEPA FILTER, AMBU
y
24
EA
I S28.39/lEA
681.36124EA
BREATHING
CPAP CIS BREATHING CIRCUIT W/ MEDIUM MASK
y
26
CA
35.95IIEA
I S934.70126EA
HEPA VENT FILTER, HIGH EFFICIENCY W/ PORT, HYDROPHOBIC PAPER TIDAL VOLUME RANGE > 500 mL
y
100
EA
$2.2011EA
S220 001100EA
_BREATHING
BREATHING
VENTILATION CIRCUIT DISP KIT, W1 EXHAUST COLLECT/ PEEP VALVE, FOR DEMAND VERSION OF PARAPACLENTIPAC
y
10
EA
519J211EA
191.20/10EA
BREATHING
VENTILATION CIRUIT. SINGLE LIMB, PORTABLE, 6 FT PATIENT TUBE, IL8 IN AND 114 IN ID FOR USE WITH EAGLE UNIVFNT
N
100
EA
$4.8911 A
489.001100EA
DIAGNOSTIC
BLOOD PRESSURE CUFFDISPADULT FOR USE WITH LIFEPAK MONITORS
N
160
EA
$3.4711EA
S555.201160EA
DIAGNOSTIC
BLOOD PRESSURE CUFF DISP CHILD FOR USE WITH LIFEPAK MONITORS
N
6
EA
2.2911EA
13.74/03EA
DIAGNOSTIC
BLOOD PRESSURE CUFF DISP INFANT FOR USE WITH LIFEPAK MONITORS
N
6
EA
$1.9511EA
51130 6EA
DIAGNOSTIC
BLOOD PRESSURE CUFF DISP LARGE ADULT FOR USE WITH LIFEPAK MONITORS
N
50
EA
$3.95150EA
197.50150EA
DIAGNOSTIC
BLOOD PRESSURE CUFF DISP SMALL ADULT FOR USE WITH LIFEPAK
N
50
EA
S2 56/lEA
128.00/50EA
DIAGNOSTIC_
DEFIBIPACING/ ECG PADS ADULT WLgUIK-COMBO C S2133,11 F11-
-y
40
EA
-S30k65/lEA
S426AOL40EA
DIAGNOSTIC
DEFIBIPACING IECG PADS PEDI W/ OUIK-COMBO CONNECTOR FOR UfePak 12 & LifePak 10 & UfePak jmv,
y
20
EA
j1229 L_EA
259.80120EA
DIAGNOSTIC
ELECTRODES S STRIP SOIBX 12BXLCS
N
30
CS
96.75/117S
DIAGNOSTIC
ELECTRODES PEDIATRIC 31PK l0PKjBX HUGGABLE
y
2
BX
$4.6911BX
$9.3812BX
DIAGNOSTIC
GLUCOSE TEST STRIPS. CAPILLARY. SO BX PRECISION XTRA
y
48
BX
22.22/113X
1066.56/488X
DIAGNOSTIC--
LANCETS. FINGERSTIX 200 BX
y
4
BX
28.40ABX
$113.60_/4BX
DIAGNOSTIC
PAPER LP11,LP12. UPIS SIZE 108 MM X 23M ROLL, 5 ROLLS BX LIFEPAK
y
75
FIX
81211BX
.001758X
DIAGNOSTIC
PENLIGHTS DISPOSABLE 61PK 'l-ld in EA 60 <0.6'WEA-
N
is
PK
53.6616EA
565.88/10SEA
DIAGNOSTIC
RAZORS PREPARATION SO BX GALLANT
y
4
FIX
916.50/50EA
DIAGNOSTIC
THE RMOSCAN PR04000 EAR THERMOMETER COVERS
y
4
BX
513.2911BX
$53.1214BX
DIAGNOSTIC
-
TINCTURE OF BENZOIN SWABSTICKS INDIVIDUALLY WRAPPED SOPKJBX
y
is
BX
8.94/111X
134.10/15BX
IMMOBILIZATION
RESTRAINT DUAL LADDER LOCK 7 FT LOOMK SAME LENGTH ORANGE ---- PLASTIC DISP - .. . 1rlre¢s�um
200
EA
No bid
No bid
IMMOBILIZATION
RESTRAINT STRAP SEAT BELT BUCKLE LOOP END 2 PIECES q FT DISP.
N
24
EA
$6.9011EA
165.60124EA
IMMOBILIZATION
EXTRICATION COLLAR. BABY NO -NECK
Y
10
EA
�4.6911EA
�46.90/10EA
IMMOBILIZATION
EXTRICATION COLLAR ADJUSTABLE PEDIATRIC STIFNECK PEDI-SELECT LAERDAL
y
10
EA
4.9011EA
S49.00/10EA
IMMOBILIZATION
EXTRICATION COLLAR ADJUSTABLE ADULT NASAL CANNULA HOOK STIFNECK SELECT LAERDAI
y
250
EA
S4,9011EA
$1225.001250EA
IMMOBILIZATION
HAND-E HAND HOLD DEVICE YELLOW
y
20
EA
S14.53/lEA
$290.60/20EA
HEAD BLOCKS STICKY FOAM - PAIR
y
200
RR
53.5911PR
$718.001200PR
_IMMOBILIZATION
IMMOBILIZATION
VACUUM SPLINT SET DISPOSABLE
N
5
SETS
S169.25I1SET
5846.25/SSETS
INFECTION
BIOHAZARD WASTE BAG, 1.2MIL, RED W! BLACK PRINT, 23 IN X 23 IN, 7-10 GAL
N
SOO
EA
S0.0811EA
5400.00L500EA
-CONTROL
INFECTION CONTROL
BODY B IT 6 GAUGE 36 IN X 90 IN 10 CS
2 BAG BASIC VINYL STRAIGHT ZIPPER
N
75
EA
k6.32/lEA
�474.00175EA
INFECTION CONTROL
EMBAGS, EMESIS BAG ISCID ml, 501pk
N
I
PK
S67.00LS0EA
S67.130150EA
INFECTION CONTROL
GERMICIDAL WIPES EXTRA LARGE SANI-CLOTH HE
y
100
TB
�ITUB
5691.1301100TUB
INFECTION CONTROL
GLOVESLATEX FREE POWDER FREE EXTENDED CUFF _NITRILE EXTRA LARGE SO BX 10BX&S FREEFORM EC
y
400
BX
59.50/IBX
S3800.004008X
INFECTION CONTROL
GLOVES LATEX FREE POWDER FREE EXTENDED CUFF NITRILE LARGE 50 BX l0BX/CS FREEFORM EC
y
300
_gx
95011BX
2850.0013006X
INFECTION
GLOVES LATEX FREE POWDER FREE EXTENDED CUFF NITRILE MEDIUM 50 BX l0BX CS FREEFORM EC
y
200
FIX
S9.501113X
$1900.D0/200BX
_CONTROL
INFECTION CONTROL
GLOVES LATEX FREE FREE EXTENDED CUFF NITRILE SMALL SO BX EC
y
io
BX
--j!LqLlBX
595milom
INFECTION
_POWDER
HAND CLEANSER FOAMING ALCOHOL 9 07 24 CS ALCARE PLUS
y
4
CS
218.88124EA
$97S.52196EA
_CONTROL
INFECTION CONTROL
RESPIRATOR 95 REGULAR SIZE 20 FIX 68X CS 3" --�A i'r h-'f'm fm ...........
y -
EA
$0.913611EA
�27.18JWEA
INFFf-, ION CONTROL
SLEEVE COVER 200 CS PPE Trauma sleeves
N _
3
CS
�52.0011CS
5156.00L3CS
INFECTION CONTROL
TRANSPORTABLE SHARPS CONTAINER, SHUTTLE W/ LOCKING MECHANISM 11 2 IN D X 6 1'2 IN L
y
P30
so
EA
�1.6311EA
INFECTION CONTROL
WASH BASIN. 6 QUART. ROSE 50 EA CS
so
EA
_jQfflLlEA
- - - =22L50EA
IV ADMINISTRATION
ALCOHOL PREP PADS LARGE 100 BX
N
4
BX
51.6811FIX
�6.7214BX
CATEGORY
IV ADMINISTRATION
ITEM DESCRIPTION
BD ECLIPSE SAFETY NEEDLE 18 G 300jBX
Brand Specified
(Y/N)
y -
EST.
QTY.
4
Units
BX
Unit price
$24.9711BX
Extended
Price
S99.88J41IX
IV ADMINISTRATION
INTRAVENOUS JIV ) ADMINISTRATION SET NEEDLE FREE IYSITE 1 VALVE IDDROP 83 INSO/Cl
N
20
1 CS
574.50LSOFA
I S1440.0011000EA
IV ADMINISTRATION
INTRAVENOUS IV ADMINISTRATION SET NEEDLE FREE 1 Y BETE 1 VALVE 60 DROP 83 !N 59 CS
N
S
CS
82.50/ SDEA
412.50250EA
IV ADMINISTRATION
INTRAVENOUS IV DRESSING TRANSPARENT ADULT 1Q0 BX SBX CS VENT sARD
Y
10
BX
36.64 1BX
366.40IOBX
IV ADMINISTRATION
INTRAVENOUS IV EXTENSION SET NEEDLE FREE WITH 2 Y SITES 43 IN 48 CS INTERLINK
Y
4
CS
87.84 105
351.36 4CS
IV ADMINISTRATION
IV EXTENSION set WITH AMSAFE NEEDIELESS INJECTION SITE 81N 100 CS
Y
4
CS
129.00 1CS
S16.Q04C5
IV ADMINISTRATION
PRESSURE INFUSOR 1 CC INFUSION CUFF W HUMBWHEEL VALVE AND ANEROIQ GAUGE
Y
10
EA
10.89 IEA
108.90 SDEA
IV ADMINISTRATION
SALINE FLUSH 0. 10 ML PREFILLED 12 ML LUER LOCK SYRINGE 100EA BX
N
4
BX
33.E 100EA
132.E 400EA
IV ADMINISFRAT€ON
SYRINGE ONLY LUER LOCK 10CC 100EA BX
N
2
BX
8.OQ 1DDEA
16.00 200EA
IV ADMINISTRATION
SYRINGE ONLY LUER LOCK C 40 BX BECTON DICKINSON
Y
S
B%
19.63 1B%
S98.15L5BX
IV ADMINISTRATION
SYRINGE ONLY BD 5 CC LUER-LOK TIP STERILE 125 BX
N
2
BX
8.75 12SEA
17.50 2SOEA
IV ADMINISTRATION
TOURNIQUET, LATEX FREEE 1 IN X 18 IN PRE -ROLLED 250 BG 1ORG CS "sold In b.. cf jQGEA "»_ ° O.Ct 100LA"II
N
10
CS
225.222 EA
20250.OQ 25 EA
!V CATHETERS
CATHETER INTRAVENOUS IIVLATEX FREE 16 GAUGE X 1.25 IN 50 BX PROTECTIV
Y
2
BX
S79.50150EA
157.00 100EA
IV CATHETERS
CATHETER INTRAVENOUS JM LATEX FREE 18 GAUGE X 1.25 IN SQ BX PROTECTIY
Y
20
BX
78.SO °SOEA
1570.00 1 EA
IV CATHETERS
CATHETER INTRAVENOUS IV LATEX FREE 20 GAUGE X 1.25 IN 50 BX PROTECTIV
Y
20
BX
578.50LSOEA
S1570.00110MEA
IV CATHETERS
CATHETER INTRAVENOUS IV LATEX FREE 22 GAUGE X 1 IN 50 BX PROTECTIV
Y
20
BX
78.50SDEA
SIS70.0011000EA
IV CATHETERS
CATHETER INTRAVENOUS IV LATEX FREE 14 GAUGE X 1.25 IN 50 BX PROTFCTIV
Y
2
BX
78.50 50EA
157.00 lDOEA
NCOMPONENTS
STOPCOCK WAY W1 SWIVAL AND MALE LUER LOCK
N
2S
EA
1.031EA
$25.7512SEA
IV SOLUTIONS
SODIUM CHLORIDE 0.9% lQWML 14EA CS
N
20
CS
S13.44114EA
268.80 28DEA
IV SOLUTIONS
SODIUM CHLORIDE D.-%100ML SINGLES 96EA CS
N
1
CS
119.04 96EA
5119Z4196EA
IV SOLUTIONS
SODIUM CHLORIDE 0.9%SOOML 24EA CS BAXTER
Y
40
CS
$19.68124EA
787.20 960EA
MEDICATIONS
ADENOCARD 12M,G 4ML ANSYR SYRINGE
Y
50
EA
585.0211EA
54251.D0150EA
MEDICATIONS
ADENOCARD 6MG 2ML ANSYR SYRINGE
Y
25
EA
42.92 IEA
1073.E 25EA
MEDICATIONS
ALBUTEROL 4.083%2.SMG 3ML 25VIALS BX
Y
4
BX
3.88 25EA
100EA 15.52
MEDICATIONS
AMIDATE ETOMIDATE Lifeshleld p,.filled s m 40MG 20 ML
Y
40
EA
36.54 AEA
$1461.6CL40EA
MEDICATIONS
AMIODARONE 150MG 3ML VIAL
Y
85
EA
1.69 IEA
S143.6518SEA
MEDICATIONS
AMMONIA INHALANTS 10 BX
N
10
BX
52.0711BX
$20.701108X
MEDICATIONS
ANECTINE 200 MG 10 ML VIAL "REFRIGERATE' 19EA B%
Y
40
EA
3.75 IEA
SISO.00L40EA
MEDICATIONS
ASPIRIN CHILDREN°S CHEWABLE ORANGE FLAVOR @1MG 36 BT
N
30
FIT
0.T6 1BT
522.8013OBT
MEDICATIONS
ATROPINE 1MG jlOML ANSYR PREFILLED SYRN.
Y
00
EA
6.03 SEA
$482.4018DEA
MEDICATIONS
CALCIUM CHLORIDE 1GM lOML ANSYR SYRINGE
Y
60
EA
618 1EA
376.80 60EA
MEDICATIONS
DEXTROSE 50%SOML ANSYR SYRINGE
Y
44
EA
55.96tlEA
S262.24L44EA
MEDICATIONS
DIAZEPAM 5MG ML 2ML LUER LOCKING CARPUIECT 10 BX
Y
10
B%
101.40 10EA
1014.00 1DOEA
MEDICATIONS
DILTIAZEM 100MG ADD -VANTAGE VIAL NON-REFRIG ADD -VANTAGE DILUENT RE UIRED-SOLD SFPERATELY
Y
10
EA
B.BS lEA
8B.S0 AOEA
MEDICATIONS
DIPHENHYDRAMINE SOME ML IML BENADRYL
Y
2S
EA
0.96`IEA
24.00 25EA
MEDICATIONS
DOPAMINE 400MG D5W 250ML 12 CS
N
62
EA
S1114711EA
649.14 62EA
MEDICATIONS
EPINEPHRINE 1:1000 1MG 1ML AMPULE
Y
75
EA
S2.6211EA
S196,50USEA
MEDICATIONS
EPINEPHRINE 1:10WO I MG 10 ML LIFESHIELD SYRINGE
Y
200
EA
5.89 1EA
$1179.00120DEA
MEDICATIONS
FENTANYL CLASS II O.OSMG ML 2ML VIAL "° ld In Lw : 4f 2'EA 0 *22= 9912>EA"-
N
20
EA
$0.919211EA
18.384 20EA
MEDICATIONS
FLUMAZENR. Q.5MG SML VIAL 10 VIALS BX ROMAZICON
Y
3
EA
10.95 lEA
32.85 3EA
MEDICATIONS
HYDROMORPHONE DILAUDID CLASS II 7 MG ML I mi a:ARPUIECT
N
30
EA
2.731 lEA
81.93 30EA
MEDICATIONS
INSTA-GLUCOSE 31GM 12 CS
N
4
CS
38.88 12EA
5155.52L48EA
MEDICATIONS
LORAZEPAM 2MG 1ML VIAL l0 BOX 'REFRIGERATE--
Y
2
B%
12.23 IBX
$24.4612BX
MEDICATIONS
METOPROLOL SMG 5ML VIAL
Y
10
EA
1.34 IEA
513.40110EA
CATEGORY
MEDICATIONS
ITEM DESCRIPTION
MIDAZOLAM ""VERSED" 5MG ML 2ML VIAL 101BOX
Brand Specified
(Y/N) 1
Y
EST.
QTY.
6
Units :
BX
Unit price
11.34 IBX
Extended
Price
68.04 68X
MEDICATIONS
MORPHINE IOMG ML 1ML Car .wt l0 BX
Y
10
BK
Z1.72 lBX
217.20 106%
MEDICATIONS
NONE 2MG 2ML LUER JET
Y
70
EA
1291.5070EA
MEDICATIONS
NITROGLYCERIN SOMG DSW 250ML BTL
y
30
EA
SS.12 SEA18.45°lEA
153.60 30EA
MEDICATIONS
NITROGLYCERIN LINGUAL SPRAY 4DOMCG SPRAY 60 DOSES 12EA I CS
N
20
EA
S153.2011EA
$3064.DOJ20EA
MEDICATIONS
ONDANSETRON 4 MG 2ML VIAL 25 EA B%
Y
40
EA
50.4711EA
S18.90140EA
MEDICATIONS
PANCURONIUM 1MG l0ML VIAL
Y
70
EA
5.16 IEA
361.20 DEA
MEDICATIONS
gUELICIN 200MG 10ML VIAL -REFRIGERATION REQUIRED-
Y
40
EA
9.54 IEA
5381,60L40EA
MEDICATIONS
SODIUMBICARBONATE 4.2% lOML INFANT LIFESHIELD
Y
10
EA
8.251EA
82.5010EA
MEDICATIONS
SODIUM BICARBONATE 8.4%LIFESHIELD SYRINGE
Y
35
EA
S6,5411EA
5228.9OL35EA
MEDICATIONS
SOLD-MEDROL 12S MG 2 ML VIAL 25EA BX
Y
25
EA
55.8311EA
145.75 25EA
MEDICATIONS
SALINE UNIT DOSE MODUDOSE 3ML 0.9%NACL INHALER EASY OPEN TWIST AND PULL 100 EA BX
Y
10
BX
11.00 100EA
_ 5110.00110WEA
MEDICATIONS
VECURONIUM 1DMG 10ML VIAL 10EA BX
Y
40
EA
4.86 lEA
$194.00140EA
OXYGEN DELIVERY
TUBING CONNECTOR FITSTUBING FROM 7132 TO 7 161N DIAMETER S IN 150 PK
N
2
PK
65.28 SOFA
130.56 100EA
OXYGEN DELIVERY
NEBULIZER SMALL VOLUME HAND HELD WITH TEE MOUTHPIECE FLEXTUBE 7FT TUBING SDEA CS
N
2
CS
32.Q0 SOEA
64.@Q 1@OEA
OXYGEN DELIVERY
OXYGEN MASK ADULT ELONGATED HIGH CONCENTRATION PARTIAL NON-REBREATHING METAL NOSE CLIP 50 E CS
N
B
CS
A9.50 SOEA
396.00 4@OEA
OXYGEN DELIVERY
OXYGEN NASAL CANNULA ADULT CONV.STYLE CLEAR FLARED NASAL PRONGES 7 FT TU81N1- SOFA CS ___ __ _
___ __ N
6
ICS _
12.50 5CEA
75 DD300EA
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 botree.co
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.
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
X
• Drug Free Workplace Form
X
• Lobbying and Conflict of Interest Clause Form
X—
o Indemnification and Hold Harmless
X
o Local Preference Form (Attachment H if applicable)
-x—
(Check mark items above, as a reminder that they are included).
I state that I am authorized to submit this proposal.
STATE OF Ohio
gnature XProposers.Lrl'
COUNTY OF Franklin Chief financial officcr
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 00%sl I I
13 day of September 20 13 00T.jVo
My commission expires: r', I Ll
NOTARY PUBLIC
v
CL -W
jbP
life
I Mark Dougherty
Dublin
penalty of perjury, depose and say that;
Attachment C
of the city of.
according to law on my oath, and under
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.
HZWKIT�
ignatu of Respondent)
Mark Dougherty who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above on this
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.
•
M
(Sign re of Res pond
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 20 13
,�.........-i
My commission expires:
NOTARY PUBLIC HI :_ 0%
® fool'® o ®®
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 rennirement.q
September 13, 2013
Attachment F
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.
(Signature)
Date: October 31, 2013
STATE OF Ohio
r • •
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
NOTARY PUBLIC
y commission expires: € t, i
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.
September 13, 2013
IM
KIMRTW��
LOCAL PREFERENCE FORM **Not Applicable"
Vendors claiming a local preference according to Ordinance 023-2009 must complete this form.
Name of Proposers/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 proposal or solicitation? ---- — 111111 ---------- (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
List Address:
Telephone Number:
B. Does the vendor/prime Respondent intend to subcontract 50°'6 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
Print Name:--
Signature and Title of Authorized Signatory for
Proposers/Responder
a-11319"s
I �Gj �19
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.
MIMI=
My commission expires:-, ----- ------ ------ ------ Seat
BOARD OF GOVERNORS FIRE AND AMBULANCE DISTRICT I
AGENDA ITEM SUMMARY
Meeting Date: November 20, 2013 Division: Emergency Services
Bulk Item: Yes X No Department: Fire Rescue
Staff Contact Person: Callahan / Pfiester 289-6088
AGENDA ITEM WORDING: Approval of Resolution authorizing the write-off of a total of 683 Fire Rescue
ground ambulance accounts receivable for CY 2008, totaling $325,166.82 from the Fire Rescue District I Fund
Account 141-115002. This write-off was inadvertently executed by the Clerk of the Courts office; the item was
pulled from the September 2012 agenda.
ITEM BACKGROUND: Monroe County contracts with Advanced Data Processing Inc., (ADPI) for ground -
ambulance billing. After 210 days of inactivity with ADPI, outstanding accounts are then placed with the collection
agency, Municipal Services Bureau (MSB). Three years from the date of incident, Monroe County Finance
Department administratively writes -off these debts after BOCC resolution. The attached Resolution authorizes the
write-off of the balances of 683 accounts totaling $325,166.82, which primarily represents the one-year period from
January 1, 2008 through December 31, 2008 (see attached Exhibit A).
These debts represent accounts which have been determined further collection efforts are fruitless. Insurance has
paid the maximum allowable on these claims, and the service recipients are now either: deceased with no available
funds in the estate; in bankruptcy; a minor with no guardian or patient found; uncollectible balances of
Medicaid/Medicare; small exceptions balances; HMO balances; patient financially indigent (homeless); foreign
address; unwarranted transports (transport did not meet the medical necessity criteria required by Medicaid); and/or
refusals to pay. Even though this is written off for accounting purposes, the collection agency will continue to
attempt collections on these accounts; if payments were to be received, revenue would be reinstated.
PREVIOUS RELEVANT BOG ACTION: On August 20, 2008 Resolution No. 250-2008 authorized the write off
of Fire Rescue ground ambulance accounts receivables in the total amount of $249,833.14. On September 16, 2009
Resolution No. 280-2009 authorized the write off of Fire Rescue ground ambulance account receivables in the total
amount of $311,040.13. On August 18, 2010 Resolutions 248-2010 and 246-2010 authorized the write off of Fire
Rescue ground ambulance accounts receivables in the total amount of $315,822.09. On September 21, 2011
Resolution 282a-2011 authorized the write off of Fire Rescue ground ambulance accounts receivables in the total
amount of $284,953.95.
CONTRACT/AGREEMENT
STAFF RECOMMENDATIONS: A.. • ,
TOTAL COST:— N/A INDIRECT BUDGETED: •
1 ..
COST O SOURCE FUNDS:
VENUE PRODUCING: Yes _ No _AMOUNT PP R MONTH Year
APPROVED Y: County Atty O%urc asing Risk Management—�
DOCUMENTATION: Included X Not Required
DISPOSITION: J• ITEM #