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2nd Renewal 10/21/2020 sP741.\ Kevin Madok, CPA F: F Clerk of the Circuit Court& Comptroller—Monroe County, Honda DATE: October 30, 2020 TO: Chief James Callahan Fire Rescue/EMS Cheri Tamborski Executive Administrator 1 FROM: Pamela G. Han tiCfi. . SUBJECT: October 21'BOCC 7Meeting Attached is an electronic copy of die following item for your handling: C9/12 2nd Renewal Agreement to the Contract with Bound"free Medical I,1,C for medical supplies, effective December 1, 2020 duough November 30, 2021. Should you have any questions please feel free to contact me at (305) 292-3550. cc: County Attorney Fin:mee File KEY WEST MARATHON PLANTA11ON KEY PK/ROTH BUILDING 500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road Key West,Florida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plantation Key,Florida 33070 305-294-4641 305-289-6027 305-852-7145 305-852-7145 2nd RENEWAL AGREEMENT BETWEEN THE BOARD OF COUNTY COMMISSIONERS,AND THE BOARD OF GOVERNORS FIRE AND AMBULANCE DISTRICT I OF MONROE COUNTY, FLORIDA,AND BOUND TREE MEDICAL, LLC FOR THE PURCHASE OF MEDICAL SUPPLIES AND PHARMACEUTICALS THIS 2nd RENEWAL (hereinafter "RENEWAL") to the contract for the purchase of medical supplies and pharmaceuticals is made and entered into this 21st day of October 2020 by and between the Monroe County Board of County Commissioners and the Board of Governors Fire and Ambulance District 1 of Monroe County, Florida, hereinafter referred to as "COUNTY" and Bound Tree Medical LLC, hereinafter referred to as "CONTRACTOR". WITNESSETH: WHEREAS, on December 1, 2016, the parties entered into an agreement whereby the Contractor is to provide medical supplies and pharmaceuticals to the County; and WHEREAS, the original agreement had an initial three-year term beginning December 1, 2016 through November 30, 2019 with two one-year options for renewal subject to the approval of the County, and WHEREAS, on November 20, 2019 the COUNTY entered into the 1st Renewal and Amendment Agreement and exercised the first of the one year options to renew and also amended the original agreement in order to incorporate certain federal provisions, and WHEREAS, the COUNTY desires to exercise the second one year renewal option; NOW THEREFORE, in consideration of the mutual promises and covenants contained in this RENEWAL, the parties agree: SECTION 1. The parties' December 1, 2016 agreement, a copy of which is attached and incorporated into this renewal as Exhibit A, is hereby renewed for a one-year term beginning December 1, 2020 and terminating November 30, 2021. SECTION 2. Paragraph 5 of the original agreement is amended to read; 5. PRICING is set forth in the Medical Supply Discount Off List and Pricing Worksheet(Attachment A—Oct. 2020). This will be inserted in the contract Page 1 of 6 which outlines both a discount in the form of a percentage off list and pricing on specified numbered items. SECTION 3. Subparagraph 9.M. of the original agreement is amended to read; M.Invoicing. The CONTRACTOR shall furnish the COUNTY complete itemized invoices for the goods received. Invoices are to reflect the prices stipulated on the purchase order and as outlined on the Medical Supply Discount Off List and Pricing Worksheet Attachment A —Oct. 2020. 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 are not limited to, the following information: o Invoice number o Company name o Purchase order number o Location and dates of delivery o Cost of items as stated on the contract and extended price to reflect total cost for number of items received CONTRACTOR shall submit to COUNTY invoices with supporting documentation acceptable to the Clerk, on a MONTHLY schedule in arrears. Acceptability to the Clerk is based on generally accepted accounting principles and such laws, rules and regulations as may govern the Clerk's disbursal of funds. The COUNTY shall pay in accordance with the Florida Local Government Prompt Payment Act; payment will be made after delivery and inspection by COUNTY and upon submission of invoice by CONTRACTOR. SECTION 4. Paragraph 16, as incorporated in the 1st Renewal and Amendment Agreement, is amended to read; 16. MAINTENANCE OF RECORDS - CONTRACTOR shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Records shall be retained for a period of seven years from the termination of this agreement or for a period of five years from the submission of the final expenditure report as per 2 CFR §200.333, whichever is greater. Each party to this Agreement or its authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the Agreement and for seven years following the termination of this Page 2 of 6 Agreement. If an auditor employed by the COUNTY or Clerk determines that monies paid to CONTRACTOR pursuant to this Agreement were spent for purposes not authorized by this Agreement, or were wrongfully retained by the CONTRACTOR,the CONTRACTOR shall repay the monies together with interest calculated pursuant to Sec. 55.03, of the Florida Statutes,running from the date the monies were paid by the COUNTY. SECTION 5. Paragraph 12 of the original agreement is amended to read; 12. ADDITIONAL REQUIRED STATEMENTS/VERIFICATION/ AFFIDAVITS. Attached hereto in attachments. Attachment A - Medical Supply Discount Off List and Pricing Worksheet Attachment B - Submission Proposal Response Form Attachment C -Non-Collusion Affidavit Attachment D - Lobbying and Conflict of Interest Attachment E - Drug Free Workplace Attachment F -Public Entity Crime Statement Attachment G - Local Preference (if applicable) Attachment H - Scope of Services Response Form Attachment I-Request for Waiver of Insurance Requirements (if applicable) Attachment J -Vendor Certification Regarding Scrutinized Companies List SECTION 6. The following FEMA/FDEM REQUIREMENTS are hereby added to the Agreement as paragraphs 19, 20, 21, 22 and 23; 19. ACCESS TO RECORDS - CONTRACTOR and their successors, transferees, assignees, and subcontractors acknowledge and agree to comply with applicable provisions governing the Department of Homeland Security(DHS) and the Federal Emergency Management Agency's (FEMA) access to records, accounts, documents, information, facilities, and staff. CONTRACTORS must: 1. Cooperate with any compliance review or complaint investigation conducted by DHS 2. Give DHS access to and the right to examine and copy records, accounts, and other documents and sources of information related to the grant and permit access to facilities, personnel, and other individuals and information as may be necessary, as required by DHS regulations and other applicable laws or program guidance. 3. Submit timely, complete, and accurate reports to the appropriate DHS officials and maintain appropriate backup documentation to support the reports. Page 3 of 6 20. DHS SEAL, LOGO AND FLAGS - CONTRACTOR shall not use the Department of Homeland Security seal(s), logos, crests, or reproduction of flags or likeness of DHS agency officials without specific FEMA approval. 21. CHANGES TO CONTRACT - CONTRACTOR understands and agrees that any cost resulting from a change or modification, change order, or constructive change of the agreement must be within the scope of any Federal grant or cooperative agreement that may fund this Project and be reasonable for the completion of the Project. Any contract change or modification, change order or constructive change must be approved in writing by both the COUNTY and Contractor. 22. The CONTRACTOR is bound by the terms and conditions of the Federally- Funded Subaward and Grant Agreement between COUNTY and the Florida Division of Emergency Management(Division). 23.The CONTRACTOR shall hold the Division and COUNTY harmless against all claims of whatever nature arising out of the CONTRACTOR's performance of work under this Agreement, to the extent allowed and required by law. SECTION 7. The following language is hereby added to the Agreement as paragraph 24; 24. NONDISCRIMINATION - The parties agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. The parties agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VII of the Civil Rights Act of 1964 (PL 88-352), which prohibit discrimination in employment on the basis of race, color, religion, sex, and national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC §§ 1681-1683, and 1685- 1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC § 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC §§ 6101-6107), which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, §§ 523 and 527 (42 USC §§ 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Page 4 of 6 Rights Act of 1968 (42 USC §§ 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC §§ 12101), as amended from time to time, relating to nondiscrimination in employment on the basis of disability; 10) Monroe County Code Chapter 14, Article 11, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; and 11) any other nondiscrimination provisions in any federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. SECTION 8. In all other respects, the parties' December 1, 2016 original agreement and the November 20, 2019 I st Renewal and Amendment Agreement not inconsistent herewith remain in full force and effect. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK. Page 5 of 6 IN WITNESS WHEREOF, each party hereto has caused this Extension to be executed h by its duly authorized representatives. ",T AL) BOARD OF COUNTY A,Nit: KEVIN MADOK,CLERK COMMISSIONERS OF MONROE COUNTY,FLORIDA 6) / Deputy Clerk By: Mayor ATMANEY F0 BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT I OF MONROE COUNTY,FLORIDA Data 10/6/20 n I c " �'� By: t///SY Mayor/Chairperson BOUND TREE MEDICAL,LLC By: (Signature) Rhiannon Greene/Senior Vice President,Pricing • Name and Title Date: 2 10/08/2020 - o r- C9 -n STATE OF: Ohio _ Co COUNTY OF: Franklin — ae Subscribed and sworn to(or affirmed)before me,by means of O physical presence orSonlinenotarizatior�g' 2 on i0/08/ZOZo (date) by Rh Cannon Greene o 0 (name of effieM). He/She is personally known to me or has produced personal ICn 00e-cite (type of identification)as identification. NO R U IC ,, '*--.Tsf'r ' RDRWJNEon EpGH : Notary Pubic State of Oho Page 6 of 6 MSCommeri07 E 025 September 0) R0�5 0 Attachment A - OCT.2020 Item List for Monroe County RFP-91-0-2016 Renewal #2 IMS LIMITED 373369 NALOXONE 2MG 2ML LUERJET 1029E 10EA/CS CS $ 427.00 $ 427.00 ANSELL HEALTHCARE 297770 Gloves,Freeform EC,XL,Extended Cuff,Nitrile,Latex Free,Powder Free 50/bx 10bx/cs BX $ 14.57 $ 14.57 PRODUCTS LLC ANSELL HEALTHCARE 297755 Gloves,Freeform EC,VIED,Extended Cuff,Nitrile,Latex Free,Powder Free 50/bx 10bx/cs BX $ 14.57 $ 14.57 PRODUCTS LLC ANSELL HEALTHCARE 297760 Gloves,Freeform EC,LG,Extended Cuff,Nitrile,Latex Free,Powder Free 50/bx 10bx/cs BX $ 14.57 $ 14.57 PRODUCTS LLC INTERSURGICAL 2114-87302 i-gel 02 Resus Pack,VIED Adult,incl size 4 i-gel 02,Lube,Strap,for Pts 50-90 kg 6ea/cs EA $ 23.59 $ 23.59 INCORPORATED___ ABBOTT E6251 Glucose Test Strips,Precision Xtra,Capillary 50/bx 12bx/cs*Not approved for multi patient BX $ 22.22 $ 22.22 use* AQUABILITI 600-10 IV Flush Syringe,Normal Saline,10 ml,Prefilled 12 cc Syringe,Sterile 100ea/bx 4bx/cs EA $ 0.36 $ 0.36 STRYKER 230107 DEFIB/PACING/ECG PADS PEDI W/QUIK-COMBO CONNECTOR FOR LP15,LP12,LP10,UPS PR $ 31.47 $ 31.47 CONMED CORPORATION 354431 INTRAVENOUS(IV)DRESSING TRANSPARENT ADULT 100/BX 5BX/CS VENT-GARD BX $ 38.02 $ 38.02 MEDTRONIC(covidien) 177268 SMART CAPNOLINE PLUS NON INTUBATED,ORAL NASAL W/02 TUBING, EA $ 9.84 $ 9.84 ADULT/INTERMEDIATE 100EA/BX PFIZER INC.(HOSPIRA) 374921 EPINEPHRINE 1:10000 1MG lOML LIFESHIELD SYRINGE 1019A lOEA/BX BX $ 61.70 $ 67.51 SAGENT PHARMACEUTICALS, 0301-68 Adenosine 12mg,4ml Luer Lock Syringe l0/BX BX $ 262.80 $ 262.80 INC. AMBU 2144-KV033 King Vision Video Laryngoscope Blade,Channeled,Disp,18mm,w/White LED,Digital CIVICS EA $ 27.99 $ 27.99 Camera l0ea/cs IMS LIMITED 371006 ATROPINE 1MG lOML LUER JET 1006E l0EA/PK PK $ 106.90 $ 106.90 BPI LABS,LLC 103-10 Epinephrine lmg,lml ampule lea 10ea/pk PK $ 138.90 $ 138.90 INTERSURGICAL 2114-87303 i-gel 02 Resus Pack,LG Adult,incl size 5 i-gel 02,Lube,Strap,for Pts 90 plus kg 6ea/cs EA $ 23.59 $ 23.59 INCORPORATED PFIZER INC.(HOSPIRA) 4755-02 ONDANSETRON 4MG 2ML VIAL 25EA/BX BX $ 20.87 $ 20.87 B.BRAUN MEDICAL,INC 358001 IV Solution,Sodium Chloride 0.9%500ml Bag 24ea/cs BBraun L8001 EA $ 2.49 $ 2.49 McKESSON C/O EVUS O430-04 *SEE NOTES*NitroMist 400 mcg Spray,4.1 gm Bottle,90 metered doses EA $ 175.09 $ 175.09 PHARMACEUTICALS PFIZER INC.(HOSPIRA) 376637 SODIUM BICARBONATE 8.4%LIFESHIELD SYRINGE 1035A lOEA/BX BX $ 113.51 $ 124.26 PFIZER INC.(HOSPIRA) 6695-02 AMIDATE(ETOMIDATE)40MG,20ML VIAL lOEA/BX BX $ 79.90 $ 79.90 PFIZER INC.(HOSPIRA) 375204 QUELICIN 200MG lOML VIAL*REFRIGERATION REQUIRED*25EA/BX BX $ 745.49 $ 745.49 CURAPLEX 2745-10108 Curaplex ECG Chart Paper,Thermal,108mm,Red Grid,for Physio-Control LPll,LP12,LP15 RL $ 1.84 $ 1.84 1/RL 60RL/CT STRYKER 236086 DEFIB/PACING/ECG PADS ADULT W/QUIK-COMBO CONNECTOR 2FT LEAD,LP12,LP15 1/PR PR $ 25.74 $ 25.74 l0PR/BX 5BX/CS CURAPLEX 1841-14000 Curaplex Tourniquet 1"x 18",Blue,Rolled,Latex-Free 250/BG 2BG/CS BG $ 22.25 $ 22.25 B.BRAUN MEDICAL,INC 7800-09 IV Solution,Sodium Chloride 0.9%1000ml Bag l2ea/cs EA $ 2.48 $ 2.48 INTERSURGICAL 2114-87301 i-gel 02 Resus Pack,SM Adult,incl size 3 i-gel 02,Lube,Strap,for Pts 30-60 kg 6ea/cs EA $ 23.59 $ 23.59 INCORPORATED CONMED CORPORATION C32716 ConMed Positrace Diaphoretic Electrode 600/CS CS $ 104.38 $ 104.38 AMSINO INTERNATIONAL INC 35108306 INTRAVENOUS(IV)ADMINISTRATION SET NEEDLE FREE 1 Y SITE 1 VALVE 10 DROP 83 IN EA $ 1.75 $ 1.75 50/CS Hikma Pharmaceuticals USA 0376-25 DIPHENHYDRAMINE 50MG/ML 1ML SDV 2035-BENADRYL 25 VIALS/PK PK $ 31.75 $ 31.75 Inc FRESENIUS 0616-03 AMIODARONE 150MG 3ML VIAL 25EA/PK 30PK/CS PK $ 47.50 $ 47.50 AMSINO INTERNATIONAL INC C944304 EXTENSION WITH AMSAFE NEEDLELESS INJECTION SITE 8IN 100/CS EA $ 1.46 $ 1.46 CURAPLEX 1330-86100 MFG B/O Curaplex Alcohol Prep Pad,Large,Sterile 100/BX l0BX/CS BX $ 2.52 $ 2.52 PFIZER INC.(HOSPIRA) 379094 C2 FENTANYL 0.05MG/ML 2ML SDV 25/BX BX $ 33.99 $ 33.99 AMBU 2144-KV031 King Vision Video Laryngoscope Blade,Standard,Disp,13mm,w/White LED,Digital CIVICS EA $ 27.99 $ 27.99 Camera 10ea/bx AMBU 520-211 BVM,SPUR II,ADULT W/MEDIUM ADULT MASK,INDIVIDUALLY BOXED 12/CS EA $ 10.05 $ 10.05 IMS LIMITED 373304 Calcium Chloride lgm,10ml Luer Jet 1010E l0/BX BX $ 109.90 $ 109.90 PFIZER INC.(HOSPIRA) 377515 DEXTROSE 50%25GM,50ML ANSYR SYRINGE 1013C lOEA/BX BX $ 95.84 $ 104.86 BAXTER HEALTHCARE-DMG 118-2BO842EA Dopamine 400MG/D5W 250MI Bag 18EA/CS CS $ 235.62 $ 235.62 BAXTER HEALTHCARE-DMG 356612 INTRAVENOUS(IV)EXTENSION SET NEEDLE FREE WITH 2 Y SITES 43 IN 48/CS INTERLINK EA $ 2.63 $ 2.63 SPACELABS HEALTHCARE 1850-80424 Pressure Infuser,UNIFUSOR,1000ml Infusion Cuff w/Aneroid Gauge and Thumbwheel EA $ 11.97 $ 13.54 Valve 24ea/cs CURAPLEX 16353 Curaplex Multi-Trauma Dressing,12 in x 30 in,Sterile,50ea/cs EA $ 1.01 $ 1.04 NEPHRON PHARMACEUTICALS 9501-25 ALBUTEROL0.083% 2.5MG/3ML 25VIALS/BX BX $ 3.65 $ 3.65 CORP LAERDAL MEDICAL CORP. L980010 Extrication Collar,Stifneck Select,Adult,Adjustable,Nasal Cannula Hook EA $ 5.20 $ 5.20 VLR TRADING CO.,INC 209936 HAND CLEANSER FOAMING ALCOHOL BASED 9 OZ 24/CS ALCARE PLUS EA $ 9.97 $ 9.97 LAERDAL MEDICAL CORP. 020500 Endotracheal Tube Holder,Thomas,Adult,for ET/SGA Tubes 6.5mm ID to 21mm OD EA $ 2.78 $ 2.78 SMITHS MEDICAL ASD,INC. 532002 VENTILATION CIRCUIT DISPOSABLE WITH PEEP VALVE 10/BG EA $ 19.57 $ 23.04 CARDINAL HEALTH-PHARMA 0542-02 Adenosine 6mg,2ml Vial 10ea/bx BX $ 39.30 $ 39.30 Attachment A-OCT.2020 Item List for Monroe County RFP-91-0-2016 Renewal #2 BEMIS MANUFACTURING 595410 SUCTION CANISTER WITH PREATTACHED 6 FT TUBING GREEN 1200cc 48/CS EA $ 6.29 $ 6.29 COMPANY GERI-CARE 911316 Aspirin 81mg Chewable,Orange Flavor 36/Bottle BT $ 0.79 $ 0.79 ADI MEDICAL 667000 BODY BAG BASIC VINYL STRAIGHT ZIPPER 6 GAUGE 36IN X 90 IN 10/CS EA $ 6.47 $ 6.98 NICE-PAK 285484 GERMICIDAL WIPES EXTRA LARGE 8 IN X 14 IN 65/TUB 6TUB/CS SANI-CLOTH HB TB $ 7.72 $ 7.72 NICE-PAK 440128 LUBRICATING JELLY POI STERILE, 2.7GM 144/BX 12BX/CS BX $ 9.67 $ 9.67 AMBU 2442-21403 MFG B/O BVM,SPUR II,PEDI,COLLAPSED,DISP,WITH MASK AND EXPIRATORY HEPA EA $ 29.39 $ 29.39 FILTER,12EA/CS AMBU AMSINO INTERNATIONAL INC 35608306 IV Admin Set,Pediatric 83 in,60 Drop,l Y-Site,1 Valve 50ea/cs EA $ 1.92 $ 1.92 SMITHS MEDICAL ASD,INC. 353055 CATHETER INTRAVENOUS(IV)LATEX FREE 18 GAUGE X 1.25 IN 50/BX 200/CS PROTECTIV EA $ 1.80 $ 1.80 DYNAREX CORPORATION 1360-07546 Ammonia Inhalant,Ampules 10/bx BX $ 2.30 $ 2.30 BAUSCH HEALTH US LLC 464631 INSTA-GLUCOSE 31GM 2064 EA $ 3.59 $ 3.59 MEDSOURCE INTERNATIONAL 533-MS-GZCS4BG Conforming stretch bandage,gauze,4 in.,sterile,12rl/bg 8bg/cs BG $ 3.25 $ 3.31 CURAPLEX 61411 *KIT ITEM ONLY*Curaplex Paramedic Shears,Black 7.25 in 50pr/bx PR $ 0.78 $ 0.78 CURAPLEX 301-100EA Curaplex Oxygen Nasal Cannula,Adult,Conventional,Clear,Flared Prongs,7 ft tubing, EA $ 0.31 $ 0.31 50ea/cs PFIZER INC.(HOSPIRA) 371113 C4 MIDAZOLAM 10MG,2ML VIAL(5MG/ML)10/BOX CS13(VERSED) BX $ 15.45 $ 15.45 BAXTER HEALTHCARE-DMG 358437 IV Solution,Sodium Chloride 0.9%100ml Bag,Singles 96ea/cs EA $ 2.08 $ 2.08 CURAPLEX 301-200EA Curaplex Select Nebulizer,Small-volume,Hand-held,T-piece,Mouthpiece,Flextube,7 ft EA $ 0.65 $ 0.65 Tubing 50/cs Cambridge Sensors USA,LLC 952000 COLD PACK INSTANT 5.5 IN X 10 IN 24/CS RAPID COLD CS $ 26.47 $ 26.47 BECTON DICKINSON 629663 SYRINGE ONLY LUER LOCK 50CC 40/BX 4BX/CS BECTON DICKINSON 309653 BX $ 21.85 $ 21.85 FRESENIUS O424-05 FLUMAZENIL 0.5MG,5ML VIAL 10VIALS/BX ROMAZICON BX $ 91.50 $ 91.50 PFIZER INC.(HOSPIRA) 0074553401 SODIUM BICARBONATE 4.2%10ML INFANT LIFESHIELD 1043A 10EA/BX BX $ 120.00 $ 131.35 TELEFLEX LLC 021005 MFG B/O Berman Airway#5 100MM Lg Adult Lavender 50/BX Bulk EA $ 0.17 $ 0.17 CURAPLEX 2021-14630 Curaplex Select Nasopharyngeal Airway,14 Fr,3.Omm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 CURAPLEX 2021-14655 Curaplex Select Nasopharyngeal Airway,22 Fr,5.5mm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 CURAPLEX 2021-14660 Curaplex Select Nasopharyngeal Airway,24 Fr,6.Omm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 BECTON DICKINSON 1641-76618 Safety Needle,BD Eclipse,18 ga x 1 1/2 in.,100/bx 12bx/cs BX $ 27.72 $ 27.72 DYNAREX CORPORATION F165200 BANDAGE ADHESIVE CLOTH 1 IN X 3 IN 100/BX 24BX/CS BX $ 2.25 $ 2.25 CURAPLEX 2021-14640 Curaplex Select Nasopharyngeal Airway,18 Fr,4.Omm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 MEDEGEN MEDICAL 290116 BIOHAZARD BAG RED 7-10 GAL 23 X 23 1.2MIL 500/CS EA $ 0.09 $ 0.09 PRODUCTS CARDINAL HEALTH 8888268086 SALEM GASTRIC SUMP TUBE 8 FIR,24 IN 10/CS EA $ 7.44 $ 7.44 PFIZER INC.(HOSPIRA) 371100 C4 LORAZEPAM 2MG 1ML VIAL 10/BOX *REFRIGERATE**CS01 BX $ 22.83 $ 22.83 WATER-JEL TECHNOLOGIES 1522-21620 Burn Dressing,Facial,Water-Jel,12 inch X 16 inch EA $ 13.33 $ 13.33 GREAT PLAINS BALLISTICS 021410 AIR FLOW MONITOR BAAM 100/CS EA $ 6.47 $ 6.47 CURAPLEX 533-MS-YKIOEA Curaplex Yankauer Suction Bulb Tip Only with Control Vent,Sterile 50ea/cs EA $ 0.80 $ 0.80 FRESENIUS 660-05 Metoprolol 5mg,5ml vial 10EA/BX BX $ 15.80 $ 15.80 CURAPLEX 32762 Curaplex Disposable Penlight 6/pk,60pk/cs PK $ 4.50 $ 4.50 MEDIQUE PRODUCTS 25711 Hydrogen Peroxide,Topical Solution,16 oz Bottle,12ea/cs EA $ 0.98 $ 0.98 CONMED CORPORATION 231620 ELECTRODES PEDIATRIC 3/PK 10PK/BX 20BX/CS HUGGABLE BX $ 5.26 $ 5.26 LAERDAL MEDICAL CORP. 260201 EXTRICATION COLLAR BABY NO NECK 50/CS STIFNECK EA $ 5.55 $ 5.64 DYNAREX CORPORATION 540047 PREPARATION RAZORS 50/BX 5BX/CS GALLANT 4251(250EA/CS) EA $ 0.37 $ 0.37 SMITHS MEDICAL ASD,INC. 350534 STOPCOCK 4 WAY WITH SWIVEL AND MALE LUER LOCK 50/CS EA $ 1.19 $ 1.22 MEDSOURCE INTERNATIONAL 533-MS-SC14EA Suction Catheter,14 Fr,coiled,w/whistle tip and thumb control port,sterile,disp,LF EA $ 0.20 $ 0.22 50ea/cs TELEFLEX LLC 021003 Berman Airway Size 3 80MM Small Adult Green 50/BX Bulk EA $ 0.17 $ 0.17 WATER-JEL TECHNOLOGIES 710206 BURN DRESSING WATER-JEL 2IN X 6IN 60/CT EA $ 2.79 $ 3.07 CARDINAL HEALTH 2231-91110 Salem Gastric Sump Tube,10 Fr,36 inch 50ea/cs EA $ 1.99 $ 1.99 MEDSOURCE INTERNATIONAL 533-MS-SCO8EA Suction Catheter,8 Fr,coiled,w/whistle tip and thumb control port,sterile,disp,LF EA $ 0.20 $ 0.22 50ea/cs MEDSOURCE INTERNATIONAL 533-MS-SC12EA Suction catheter,12 Fr,coiled,w/whistle tip and thumb control port,sterile,disp,LF EA $ 0.20 $ 0.22 50ea/cs CARDINAL HEALTH 2114-32216 NG Tube,Levin,16 Fr,Clear,48 inch,Markings 18,22,26 and 30 in,Open Distal End, EA $ 1.06 $ 1.06 50ea/cs CARDINAL HEALTH 2114-33018 NG Tube,Levin,18 Fr,Clear,48 inch,Markings 18,22,26 and 30 in,Open Distal End, EA $ 1.06 $ 1.06 50ea/cs CURAPLEX 64250 Curaplex Sharps Solo,Sharps container with one time lockable seal,6.5 in 24ea/cs EA $ 1.35 $ 1.35 PFIZER INC.(HOSPIRA) 1312-30 C2 HYDROMORPHONE 2MG/ML 1ML CPJ 10/BX BX $ 28.52 $ 31.25 MEDICAL SUPPLY SOLUTIONS, NS5251 UD Saline,Modudose,3ml,Sodium Chloride 0.9%,for Inhalation,Easy Open Twist/Pull EA $ 0.13 $ 0.13 INC 100ea/bx 10bx/c Attachment A-OCT.2020 Item List for Monroe County RFP-91-0-2016 Renewal #2 CURAPLEX 2021-14635 Curaplex Select Nasopharyngeal Airway,16 Fr,3.5mm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 CURAPLEX 30061MS Curaplex Burn Sheet,60 inch x 90 inch,Sterile 50ea/cs EA $ 2.09 $ 2.12 MEDSOURCE INTERNATIONAL 533-MS-SC18EA Suction catheter,18 Fr,coiled,w/whistle tip and thumb control port,sterile,disp,LF EA $ 0.20 $ 0.22 50ea/cs CARDINAL HEALTH 2114-31412 NG Tube,Levin,12 Fr,Clear,48 inch,Markings 18,22,26 and 30 in,Open Distal End, EA $ 1.06 $ 1.06 50ea/cs CURAPLEX 38020 Curaplex Endotracheal Tube with Stylette,9.Omm,Cuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 MEDSOURCE INTERNATIONAL 533-MS-SC06EA Suction Catheter,6 Fr,coiled,w/whistle tip and thumb control port,sterile,disp,LF EA $ 0.20 $ 0.22 50ea/cs CARDINAL HEALTH 2114-71114 NG Tube,Levin,14 Fr,Clear,48 inch,Markings 20,24,28 and 32 in,Open Distal End, EA $ 1.11 $ 1.11 50ea/cs TELEFLEX LLC 021002 Berman Airway Size 1 60MM Child Black 50/BB Bulk EA $ 0.17 $ 0.17 TELEFLEX LLC D4244 Airway,Berman 70MM LG Child White 50/BX Bulk EA $ 0.17 $ 0.17 CAPITAL WHOLESALE DRUG 0047-22 LTD CITY-USE 0409-0047-22 Solu-Medrol,125mg,2ml ACT-O-VIAL 25ea/bx BX $ 295.50 $ 295.50 TELEFLEX LLC 020603 MASK NON-REBREATHER PARTIAL HIGH CONCENTRATION,100%02, ADULT 50/CS EA $ 1.10 $ 1.10 TELEFLEX LLC 021004 Berman Airway#490MM Medium Adult Yellow 50/BX Bulk EA $ 0.17 $ 0.17 PFIZER INC.(HOSPIRA) 0409-4350-03 Diltiazem 100mg ADD-vantage Vial,Non-Refrig,(ADD-vantage diluent required-sold BX $ 152.40 $ 166.73 .separately).10EA/BX DYNAREX CORPORATION 083501P Dressing,Abdominal,Combine Pad,Sterile,5 in x 9 in 20/pk 20pk/cs PK $ 2.15 $ 2.15 DYNAREX CORPORATION 10635 bandage,Ace-type,Dynarex,elastic,latex-free,6m 50ea/cs EA $ 0.91 $ 0.91 MEDUNE INDUSTRIES,INC. 1072-80347 Wash Basin,Rectangular,6 Quart,Graphite,50ea/cs EA $ 0.68 $ 0.74 DYNAREX CORPORATION 1350-14547 Triple Antibiotic Ointment,0.9gm Foil Pack 144/bx 12bx/cs BX $ 11.89 $ 11.89 WATER-JEL TECHNOLOGIES 1522-36304 Burn Wrap,Water Gel,Foil Pouch lea 4ea/cs EA $ 54.00 $ 54.00 PFIZER INC.(HOSPIRA) 1632-01 VECURONIUM 10MG lOML VIAL(POWDER)10EA/BX BX $ 88.80 $ 88.80 B.BRAUN MEDICAL,INC 1633-05305 Syringe Only,5cc,Luer Lock,100ea/bx 20bx/cs EA $ 0.11 $ 0.11 B.BRAUN MEDICAL,INC 1633-10010 Syringe Only,lOcc,Luer Lock,100ea/bx 12bx/cs EA $ 0.13 $ 0.13 PFIZER INC.(HOSPIRA) 1893-01 C2 Morphine Sulfate,10mg/ml,lml PF CPJ 10/bx BX $ 24.09 $ 26.34 CURAPLEX 2021-14650 Curaplex Select Nasopharyngeal Airway,20 Fr,S.Omm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 CURAPLEX 2021-14665 Curaplex Select Nasopharyngeal Airway,26 Fr,6.5mm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 CURAPLEX 2021-14670 Curaplex Select Nasopharyngeal Airway,28 Fr,7.Omm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 CURAPLEX 2021-14675 Curaplex Select Nasopharyngeal Airway,30 Fr,7.5mm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 CURAPLEX 2112-38004 Curaplex Endotracheal Tube with Stylette,4.Omm,Uncuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CARDINAL HEALTH 2211-65950 SUCTION TUBING CONNECTOR YTYPE STERILE 50/CS CS $ 74.33 $ 74.33 AMBU 2442-54402 BVM,SPUR II,NEONATE,INFANT WITH OXYGEN RESERVOIR TUBE 12/CS EA $ 13.28 $ 13.28 LAERDAL MEDICAL CORP. 260202 EXTRICATION COLLAR PEDIATRIC 50/CS STIFNECK EA $ 5.59 $ 5.68 SPACELABS HEALTHCARE 2614-32016 BP Cuff,SoftCheck,Child,Disposable,Vinyl,Single Tube with HP/Bayonet Fitting 5ea/bx EA $ 2.29 $ 3.10 SPACELABS HEALTHCARE 2614-63516 BP Cuff,SoftCheck,Adult,Disposable,Vinyl,Single Tube with HP/Bayonet Fitting 5ea/bx EA $ 3.47 $ 3.97 SPACELABS HEALTHCARE 2614-81416 BP Cuff,SoftCheck,Infant,Disposable,Vinyl,Single Tube with HP/Bayonet Fitting 5ea/bx EA $ 1.95 $ 2.12 SPACELABS HEALTHCARE 2614-82616 BP Cuff,SoftCheck,SM Adult,Disposable,Vinyl,Single Tube with HP/Bayonet Fitting 5ea/bx EA $ 2.56 $ 3.29 MEDTRONIC(covidien) 2722-76800 CO2 Sampling Line,Microstream Filterline Set,Adult/Pediatric,l4ft long,Airway Adapter EA $ 8.89 $ 8.89 25ea/bx WELCH ALLYN,INC.. 2733-57505 *NON-RETURNABLE*Probe Covers,Braun ThermoScan Pro 4000 Thermometer,Disposable BX $ 14.79 $ 14.79 200/bx 25bx/cs DUKAL CORP. 276-8506BG Gauze sponge,basic economy,2 in x 2 in,12 ply,non-sterile,200/bg 40bg/cs BG $ 0.92 $ 0.92 DYNAREX CORPORATION 279-3343BX Gauze sponge,sterile,4 in x 4 in,12 ply,2/pk,25pk/bx 24bx/cs BX $ 1.75 $ 1.75 3M HEALTH CARE 291860 *NON-RETURNABLE*Particulate Respirator,N95,REG Size,Cup,Blue,Nosefoam,Fluid BX $ 19.92 $ 19.92 Resistant,Disp,L ANSELL HEALTHCARE 297750 Gloves,Freeform EC,SM,Extended Cuff,Nitrile,Latex Free,Powder Free 50/bx 10bx/cs BX $ 14.57 $ 14.57 PRODUCTS LLC......_ CURAPLEX 301-439EA Curaplex High efficiency HEPA filter,w/port,hydrophobic paper,TV greater than 500ml EA $ 2.39 $ 2.39 50ea/cs CURAPLEX 301-B3010EA Curaplex Select GreenLine/D Laryngoscope Blade,MAC 1,Fiber Optic,Infant,Disposable EA $ 3.89 $ 3.89 20ea/cs CURAPLEX 301-B3020EA Curaplex Select GreenLine/D Laryngoscope Blade,MAC 2,Fiber Optic,Child,Disposable EA $ 3.89 $ 3.89 20ea/cs CURAPLEX 301-B3030EA Curaplex Select GreenLine/D Laryngoscope Blade,MAC 3,Fiber Optic,VIED Adult, EA $ 3.89 $ 3.89 Disposable 20ea/cs CURAPLEX 301-B3040EA Curaplex Select GreenLine/D Laryngoscope Blade,MAC 4,Fiber Optic,LG Adult,Disposable EA $ 3.89 $ 3.89 20ea/cs CURAPLEX 301-B3100EA Curaplex Select GreenLine/D Laryngoscope Blade,MILLER 0,Fiber Optic,Neonate, EA $ 3.89 $ 3.89 .......Disposable 20ea/cs Attachment A-OCT.2020 Item List for Monroe County RFP-91-0-2016 Renewal #2 CURAPLEX 301-B3110EA Curaplex Select GreenLine/D Laryngoscope Blade,MILLER 1,Fiber Optic,Infant,Disposable EA $ 3.89 $ 3.89 20ea/cs CURAPLEX 301-B3120EA Curaplex Select GreenLine/D Laryngoscope Blade,MILLER 2,Fiber Optic,Child,Disposable EA $ 3.89 $ 3.89 20ea/cs CURAPLEX 301-B3130EA Curaplex Select GreenLine/D Laryngoscope Blade,MILLER 3,Fiber Optic,VIED Adult, EA $ 3.89 $ 3.89 Disposable 20ea/cs CURAPLEX 301-B3140EA Curaplex Select GreenLine/D Laryngoscope Blade,MILLER 4,Fiber Optic,LG Adult, EA $ 3.89 $ 3.89 Disposable 20ea/cs EMERGENCY PRODUCTS& 3176-07705 HAND-E HAND HOLD DEVICE YELLOW EA $ 16.99 $ 16.99 RESEARCH SMITHS MEDICAL ASD,INC. 353042 CATHETER INTRAVENOUS(IV)LATEX FREE 16 GAUGE X 1.25 IN 50/BX 200/CS PROTECTIV EA $ 1.80 $ 1.80 SMITHS MEDICAL ASD,INC. 353048 CATHETER INTRAVENOUS(IV)LATEX FREE 14 GAUGE X 1.25 IN 50/BX 200/CS PROTECTIV EA $ 1.80 $ 1.80 SMITHS MEDICAL ASD,INC. 353050 CATHETER INTRAVENOUS(IV)22 GAUGE X 1 IN 50/BX 200/CS PROTECTIV EA $ 1.80 $ 1.80 SMITHS MEDICAL ASD,INC. 353056 CATHETER INTRAVENOUS(IV)LATEX FREE 20 GAUGE X 1.25 IN 50/BX 200/CS PROTECTIV EA $ 1.80 $ 1.80 PFIZER INC.(HOSPIRA) 371104 C4 DIAZEPAM 5MG/ML 2ML LUER LOCKING CARPUJECT 10/BX CS04 BX $ 317.68 $ 317.68 CURAPLEX 38001 Curaplex Endotracheal Tube with Stylette,2.5mm,Uncuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CURAPLEX 38002 Curaplex Endotracheal Tube with Stylette,3.Omm,Uncuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CURAPLEX 38003 Curaplex Endotracheal Tube with Stylette,3.5mm,Uncuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CURAPLEX 38005 Curaplex Endotracheal Tube with Stylette,4.5mm,Uncuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CURAPLEX 38011 Curaplex Endotracheal Tube with Stylette,S.Omm,Cuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CURAPLEX 38012 Curaplex Endotracheal Tube with Stylette,5.5mm,Cuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CURAPLEX 38014 Curaplex Endotracheal Tube with Stylette,6.5mm,Cuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CURAPLEX 38015 Curaplex Endotracheal Tube with Stylette,7.Omm,Cuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CURAPLEX 38016 Curaplex Endotracheal Tube with Stylette,7.5mm,Cuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CURAPLEX 38017 Curaplex Endotracheal Tube with Stylette,B.Omm,Cuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CURAPLEX 38018 Curaplex Endotracheal Tube with Stylette,8.5mm,Cuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 HARTWELL MEDICAL LLC 4162 Convenience Bag,BioHoop,50cc-2000cc,Emesis and Hazardous Waste Bag,No Hook EA $ 1.55 $ 1.58 12ea/pk 40pk/cs DMS 5060220 Restraint Strap,Orange,2 pc,5 ft,Nylon,Metal Push Button Buckle,Loop Ends EA $ 7.39 $ 7.58 QMED CORPORATION 533764 Ventilator Circuit,Universal,Portable,Adult,72 in,Disp,for use w/PB 2800 Series,HT50 EA $ 5.73 $ 5.73 15/cs MEDSOURCE INTERNATIONAL 533-MS-SC16EA Suction catheter,16 Fr,coiled,w/whistle tip and thumb control port,sterile,disp,LF EA $ 0.20 $ 0.22 50ea/cs BEMIS MANUFACTURING 592041 SUCTION CANISTER DISPOSABLE RED TOP 800cc 100/CS EA $ 2.93 $ 2.93 COMPANY SUN VIED 792-9-0212-72EA ET Tube Introducer 15 Fr x 70 cm,straight tip,flex,disp,sterile 10ea/bx EA $ 4.79 $ 4.79 ADI MEDICAL D4808 SUCTION TUBING ONLY 1/4 IN X 6 FT 50/CS EA $ 0.60 $ 0.65 MORRISON MEDICAL D6411 HEAD BLOCKS STICKY FOAM-PAIR PR $ 5.02 $ 7.06 PRODUCTS DYNAREX CORPORATION F165631 TAPE ADHESIVE CLOTH SURGICAL 1 IN X 10 YDS 12/BX 12BX/CS BX $ 7.70 $ 7.70 DYNAREX CORPORATION F165632 TAPE ADHESIVE CLOTH SURGICAL 2 IN X 10 YDS 6/BX 12BX/CS BX $ 7.70 $ 7.70 CURAPLEX PU80000 Curaplex VACUUM SPLINT SET,DISPOSABLE EA $ 285.00 $ 314.43 TELEFLEX LLC SD121950 Berman Airway 50MM Individually Wrapped Lt.Blue 50/BX EA $ 0.36 $ 0.36 Discontinued Items PROTECTIVE INDUSTRIAL 295561 *DC-VEND-NO SUB*NON-RETURNABLE*SLEEVE WHITE GAUNTLET,ELASTIC OPENINGS,18 EA $ 0.20 PRODUCTS,INC. IN 200/CS CURAPLEX 1124-03680 *DC-USE 1124-32400*Curaplex Triangular Bandage,Polypropylene 240ea/cs EA $ 0.27 CURAPLEX 51150 *DC-USE 023312*Curaplex NPA 12F 3.Omm,Latex Free PVC 1/EA 10EA/BX 10BX/CS EA $ 1.15 Potential Subs CURAPLEX 1124-32400 Curaplex Triangular Bandage,Muslin 12/pk 20pk/a 40 in x 40 in x 56 in PK $ 3.24 MEDSOURCE INTERNATIONAL-023312 NASOPHARYNGEAL AIRWAY-NPA-LATEX FREE PVC 12 FRENCH 10/BX RUSCH EA $ 2.29 IMPORT Attachment B SUBMISSION PROPOSAL RESPONSE FORM SET PRICING FOR MEDICAL SUPPLIES AND PHARMACEUTICALS Proposer's Name and Mailing Address: Bound Tree Medical, LLC 5000 Tuttle Crossing Blvd Dublin, OH 43016 Telephone and Fax Numbers: I have included: f • Proposal/Tabbed Sections Y • Medical Supply Discount Off List and Pricing Worksheet (Attachment A) • Submission Proposal Response Form (Attachment B) V • Non-Collusion Affidavit (Attachment C) J • Lobbying and Conflict of Interest Clause Form (Attachment D) • Drug Free Workplace Form (Attachment E) • Public Entity Crime Statement (Attachment F) • Local Preference Form (Attachment G) ! • Scope of Services Response Form (Attachment H) • Insurance Requirements,Indemnification/Hold Harmless, f and Request for Waiver of Insurance Requirements (Attachment 1) V (Check mark items above, as a reminder that they are included). I state that I am authorized to submit this proposal. STATE OF Ohio ignature of Proposers) COUNTYOF Franklin Vice President Date 9/06/2016 PERSONALLY APPEARED BEFORE ME,the undersigned authority, kh f tr}non who,after first being sworn by me,(name of individual signing}affi ature in the space provided above on this 6 t n day of♦ ��i ,20 i 6 i DWd DO II My commission e= lyl14�INd� NOTARY PUBLI � � Attachment C NON-COLLUSION AFFIDAVIT 1, Rhiannon Greene ,according to law,on my oath,and under penalty of perjury,depose and say that: I. lam Vice President ofthe firmof Bound Tree Medical, LLC the bidder/responder making the proposal for the project described in the Notice of Request for Competitive Solicitations for: Medical Supplies and Pharmaceuticals and I executed the said proposal with full authority to do so. 2. The prices in this proposal have been arrived at independently without collusion,consultation,communication or agreement for the purpose of restricting competition,as to any matter relating to such prices with any other bidder/responder or with any competitor. 3. Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the bidder/responder and will not knowingly be disclosed by the biddedresponder prior to the opening of the responses, directly or indirectly,to any other bidder/responder or to any competitor. 4. No attempt has been made or will be made by the bidder/responder to induce any other person,partnership or corporation to submit,or not to submit,a proposal for the purpose of restricting competition. 5. Th ents contained in this affidavit are true and correct,and made with full knowledge that Monroe County relies upon e truth of statements contained in this affidavit in awarding contracts for said project. AW 09/06/2016 (Signature ofBidder/Responder) (Date) Rhiannon Greene, Vice President Print Name/Title STATE OF: Ohio COUNTY OF: Franklin PERSONALLY APPEARED BEFORE ME,the undersigned authority, K it,#,h n o y\ It f Q A R (name of individual signing Affidavit),who,after first being sworn by me,affixed his/her signature in the space provided above on this 6th day of September 20 16 MyCommissio� N i ` David Mello II NOTARY IC L *� 1to�ryPu6it;8mrdONO Z � C�am�on 6q>tw�upult tb� Ui11111N� j Attachment D LOBBYING AND CONFLICT OF INTEREST FORM SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 jtiMONROE COUNTY.FLORIDA ETHICS CLAUSE Rhianron Greene, Vice President warrants that he/it has not employed, retained or otherwise had act on his/its behalf any former County officer or employee in violation of Section 2 of Ordinance No. 10- 1990 or any County officer or employee in violation of Section 3 of Ordinance 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: 9/06/201 E STATE OF: Ohio COUNTY OF: Franklin PERSONALLY APPEARED BEFORE ME,the undersigned authority, (name of individual signing Affidavit), who, after first being sworn by me, affixed his/her signature in the space provided above on this sth day of September 20 16 . My Commission Expires: ! a AL & NOTILRYPUBLIC David bdello II Q. WwAVA%20 f Attachment E DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: Sound Tree Medical LLC (Name of Business) i. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free Workplace,any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection(1). 4, In the statement specified in subsection(1), notifies the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of,or plea of guilty or nolo contendere 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. i 5. Imposes a sanction on,or requires the satisfactory participation in,a drug abuse assistance or rehabilitation program if such is available in the employee's community,for any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. i As the person authorized to sign the statement,I certify that this firm complies fully with the above requirements. Di t Bidder's Signature Rhiannon Greene, Vice President 9/06/2016 Date '= David Mello H '`colntawtolt��tlpu�ttasc�o �N/III{{lN� f r Attachment F PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work,may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." I have read the above and state that neither Pound Tree Medical, uLc (Proposer's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (Signature) Rhiannon Greene, Vice President Date: 9/0U2016 STATE OF: Ohio COUNTY OF: Franklin Subscribed and sworn to(or affirmed)before me on the Etta day of September ,20 16 by k;T, 'A br (name of individual signing Affidavit). He/She is personallyown to me or has produced (type of identification)as identification. My Commission Expires: ' NOTARY TBLTC David Zdello II *: �ry Pubic,9�1r ddio WuAodit i Attachment G "Not Applicable LOCAL PREFERENCE FORM ** A. Vendors claiming a local preference according to Ordinance 023-2009 must complete this form. Name of Bidder/Responder Date: 1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at least one year prior to the notice or request for bid or proposal? (Please 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 contractor intend to subcontract 50%or more of the goods,services or construction to local businesses meeting the criteria above as to licensing and location? If yes,please provide: 1 Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subcontractor dated at least one year prior to the notice or request for bid or proposal. 2. Subcontractor Address within Monroe County from which the subcontractor operates: Telephone Number Address Address Print Name: Signature and Title of Authorized Signatory for Bidder/Responder STATE OF COUNTY OF } On this day of 20 before me, the undersigned notary public, personally appeared known to me to be the person whose name is subscribed above or who produced as identification, and acknowledged that he/she is the person who executed the above Local Preference Form for the purposes therein contained. My commission expires. Notary Public (Seal) Print Name **This Form is only required if Local Preference is applicable pursuant to Sec.2-349,Monroe County Code. 4 i Attachment H - Scope of Services Response Form 2016 The Proposer will be evaluated on compliance with the below service requirements. By submitting a proposal,the Proposer agrees that these provisions will be part of the agreement between the parties. YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) QUALITY ASSURANCE PROVISIONS Ordered Supplies/Receiving: A system of test inspections shall be used to assure quality and quantity of materials received by County. Materials will be promptly inspected and any discrepancies from the purchase order and/or the supplier's invoice shall be reported immediately by the Monroe County Logistics Specialist to the Supplier and x shall be corrected within a two(2)business day time frame when the County has made that report within normal working hours of 8 am to 5 pm Monday through Friday. Material Safety Data Sheet(MSDS): Any items delivered must be accompanied by a MSDS. The MSDS will be maintained by the County and must include the following information: 1. The Chemical name and the common name of the x toxic substance. 2. The hazards or other risks in the use of the toxic x substance,including: a) The potential for fire,explosion,corrosively x and reactivity; b) The known acute and chronic health effects of risk from exposure,including the medical x conditions which are generally recognized as being aggravated by exposure to the toxic substance;and c) The primary routes of entry and symptoms of x overexposure. 3. The proper precautions,handling practices, necessary personnel protective equipment,and x i Attachment H - Scope of Services Response Form 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) other safety precautions in the use of,or exposure to,the toxic substances,including appropriate emergency treatment in the case of overexposure. 4. The emergency procedure for spills,fires,disposal x and first aid. 5. A description,in lay terms,of the known specific J potential health risks posed by the toxic x substance intended to alert any person reading this information. 5. The year and month,if available,that the information was compiled and the name, x address,and emergency telephone number of I the manufacturer responsible for preparing the information. I Supply rime: I Proposers must be able to supply contracted requested supplies within a three(3)business day time frame of normal request of supplies when the County has made x I i that request within normal working hours of 8 am to 5 pm Monday through Friday. I Natural or Man-Made Emergencies: During emergency(natural or man-made emergencies) situations,Proposers must be able to supply requested supplies on a next day basis,twenty-four(24)hours a x day seven(7)days a week. PROPOSERS LIABILITY Warranty: It shall be the Proposer's responsibility to submit at the time of shipment the original manufacturer's warranty x for the materials supplied. 6 t S i 1 Attachment H - Scope of Services Response Form 2016 f E YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Defects: Upon un-packaging and discovering defects to materials shipped by Supplier,any medical supplies and/or x pharmaceuticals requiring replacement shall be finalized within five(5)working days of reporting the defect. (See also information required behind Tab 2 regarding warranties and replacements.) Guarantee: The material(s)supplied shall be guaranteed to be free from defect of composition,conception and workmanship for a minimum period of 120 days from the date of acceptance by the County.Any parts or portions found not in accordance with this specification will be rejected by the County and returned to the Proposer at the Proposer's expense for immediate replacement. Quality: --- ----- --- ---------_— The materials to be furnished shall be currently in production and shall be of the manufacturer's standard r. or better quality. Quantities: The quantities listed on the Medical Supply Discount Off List and Pricing Worksheet(Attachment A)are estimated quantities for one(1)year and are for cost comparison only. Any reference to forecasted or estimated quantities within the proposal documents is intended to inform the proposers of approximate x annual requirements.The County shall not be required to purchase any minimum or maximum quantities during the term of any award resulting from this specification.The County may purchase as little as zero percent(0%)or exceed as much as one hundred percent(100%)of the forecasted or estimated quantities. i 3 Attachment H - Scope of Services Response Form 2016 i YES YES NO SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Packaging: Only-materials that are packaged in the original factory fresh packaging shall be accepted.No materials that have been re-packaged or that are in the adulterated or damaged packages shall be accepted at the receiving location,nor shall after-market materials be accepted at the receiving location.Any attempts by the Proposers to furnish the County with other than first quality materials shall constitute default as outlined in this specification. j i Refrigeration: f Maintaining a specific temperature range throughout the shipping process is essential to the quality of healthcare products. Proposer has the ability to ship x I i products in a proper tem peratu re-control led environment. Only materials which have been properly j shipped in a temperature-controlled environment shall be accepted by the COUNTY. _ } Expiration Dates: Where applicable,all merchandise shall have a minimum expiration date of 18 months from date of shipment,and date must be displayed on the package. CONDITIONS Authorization: z Proposer has the ability to handle orders placed by the electronic ordering software Operative IQ. (All orders shall be placed via Monroe County by individual Purchase Orders generated by the County's electronic ordering software,Operative IQ,or as"Open"Purchase orders.) Furnishing Proposal Items: Contract items are to be furnished on an"as needed, when needed basis"during the life of the contract. ?' E t i Attachment H - Scope of Services Response Form [ 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Delivery: Materials ordered shall be delivered within three(3) business days after receipt of order.Failure to do same x shall be considered breach of contract or default,and the County shall utilize its options as stated within the contract. Backorders: In the event an item is not immediately available at the time of an order,and able to be delivered within three (3)days,the County shall have the option of purchasing x the item from another vendor. Penalties: The County reserves the right to increase or decrease quantities shown without penalty. x Samples(Medical Supplies only): From time to time,either at the stage of the Proposal or subsequently while the contract is in force,the Proposer may wish to recommend an alternative to an item listed on Medical Supply Discount Off List and Pricing Worksheet(Attachment A). in those situations, the County may require the Proposer or the Proposer may elect to submit a sample for inspection,to ensure x that the alternative is of similar quality. Such samples shall be labeled with the Proposer's name and item number and shall be furnished free of charge. The vendor can determine whether the sample should be returned or destroyed. Samples not destroyed will be returned upon request at the Proposer's expense within ten days following receipt of the sample. Substitution: No items will be substituted without the prior written approval of the County. Any violation of such procedure may result in a possible cancellation of the x contract. All approved substitutes shall be annotated as such on the Proposer's shipping document(s). i Attachment H - Scope of Services Response Form 2016 �.ss�e■ ma�soaea YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Proposal Prices: Proposal prices quoted on Medical Supply Discount Off List and Pricing Worksheet(Attachment A)shall be firm and shall not be amended after the dates and time of x the proposal opening. Any attempt by the Proposer to amend said proposal prices shall constitute default as outlined in this specification. Shipping Costs: Prices quoted in the Proposal and Proposal Response form shall include all shipping costs,shipped F.O.B x Marathon,Florida or to the facility location specified by the requestor or the purchase order. Taxes: All taxes of any kind and character payable on account of the word done and materials furnished under the award shall be paid by the Proposer and shall be x deemed to have been included in the proposal. The County is exempt from all state and federal sales,use, transportation,and excise taxes. Infringement: Proposal prices must include all royalties and costs arising from patents,trademarks,and copyrights in any way involved in the work. Whenever the Proposer is required or desires to use any design,device,material or process covered by letters of patent or copyright,the Proposer shall indemnify and save harmless the County, I its officers,agents,and employees from any and all x claims of infringement by reason of the use of any such patented design,toll, material,equipment or process, to be performed under the contract,and shall indemnify the said County,its officers,agents and employees for any costs,expenses and damage which may be incurred by reason of any infringement at any time during the prosecution or after the completion of the work. `s I 3 a i i 4 Attachment H - Scope of Services Response Form 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Award Changes: No changes,over the contract period,shall be permitted unless prior written approval is given by the County and,where applicable,confirmed by the x Monroe County Board of Commissioners. Assignment: No Proposer shall assign the contract or any rights or obligations thereunder to a subcontractor without the X written consent of the County and approval of the Monroe County Board of Commissioners. Price Escalation: The County will allow a price escalation provision with this award. The original proposal prices quoted on Medical Supply Discount Off List and Pricing Worksheet (Attachment A)shall be firm for a one,1)year minimum period. A price escalation/de-escalation will be allowed one(1)year after the beginning of the award period and at one(1)year intervals thereafter, provided the Proposer notifies the County,in writing of any requested price changes at least sixty(60)days prior to those changes taking effect. This request must be accompanied by a certified letter from the Proposer's supplier showing the price increase to the contractor.The price increase to the County shall be limited to the percentage increase to the Proposer as stated in this letter. If,at the point of exercising the price escalation provision,market media indicators show that the prices have decreased,and that the Proposer has not passed the decrease on to the County,the County reserves the right to place the Proposer in default,cancel the contract,and remove the Proposer from the County's proposer list for a period of time deemed suitable to the County. Attachment H - Scope of Services Response Form 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Invoicing: The Proposer shall furnish the County complete itemized invoices for the goods received. Invoices are to reflect the prices stipulated on the purchase order and as outlined on the Medical Supply Discount Off List and Pricing Worksheet(Attachment A). Invoices are x also to reflect the provisional price discount in the form of a percentage at which the Proposer will sell these items off its list price. The County will not accept an aggregate invoice. As part of the award process,the County may request a sample invoice. Invoices shall contain, but not limited to the following information: • Invoice number • Company name • Purchase order number • location and dates of delivery • Cost of items as stated on Proposal Response and extended price to reflect total cost for number of items received. Prompt Payment Act: The Proposer agrees to accept payment per the terms of the Florida Local Government Prompt Payment Act. x Normal processing time is approximately 30 days from presentation of the invoice. Ordering: Proposers will provide web-based online ordering website designed specifically for service. '� Disaster Recovery: Proposers have a proven Disaster Support Program in place and can demonstrate previous experience in disaster recovery supply chain management and shall x provide the County with emergency numbers for these situations.These numbers will be updated immediately if the contact number changes. Attachment H - Scope of Services Response Form 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Indemnification and Insurance Requirements: The Proposer can comply with the insurance requirements outlined in Attachment I to the RFP,or has submitted a Request for Waiver(also found in " Attachment 1). Also,the Proposer can comply with the indemnification and hold harmless requirements(also found in Attachment 1). ATTACHMENT J VENDOR CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS Project Description(s): Purchase of Medical Supplies and Pharmaceuticals Respondent Vendor Name: Bound Tree Medical, LLC Vendor FEIN: 31-173 9487 Vendor's Authorized Representative Name and Title: Rhiannon Greene/ Senior Vice President, Pricing Address: 5000 Tuttle Crossing Blvd., Dublin, OH 43016 City: Dublin State: OH Zip: 43016 Phone Number 800-533-0523 Email Address: submitbids@boundtree.com Section 287.135,Florida Statutes prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if, at the time of contracting or renewal, the company is on the Scrutinized Companies that Boycott Israel List, created pursuant to Section 215.4725,Florida Statutes,or is engaged in a Boycott of Israel. Section 287.135,Florida Statutes, also prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of$1,000,000 or more, that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector Lists which were created pursuant to s. 215.473, Florida Statutes, or is engaged in business operations in Cuba or Syria. As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the Section entitled"Respondent Vendor Name"is not listed on the Scrutinized Companies that Boycott Israel List or engaged in a boycott of Israel and for Projects of$1,000,000 or more is not listed on either the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or engaged in business operations in Cuba or Syria. I understand that pursuant to Section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney's fees, and/or costs. I further understand that any contract with the County may be terminated, at the option of the County, if the company is found to have submitted a false certification or has been placed on the Scrutinized Companies that Boycott Israel List or engaged in a boycott of Israel or placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List or been engaged in business operations in Cuba or Syria. Certified By: Rhiannon Greene , who is authorized to sign on behalf of the above referenced company. Authorized Signature: Print Name: Rhiannon Greene Title: Senior Vice President, Pricing Note: The List are available at the following Department of Management Services Site: htta://www.dsns.lnyflorida.coln/business o�crations/stateurchasin /vendor information/convi cted sus ended®diseriminatory�comlaints vendor®lists DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/13/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this L certificate does not confer rights to the certificate holder in lieu of such endorsement(s). tv PRODUCER CONTACTNAME: AOn Risk services Northeast, Inc. PHONE FAX Columbus OH Office (A/C.No.EM): (866) 283-7122 AlC.No.; (800) 363-0105 445 Hutchinson Avenue E-MAIL 6 Suite 900 ADDRESS: _ Columbus OH 43235 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Fire insurance Co. 19682 Sarnova, Inc., Bound Tree Medical, LLC INSURER B: Hartford Casualty Insurance Co 29424 5000 Tuttle Crossing Blvd. Dublin OH 43016 USA INSURERC: sentinel Insurance Company, Ltd 11000 INSURER D: Medmarc casualty Ins Co 22241 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570065283042 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYW MMIDD LIMITS A X COMMERCIALGENERALLIABILITY UUNVG3435 1ZIOlIZO17 EACH OCCURRENCE $1,000,000 CLAIMS-MADE —1OCCUR DAMAGE TO nR= $300,000 PREMISES Ea occurrence MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 ro POLICY ❑X PRO- JECT O LOC PRODUCTS-COMP/OPAGG Excluded ui OTHER: o n C Y 33 UUN VG3435 12/01/2016 12/01/2017 COMBINED SINGLE LIMIT `O AUTOMOBILE LIABILITY S1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) O 2 OWNED SCHEDULED BODILY INJURY(Per accident) N AUTOS HIRED AUOTOSY NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident d B X UMBRELLALIAB TOCCIMUR 33RHUVG1892 12/01/2016 12/01/2017 EACH OCCURRENCE $10,000,000 L) EXCESS LIAB MADE AGGREGATE $10,000,000 DED I X RETENTION$10,000 WORKERS COMPENSATION AND PER STATUTE OTH- EMPLOYERS'LIABILITY YIN ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? ❑NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT _ D Products Liab 160H380015 12/01/2016 12/01/2017 Aggregate Limit $10,000,000 claims Made SIR Aggregate $150,000 SIR applies per policy ter s & conditions Per Occ Limit $10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached ff more space is required) Re: Account No. 104754. Monroe County BOCC is included as Additional insured in accordance with the policy provisions of the General Liability and Auto Liability policies. kk GEMENTtI DATE WAIVER N/A YES„ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe county BOCC AUTHORIZED REPRESENTATIVE - 1111 12th St. Suite 408 Key west FL 33040 USA e�Gxon i �Gw7V6 c//fe.�edc.//o �lnelci46✓>� ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000037575 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk services Northeast, Inc. Sarnova, Inc., Bound Tree Medical, LLC POLICY NUMBER See Certificate Number: 570065283042 CARRIER NAIC CODE See Certificate Number: 570065283042 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. INSR POLICY POLICY ADDL SUBR POLICY NUMBER LIMITS LTR TYPE OF INSURANCE INSD WVD EFFECTIVE EXPIRATION DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) OTHER D Products Liab 160H380015 12/01/2016 12/01/2017 SIR Per S50,000 claims Made Occurrence SIR applies per policy to ms & conditions ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID.SARNINC-01 BDICKSON LOC#: A O' ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Thompson Flanagan Executive Liability Group Sarnova,Inc.Bound Tree Medical,LLC g y p 5000 Tuttle Crossing Blvd. POLICY NUMBER P.O.Box 8023 EE PAGE 1 Dublin,OH 43016 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: EE PA E 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Named Insureds 1.Sarnova,Inc. FEIN:262386055 2.Bound Tree Medical Products,Inc. FEIN:731646550 3.Tri-Anim Health Services, Inc. FEIN:952959155 4.Bound Tree Medical, LLC FEIN: 311739487 5.Sarnova HC LLC FEIN:262549813 6.Emergency Medical Products Inc. FEIN:391164909 7.Cardiovascular Concepts,Inc. FEIN:751835412 E i t ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) A �® CERTIFICATE OF LIABILITY INSURANCE 1 Z 19/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain !7-� p y, policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 'a NAME: Aon Risk services Northeast, Inc. PHONE FAX W Columbus OH Office (A/C.No.Ezt): (866) 283-7122 (AN Columbus (800) 363-0105 'a 445 Hutchinson Avenue E-MAIL = Suite 900 ADDRESS: Columbus OH 43235 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Medmarc Casualty Ins Co 22241 Sarnova, Inc., Bound Tree Medical, LLC INSURERB: Hartford Fire Insurance Co. 19682 5000 Tuttle Crossing Blvd. Dublin OH 43016 USA INSURERC: sentinel Insurance Company, Ltd 11000 INSURERD: Hartford Casualty Insurance Co 29424 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570079659291 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, Limits shown are as re uested INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (POLICY (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY Y 33UUNVG3435 127012019 12 70l 2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE F71 OCCUR Approvednageme t with Attahments PREMISES(Ea occurrence) $300,000 .�L. MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 P'LAGGREGATE LIMITAPPLIES PER: 10-17-2020 GENERAL AGGREGATE $2,000,000 POLICY �PEO ❑LOC PRODUCTS-COMP/OPAGG Excluded r OTHER: o r C Y 33 UUN VG3435 12/01/2019 12/01/2020 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $1,000,000(Ea accident) X ANYAUTO BODILY INJURY(Per person) 0 O OWNED SCHEDULED BODILY INJURY(Per accident) Z AUTOS ONLY AUTOS HIREDAUTOS NON-OWNED PROPERTY DAMAGE W 2 ONLY AUTOS ONLY (Per accident) U 'C W D X UMBRELLA LIAB X OCCUR 33RHUVG1892 12/01/2019 12/01/2020 EACH OCCURRENCE $10,000,000 O EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED I X RETENTION $10,000 WORKERS COMPENSATION AND PER STATUTE I IOTH- EMPLOYERS'LIABILITY ER Y/N ANY PROPRIETOR/PARTNER/ E.L.EACH ACCIDENT EXECUTIVE OFFICER/MEMBER N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A Products Liab 1190H380015 12/01/2019 12/01/2020 Aggregate Limit $10,000,000 Claims Made Agg Deductible $150,000 Per Occ Limit $10,000,000 4L DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) s'ei RE: Account No. 104754. Monroe County BOCC is included as Additional Insured in accordance with the policy provisions of the Wj General Liability and Automobile Liability policies. =16- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. y yZy Monroe County BOCC AUTHORIZED REPRESENTATIVE 1111 12th St., Suite 408 Key West FL 33040 USA R-0 air v� _ ©1988-2015 ACORD CORPORATION.All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks ofACO AGENCY CUSTOMER ID: 570000037575 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. Sarnova, Inc. , Bound Tree Medical , LLC POLICY NUMBER See Certificate Numbe 570079659291 CARRIER I NAIC CODE See Certificate Numbe 570079659291 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY IN"SR ADDL SURR POLICY NTNIRER LLNIITS LTR TYPE OF INSURANCE INSD WVD EFFECTIVE EXPIRATION DATE DATE (MM/DD/YYYY) OTHER A Products Liab 190H380015 12/01/2019 12/01/2020 Per Occ $50,000 claims Made Deductible ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD