Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Item C09
C.9 BOARD OF COUNTY COMMSSIONERS County of Monroe f Mayor Heather Carruthers,District 3 h} ] Mayor Pro Tem Michelle Coldiron,District 2 The Florida Keys Craig Cates,District 1 David Rice,District 4 Sylvia J.Murphy,District 5 County Commission Meeting October 213, 2020 Agenda Item Number: C.9 Agenda Item Summary #7373 BULK ITEM: Yes DEPARTMENT: Emergency Services TIME APPROXIMATE: STAFF CONTACT: James Callahan (305) 289-6088 9:30 AM BOCC/BOG AGENDA ITEM WORDING: BOCC approval to exercise the second of two 1-year options to renew contract with Bound Tree Medical LLC for medical supplies, effective 12/01/20 through 11/30/21. ITEM BACKGROUND: The Agreement between Monroe County Fire Rescue and Bound Tree Medical, LLC provided for a three (3) year term from December 1, 2016 through November 30, 2019 with two one-year renewal options, subject to the approval of the BOCC and BOG. Approval is being requested to exercise the 2nd of two one-year options which will extend the contract from 12/01/20 through 11/30/21. PREVIOUS RELEVANT BOCC AND BOG ACTION: On 11/22/16, the Board of County Commissioners (BOCC) and Board of Governors of Fire and Ambulance District 1 (BOG) approved the three-year agreement with Bound Tree Medical, LLC. (BOCC item: F21. BOG item: J2.) On 11/20/19, the BOCC and BOG approved the first of two one-year renewal options which extended the contract from 12/01/19 through 11/30/20. (BOCC item: F1. BOG item: K2.) CONTRACT/AGREEMENT CHANGES: Exercise 2nd Renewal Option STAFF RECOMMENDATION: Approval DOCUMENTATION: BOUND TREE EXTENSION 2nd 1 year renewal Oct 2020 (with pricing Attachment A) Bound Tree Medical, LLC - 1st Renewal and Amendment-Expires 11-30-2020 Bound Tree Medical, LLC - Medical Supplies and Pharmaceuticals -Expires November 30, 2019 Packet Pg. 268 C.9 Bound Tree COI- Effective 12-01-19 thru 12-01-20 FINANCIAL IMPACT: Effective Date: December 1, 2020 Expiration Date: November 30, 2021 Total Dollar Value of Contract: TBD Total Cost to County: TBD Current Year Portion: TBD Budgeted: Yes Source of Funds: N/A CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: N/A If yes, amount: N/A Grant: N/A County Match: N/A Insurance Required: Yes, COI attached Additional Details: N/A REVIEWED BY: Pedro Mercado Completed 10/02/2020 4:53 PM James Callahan Completed 10/03/2020 2:23 PM Purchasing Completed 10/06/2020 1:54 PM Budget and Finance Completed 10/06/2020 2:06 PM Maria Slavik Completed 10/06/2020 2:41 PM Liz Yongue Completed 10/06/2020 3:40 PM Board of County Commissioners Pending 10/21/2020 9:00 AM Packet Pg. 269 C.9.a 2nd RENEWAL AGREEMENT BETWEEN 0 m THE BOARD OF COUNTY COMMISSIONERS, AND THE BOARD OF GOVERNORS FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FLORIDA, AND 2 BOUND TREE MEDICAL, LLC '" FOR THE PURCHASE OF MEDICAL SUPPLIES AND PHARMACEUTICALS c.> THIS 2nd RENEWAL (hereinafter "RENEWAL") to the contract for the purchase of medical supplies and pharmaceuticals is made and entered into this 21" day of October 2020 by 0 and between the Monroe County Board of County Commissioners and the Board of Governors Fire and Ambulance District I of Monroe County, Florida, hereinafter referred to as "COUNTY" and Bound Tree Medical LLC, hereinafter referred to as "CONTRACTOR". WITNESSETH: U 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, CL 2016 through November 30, 2019 with two one-year options for renewal subject to the approval of the County, and 3: Q N WHEREAS, on November 20, 2019 the COUNTY entered into the I" 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 CU a� WHEREAS, the COUNTY desires to exercise the second one year renewal option; CU 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 z W incorporated into this renewal as Exhibit A, is hereby renewed for a one-year term �- X beginning December 1, 2020 and terminating November 30, 2021. W F- SECTION 2. Paragraph 5 of the original agreement is amended to read; m 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 E U Page 1 of 6 Packet Pg. 270 C.9.a which outlines both a discount in the form of a percentage off list and pricing on 0 specified numbered items. X a) SECTION 3. Subparagraph 9.M. of the original agreement is amended to read; 0 M. Invoicing. The CONTRACTOR shall furnish the COUNTY complete itemized 2 CL invoices for the goods received. Invoices are to reflect the prices stipulated on the CL 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 0 price discount in the form of a percentage at which the CONTRACTOR will sell °° these items off its list price. 0 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 U 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. N 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. CU 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 I" Renewal and Amendment Agreement, is � amended to read; 0 Cn 16. MAINTENANCE OF RECORDS - CONTRACTOR shall maintain all books, UUj - records, and documents directly pertinent to performance under this Agreement in w accordance with generally accepted accounting principles consistently applied. w 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 D or its authorized representatives shall have reasonable and timely access to such 0 m 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 a) U Page 2 of 6 Packet Pg. 271 C.9.a Agreement. If an auditor employed by the COUNTY or Clerk determines that 0 monies paid to CONTRACTOR pursuant to this Agreement were spent for purposes not authorized by this Agreement, or were wrongfully retained by the a CONTRACTOR,the CONTRACTOR shall repay the monies together with interest a) calculated pursuant to Sec. 55.03, of the Florida Statutes, running from the date the monies were paid by the COUNTY. 2 CL CL SECTION 5. Paragraph 12 of the original agreement is amended to read; 0 12. ADDITIONAL REQUIRED STATEMENTS/VERIFICATION/ M AFFIDAVITS. Attached hereto in attachments. 0 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 U (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 C, SECTION 6. The following FEMA/FDEM REQUIREMENTS are hereby added to the 04 Agreement as paragraphs 19, 20, 21, 22 and 23; 04 U 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, a 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 Cn permit access to facilities, personnel, and other individuals and information as may be necessary, as required by DHS regulations and w other applicable laws or program guidance. u� 3. Submit timely, complete, and accurate reports to the appropriate DHS officials and maintain appropriate backup documentation to support the Z reports. D U Page 3 of 6 Packet Pg. 272 C.9.a 20. DHS SEAL, LOGO AND FLAGS - CONTRACTOR shall not use the 0 Department of Homeland Security seal(s), logos, crests, or reproduction of flags or likeness of DHS agency officials without specific FEMA approval. X a) 21. CHANGES TO CONTRACT - CONTRACTOR understands and agrees that 0 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 2 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 0 Contractor. M 22. The CONTRACTOR is bound by the terms and conditions of the Federally- 0 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. c U SECTION 7. The following language is hereby added to the Agreement as paragraph 24; CL 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, N this Agreement automatically terminates without any further action on the part of N U any party, effective the date of the court order. The parties agree to comply with CU 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 CU 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 0 Cn 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 X of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as w 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 D on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of m 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 U Page 4 of 6 Packet Pg. 273 C.9.a Rights Act of 1968 (42 USC §§ 3601 et seq.), as amended, relating to 0 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, 2 relating to nondiscrimination in employment on the basis of disability; 10) Monroe a) 0 County Code Chapter 14, Article II, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender 0- CL identity or expression, familial status or age; and 11) any other nondiscrimination CL provisions in any federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. m SECTION 8. In all other respects, the parties' December 1, 2016 original agreement and the November 20, 2019 1"Renewal and Amendment Agreement not inconsistent herewith remain in full force and effect. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK. U 04 04 U 04 Cn X U Page 5 of 6 Packet Pg. 274 C.9.a IN WITNESS WHEREOF, each party hereto has caused this Extension to be executed 0 by its duly authorized representatives. (SEAL) BOARD OF COUNTY X Attest: KEVIN MADOK, CLERK COMMISSIONERS OF MONROE 0 COUNTY, FLORIDA 2 By: Deputy Clerk By: m Mayor NB �V OU A TOHNEI( BOARD OF GOVERNORS OF FIRE r- (7 FORM AND AMBULANCE DISTRICT 1 OF '? � MONROE COUNTY FLORIDA P�EU O J. ---a ' � ASS[STA UNTY iiTURNEY [date 10/6/20 By: U Mayor /Chairperson BOUND TREE MEDICAL, LLC S By: 04 (Signature) 04 U Crj Name and Title Date: Crj a� STATE OF: COUNTY OF: en Subscribed and sworn to(or affirmed)before me, by means of❑physical presence or❑online notarization, X on (date) by (name of affiant). He/She is personally known to me or has produced (type of identification) as identification. NOTARY PUBLIC U Page 6 of 6 Packet Pg. 275 C.9.a Attachment A - OCT.2020 Item List for Monroe County RFP-91-0-2016 Renewal #2 0 Q) IMS LIMITED 373369 NALOXONE 2MG 2ML LUERJET 1029B 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 0 PRODUCTS LLC t� 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 L_ PRODUCTS LLC CL 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 ED 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-CARD BX $ 38.02 $ 38.02 MEDTRONIC(covidien) 177268 SMART CAPNOUNE 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 10ML LIFESHIELD SYRINGE 1019A 10EA/BX BX $ 61.70 $ 67.51 SAGENT PHARMACEUTICALS, 0301-68 Adenosine 12mg,4ml Luer Lock Syringe 10/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 10ea/cs IMS LIMITED 371006 ATROPINE 1MG 10ML LUER JET 1006B 10EA/PK PK $ 106.90 $ 106.90 BPI LABS,LLC 103-10 Epinephrine 1mg,1ml 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 cri 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 10EA/BX BX $ 113.51 $ 124.26 •i PFIZER INC.(HOSPIRA) 6695-02 ANIMATE(ETOMIDATE)40MG,20ML VIAL 10EA/BX BX $ 79.90 $ 79.90 CL PFIZER INC.(HOSPIRA) 375204 QUELICIN 200MG 10ML VIAL*REFRIGERATION REQUIRED*25EA/BX BX $ 745.49 $ 745.49 CURAPLEX 2745-10108 Curaplex ECG Chart Paper,Thermal,108mm,Red Grid,for Physio-Control LP11,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 CD 10PR/BX 5BX/CS N CD CURAPLEX 1841-14000 Curaplex Tourniquet 1"x 18",Blue,Rolled,Latex-Free 250/BG 2BG/CS BG $ 22.25 $ 22.25 04 B.BRAUN MEDICAL,INC 7800-09 IV Solution,Sodium Chloride 0.9%1000ml Bag 12ea/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 y Inc i FRESENIUS 0616-03 AMIODARONE 150MG 3ML VIAL 25EA/PK 30PK/CS PK $ 47.50 $ 47.50 cri AMSINO INTERNATIONAL INC C944304 EXTENSION WITH AMSAFE NEEDLELESS INJECTION SITE 8 IN 100/CS EA $ 1.46 $ 1.46 CURAPLEX 1330-86100 MFG B/O Curaplex Alcohol Prep Pad,Large,Sterile 100/BX 10BX/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 CMOS EA $ 27.99 $ 27.99 04 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 1gm,10ml Luer Jet 1010B 10/BX BX $ 109.90 $ 109.90 U) PFIZER INC.(HOSPIRA) 377515 DEXTROSE 50%25GM,50ML ANSYR SYRINGE 1013C 10EA/BX BX $ 95.84 $ 104.86 LIJ BAXTER HEALTHCARE-DMG 118-280842EA Dopamine 400MG/D5W 250MI Bag 18EA/CS CS $ 235.62 $ 235.62 F- BAXTER HEALTHCARE-DMG 356612 INTRAVENOUS(IV)EXTENSION SET NEEDLE FREE WITH 2 Y SITES 43 IN 48/CS INTERLINK EA $ 2.63 $ 2.63 X LIJ SPACELABS HEALTHCARE 1850-80424 Pressure Infuser,UNIFUSOR,1000ml Infusion Cuff w/Aneroid Gauge and Thumbwheel EA $ 11.97 $ 13.54 LIJ Valve 24ea/cs LIJ CURAPLEX 16353 Curaplex Multi-Trauma Dressing,12 in x 30 in,Sterile,50ea/cs EA $ 1.01 $ 1.04 NEPHRON PHARMACEUTICALS 9501-25 ALBUTEROLO.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 U Packet Pg. 276 C.9.a Attachment A-OCT.2020 Item List for Monroe County RFP-91-0-2016 Renewal #2 0 Q) BEMIS MANUFACTURING 595410 SUCTION CANISTER WITH PREATTACHED 6 FTTUBING GREEN 1200cc 48/CS EA $ 6.29 $ 6.29 COMPANY 0 GERI-CARE 911316 Aspirin 81mg Chewable,Orange Flavor 36/Bottle BT $ 0.79 $ 0.79 �A AD[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 0 NICE-PAK 440128 LUBRICATING JELLY PDI STERILE, 2.7GM 144/BX 12BX/CS BX $ 9.67 $ 9.67 i- CL AMBU 2442-21403 MFG B/O BVM,SPUR II,PEDI,COLLAPSED,DISP,WITH MASK AND EXPIRATORY HEPA EA $ 29.39 $ 29.39 CL FILTER,12EA/CS AMBU AMSINO INTERNATIONAL INC 35608306 IV Admin Set,Pediatric 83 in,60 Drop,1 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 ED DYNAREX CORPORATION 1360-07546 Ammonia Inhalant,Ampules 10/bx BX $ 2.30 $ 2.30 BAUSCH HEALTH US LLC 464631 INSTA-GLUCOSE 3IGM 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 0 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 U FRESENIUS O424-05 FLUMAZENIL 0.5MG,5ML VIAL 10VIALS/BX ROMAZICON BX $ 91.50 $ 91.50 crj 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 $ 2.29CL 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 11/2 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 04 CURAPLEX 2021-14640 Curaplex Select Nasopharyngeal Airway,18 Fr,4.Omm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 04 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**CSOI BX $ 22.83 $ 22.83 crj 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-YK10EA Curaplex Yankauer Suction Bulb Tip Only with Control Vent,Sterile 50ea/cs EA $ 0.80 $ 0.80 i FRESENIUS 660-05 Metoprolol 5mg,5ml vial 10EA/BX BX $ 15.80 $ 15.80crj 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 04 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 U) 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 X MEDSOURCE INTERNATIONAL 533-MS-SC08EA 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 ED 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/bx10bx/c U Packet Pg. 277 C.9.a Attachment A-OCT.2020 Item List for Monroe County RFP-91-0-2016 Renewal #2 0 Q) CURAPLEX 2021-14635 Curaplex Select Nasopharyngeal Airway,16 Fr,3.5mm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 0 CURAPLEX 30061MS Curaplex Burn Sheet,60 inch x 90 inch,Sterile 50ea/cs EA $ 2.09 $ 2.12 �A 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 i CL 50ea/cs CL 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 ED 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 $ 0.1704 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 0 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,6in 50ea/cs EA $ 0.91 $ 0.91 MEDLINE 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 10ML VIAL(POWDER)10EA/BX BX $ 88.80 $ 88.80 B.BRAUN MEDICAL,INC 1633-05305 Syringe Only,Scc,Luer lock,100ea/bx 20bx/cs EA crj $ 0.11 $ 0.11 B.BRAUN MEDICAL,INC 1633-10010 Syringe Only,10cc,Luer Lock,100ea/bx 12bx/cs EA $ 0.13 $ 0.13 PFIZER INC.(HOSPIRA) 1893-01 C2 Morphine Sulfate,10mg/ml,1ml 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 $ 2.29CL CURAPLEX 2021-14670 Curaplex Select Nasopharyngeal Airway,28 Fr,7.Omm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 +s CURAPLEX 2021-14675 Curaplex Select Nasopharyngeal Airway,30 Fr,7.5mm,Latex Free PVC 10ea/bx EA $ 2.29 $ 2.29 CD 04 CURAPLEX 2112-38004 Curaplex Endotracheal Tube with Stylette,4.Omm,Uncuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 CD CARDINAL HEALTH 2211-65950 SUCTION TUBING CONNECTOR Y TYPE STERILE 50/CS CS $ 74.33 $ 74.33 04 AMBU 2442-54402 BVM,SPUR II,NEONATE,INFANT WITH OXYGEN RESERVOIR TUBE 12/CS EA $ 13.28 $ 13.28 U 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 crj SPACELABS HEALTHCARE 2614-63516 BP Cuff,SoftCheck,Adult,Disposable,Vinyl,Single Tube with HP/Bayonet Fitting 5ea/bx EA $ 3.47 $ 3.97 Q) SPACELABS HEALTHCARE 2614-81416 BP Cuff,SoftCheck,Infant,Disposable,Vinyl,Single Tube with HP/Bayonet Fitting 5ea/bx EA $ 1.95 $ 2.12crj i i 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,14ft 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 04 200/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 U) 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 F- 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 U Packet Pg. 278 C.9.a Attachment A-OCT.2020 Item List for Monroe County RFP-91-0-2016 Renewal #2 0 Q) CURAPLEX 301-B3110EA Curaplex Select Greenline/D laryngoscope Blade,MILLER 1,Fiber Optic,Infant,Disposable EA $ 3.89 $ 3.89 20ea/cs 0 CURAPLEX 301-B3120EA Curaplex Select Greenline/D laryngoscope Blade,MILLER 2,Fiber Optic,Child,Disposable EA $ 3.89 $ 3.89 �A 20ea/cs ru CURAPLEX 301-B3130EA Curaplex Select Greenline/D laryngoscope Blade,MILLER 3,Fiber Optic,VIED Adult, EA $ 3.89 $ 3.89 Disposable 20ea/cs i CURAPLEX 301-B3140EA Curaplex Select Greenline/D laryngoscope Blade,MILLER 4,Fiber Optic,LG Adult, EA $ 3.89 $ 3.89 CL CL 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 F 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 0 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 U 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,8.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/pk40pk/cs t� DMS 5060220 Restraint Strap,Orange,2 pc,5 ft,Nylon,Metal Push Button Buckle,Loop Ends EA $ 7.39 $ 7.58CL 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 04 COMPANY 04 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 AD[MEDICAL D4808 SUCTION TUBING ONLY 1/4IN X 6 FT 50/CS EA $ 0.60 $ 0.65 MORRISON MEDICAL D6411 HEAD BLOCKS STICKY FOAM-PAIR PR $ 5.02 $ 7.06 crj 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 i TELEFLEX LLC SD121950 Berman Airway 50MM Individually Wrapped Lt.Blue 50/BX EA $ 0.36 $ 0.36 CU Discontinued Items en PROTECTIVE INDUSTRIAL 295561 *DC-VEND-NO SUB*NON-RETURNABLE*SLEEVE WHITE GAUNTLET,ELASTIC OPENINGS,18 EA $ 0.20 F- PRODUCTS,INC. IN 200/CS X 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/cs 40 in x 40 in x 56 in PK $ 3.24 MEDSOU RCE INTERNATIONAL-023312 NASOPHARYNGEAL AIRWAY-NPA-LATEX FREE PVC 12 FRENCH 10/BX RUSCH EA $ 2.29 IMPORT U Packet Pg. 279 C.9.a ATTACHMENT J 0 m VENDOR CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS a� Project 2 Description(s): '" Respondent Vendor Name: c.> Vendor FEIN: 0 Vendor's Authorized Representative Name and Title: Address: U City: State: Zip: CL Phone Number Email Address: 04 04 U Section 287.135, Florida Statutes prohibits a company from bidding on, submitting a proposal for CU 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 CU 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, 0 Florida Statutes, or is engaged in business operations in Cuba or Syria. Cn W As the person authorized to sign on behalf of Respondent, I hereby certify that the company x identified above in the Section entitled"Respondent Vendor Name"is not listed on the Scrutinized W 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 D business operations in Cuba or Syria. m I understand that pursuant to Section 287.135, Florida Statutes, the submission of a false a certification may subject company to civil penalties, attorney's fees, and/or costs. I further Packet Pg. 280 C.9.a understand that any contract with the County may be terminated, at the option of the County, if 0 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 a) a) 0 Petroleum Energy Sector List or been engaged in business operations in Cuba or Syria. 2 Certified By: who is authorized to sign on behalf of the above referenced company. m Authorized Signature: Print > a� Name: Title: E U Note: The List are available at the following Department of Management Services Site: htt ://www.d� s.� yflorida.co� /business operations/state �rchasin /vendor information/convi cted sus�aended discri� inator co� laints vendor lists N U CU CU 04 U) LU LU LU LU Packet Pg. 281 �01 C-OURTQ r Kevin Madok, CPA 4.��y EVIOVf Clerk of the Circuit Court& Comptroller Monroe County, Florida COo^ U L 0 U DATE: January 27, 2020 TO: Chief James Callahan 0 Fire Rescue/EMS Cheri Tamborski Executive Administrator 2 FROM: Pamela G. Hanc C. CLCL SUBJECT: January 22nd BOCC Meeting Attached is an electronic copy the following item(s) for your handling: Q 04 04 C7/H2 1 st Renewal and Amendment to the Bound Tree Medical, LLC Agreement. r Should you have any questions, please feel free to contact me at(305) 292-3550. 2 CL r CU r J J CU cc: County Attorney Finance File 0 U KEY WEST MARATHON PLANTATION 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- Packet Pg. 282 C.9.b U 1st RENEWAL AND AMENDMENT OF AGREEMENT BETWEEN r_ 0 THE BOARD OF COUNTY COMMISSIONERS,AND THE BOARD OF GOVERNORS FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FLORIDA,AND 0 BOUND TREE MEDICAL, LLC FOR THE PURCHASE OF MEDICAL SUPPLIES AND PHARMACEUTICALS 2 THIS 1st RENEWAL and AMENDMENT(hereinafter"RENEWAL")to the contract for CL0. the purchase of medical supplies and pharmaceuticals is made and entered into this 20'h day of November 2019 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 ED E to as "COUNTY" and Bound Tree Medical LLC, hereinafter referred to as "CONTRACTOR". WITNESSETH: co r WHEREAS, on December 1, 2016, the parties entered into an agreement whereby the Cn Contractor is to provide medical supplies and pharmaceuticals to the County; and CL WHEREAS,the original agreement had an initial three-year term beginning December 1, X 2016 through November 30, 2019 with two one-year options for renewal subject to the approval of the County, and WHEREAS, pursuant to the terms of the original agreement the parties desire to renew the agreement for another one-year term, and WHEREAS, the parties also wish to amend the original agreement to incorporate federal CU provisions such that federal funding may be applied to purchases made under this agreement in the event of an emergency or natural disaster; NOW THEREFORE, in consideration of the mutual promises and covenants contained in this Cn RENEWAL,the parties agree: r 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, 2019 and terminating November 30,2020. U SECTION 2. Paragraph 3 of the original agreement is amended to read; °S CONTRACT TERMINATION A. Termination for Convenience: The COUNTY may terminate this Agreement for convenience, at any time, upon sixty (60) days' notice to CONTRACTOR. If the 0 COUNTY terminates this agreement with the CONTRACTOR, COUNTY shall pay CONTRACTOR the sum due the CONTRACTOR under this agreement prior to termination, unless the cost of completion to the COUNTY exceeds the funds U Page 1 of 10 Packet Pg. 283 C.9.b Z U remaining in the contract. The maximum amount due to CONTRACTOR shall not exceed the spending cap in this Agreement. In addition, the COUNTY reserves all 0 rights available to recoup monies paid under this Agreement,including the right to sue for breach of contract and including the right to pursue a claim for violation of the COUNTY's False Claims Ordinance, located at Section 2-721 et al. of the Monroe County Code.Either of the parties hereto may cancel this Agreement without cause by 0 giving the other party sixty(60)days written notice of its intention to do so to the other party;however,this provision may not be exercised during hurricane season(June 1 to November 30) unless both parties mutually agree to terminate. In the event of termination,the COUNTY shall owe for all goods and services delivered prior to the 0 date of termination. 2 B. Termination for Cause and Remedies: In the event of breach of any contract terms,the CL CL COUNTY retains the right to terminate this Agreement. The COUNTY may also terminate this agreement for cause with CONTRACTOR should CONTRACTOR fail to perform the covenants herein contained at the time and in the manner herein provided. In the event of such termination, prior to termination, the COUNTY shall Q provide CONTRACTOR with five (5) calendar days' notice and provide the CONTRACTOR with an opportunity to cure the breach that has occurred. If the breach co is not cured, the Agreement will be terminated for cause. If the COUNTY terminates this agreement with the CONTRACTOR, COUNTY shall pay CONTRACTOR the sum due the CONTRACTOR under this agreement prior to termination,unless the cost of completion to the COUNTY exceeds the funds remaining in the contract; however, CL the COUNTY reserves the right to assert and seek an offset for damages caused by the , breach. The maximum amount due to CONTRACTOR shall not in any event exceed the spending cap in this Agreement. In addition, the COUNTY reserves all rights available to recoup monies paid under this Agreement, including the right to sue for breach of contract and including the right to pursue a claim for violation of the COUNTY's False Claims Ordinance, located at Section 2-721 et al. of the Monroe County Code. In the event that the CONTTRACTOR shall be found to be negligent in CU any aspect of service, the COUNTY shall have the right to terminate this Agreement after five(5) days written notification to the CONTRACTOR. SECTION 3. Paragraph 5 of the original agreement is amended to read; ur r 5. PRICING is set forth in the Medical Supply Discount Off List and Pricing Worksheet (Attachment A—Nov 2019). This will be inserted in the contract which outlines both a discount in the form of a percentage off list and pricing on specified numbered items. CU SECTION 4. Subparagraph 8.C. of the original agreement is amended to read; °S C. Quantities.The quantities listed on the Medical Supply Discount Off List and Pricing �... Worksheet Attachment A — Nov 2019 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. U Page 2 of 10 Packet Pg. 284 C.9.b Z U SECTION 5. Subparagraph 9.I. of the original agreement is amended to read; 0 I. Contract Prices. Contract prices from Medical Supply Discount Off List and Pricing Worksheet Attachment A—Nov 2019 shall be firm and shall not be amended after the RENEWAL is executed. Any attempt by the CONTRACTOR to amend said prices unilaterally shall constitute default as outlined in the contract. 0 Prices quoted shall include all shipping costs, shipped F.O.B. Marathon. Florida or to the facility location specified by the requestor or the purchase order. x a) All taxes of any kind and character payable on account of the work done and materials 0 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 2 use transportation and excise taxes. CL CL 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 N officers, agents, and employees from any and all claims of infringement by reason of the N use of any such patented design,toll,material,equipment or process,to be performed under co 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. CL SECTION 6. Subparagraph 9.J. of the original agreement is amended to read; I Contract Provisional Prices off List Price. Contract pricing for items not included on Medical Supply Discount Off List and Pricing Worksheet Attachment A—Nov 2019 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 RENEWAL is executed. Any attempt by the CONTRACTOR to amend said prices shall constitute default as outlined in the contract. CU 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 price. SECTION 7. Subparagraph 9.L. of the original agreement is amended to read; L. Price Escalation. The County will allow a price escalation provision for items on the Medical Supply Discount Off List and Pricing Worksheet Attachment A—Nov 2019 with CU this award.The original CONTRACTOR prices on Medical Supply List Pricing Worksheet U Attachment A — Nov 2019 shall be firm for a one (1) year minimum period. A price °S 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 accompanied by a certified letter from the CONTRACTOR supplier showing the price increase to the contractor.The price increase to the County shall be limited to the U Page 3 of 10 Packet Pg. 285 C.9.b U percentage increase to the CONTRACTOR as stated in this letter. At the sole discretion of the County,the County may waive the requirement that the price increase be accompanied 0 by a certified letter from the CONTRACTOR supplier showing the price increase to the contractor. Any such waiver shall be in writing and signed by the Battalion Chief of Administration. If at the point of exercising the price escalation provision, market media indicators show that the prices have decreased and that the CONTRACTOR has not passed the decrease on to the COUNTY,the COUNTY reserves the right to place the CONTRACTOR in default cancel the contract and remove the CONTRACTOR from the COUNTY's CONTRACTOR list for a period of time deemed suitable to the COUNTY. 0 SECTION 8. Subparagraph 9.M. of the original agreement is amended to read; 2 CL CL 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—Nov 2019.Invoices are also to reflect the provisional price discount in the M form of a percentage at which the CONTRACTOR will sell these items off its list price. N r The COUNTY will not accept an aggregate invoice. As part of the award process the co COUNTY may request a sample invoice Invoices shall contain but not limited to the following information: CL o Invoice number X 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 SECTION 9. The following FEDERAL CONTRACT REQUIREMENTS are hereby added to the Agreement as paragraphs 15, 16, 17 and 18 and shall read as follows: CU 15. PUBLIC RECORDS -Pursuant to F.S. 119.0701 and the terms and conditions of this contract,the CONTRACTOR is required to: (a) Keep and maintain public records that would be required by the County to perform the service. (b) Upon receipt from the County's custodian of records,provide the County with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this CU chapter or as otherwise provided by law. — (c) Ensure that public records that are exempt or confidential and exempt from °S public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the CONTRACTOR does not transfer the records to the County. (d) Upon completion of the contract,transfer,at no cost,to the County all public records in possession of the Contractor or keep and maintain public records that would be required by the County to perform the service. If the CONTRACTOR transfers all public records to the County upon completion of the contract, the CONTRACTOR shall destroy any duplicate public records that are exempt or U Page 4 of 10 Packet Pg. 286 C.9.b Z U confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, 0 the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the County, upon request from the County's custodian of records, in a format that is compatible with the information technology systems of the County. (e) A request to inspect or copy public records relating to a County contract must be made directly to the County, but if the County does not possess the requested records, the County shall immediately notify the CONTRACTOR of the request, and the CONTRACTOR must provide the records to the County or allow the records to be inspected or copied within a reasonable time. 0 IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF 2 CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TOCL PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS,BRIAN BRADLEY, AT(305)292-3470 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 three r7 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 CL for public records purposes during the term of the Agreement and for four years following the termination of this 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. 17. EQUAL EMPLOYMENT OPPORTUNITY CU During the performance of this Agreement,the CONTRACTOR,in accordance with Equal Employment Opportunity (30 Fed. Reg. 12319, 12935, 3 C.F.R. Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, Amending Executive Order 11246 ur Relating to Equal Employment Opportunity, and implementing regulations at 41C.F.R. Part 60 (Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor). See 2 C.F.R. Part 200, Appendix Il, ¶ C, agrees as follows: CU U A. The CONTRACTOR will not discriminate against any employee or applicant for °S employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. The CONTRACTOR will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race,color,religion,sex,sexual orientation,gender identity,or national � origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The CONTRACTOR agrees to post in conspicuous places, U Page 5 of 10 Packet Pg. 287 C.9.b Z U available to employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination clause. 0 a) B. The CONTRACTOR will, in all solicitations or advertisements for employees placed by or on behalf of the CONTRACTOR, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation,gender identity,or national origin. C. The CONTRACTOR will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant.This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or 2 CL applicants as a part of such employee's essential job functions discloses the CL compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge,in furtherance of an investigation,proceeding,hearing,or action,including an investigation conducted by the employer,or is consistent with the M CONTRACTOR's legal duty to furnish information. N r D. The CONTRACTOR will send to each labor union or representative of workers with co which it has a collective bargaining agreement or other contract or understanding, a notice to be provided by the agency contracting officer, advising the labor union or workers' representative of the contractor's commitments under section 202 of CL Executive Order 11246 of September 24, 1965, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. E. The CONTRACTOR will comply with all provisions of Executive Order 11246 of September 24, 1965,and of the rules,regulations,and relevant orders of the Secretary of Labor. F. The CONTRACTOR will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by the rules, regulations, and orders of the CU Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the contracting agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules,regulations, and orders. G. In the event of the CONTRACTOR 's non-compliance with the nondiscrimination clauses of this contract or with any of such rules, regulations, or orders, this contract may be canceled,terminated or suspended in whole or in part and the CONTRACTOR may be declared ineligible for further Government contracts in accordance with CU procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order °S 11246 of September 24, 1965,or by rule,regulation,or order of the Secretary of Labor, or as otherwise provided by law. H. The CONTRACTOR will include the portion of the sentence immediately preceding subparagraph (A) and the provisions of paragraphs (A) through (G) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor U Page 6 of 10 Packet Pg. 288 C.9.b Z U or vendor. The CONTRACTOR will take such action with respect to any subcontract or purchase order as the administering agency may direct as a means of enforcing such 0 provisions, including sanctions for non-compliance; provided, however, that in the event a contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency the contractor may request the United States to enter into such litigation to protect the interests of the United States. 0 18. CODE OF FEDERAL REGULATION -The CONTRACTOR and its subcontractors must follow the provisions as set forth in 2 C.F.R. §200.326 and 2 C.F.R. Part 200, as amended including but not limited to: 0 A. Davis-Bacon Act, as amended (40 U.S.C. §§3141-3148). When required by Federal 2 CL program legislation, which includes emergency Management Preparedness Grant CL Program, Homeland Security Grant Program, Nonprofit Security Grant Program, Tribal Homeland Security Grant Program, Port Security Grant Program and Transit Security Grant Program, all prime construction contracts in excess of$2,000 awarded by non-Federal entities must comply with the Davis-Bacon Act (40 U.S.C. §§3141- 3144, and §§3146-3148) as supplemented by Department of Labor regulations (29 N CFR Part 5, "Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction").In accordance with the statute,contractors must co be required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor. In addition, contractors must be required to pay wages not less than once a week. If applicable,the CL COUNTY must place a current prevailing wage determination issued by the Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance of the wage determination. The COUNTY must report all suspected or reported violations to the Federal awarding agency. When required by Federal program legislation, which includes emergency Management Preparedness Grant Program, Homeland Security Grant Program, Nonprofit Security Grant Program, Tribal Homeland Security Grant Program, Port Security Grant Program and Transit Security Grant Program(it does not apply to other FEMA grant and cooperative agreement programs, including the Public Assistance CU Program), the contractors must also comply with the Copeland "Anti-Kickback" Act (40 U.S.C. §3145),as supplemented by Department of Labor regulations(29 CFR Part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States").As required by the Act, each contractor or subrecipient is prohibited from inducing,by any means,any person employed in the construction,completion,or repair of public work,to give up any part of the compensation to which he or she is otherwise entitled. The COUNTY must report all suspected or reported violations to the Federal awarding agency. (i) CONTRACTOR. The CONTRACTOR shall comply with 18 U.S.C. § 874,40 U.S.C. § 3145, and the requirements of 29 C.F.R.pt. 3 as may be °S applicable,which are incorporated by reference into this Agreement. (ii) Subcontracts. The CONTRACTOR or subcontractor shall insert in any subcontracts the clause above and such other clauses as the FEMA may by appropriate instructions require, and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts.The prime CONTRACTOR shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all of these contract clauses. U Page 7 of 10 Packet Pg. 289 C.9.b Z U (iii) Breach. A breach of the contract clauses above may be grounds for 0 termination of the contract, and for debarment as a contractor and subcontractor as provided in 29 C.F.R. § 5.12. B. Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where applicable, which includes all FEMA grant and cooperative agreement programs, all contracts awarded by the COUNTY in excess of$100,000 that involve the employment of mechanics or laborers must comply with 40 U.S.C.§§ 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. §3702 of the Act, each contractor must compute the wages of every mechanic and 0 laborer on the basis of a standard work week of 40 hours. Work in excess of the ru standard work week is permissible provided that the worker is compensated at a rate 2 of not less than one and a half times the basic rate of pay for all hours worked in excessCL of 40 hours in the work week. The requirements of 40 U.S.C. 3704 are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or N transmission of intelligence. c� r co C. Rights to Inventions Made Under a Contract or Agreement. If the Federal award meets the definition of"funding agreement" under 37 CFR §401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit CL organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that "funding agreement," the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. D. Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387). Contractor agrees to comply with all applicable standards, CU orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. §§7401-7671q) and the Federal Water Pollution Control Act as amended(33 U.S.C. §§1251-1387)and will report violations to FEMA and the Regional Office of the Environmental Protection Agency(EPA).The Clean Air Act(42 U.S.C. 7401-7671q.)and the Federal Water Pollution Control Act(33 U.S.C. 1251-1387),as amended—applies to Contracts and subgrants of amounts in excess of$150,000. J E. Debarment and Suspension (Executive Orders 12549 and 12689)A contract award CU (see 2 CFR 180.220) must not be made to parties listed on the governmentwide exclusions in the System for Award Management(SAM),in accordance with the OMB °S guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment and Suspension." SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. F. Byrd Anti-Lobbying Amendment(31 U.S.C. 1352)—Contractors that apply or bid for an award exceeding$100,000 must file the required certification.Each tier certifies to U Page 8 of 10 Packet Pg. 290 C.9.b U the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or 0 employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non-Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non-Federal award. G. Compliance with Procurement of recovered materials as set forth in 2 CFR§200.322. CONTRACTOR must comply with section 6002 of the Solid Waste Disposal Act, as 0 amended, by the Resource Conservation and Recovery Act. The requirements of ru Section 6002 include procuring only items designated in guidelines of the 2 Environmental Protection Agency(EPA) at 40 CFR part 247 that contain the highestCL percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition,where the purchase price of the item exceeds$10,000 or the value of the quantity acquired during the preceding fiscal year exceeded$10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for N procurement of recovered materials identified in the EPA guidelines. c� co H. Americans with Disabilities Act of 1990, as amended (ADA) —The CONTRACTOR will comply with all the requirements as imposed by the ADA, the regulations of the Federal government issued thereunder, and the assurance by the CONTRACTOR CL pursuant thereto. X r I. Disadvantaged Business Enterprise (DBE) Policy and Obligation - It is the policy of the COUNTY that DBE's,as defined in 49 C.F.R.Part 26, as amended,shall have the opportunity to participate in the performance of contracts financed in whole or in part with COUNTY funds under this Agreement. The DBE requirements of applicable federal and state laws and regulations apply to this Agreement.The COUNTY and its CONTRACTOR agree to ensure that DBE's have the opportunity to participate in the performance of this Agreement. In this regard,all recipients and contractors shall take CU all necessary and reasonable steps in accordance with 2 C.F.R. § 200.321(as set forth in detail below), applicable federal and state laws and regulations to ensure that the DBE's have the opportunity to compete for and perform contracts.The COUNTY and the CONTRACTOR and subcontractors shall not discriminate on the basis of race, color, national origin or sex in the award and performance of contracts, entered pursuant to this Agreement. 2 C.F.R. § 200.321 CONTRACTING WITH SMALL AND MINORITY BUSINESSES, WOMEN'S BUSINESS ENTERPRISES, AND LABOR SURPLUS CU AREA FIRMS U a. If the CONTRACTOR, with the funds authorized by this Agreement, °S seeks to subcontract goods or services, then, in accordance with 2 C.F.R. §200.321, the CONTRACTOR shall take the following affirmative steps to assure that minority businesses, women's business enterprises, and labor surplus area firms are used whenever possible. b. Affirmative steps must include: (1) Placing qualified small and minority businesses and women's business enterprises on solicitation lists; U Page 9 of 10 Packet Pg. 291 C.9.b U (2) Assuring that small and minority businesses, and women's business enterprises are solicited whenever they are potential sources; 0 (3) Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small and minority businesses,and women's business enterprises; (4) Establishing delivery schedules, where the requirement permits, which encourage participation by small and minority businesses, and women's o business enterprises; (5) Using the services and assistance,as appropriate, of such organizations as the Small Business Administration and the Minority Business Development Agency of the Department of Commerce. 0 (6) Requiring the Prime contractor, if subcontractor are to be let, to take the affirmative steps listed in paragraph(1) through(5) of this section. 2 CL CL J. The CONTRACTOR shall utilize the U.S. Department of Homeland Security's E- Verify system to verify the employment eligibility of all new employees hired by the Contractor during the term of the Contract and shall expressly require any subcontractors performing work or providing services pursuant to the Contract to M likewise utilize the U.S.Department of Homeland Security's E-Verify system to verify N the employment eligibility of all new employees hired by the subcontractor during the Contract term. co r SECTION 10. In all other respects,the parties' December 1,2016 agreement remains in full force and effect. CL x r _ J! N. WITNESS WHEREOF, each party hereto has caused this Extension to be executed by its duly uthc�r d representatives. -mQ J CI L i \� kSEA�L' BOARD OF COUNTY COMMISSIONERS •641�if.�b ���. u,n�Att�sf�:W r VIN MADOK,CLERK OF MONROE COUNTY,FLORIA Aj L r � � :� Q CU Tarr;Er u NCD By: By: Deputy Clerk Udyor <" rrj -� ►3- n BOUND TREE MEDICAL,LLC BOARD OF GOVERNORS OF DIRE ANC AMBULANCE DISTRICT 1 OF MONR(W —� COUNT FLORIDA By: I&U (Signature) By: Rhiannon Greene/Senior VP of Pricing Mayor/Chairperson Name and Title Date: 10/31/2019 MO E COU ATTO 0 ED .� P.EDRQ J.MERCADO ASSIST Page 10 of 10 Packet Pg. 292 C.9.b Attachment A - Nov. 2019 Item List for Monroe County Medical Supplies and Pharmaceuticals RFP-91-0-2016,Renewal 1 0 Vendor Name Item Description _ F ;ABBOTT 11 ,_---Glucose Test Strips,Precision _ra Capillary 50/bx 12bx/cs -_-jBX $ 22.22 i$ 22.22 C IVO DIEN �- 177268 SMART CAPNOLINE PLUS NON INTUBATED ORAL NASAL W/02 TUBING EA $ 9.84 I$ 9.84 I j _ _ (ADULT/INTERMEDIATE 100EA/BX ___ AQUABILITI -� �i600-10 - IV Flush Syringe,Normal Saline,10 ml,Prefilled 12 cc Syringe,Sterile 100ea/bx EA j$ 0.36 $ 0.36 - -_------___.-_1_ _______ ...... INTERSURGICAL 2114-87302 li-gel 02 Resus Pack,MED Adult,incl size 4 i-gel 02,Lube,Strap,for Pts 50-90 kg EA $ 23.59 $ P23.59 I INCORPORATED I _ 6ea/cs ��_-- CONMED CORPORATION j354431 J - INTRAVENOUS(IV)DRESSING TRANSPARENT ADULT 100/BX 5BX/CS VENI-GARD BX I$ 38.02$ 38.02 i IMS LIMITED _ 373369 INALOXONE 2MG 2ML LUERJET 1029B 10EA/CS EA I$ 42.70 $ 42.70 I 0430 �*SEE NOTES*Nrt 400 mcg Spray 4.1 gm Bottle 90 metered doses _ - _ �EA j$ 5.09 $ 175.09 Icri EVUS PHARMACEUTICALS � -04 itoMis , , 17_ __ _ --�� AMBU 12144-KV033 King Vision Video Laryngoscope Blade,Channeled,Disp,18mm,w/White LED,Digital EA^�$ 27.99 $ 27.99 I `> _ _ CIVICS Camera l0ea/cs-__ �__ _fi INTERSURGICAL 2114-87301 ~4�i.gel 02 Resus Pack,SM Adult,incl size 3 i-gel 02,Lube,Strap,for Pts 30-60 kg 6ea/cs EA $ 23.591$ 23.59 j CL CL INCORPORATED F I I PFIZER INC.(HOSPIRA)_ j374921 ,EPINEPHRINE 1:10000 1MG 10ML LIFESHIELD SYRINGE 1019A 10EA/BX IBX $ 59.90 j$ 61.70 j INTERSURGICAL I2114-87303 11-gel 02 Resus Pack,LG Adult,incl size 5 i-gel 02,Lube,Strap,for Pts 90 plus kg 6ea/cs EA $ 23.59 1$ 23.59 INCORPORATED CAPITAL WHOLESALE DRUG '0047-22 !LTD QTY-USE 0409-0047-22 Solu-Medrol,125mg,2ml ACT-O-VIAL 25ea/bx IEA-j$ 10.25 ;$ 11.82 jSTRYKER �236086 jDEFIB/PACING/ECG PADS ADULT W/QUIK-COMBO CONNECTOR 2FT LEAD,LP12, I!PR-I$ 22.06 1$ 25.74 CD --------_-.--- ---------------ILP151/PR lOPR/BX SBX/CS-------------'------------- --------- N 1 _ .. _ 1 � PFIZER INC.(HOSPIRA) - 4755-02A _ __�ONDANSETRON 4MG 2ML_VIAL 25EA/BX _ `- _.. jBx-_-�$-_13.25 is ry 20_87 I 04 LPFIZER INC.(HOSPIRA)- 16695-02 1Zil);TE(ETOMIDATE)40MG_20ML VIAL 10EA/BX IBX �$ 79.90 I$ 79.90 1CD ICURAPLEX - �330-86100 iCuraplex Alcohol Prep Pad Large Sterile 100/BX 10BX/CS �BX E$ _ 2.1 $ 2.52 �i _____ ._...___ ___r__.._._ -- CONMED CORPORATION - 2716 ._ I ELECTRODES 5/STRIP 12BX/CS .. CS 1$, 104 38 j$ 104.38 j IMS LIMITED 371006 ATI ROPINE iN 10ML LUER JET 1006B 10EA/PK ____.._........ EA1.$_ 10.69 1$A 10.69 AMSINO INTERNATIONAL INC 35108306 (INTRAVENOUS(IV)ADMINISTRATION SET NEEDLE FREE 1 Y SITE 1 VALVE 10 DROP 83 SEA 1$ 1.75 1$ 1.75CL i AMSINO INTERNATIONAL INC C944304 !EXTENSION WITH AMSAFE NEEDLELESS INJECTION SITE 81N 100/CS jEA [$ 1.46 $ 1.46 PFIZER INC.( 150DIUM BICARBONATE 8.4%LIFHIELD SYRINGE 1035A lOEA/BX �BX ;$_ 110.20�$�113_51_ L(HOSPIRA) f376637 ES j Hikma Pharmaceuticals USA lncj0376-25___ DIPHENHYDRAMINE 50MG/MLIMLSDV2035-BENADRYL 25VIALS/PK jEA is 1.03 $ 1.271 _ j iFRESENIus- 0616 03 IAMIODARONE 150MG 3ML VIAL iEA 1$ 1.90 j$ 1.90 'CURAPLEX _ �1841 14000 1Curaplex Tourniquet 1 x 18 Blue Rolled,Latex-Free 250/BG 2BG/CS IBG-_;$ 20.38 j$ 22.25_j PFIZER INC(HOSPIRA) _ _j371104 C4 DIAZEPAM 5MG/ML 2_ML LU ER LOCKING CARPUJ ECT 10/BX_CS044 [BX _i$ 282.99 i$ 317.68 j ......._._. [LP5._.._----__-.__ __.`._..-_. ._._.. .�� - IEA._1$ ..-10.05 !S 10.05 STRYKER� �- 230107 DEFIB/PACING/ECG PADS PEDI W/QUIK COMBO CONNECTOR FOR LP15 LP12,LP10, PR $ 26.97 I 31.47 j AMBU _ -_ `520 211 - .BVM,SPUR II,ADULT W/MEDIUM ADULT MASK,INDIVIDUALLY BOXED 12/CS- �- ' 1-m- cri PFIZ_E_R INC(HOSPIRA) 1375204 IQUELICIN 200MG 10ML VIAL*REFRIGERATION REQUIRED*25EA/BX B_X_ _ $_ 723.75 $ 7_45 49 )CURAPLEX_ -_- �61411 Curaplex Paramedic Shears,Black 7.25 in SOpr/bx - PR ;$ 0.78 1$ -0.78 I ('SPACELABS HEALTHCARE 1850 80424 jPressure Infuser,UNIFUSOR,1000ml Infusion Cuff w/Aneroid Gauge and {EA I$ 11,97]$ 11.97 iThumbwheel Valve 24ea/cs !LAERDAL MEDICAL CORP. �L980010 Extrication Collar,Stifneck Select Adult Adjustable Nasal Cannula Hook_ iEA i$ 5.20 I is 5.20 B.BRAUN MEDICAL,INC 1358001 IV Solution,Sodium Chloride 0.9%500ml Bag 24ea/cs BBraun L8001 !EA j$ _ 2.30 $ 2.4'9 +,+AMBU 2144-KV031 ('King Vision Video Laryngoscope Blade,Standard,Disp,13mm,w/White LED,Digital EA I1$ 27.99 j$ 27.99 I e CM OS Camera 10ea/bx 1 CURAPLE_X_ j16353 _ _-`iCuraplex Multi-Trauma Dres_sing,.12 inx_30in,Sterile,_Soea/cs _ 1EA is 1.01 is 1.ol BAXTER HEALTHCARE-DMG 1118-2B0842EA ���---Do---pamine 400MG/D5W 250MI Bag 18EA/CS _ - _- -SEA 13.09 I$ 13.09 rNEPHRON PHARMACEUTICALS I9501-25 IHLBUTEROL 0.083% 2.SMG/3ML 25VIALS/BX IBX I$ 3.65 I$ 3.65 1 cri _.1__._ /.I. / 1$ 7.72 7.$ 72 j(NICE-PAK 1285484 ,GERMICIDAL WIPES EXTRA LARGE 81N X 141N 65 UB 6TUB CS SANI-CLOTH HB TB i B.BRAUN MEDICAL,INC 7800-09 IV Solution,Sodium Chloride 0.9%10o0ml Bag 12ea/cs E8000 EA�_$ 2.35 $ 2.48 DYNARE_X CORPORATION _ ;1360-07546 Ammonia Inhalant,Ampules 10/bx __ _ _ BX }$_2.30 f$ 2.30 SMITHS MEDICAL_ASD,INC. j532002 -�y ,_VENTILATION CIRCUIT DISPOSABLE WITH PEEP_VALVE_10/BG �_-_�-� IEA F$ __1_9.57F$ _19.57J i BEMIS MANUFACTURING 595410 SUCTION CANISTER WITH PREATTACHED 6 FT TUBING GREEN 1200cc 48/CS- IEA $ 6.29 $$ 6.29 COMPANY PFIZER INC.(HOSPIRA) 371113 'C4 MIDAZOLAM 10MG,2ML VIAL(5MG/ML)10/BOX CS13(VERSED) BX I$ 14.99 $ 15.45 --_l__.. a �_ _._ _ 1 _ _ 1_ _ 1 COMPANY INC.(HOSPIRA) �377515_ !DEXTROSE 50%25GM,50ML A_NSYR SYRINGE 1013C 10EA/BX jBX $ 78.901$ 95.84j 0 -- _ LAERDAL MEDICAL CORP. I020500 �Endotracheal Tube Holder,Thomas,Adult,for ET/SGA Tubes 6.5mm ID to 21mm OD `EA $ 2.78 $ 2.78 j MEDSOURCE INTERNATIONAL 533-MS-GZC54BG jConforming stretch bandage,gauze,4 in.,sterile,12rl/bg 8bg/cs� - BG ,$ 3.25 l$ 3.25 ` _____j AMSINO INTERNATIONAL INC 35608306 - IV Admin Set,Pediatric 83 in,60 Drop,l Y-Site,1 Valve 50ea/cs JEA 1+$ 1.92 t$ 1.92 I! CU Packet Pg. 293 C.9.b U Cambridge Sensors USA,LLC I952000 COLD PACK INSTANT 5.51N X 10 IN 24/CS RAPID COLD SCCSS $ 26.47 1$ 26.47 0 BAXTER HEALTHCARE-DMG 356612 INTRAVENOUS(IV)EXTENSION SET NEEDLE FREE WITH 2 Y SITES 43 IN 48/CS - EA $ 2.63 $ 2.63 _ INTERLINK FEA S`92._"_ CURAPLEX 30061M5 Curaplex Burn Sheet,60 inch x 90 inch,Sterile 50ea/cs EA $ 2.09 $ 2.09 ADI MEDICAL 667000 BODY BAG BASIC VINYL STRAIGHT ZIPPER 6 GAUGE 36 IN X 90 IN 10/CS EA $_ 6.47 I$ 6.47 Z131.1 �^� 2442-21403 BVM,SPUR II,PEDIATRIC,COLLAPSED,DISP,WITH MASK AND EXPIRATORY HEPA EA-�$ 29.39 '$ 29.39 FILTER,I2EA/CS AMBU _ _ I!i f,BEcTON DICKINSON 1641-76618 jSafety Needle,BD Eclipse,18 ga x 11/2 in.,100/bx 12bx/cs BX $ 27.72 $ 27.72 CONMED CORPORATION 1231620 _ ELECTRODES PEDIATRIC 3/PK 10PK/BX 20BX/CS HUGGABLE BX $ 5.26($ 5.26 CARDINAL HEALTH 2231-91130 Salem Gastric Sump Tube,10 Fr,36 inch SOea/cs �-' EA _$ $ 1.99 BAUSCH HEALTH US LLC _ 464631 -^ NSTA-GLUCOSE 31GM 2064 -� EA !$ ~_-3.59'$ 3.59 �PFIZER INC.(HOSPIRA) 1371100 --SC4 LORAZEPAM 2MG 1ML VIAL 10/BOX`REFRIGERATE"CS01 BX $_^21.74 $ 22.83 DIMS LIMITED 1373304y jCalcium Chloride Sgm,SOml LuerJet 1010B jEA 1($� 10.99 $ 10.99 1BECTON DICKINSON I629663 � ISYRINGE ONLY LUER LOCK 60CC 40/BX 4BX/CS BECTON DICKINSON 309653�"BX $ 21.85 $ 21.85 !�EMERGENCY PRODUCTS& 3176-07705 HAND-E HAND HOLD DEVICE YELLOW T EA i$ 16.99 $ 16.99 !RESEARCH _ _ _ _ _ > MEDSOURCE INTERNATIONAL 533-MS-SCOSEA Suction Catheter,8 Fr,coiled,w/whistle tip and thumb control port,sterile,disp,LF EA $ 0.20E$ 0.20 L- 50ea/cs CL CL )SMITHS MEDICAL ASD,INC. 350534 STOPCOCK 4 WAY WITH SWIVEL AND_MALE LUER_LOCK 50/CS EA !$ 1.19 $ 1.19 CURAPLEX 533-MS-YK10EA Curaplex Yankauer Suction Bulb Tip Only with Control Vent,Sterile 50ea/cs EA j$ 0.80 $ 0.80 WATER-J EL TECHN OLOGIES ,710206 IBURN DRESSING WATER-JEL21N X 6 1 N 60/CT __ IEA 1$ 2.79!$ 2.79 I CURT APLEX 1301-100EA ^�Curaplex Oxygen Nasal Cannula,Adult,Conventional,Clear,Flared Prongs,7 ft �l EA ($ 0.31 1$ 0.31 I} )tt ubing,50ea/cs l DYNAREX CORPORATION 540047 )_PREPARATION RAZORS SO/BX SBX/CS GALLANT 4251(250EA/CS) -� �_ EA $ 0.37 1$ 0.37 Il_._.__�.v....104 CURAPLEX 301-439EA )Curaplex High efficiency HEPA filter,w/port,hydrophobic paper,TV greater than EA 1$ 2.39 1$ 2.39 _I104 500ml 50ea/cs __ I -PFRER INC.(HOSPIRA) I0074553401 SODIUM BICARBONATE 4.2%lOML INFANT LIFESHIELD,1043A lOEA/BX BX $ _1.16.50 i$ 120.00 I BAXTER HEALTHCARE-DMG 135843_7 IV Solution,Sodium Chloride 0.9%100ml Bag,Singles 96ea/cs T_EA__�$ _1.85�$ 2.08J i IICURAPLEX � 1301-200EA 1 Curaplex Select Nebulizer,Small-volume,Hand-held,T- iece,Mouthpiece,Flextube, EA ' 0 �'p p' p' $ 0.65 1$ 0.65 17 ft Tubing 50/cs _ MEDSOURCE INTERNATIONAL 533-MS-SC12EA Suction catheter,12 Fr,tolled,w/whistle tip and thumb control port,sterile,disp,LF EA `$ 0.20 I$ -0.20 i 150ea/csCL ..w......._._,.._..,_.....__..-....__.____....._....___._-_....__....._....,....._.._..___-_-____.._.______...._._ __-.___ ,.._...e.....__......- MEDSOURCE INTERNATIONAL 533-MS-SC14EA ISuction Catheter,14 Fr,coiled,w/whistle tip and thumb control port,sterile,disp,LF 1 IEA {$ 0.20{$ 0.20 UJI ....._._.._.-._..___._ �._......_v._-1 e 1 MEDSOURCE INTERNATIONAL 533-MS-SC18EA Suction catheter,18 Fr,coiled,w/whistle tip and thumb control port,sterile,disp,LF �EA $ _ 0.20 I$ 0.20 I i � GREAT PL_AIN LIS_S BALTIC_5 021410 _ AIR FLOW MONITOR �_R BAAM 100/CS_ _-_ EA j$ 6.47�$-6.4747 Q) {N CARDINAL HEALTH +�2114-31412 - G Tube,Levin,12 Fr,Clear,48 inch,Markings 18,22,26 and 30 in,Open Distal End, EA !$ 1.06 $ 1.06- S ISOe -�_._a/cs _ _________ �-__S 'I ��_._...r._ �MEDSOURCE INTERNATIONAL 533-MS-SCO6EA Suction Catheter,6 Fr,coiled,w/whistle tip and thump co_ntrol port,sterile,disp,LF IEA J$ 0.20T$ 0.20, i ------ - '-- ------- ----I50ea/cs__ _. - -- ----- ---' _ -'-- ' - - - t LAERDAL MEDICAL CORP. 260201 EXTRICATION COLLAR BABY NO NECK 50/CS STIFNECK IEA $ 5.55 $ 5.55 FRESENIUS I0424-OS �FLUMAZENILO.SMG,SMLVIAL lOVIALS/BX ROMAZICON _ _ _SEA.-�_$_ 9.15�$ 9^15.j WEST CHESTER HOLDINGS, _ 1295561 SLEEVE WHITE GAUNTLET,ELASTIC OPENINGS,181N 200/CS EA I$ 0.20 1$ 0.20 Crj INC. _ADI MED 80 )�- . Crj ICAL _ ID48 SUCTION TUBING ONLY 1/41N X 6 FT SO/CS _ _ _ �EA_ $ 0.60 $ 0.60_� MEDICAL SUPPLY SOLUTIONS, NS5251 BUD Saline,Modudose,3m1,Sodium Chloride 0.9%,for Inhalation,Easy Open EA $ 0.11 $ 0.13 I I_NC _ ___i _ _ __ __Twist/Pull 100ea/bx lObx/c __ _ _ 111fIfIfIF ___�__.._..._.__.._. _._...._....� CARDINAL HEALTH 12114-33018 1NG Tube,Levin,18 Fr,Clear,48 inch,Markings 18,22,26 and 30 in,Open Distal End, jEA $ 1.06 j$ 1.06 ______ (50ea/cs CARDINAL HEALTH - 12114-32216 SING Tube,Levin,16 Fr,Clear,48 inch,Markings 18,22,26 and 30 in,Open Distal End, !EA '$ 1.06 $ 1.06 U} e )CURAPLEX 301-B3030EA Curaplex Select GreenLine/D Laryngoscope Blade,MAC 3,Fiber Optic,MED Adult, EA 1$ 3.89�$ 3.89 Disposable 20ea/cs CURAPLEX 1301-133130EA Curaplex Select GreenLine/D Laryngoscope Blade,MILLER 3,Fiber Optic,MED Adult, JEA $ 3.89 l$ 3.89 - Disposable 20ea/cs_ I TELEFLEX LLC r 020603 (MASK NON-REBREATHER PARTIAL HIGH CONCENTRATION,100%02,ADULT 50/CS EA J$ 1.10 $ 1.10 _TELEFLEX LLC 021002 _ AIRWAY BERMAN CHILD SIZE 160MM 50/BX BULK 121802 _ -��EA�)$ _0.16 1$ -0.17 a) TELEFLEX LLC .__. 021003 (AIRWAY BERMAN SMALL ADULT SIZE 3 SOMM 50/BX BULK 121803 _ EA__ $ 0.16 j$ 0.17 TELEFLEX LLC 021004 AIRWAY BERMAN MEDIUM ADULT SIZE 4 90MM 50/BX BULK N/S SEA $~� 0.16 $ 0.17 TELEFLEX LLC 621005 _AIRWAY_BERMAN LARGE ADULT SIZE 5 100MM 50/BX BULK 121805 EA $ 0.16 $ 0.17 y PFIZER INC.(HOSPIRA) 0409-4350-03 -Diltiazem 100mg ADD-vantage Vial,Non-Refrig,(ADD-vantage diluent required-sold BX 1$ 147.90 $ 152.40 !separately 10EA/BX 1�__ DYNAREX CORPORATION 083501P _ jDressing,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^6in 50ea/cs EA_ $ 0.91 $ 0.91 11 MEDLINE INDUSTRIES,INC. 1072-80347 Wash Basin,Rectangular,6 Quart,Graphite,50ea/cs_ EA $ 0.68 $ 0.68 I CURAPLEX 1124-03680 LTD CITY-use 1124-32400-Curaplex Triangular Bandage,Polypropylene 240ea/cs EA _-I �PFIZER INC.(HOSPIRA)-V 11312-30 - C2 HYDROM_ORPHONE 2MG/ML 1ML CPJ 10/BX BX-I$ --27.69 $ 28.52_III DYNAREX CORPORATION 1350-14547 - Triple Antibiotic Ointment,0.9gm Foil Pack 144/bx 126x/cs �BX $ S1.S9 $ 11`89 PFIZER INC.(HOSPIRA)` 1632-01 VECURONIUM 10MG 10ML VIAL(POWDER)10EA/BX _!BX IS -88.80 i$ 88.80 1 U CU_. �. Packet Pg. 294 C.9.b U B BRAUN MEDICAL,INC 1633-05305 �1Syringe Only,5cc,Luer Lockkl00ea/bx 20bx/cs IEA^y ._._._._ r _ B.BRAUN MEDICAL,INC 1633-10010 Syringe Only,10cc,Luer Lock,100ea/bx 12bx/cs � _ !EA i$ 0.09($ 0.13; 0 PFIZE�HOSPIRA) 1893-01 C2 Morphine Sulfate,10mg/ml,1ml PF CPJ 10/bx � BX $ 24.09 $ 24.09 (CURAPLEX 2021-14630 Curaplel Nasopharyngeal Airway,14 Fr,3.0mm,Latex Free PVC 10ea/bx �� EA $ex Sect 2.29 $ 2.29} i 'CURAPLEX 463 2021-15v�` Curaplex Select Nasopharyngeal Airway,16 Fr,3.5mm,Latex Free PVC 10ea/bx rl EA j$ �2.29 $ 2.29 CURAPLEX 12021-14640 iCuraplex Select Nasopharyngeal Airway,18 Fr,4.Omm,Latex Free PVC 10ea/bx yEA `$ 2.29 $ 2.29 CURAPLEX 2021-14650 v Curaplex Select Nasopharyngeal Airway,20 Fr,S.Omm,Latex Free PVC 10ea/bx EA T�2.29 $ 9!3 CURAPLEX i2021-14655 (Curaplex Select Nasopharyngeal Airway,22 Fr,S.Smm,Latex Free PVC l0ea/bxEA $ 2.29 $ 2.29 1 i CURAPLEX �2021-14660 Curaplex Select Nasopharyngeal Airway,24 Fr,6.Omm,Latex Free PVC l0ea/bx� IEA $ 2.29($ 2.29 CURAPLEX i2021-14665 ICurI aplex Select Nasopharyngeal Airway,26 Fr,6.5mm,Latex Free PVC 10ea/bx j EA $ 2.29 $ 2.29 Crj CURAPLEX I2021-14670 ,Curaplex Select Nasopharyngeal Airway,28 Fr,7.Omm,Latex Free PVC l0ea/bx EA .$ 2.29 $ 2.29 j 0 lCL 'CURAPLEX �2021-14675 (Curaplex Select Nasopharyngeal Airway,30 Fr,7.5mm,Latex Free PVC l0ea/bx !EA ;$ 2.29 $ 2.29 i CL yLR TRADING CO.,INC 1209936 IHAND CLEANSER FOAMING ALCOHOL BASED 9 OZ 24/CS ALCARE PLUS _ IEA ($ 9.97($ 9.97 CURAPLEX I2112-38004 (Curaplex Endotracheal Tube with Stylette,4.Omm,Uncuffed l0ea/bx 10bx/cs IEA $ __._.1.52 $_ 1.52 Py I CARDINAL HEALTH_____._ (2114-71114 ING Tube,Levin,14 Fr,Clear,48 inch,Markings 20,24,28 and 32 in,Open Distal End, iEA $ 1.06 $ 1.11; ar CARDINAL HEALTH 2211_65950 UCTION TUBING CONNECTOR Y TYPE STERILE 50/CS� �^ (CSY ($ 74_33�$ 74.33 1 04 A .___µ _!2442-54402 iBVM,SPUR II NEONATE INFANT WITH OXYGEN RESERVOIR TUBE 12/CS -_-�E_A ($ 04 13.28 1$ 13.28 1 �MEDIQUE PRODUCTS r25711 �~tHydrogen Peroxide,Topical Solution,16 oz Bottle,12ea/cs IEA $ 0.9_8;$ 0.98 r .�...�_..�.�____.._.. ._.w._.. ...__..r.._..._.._._._. ..__ +- LAER DAL MEDICAL CORP. 1261262 ��� EXTRICATION COLLAR PEDIATRIC_50/CS STIFNECK_ EAw!$ 5.59 i$ 5.59 C0 �.._....._.._..,.,_.m_______.. _ ..._...P._._,.._._.w. ._........__:_.._.d..._ e (SPACELABS HEALTHCARE 2614-32016 BP Cuff,SoftCheck,Child Disposable,Vinyl,Single Tube with HP/Bayonet Fitting jEA E$ 2.291 $ 2.29 _ Sea/bx SPACELABS HEALTHCARE_ '2614-63516 {BP Cuff,SoftCheck,Adult,Disposable,Vinyl,Single Tube with HP/Bayonet Fittings EA„ $ 3.47 $ 3.47 M I 15ea/bxCL i }SPACELABS HEALTHCARE 12614-81416 1,BP Cuff,SoftCheck,Infant,Disposable,Vinyl,Single Tube with HP/Bayonet Fitting EA $ 1.95#$ 1.95 I 5ea/bx ' Uj ;SPACELABS HEALTHCARE 12614-82616 jBP Cuff,SoftCheck,SM Adult,Disposable,Vinyl,Single Tube with HP/Bayonet Fitting IEA {$ 2.51 $ 1.56( r iCOVIDIEN_ 12722-76800 1CO2 Sampling Line,Microstream Filterline Set,Adult/Pediatric,14ft long,Airway IEA $ 8.89;$ 8.89 ( I (Adapter 25ea/bx _._.........._ 'WELCH ALLYN,INC.. 12733-57505 ;Probe Covers,Braun ThermoScan Pro 4000 Thermometer,Disposable 200/bx 25bx/cs IBX 1$ 14.79 j$ 14.79 I 'DUKAL CORP. r276-8506BG (Gauze sponge basic economy,2 in x 2 in,12 ply,non sterile 200/bg 406g/cs IBG $ 0 92 0.92l (DYNAREX CORPORATION 1279-3343BX Gauze sponge sterile 4 in x 4 in,12 ply,2/pk 25pk/bx 24bx/cs __ _(BX $ 1.75 1$ _1 75 MEDEGEN MEDICAL ^+ 1290116 (BIOHAZARD BAG RED 7-10 GAL 23 X 231.2MIL 500/CS IEA 1 S 0.09 j$ 0.09 Crj :PRODUCTS 3M HEALTH CARE 291860 YJ (Particulate Respirator,N95,REG Size,Cup,Blue,Nosefoam,Fluid Resistant,Disp,LF )BX !$ 19.53 $ 19.92 I 120/bx 6bx/cs ANSELL HEALTHCARE 1297750 Gloves,Freeform EC,SM,Extended Cuff,Nitrile,Latex Free,Powder Free 50/bx�~PBX '$......__.8.50 $ 8.51 fv PRODUCTS LLC ! _ f 10bx/cs _ _ �- _ _.._.__ ._..��._.... _.,. _ _ _.._� (ANSELL HEALTHCARE (297755 u`Gloves,Freeform EC,MED,Extended Cuff,Nitrile,Latex Free,Powder Free 50/bx IlBX $ 8.50($ E. 1 ,PRODUCTS LLC } 10bx/cs ;ANSELL HEALTHCARE t297760 Gloves,Freeform EC,LG,Extended Cuff,Nitrile,Latex Free,Powder Free 50/bx IBX $ 8.50 I$ 8.51 E ;PRODUCTS LLC_ _ (10bx/cs 4 _______ (ANSELL HEALTHCARE _ i 9 770Gloves,Freeform EC,XL,Extended Cuff,Nitrile,Latex Free,Powder Free 50/bx )BX ;$ 8.50 f I PRO_DU_CTS LLC CURAPLEX _ �7 3 01-8 3010EA~ iCuraplex Se lect G reenLi ne/D Laryngoscope Blade,MAC 1,Fiber Optic,Infant, 'EA $ 3.89 $ 3.89 1 I Dis usable 20ea cs _ _ _ Crj ;CURAPLEX Y �^ i301-133020EA lCuraplex Select GreenLine/D Laryngoscope Blade,MAC 2,Fiber Optic,Child, v IEA i$ 3.89;$ 3.89 1 U i Disposable 20ea/cs � ' I CURAPLEX i301-133040EA iCuraplex Select GreenLine/D Laryngoscope Blade,MAC 4,Fiber Optic,LG Adult, 1EA 1$ 3.89 $ 3.89 1Dis�osable 20ea/cs ICURAPLEXt301-83100EA Curaplex Select GreenLine/D Laryngoscope Blade,MILLER 0,Fiber Optic,Neonate, SEA $ 3.89 i$ 3.89 Disposable 2Oea/cs I CURAPLEX MJ � 301 B3110EA ICuraplex Select GreenLine/D Laryngoscope Blade,MILLER 1,Fiber Optic,Infant, i~EA 1$ 3.89 $ 3.89 I �' _ �`Dis.o_sable 20ea/cs_ _ f_ ��r„ CURAPLEX (301-B3120EA �Ct uraplex Select GreenLine/D Laryngoscope Blade,MILLER 2,Fiber Optic,Child, �EA $ 3.89 $ 3.89 (Disposab!___ le 20ea CURAPLEX i301-133140EA�v Curaplex Select GreenLine/D Laryngoscope Blade,MILLER 4,Fiber Optic,LG Adult, SEA 1$ 3.89 $ 3.89 ...W. Disposable 20ea/cs SMITHS MEDICALASD,INC. j353042 CATHETER INTRAVENOUS(IV)LATEX FREE 16 GAUGE X 1.251N 50/BX 200/CS SEA~-$ 1.80 i$__ 1-.80 PROTECTIV SMITHS MEDICAL ASD,INC. _�353048 �t CATHETER INTRAVENOUS(IV)LATEX FREE 14 GAUGE X 1.25 IN 50/BX 200/CS.._ iEA I$ 1.80 $ 1.80 .,......�..._.,._..�______� IPROTECTIV I- ._._., U +s Packet Pg. 295 C.9.b SMITHS MEDICALASD,INC. 3� 53050 CATHETER INTRAVENOUS(IV)22 GAUGE X 1 IN 50/BX 200/CS PROTECTIV �EA I-r$ 1.80 $ 1.80 SMITHS MEDICAL ASD,INC. 1353055 °(CATHETER INTRAVENOUS(IV)LATEX FREE 18 GAUGE X 1.25 IN 50/BX 200/CS EA E$ 1.80 $ 1.80 lPROTECTIV _ _ _ SMITHS MEDICAL ASD,INC._ 353056 � CATHETER INTRAVENOUS(IV)LATEX FREE 20 GAUGE X 1.25 IN 50/BX 200/CS EA $ 1.80 $ 1.8� PROTECTIV �P-FFIIZZER INC.(HOSPIRA) -T379094 _ C2 FENTANYL0.05MG/ML2MLSDV 25/BX BX I$ 33.00 $ 33.99 iICURAPLEX 138001 `'--`-�iCuraplex Endotracheal Tube with Stylette,2.5mm,Uncuffed 10ea/bx SObx/cs EA $ 1.52 $ 1.52 CURAPLEX 38002 Curaplex Endotracheal Tube with Stylette,3.Omm,Uncuffed 10ea/bx 30bx/cs EA �I 1.52 1$ _ 1.52 CURAPLEX 38003 Curaplex Endotracheal Tube with Stylette,3.5mm,Uncuffed 10ea/bx SObx/cs EA $ 1.52 1$ 1.52 CURAPLEX 38005 Curaplex Endotracheal Tube with Stylette,4.5mm,Uncuffed 10ea/bx 10bx/cs EA $ 1.52 $ 1.52 _ _ 4 X CURAPLEX 38011 Curaplex Endotracheal Tube with Stylette,S.Omm,Cuffed 10ea/bx SObx/cs-^ EA i$ 1.52 $ 1.52 r-_.��_...___......._.._.__..�..� ____._____.._...... ....._ _ CURAPLEX EE Curaplex Endotracheal Tube with Stylette,S.Smm,Cuffed SOea/bx 30bx/cs EA $ 1.52 $ 1.52 �.._.. ..-_ _._. _.. .. .._..__�__._ _____.__ __ -..__--- �_ 0 CURAPLEX 38014_ Curapl_ _ex Endotrac._. __ _heal�Tube with Stylette,6.Smm.,Cuffed_10ea� /bx.-�lObx/cs.. EA �$ 1.52 $ 1.52 0 CL CL CURAPLEX 38015 Curaplex Endotracheal Tube with Stylette,7.Omm,Cuffed l0ea/bx 10bx/cs" EA $ 1.52 $ 1.52 CURAPLEX 38016 Curaplex Endotracheal Tube with Stylette,7.5mm,Cuffed 10ea/bx 10bx/cs EA I$ 1.52 $ 1.52 CURAPLEX 38017 Curaplex Endotracheal Tube with Stylette,8.0mm,Cuffed 10ea/bx 10bx/cs" " EA i$ 1.52 $ 1.52 CURAPLEX 38018 Curaplex Endotracheal Tube with Stylette,B.Smm,Cuffed l0ea/bx SObx/cs EA $ 1.5 1.52 CU04 RAPLEX 38020 Curaplex Endotracheal Tube with Stylette,9.Omm,Cuffed 10ea/bx 30bx/cs EA $ ___..1.52 j$ 1.52 HARTWELL MEDICAL LLC 4162 Convenience Bag,BioHoop,50cc-2000cc,Emesis and Hazardous Waste Bag,No Hook EA $ 1.52 $ 1.55 i 12ea/pk40pk/cs NICE-PAK � 440128 LUBRICATING JELLY PDI STERILE,2.7GM 144/BX 12BX/CS "m BX �$ _9.67)$ 9.67 j t DMS 5060220 Restraint Strap,Orange,2 pc,5 ft,Nylon,Metal Push Button Buckle,Loop Ends EA $ 7.39 $ 7.39'"3p i CURAPLEX 51150 LTD QTY-Curaplex NPA 12F 3.Omm,Latex Free PVC 1/EA 30EA/BX SOBX/CSUJI R"QMED CORPORATION 533764 Ventilator Circuit,Universal,Portable,Adult,72 in,Disp,for use w/PB 2800 Series, EA $ 5.50 1$ 5.73 HT5015/cs I 'MEDSOURCE INTERNATIONAL 533-MS-SC16EA Suction catheter,16 Fr,coiled,w/whistle tip and thumb control port,sterile,disp,LF EA '$ 0.20 C$ 0.20 BEMIS MANUFACTURING 592041 SUCTION CANISTER DISPOSABLE REDTOP 800cc 100/CS EA i$ 2.93,$ 2.93 COMPANY _ __..._____ ___ T. _ CURAPLEX ���Mrw Curaplex Sharps Solo,Sharps container with one time lockable seal,6.5 in 24ea/cs EA $ 1.35 $�W"1.35 SUN MED 792-9-0212-72EA ET Tube Introducer 15 Fr x 70 cm,straight tip,flex,disp,sterile l0ea/bx EA $�u 4.79 $ �4.79 1 TELEFLEX LLC D4244 AIRWAY BERMAN LARGE CHILD 70MM 50/BX BULK EA $ 0.16 $ 0.17 Crj MORRISON MEDICAL 66411 HEAD BLOCKS STICKY FOAM-PAIR PR $ 5.02 $ 5.02 PRODUCTS _ I DYNAREX CORPORATION F165200 BANDAGE ADHESIVE CLOTH 1 IN X 3 IN 100/BX 24BX/CS BX�$ 2.25 $ 2.2 DYNAREX CORPORATION F165_631 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 SO YDS 6/BX 12BX/CS BX $ 7.70 $ _7.70 CURAPLEX PU80000 Curaplex VACUUM SPLINT SET,DISPOSABLE EA $ 285.00 $ 285.00 u) TELEFLEX LLC 5D121950 AIRWAY BERMAN INFANT50MM INDIVIDUALLY WRAPPED 50/BX � EA $ _ 0.33 $ 0.36 e J Discontinued Items DescriptionVendor Name Item ® U a) LEONHARD LANG USA,INC. 492-12-394PK *DC*MFG USE 2745-10108 Paper,LPSS,LP12 and LP15,Size 108 mm x 23 m roll, PK 1$ 9.59 _ )5rolls/pk,LifePak _I PFIZER INC.(HOSPIRA) 0641142035 DC*-USE 103-10* MFG EPINEPHRINE 1:10001MG 1MLAMPULE 2043 25ea/bx EA $ 3.52 i CURAPLEX 14756M5" *DC*USE 8888268086 Curaplex Nasogastric Tube,SFr 280ea/cs EA _ $ 2.35 ASCENSIA DIABETES CARE 1175965 *DC*MFG LANCETS FINGERSTIX 200/BX 6BX/CS � BX $33.00 ADI MEDICAL"-�1880-92078 DC*USE 1841-14000 Tourniquet,Latex Free,1 in x 18 in,Light Gray,100/bx 10bx/cs BX $ 8.15 M_YLA_N SPECIALTY LP 25021-301-02 *DC_-USE 05_42-02 ADENOSINE 6MG,2ML VIAL 10ea/bx _EA $ 4- 3.93 ISPACELABS HEALTHCARE i2614-24216 *DC*BP Cuff,SoftCheck,LG Adult,Disposable,Vinyl,Single Tube w/HP/Bayonet EA $ �3.95 MYLAN SPECIALTY LP 303-OS *DC-USE 660-05 Metoprolol 5mg,5ml Vial,30ea/bx EA $ 1.32 CURAPLEX 3173-08715 *DC-NO SUB*Curaplex DUAL LADDER LOCK 7 FT LOOPLOCK SAME LENGTH EA $ 4.16 Crj ORANGE PLASTIC DISP RESTRAINT Packet Pg. 296 C.9.b U ASTELLAS PHARMA.U5,INC. 1371255 'DEC*USE 0301-68 ADEN OCARD 12MG 4MLANSYR SYRINGE 1002C� v� EA I$ 85.52� U PITAL WHOLESALE DRUG f375016 I'DC*USE 911316 ASPIRIN CHILDRENS CHEWABLE ORANGE FLAVOR 81MG 36/BT �BT .$ 1.40 NICE-PAK�� 541231 *DC-NO SUB'TINCTURE OF BENZOIN SWABSTICKS INDIVIDUALLY WRAPPED `BX �$ 10.15 _ 50PK/BX l0BX/CS EXP: (WATER-_ELTECH NOLOG IES 7 112 16_._..__._.. �'DC-USE 1522-21620*BURN_FACE MASK WATER-J EL 20EA/CS _»�_.._ �IEA $ 13.33 WATER-JEL TECHNOLOGIES 1 4EA/ 713036 *DC*USE 1522-36304 MFG DC BURN WRAP IN FOIL POUCH 3 FT 2.5 FT CS IEA $ 54.00� _ IP3630-4 _ I 0 MACO INTERNATIONAL _ IAS65118 *DC*LARYNGOSCOPE HANDLE FIBEROPTIC SMALL GREEN SYSTEM _ 'EA $ 32.29 DYNAREX CORPORATION ;F1654 DC*BTM USE 1330-86100 ALCOHOL PADS LARGE 100/BX 10BX/CS_w _ BX t$ _2.13 IMEDSOURCE INTERNATIONAL �K4036 f DC*-USE 32762*PENLIGHT DISPOSABLE EACH WITH PUPIL GAUGE 300EA/CS JEA $ ...._0.751 .� 0 Potential Subs — Vendor Name Item Description CL CL fCURAPLEX 12745-10108 Curaplex ECG Chart Paper Thermal,108mm,Red Grid,for Physio-Control LP11,LP12 RL $ 1.84� _LP15 1/RL 60RL/CT JBPI LABS,LLC _ _ 1103 10 _ Epinephrine 1_mg,lml ampule lea 10ea/pk }EA I$— 13.89 ! CARDINAL HEALTH__ _8888268086 SALEM GASTRIC SUMP TUBE 8 FR 24 1N 10/CS EA 1$ 7.4ZI CARDINAL HEALTH-PHARMA 10542-02 Adenosine 6mg,2ml Vial l0ea/bx__._._ ._.... iEA 1_11 3.93` FRESENIUS �660-05 IMetoprolol 5mg,Sml vial_._..._,...._._,._._a._.___ ....__ ____..._.�.__....,_.,...._._._._iEA—t.$ _ 1.58704 �SAGENT PHARMACEUTICALS, j0301-68 _.___ Adenosine 12mg,4ml Luer Lock Syringe l0ea/bx iEA $ 26.25 04 iINC. _ t _ IGERI-CARE . 1911316 � tAspirin 8lmg Chewable,Orange Flavor36/Bottle �BT �$ 0.79� t._...._.._.._......_.._.__..._.._.._._. ..._........_.._._...... _ ...�_ _ C', LAR-1 ELTECHNOLOGIES i1522-21620 Burn Dressing,Facial,Water-Jel,12 inch X 16 inch M'EA $ 13.33 I R-JELTECHN_OLOGI11522-36304 !Burn Wrap,Water Gel,Foil Pouch lea 4ea/cs JEA `$ 54.00_PLEX_~ 32762 Cura lex Disposable Penlight 6/pk_60pk/cs !PK 4.0_._...... ___....�.._..__._.___..._....�.�__- P i CL e +s e J J U U CU Packet Pg. 297 C.9.b DATE(MM/DDNYYY) A��o CERTIFICATE OF LIABILITY INSURANCE 7179I2019 U 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 0 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED U 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 w this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAME: 0 Aon Risk Services Northeast, Inc. PHONE FAX Columbus OH Office (A/C.No.Eat): (866) 283-7122 (A/C. (800) 363-0105 a 445 Hutchinson Avenue E-MAIL 2 Suite 900 ADDRESS: Columbus OH 43235 USA INSURER(S)AFFORDING COVERAGE NAIC p a) INSURED INSURER A: Medmarc Casualty Ins Co 22241 0 Sarnova, Inc., Bound Tree Medical, LLC INSURERB: Hartford Fire insurance Co. 19682 5000 Tuttle Crossing Blvd. cri Dublin OH 43016 USA INSURERC: Sentinel insurance Company, Ltd 11000 INSURERD: Hartford Casualty insurance Co 29424 L_ CL CL 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 M CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CD Limits shown are as requested (11 INSR ADDL SUBR POLICY EFF POLICY EXPCD LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) LIMITS B Y 33UUNVG3435 12/01 2019 12 Ol/2020 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CD CLAIMS-MADE 17(I OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $300,000 g I� MED EXP(Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 n i GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000CL � .® POLICY �JEIT FLOC PRODUCTS-COMPIOPAGG Excluded ptOj 0UJ OTHER: r e C AUTOMOBILE LIABILITY Y 33 UUN VG3435 12/01/2019 12/01/2020 COMBINED SINGLE LIMIT $1,D0Q,ODO (Ea accident) X ANY AUTO BODILY INJURY(Per person) G SCHEDULED BODILY INJURY(Per accident) Z OWNED AUTOS a) t: AUTOS ONLY PROPERTY DAMAGE i0 HIREDAUTOS NON-OWNED (Per accident) ONLY AUTOS t: d 0 X UMBRELLA LUlB OCCUR 33RHUVG1892 12/01/2019 12/01/2020 EACH OCCURRENCE $10,000,000 O X EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 cri DED I X RETENTION $10,000 WORKERS COMPENSATION AND I PER STATUTE I ETRH- EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR I PARTNER I E.L.EACH ACCIDENT EXECUTIVE OFFICERIMEMBER N I A (Mandatory in NH) L E.L.DISEASE-EA EMPLOYEE Ilyyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A Products Liab 190H380015 12/01/2019 12/01/2020 Aggregate Limit $10,000,000 , Claims Made Agg Deductible $150,000=_ tu Per Occ Limit $10,000,000 B DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE: Account No. 104754. Monroe County BOCC is included as Additional Insured in accordance with the policy provisions of the �' cri General Liability and Automobile Liability policies. ,U_ gAYPR V WAIVER N/A Y S_._, 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. 0 Monroe County BOCC AUTHORIZED REPRESENTATIVE 1111 12th St., Suite 408 Key west FL 33040 USA o03 ©1988-2015 ACORD CORPORATION.All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ADO Packet Pg. 298 C.9.b AGENCY CUSTOMER ID: 570000037575 LOC#: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED L Aon Risk Services Northeast, Inc. sarnova, Inc., Bound Tree Medical, LLc O POLICY NUMBER U see certificate Numbe 570079659291 CARRIER NAIC CODE �... see certificate Numbe 570079659291 EFFECTIVE DATE: ADDITIONAL REMARKS O THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance +s INSURER(S)AFFORDING COVERAGE NAIC# O INSURER INSURER O CL INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD Q certificate form for policy limits. 04 04 POLICY POLICY e INSR ADDL SUBR POLICY NUMBER LIMITS i EFFECTIVE EXPIRATION DATE CrJ LTR TYPE OF INSURANCE INSD WVD DATE (MM/DDfYYYY) OTHERCL u} 1 i A Products Liab 190H380015 12/01/2019 12/01/2020 Per Occ $50,000 claims Made Deductible , r J J U F- O U ACORD 101(2008101) ©2008 ACORD CORPORATION.All rights reserved. ..The ACORD name and logo are registered marks of ACORD Packet Pg. 299 C.9.b Exhibit A CONTRACT BETWEEN 2 THE BOARD OF COUNTY COMMISSIONERS AND U THE BOARD GOVERNORS FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY,FLORIDA AND BOUND TREE MEDICAL,LLC FOR THE PURCHASE OF MEDICAL SUPPLIES AND PHARMACEUTICALS X a) THIS CONTRACT, hereinafter "CONTRACT" or "AGREEMENT", is made and entered into 2 this I" day of December, 2016 by and between the Monroe County Board of County Commissioners and Board of Governors Fire and Ambulance District 1 of Monroe County, LCL _ Florida, hereinafter referred to as "COUNTY", and Bound Tree Medical, LLC, hereinafter referred to as"CONTRACTOR". WITNESSETH: M WHEREAS, the COUNTY advertised a notice of request for proposals for medical supplies and pharmaceuticals. co WHEREAS,the successful Proposer was Bound Tree Medical, LLC, and; CL WHEREAS, this CONTRACTOR represents that it is capable and prepared to provide such r 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, CU NOW,THEREFORE, in consideration of the promises contained herein,the parties agree as follows: 1. CONTRACT DOCUMENTS — This contract consists of the Agreement, the CONTRACTOR'S response to the Request for Proposals (RFP), and the documents referred to in the Agreement as a part of this Agreement. In the event of any conflict between any of the contract documents, the one imposing the greater burden on the CU CONTRACTOR will control. U 2. CONTRACT PERIOD AND RENEWAL - The effective date of this Agreement shall be December 1, 2016 through November 30, 2019, with two one-year options for renewal, subject to the approval of the Monroe County Board of County Commissioners and the Board of Governors of Fire and Ambulance District 1. 0 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 Packet Pg. 300 u -- -,_ u 0 0 0 L- CL CL CD 04 CD 04 CD CL r x r r J u u Packet Pg. 301 u u 0 0 0 L- CL CL CD 04 CD 04 CD CL r x r r J J u u Packet Pg. 302 C.9.b Z Any attempts by the CONTRACTOR to furnish the COUNTY with other than first quality materials shall constitute default as outlined in this specification. U 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. o F. Expiration Dates. All merchandise shall have a minimum expiration date of 18 X months from date of shipment, and date must be displayed on the package. 0 9. CONDITIONS: > 2 CL CL A. Authorization. All orders shall be placed via Monroe County by individual Purchase Orders generated by the County's electronic ordering software, Operative IQ, or as "Open" Purchase orders, at the County's election. B. Furnishing Items. Contract items are to be furnished on an "as needed, when N needed basis"during the life of the contract. co r 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 CL specification. r D. Backorders. In the event an item is not immediately available at the time of an order, or is not able to be delivered within three (3) days, the County shall have the option of purchasing the item from another vendor. E. Penalties. The COUNTY reserves the right to increase or decrease quantities shown without penalty. F. Addition/Deletion. The COUNTY reserves the right to add or delete any item from this proposal or resulting contract when deemed to be in the interest of the COUNTY. r G. Samples. When required, samples shall be labeled with the CONTRACTORS' name and item number and shall be furnished free of charge. Samples not CU destroyed will be returned upon request at the CONTRACTOR'S expense. H. Substitution. The CONTRACTOR shall not substitute items fdr 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). 0 I. Contract Prices. Contract prices from Medical Supply Discount Off List and Pricing Worksheet (Attachment A) shall be firm and shall not be amended after the contract is executed. Any attempt by the CONTRACTOR to amend said prices unilaterally shall constitute default as outlined in the contract. Packet Pg. 303 C.9.b U 2 Prices quoted shall include all shipping costs, shipped F.O.B Marathon, Florida or r_ to the facility location specified by the requestor or the purchase order. U All taxes of any kind and character payable on account of the work done and materials furnished under the award shall be paid by the CONTRACTOR and shall be deemed to have been included in the price. •The COUNTY is exempt from all state and federal sales, use, transportation, and excise taxes. x Contract prices shall include all royalties and costs arising from patents, 0 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 CL CL 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 N at any time during the prosecution or after the completion of the work. 0,4 co r J. Contract Provisional Prices off List Price. Contract pricing for items not included on Medical Supply Discount Off List and Pricing Worksheet (Attachment A) and sold to the County at a discounted percentage rate off the list CL price issued by CONTRACTOR shall be firm and shall not be amended after the r 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 r under to a subcontractor without the prior written approval of the Monroe County Board of Commissioners and the Board of Governors of Fire and Ambulance District 1. Crj U L. Price Escalation. The County will allow a price escalation provision for items on the Medical Supply Discount Off List and Pricing Worksheet(Attachment A) with this award. The original CONTRACTOR prices on Medical Supply List Pricing Worksheet (Attachment A) shall be firm for a one (1) year minimum period. A price escalation/de-escalation will be allowed one (1) year after the beginning of 0 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 Packet Pg. 304 C.9.b Z 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. U If, at the point of exercising the price escalation provision, market media indicators show that the prices have decreased, and that the CONTRACTOR has not passed the decrease on to the COUNTY, the COUNTY reserves the right to place the CONTRACTOR in default, cancel the contract, and remove the CONTRACTOR from the COUNTY's CONTRACTOR list for a period of time deemed suitable to the COUNTY. X a) 0 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 CL C CL 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 N process, the COUNTY may request a sample invoice. Invoices shall contain, but not limited to the following information: co o Invoice number a o Company name CL x o Purchase order number r 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. N. Payment. Full payment will be made by the COUNTY after receipt and acceptance of materials/services and proper invoices in accordance with the CU Florida Local Government Prompt Payment Act, Section 218.70 et al. CU O. Ordering. CONTRACTOR will provide web-based online ordering website designed specifically for service. r P. Disaster Recovery. CONTRACTOR must have a proven Disaster Support Program in place and shall provide the COUNTY with emergency numbers for these situations. These numbers will be updated immediately if the contact CU number changes. 10. INDEMNIFICATION — CONTRACTOR shall indemnify and hold the COUNTY and Monroe County and Monroe County Fire and Ambulance District I 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 0 as per "Attachment P. 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. Packet Pg. 305 C.9.b 11. INSURANCE — The Proposer will comply with the insurance requirements listed in Attachment I to the RFP. 0 U 12. ADDITIONAL REQUIRED STATEMENTS/VERIFICATIONS/ 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 X Attachment D—Lobbying and Conflict of Interest 0 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) 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. co r 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. x SS WHEREOF, each party hereto has caused this contract to be executed by its duly or resentative. BOARD OF COUNTY COMMISSIONERS MADOK OF MONROE COUNTY,FLORIDA S�9.y4CrJ N. By: By: Je- iY)4-"4-50*d Clerk of Court Mayor r J BOUND TREE MEDICAL,LLC: BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY,FL do�= By: 1- By: Print Name and Title Mayor/Chairperson Date: CrJ A` ""c :;'a;,y^r . .y, =Y Packet;Pg. 306 r..I I 12/7 c;l A C.9.b Z U SECTION FOUR: ATTACHMENTS AND FORMS . r_ 0 Attachment A Medical Supply Discount Off List and Pricing Worksheet Attachment B Submission Proposal Response Form 0 Attachment C Non-Collusion Affidavit Attachment D Lobbying and Conflict of Interest a) 0 Attachment E Drug Free Workplace 2 Attachment F Public Entity Crime Statement CL CL Attachment G Local Preference Attachment H Scope of Services Response Form Q N Attachment I Insurance Requirements, Indemnification/Hold Harmless, and Request for co Waiver of Insurance Requirements x r CU r J CU U 0 U Packet Pg. 307 ) O O -O -LL saa' x3 -IUOWPUOWV PUB I a s Is - 'IBOIPa anal p r o a} aLu o ll o .cz i o C) - Cl) v a u CI.SpIt ps AQ OQ4Q� a! 51 El u ZZ N N M K M N M M M aA •17 M M a� MM M M in vn in &n in Lf1 X M M H ds AN AA A a M H A, N d •�: X X X X X X X X a X X X X X d Q X x Q w co co m co to m m co W co cc co am W W m m W u � ' � N rmn N N N N ILC. l c� ]C m Y to W Q Q J C7 W D: W Y U Q p vi O 3 � � to J u u ~ _ o W 0 C w 1 Z Z Z Z W J 3 Z Z N J \ x= J J J J W E O J J J 3 W W W Z w QQ QQ a W W W W � C cc W W W W W W �( N N U n O � m Q .'� XN VI VI lA �V(1 IA v1 V1 W W W W W 4' C 4' � N u U u u J N W W W W W W W W LL LL LL LL LL X !W' W W N 4` c C J J J J J J J J X X X X X = Z N C L x LL w LL LL U. LL LL m m m m m (f J J J J J X x X X x X X X O O O O O Z m m m W O H F F F H T m m m m m m m m 'y ey M M e� W a O O O O O O O O -i V1 O Vl O VI W O O W y y H N O. .-� .ti N .� .i .-� ti .r 0 N M iri at a m Z Z Z Z p w w w w w O Vl VI O V1 O VI O O W W W w W Z V1 ut Vf lD 1� 1� a0 CO Q� H V WJ CJii J �J.i rJ Jr �rJru R0r r r rY Q W OO Z 0 Q 0 {N W N kn F VI x x s x x x x t t t t t r- c 3 3 3 3 3 r y Y Qd d nc W W. cc W W W 3 3 3 3 3 3 3 3 a W W W W W J M w m 3 m m m m m W LL LL LL LL LL m N N N 0 N {LL LL W LL LL W W W W W W W W O = O O O N N w 4 4 4 4 4 LL LL u..LL LL LL LL LL LL u U U U U W F- r F Z Z N_ vt ut Vl H m D 7 7 7 > > > O Z Z Z Z Z U -.J J J z Z O 4A Ln &n LA u u U u U U u U x > > > > M > > > > m m w a w w w W W W W W W W W W W W W W W 0 O m m m m m m m m m m m m m m p ¢ a Q s g p Z,. > > > > > > > > > > > M > > m Y Y Y p p g g g g g r r r F F- r r r r- r-- h r ¢ 4 ¢ w w m m m m m '�- J dJd QJ aJa J J J J J JQ J J J -j Z 4 4 4 p Q W W W W W r; a W 47 W Q a a a Q W Q 4 Q Q N N N > 4 4 6 4 6 W W W W W W au w W W W x x S S S x X X x S S S 0 p N 7 O O u V 0 0 0 u u Cl u u u u u u u cs3 u u w yi a a a s a a a a a o o _ 0 0 0 0 0 m 44 n a� m m ¢ w m ¢ a w w in ~ ~ ~ O O O O O O O m p p a y y y > > Q dd �l W W W W W W W w W W w W W W .r1.C." > > r } > r > a } > r > r > r > > T y > r r s Q a a a a a Q a d a a 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 It :• s ¢ a: a: m ¢ m a a rt rt K m oc z z ac o: o: o: g oC � o: m a 'a a a a a a a a a a a rl N M N tD 1� 00 01 CD � �•.K �4 N M It to lD h O CO M 9 '4 .y N ti -4 ) O O -O -LL saa' x -IUOWPUOWV PUB I a s Is - 'IBOIPa anal p r o a} aLu o ll � .cz i r:o Cl) v a � 91gStgIRStCL r� � � � x = W W W W W m W W W W m m m m m m m m m m W W W W W 4i W u N e0-1 N N .N-1 N N N N N f V N N N N Q M a N N ;04.;m z z r_ z z z i z,z,z z�z �c z :+• .ti• y+ sr+ >+ �• .7. :�. s N 3 W La Fa F' tl m a` m N -� U, V C W W W W ri Q (0 Z Z Z z he C �+ z Z Z Z p Q S x x S S 2 2 2 2 2 w w w w F n u u u u u u u u u u Q VI Vf IA V1 VI V1 1A to M H 1n CC w w 0: OC W 0C w Q H N M a W X X X X X X X X X X V ii Yt ft o m m ` w ` m ` ` 0 u C nc aC m m m O O 4 O O O O O O O Q Q W W W W r-1 ri ri .-1 ri .-1 �-1 ri r1 r1 S ix O J J = 2 2 O u u u u u u u u u u W z z z z z z z z z z z J J J J W W W W W W w WWE W W G W W W W t w w w w w w w K w w K W W W W J r w LL w LL LL LL LL LL LL LL S ? F- Z Q N a w co O N a tp w O W N N r CL N t; Wn ?l N N ri ri N N N N N M W W W W V J > > > > > > > �y m VI N H w {{j a n a n a a a n. a H Z Z Z Z d CC W W W W W W W w W W O m W K CL w W- C LC K CG m L V N Q d H u r LL LL LL LL LL LL LL LL LL LL z '� W � X 77[[ X X X X X X X X Q a _u u _u u_ m Y w u! w w w w w w W w Z r r r LL u W W W W W w ,... w r w r r r {- r d W Z 0 W o a o o. w a y > 5 5 3 g S 5 3 5 3 3 g W a Q ¢ o Z J . . . . . . n' m W W W W J O J J J J J J ¢ Q d Q Q Q Q Q Q Q m N 1 K K W OC m m m m Z a: WLL 2 S S 2 2 S n a n m m a n n a a W W W m u1 a a a a Q z z z z z z z z z z a 0 Y µ m/ z 3 m uu Q > r > r Y i } } r > a' d 1 W O ¢ s D 0 v_1 1n l7 a� m oc ac oc m oc ¢ d Q Q d d Q d Q d O of u = w �n n 0 w o 0 1LL•� 3 > a L 0 w0 O O ri _x ac m g ¢ a[ _z K oc ¢_ 1n Z N Q ¢ 4 6 Q Q 6 Q Q Q cc c�c �S c�c C� c2c O Ste` co w co co Q > m w w co m m J J J J QJQ J QJ QQJ m m m m S J O O 7 W W W W tOfl lb Q 000 041 r W W W W W ^ (-• r r r r (.- a a a a a l7 0 0 0 0 0 0 C7 l? C� � u O O O o O t7 u u u u u z Z z z z z z z Z z > >= } > r > Z 2 0 a u u U v z oc � > > > > > > > > > a ¢ ¢ Q Q Q ¢ a 1yi v+ � r r � � y 0 0 0 0 0 1- `a '� `a�77 t� tt`a�� l�� x S x 2 x 2 x i 2 2 m m z ac z ac z z C y > y y } R O O Of O O O O v O� O O J J J a j O O . a Q1r m cQc mQ 3 3 3 5 3 J zi z z z z z z z z z z z z z z 01010 01010 u oc of oc m m ac ac oC ae s oc n m z oc m g � g a ¢ oc ¢ ec m a z rr ¢ a< c a a a a a ¢ a Q a a a s a a a a a a a M •! !fl 10 11 CO O1 O rA N M < 1A tp f� W Q1 O ri N M U1 M M M M �t �? st Q Q �f it V V it N to 1fl N u1 U1 ) O O -O -LL saa' x -IUOWPUOWV PUB I a s Is - 'IBOIPa anal puno a} aLu o ll o v a CL 6 Vi 6 Cp w b a.r r r r r r �p C► r• � � tNV pry s V. otAlet, a e+� �iL� '.RM� v7NeDI it � �bVn «iu'il '.�iN V"t � Lf �A d N yy�� QQ W W W W W W W U W W LL m m m V W LL LL W U m m m m m W m m 7. tf if It a Q 'tt VI �..� O Fj O m h M W O O O N O N N O N Q w f0 b tp N N N N N N h .-1 N Vf rl N N N �-1 .A .4 .i V M N M M m M W i\ VA to '✓+ i� i� r :� :n i. i. 'r+ :n l :.� 'r i+ r� C.+ 'r� L� 'r :� �+ 'r C.. r� 'r :++ 'r+ hr� d s O 3 m L W d z a H O o out �+ V) W ^ m Q1 N a a a K W W W Z \ �.1 Y Y Y Y Y Y d w O d X Z Z Z C N tJ ui ui uJ ui Y Y u \ O X c`� u u u u ui Lu F m Q\Q m 3 LL LL LL LL Q Q J V .Q N W m N Q a a a a LL LL a 0 .� V) a a W z N N z Q S\ N oC �} W {L) W W W W Z A \ X M a LL! N _ � CO X W t7 a a a a 0 0 0 N LL LL LL LL LL 0 W In M rnn O F N S d W W W W {Oµu� O E" V>r' Q X X M LM O_ Z Z Z ~ V X X Z 0 Z X N CL O N Z X m X O d '" d '� N F W LL N z X T \ CJ a ¢ Q O 0 = O m v } ut .y LL -+ O of Z x w )O N ? - o O O C7 (� 1 (CDC a F W Z x X d Z_ l0 �-1 Y J N J J W cc Q Q WO O a a [L)O Z O N Z X X X Z d .,Z w CC CL c} N Y } J J J J w W ~ X J W lD Z Z Z C) Z O Q N C = N O O V V V V O O 7 Z Z p wa W x 0 N a m m U. X Z O J Z W X X V U m ` a aQ X ima. ~ d W X Z m a a U K 'i Z Z CC LC Q U O w LC Q Z_ ut = Lu w tin m '4 N 11, LIE um, J Z O H F �" `�' F N u Q `^ U l7 w x 2 O S a ; tri Z O or oc oc ¢ d s Z 2 Z tA u 3 3 3 3 3 a z m o u u _ z z z z z m Z 0 w 0 0 o W > y>� = LLU " w J W Q 1�/1 N/1 IN/7 1W/1 Y C? a O O Z z W W y� a Q Z W W W W a K a s a W U r2 (7 a a w S S W Z Z Z z z Z z Z d 0 J C9 l.7 l7 O L] L] O O VI d o Z V) Ln . l7 p C O O O O O O O O O QQ Q ¢ d ¢ a 0 w w uP O d d .G7 Q z Q ¢ Q ¢ 7 m 7 cc 7 = 0 0 � 6 Q Q ¢ Q Vt h ut m Vt V) to vt m w LL m m m m m m m m m m V u O 0 l9 0 2 f 1 Vt Vf V) V) N H V) Vt 0 VI VI CA (A VI VI LA (0 IA yZ z z z _z�AA z z �_2�An z _z y_zy�� z z z {z_{AA yz_y�� z ��z_An z V1 vi N N N N Lnn N N �{nn {tAn Vf to 1Nn in VI N N N %%A W W W W W W W W W W W w W W W W W W W a a a a a a a a a a a a a a a a a a a a COO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ 1 \ w \ N N VI Vf VI N VI VI N VI N N ,n Vf {n N VI {n W W W W W W W W W W W W W W W W W W W 0 U' t7 O O O C7 (9 C7 l7 V' ( C7 V' V' l7 l7 V' C7 Q Q 3 3 3 3 3 3 3 3 3 3 3 z z z z z z z z z o z z z z z z z z cg a a a a a a a a a a m m m m $ m m m m °� m m m m V1 ID h 00 Of O N M V M �O h CO 01 O .4 N M -! V1 Ln Vf V) V1 w w tG �O t0 tD �D �O �O w h h 1, h h h h h h h w w w w w m ) O O -O -LL saa' x -IUOWPUOWV PUB I a s Is - 'IBOIPa anal p r o a} aLu o ll v a o a� CL N H V7 4�1 M�"1 to A 4n ~ N fA W~! E� H &A H R F � ~ N ~ v1 H n oft y�� � R� :3 Om. M M! F! ^ d'► !i IYY Wt PF M ' M! M d�f M 17 N w m w w w w w w w W w w w w w w u OD CO GOm a m m m w w W w w yy oo F tnrl m N co v N N N N 'O t0 t❑!1 N -T N M Q W �6if Sr t'+ 'rr 'r+ Tn 7 `r+ "l. ` �++ 'r+ L� 'r+ r+ ;++ 'r+ i+ •r C+� C� 'r. 'r 'r+ L+ Y� >+ `r+ h w F- p Z m uul > W 4 Z O� ty;Lu' U t K co U w Y J co J d x C a ¢ E dS 3 in 3 Lu o Q (� J ^ O Y W LL W 2 0 N cid Q rV L. K j a ZQQ O LL W O ace d H ~ 2 OG 6' Y S W cc } w tu> Z ,n O. ynj a J O ac . ti G Q a � z M o > {Lo a Q J Q 0tn 00 V w J tu O Z m W Q p 0 0 N D u K Z Z p m �- w Z d LL p O a x Q be X Q m 14 m a O g J t ¢ m Z G K O 7 y w O y Y tFi CC w y K 'u y p LL F > ° Q f0 O O O W w ¢ LL -' LAO p 'wi' O U a 3 Z zz m a F- Y LL LL O ¢ m In LA ri x N h y ¢ � J �j 0 \ a U' 'n w g 0 W m m a 3 Y a F a a w Z G cr a w W ° O a O in w Z V Z Q. O N ¢ G w j = w ul 3 v Z z cc 3 a z Q K K 7 m O j p y = m S 0 > m Ou j > n J m 1Q_- '0.i' cc `�` r Ou L 3 3 w O o m Co 'ui a Q u z u `a H y Q p N m '^ H H r Ou 0 l07 a ! > s a ae Z �O a O p d O H = O m -� -� X u 7 m ru > 0. O !- d N K uw O_ \+� Q Q m 0 0 > > _Y S X n ❑ 0 0 a p m J 0. p 7 X a O „ Q Q d O VN� X o X ZQ O ? w V W ❑ Z 7 K Z \ m G < w Q \ a l.� \ } ..i U Y w t� W 7 Ll Q a \ W $ O LL 3 's m o m co Q w r a m m r z '^ i v a u Z 3 � 0 n 'r g o �' r N u m z Q ¢ au t au ❑ a a a a n X m .7 F O O w 4 l7 v' u1 'n of of 4 a m ` a m Q W Qa _� S K Z O O O ❑ K \ M 3 $ K a w v�'i w m m ❑ p K Z O � J u w p K LL LL U. LL LL 0. Q K K n .-' J z $ Z p Q - Q Q cc O W \ O Ur X t > > ❑ a m O. 6 d X i1. Q O a O p W m m ¢ Z w U Z 3 U. Z m U ❑ U U U u U U C7 6 Q m y~j - K F- O Nwwwu d g s NF y y Y H IW-' 15 K OC C OC 1' m \ \ \ W K W rni 1 d W Q O O O O J u u` > > > > > 'n A. 0 a D a m O u v u m 2 m m w LL Z Z K K " 4 v' O Z J w Z M vl of Z Z K K "_ _Z p W LL O K Z Z Z r�47'ir{ Q Z J J J {/1 yZj O O G, a s o. cc n. Q Q Q 0 N LL J r S Kp ►' O g O Y- W yj d d f- c g Q cc a a a 0 > 5_ S p p o 0 0 a oc O m 0 S a > > > a a F O o /pyam o o m m G r, u u W O 0 ac �j wQ l7 (9 l7 Q a Z O O V O O LL LL w W O Z 'L Z ^� = Z w Q QQ Q Q. W W W J J J J J W W J J J Q Q W m u x > > m m m m m a p W W ED S 1 d m �- ►- a m K K Z Z K cc O O _O _O O h u_ u _u u_ u u u u u u u u u u u u ~ ~ ~ ~ O c� O c� O ►- F F ►= F r= E 3 'S W W Z z Z Z Z Z Z �jj K �j �j (/' K K K K K K K O J S = x x x S 2 0 0 0 O O O O O O O O O O O O O ap m m m m h F- F z z 2 Z Z Z 2 Z Z z z Z Z Z Z Z 0 a 0 0 a a a owc cwc owc us c� t� O QQ Q Q Q Q •¢ a Q Q a a a a a Q a C O O O O C O O aC O d O op p �t om0 m oD am0 C1 Q~i Qrv1 T O�1 aK, Omi Ori Omi Qmi N O O O O o O o o O .�'i 1-4 ) O O -O -LL saa' x -IUOWPUOWV PUB I a s Is - 'IBOIPa anal p r o :IuawqoellV 04 C� M CU a $ $ a 2 Lm � 2 g g 2 Q� 2 S 5i a m a 2 z 9 x r 2 2 a :9 � M N + G d y y y N rig M N in rlY M a t q o to 4 0 ¢ �Mgl �(I �pJ ��p iV �fJ ivy[ Yl v L:i K`) � CJ v V {L9 u N v I M} Y! N 14 -0 �f N M N : rm Lo H Z w 6�. W W CY. m OXO m m m U W V W W m m V V m U CJ w CO m m m U m p Q in M N N v N IA v v Q c N IA N N W W m us.� 'r+ 'r+ •r. 'r+ `r+ 'r C�+ `r. •r. r+ 'r+ r t� •r+ '✓+ r t�+ �n r r+ 'r. i+� :n :� r 'r+ `v+ i� i++ r d d H U Y W L 3 m W O W C W J l/� t/) C R K - cr N V V UA Lo u `L O W o o o O Q Ln Ln Q •L W LL W X Y LD m W LL G 2 Z z _O o \ z m m -' O Q to J m X o X -1 0 0 W >�.. LLS m o ur N $ `� �, Q Q 1Nn o Q 3 ryCc WW Q W cW e-1 rl X t Z J W 14 'O V X O V1 G F C W Z W z U` Z Z W m N 01 J = � WJ J z H N X N F- _ } Z U1 N Z N cc 1m- OC Q U N Z m Y O X N a z z z z z g W W g F ' Yco O X Q W LL LL LL LL N \ LL j 3 G V � a .7 U m O N W W O O O N beO S u u u M U O M W J J p W Z W ui 5 Q V Q S O O O O O1 0 J O � Q W � � 'Z J l7 U h W W W W U W W �-.. u' tNn LL J 1O- m m to Z Z Z Z !Q m y = !z- Z W � W.� V X W N a w 3 a Y z X X rx m x W V7 �n X t- W m W J Z m m z 3 X N tJ \ N V1 Q W O O m oo LL W W W W O m N W X O Z Z !/) z W N W qa� \ CC W K N W W W W W W 0 N F z_ 4/ ` �-1 O 0 Q E Z O J ,y O O X I- J Q J cc_J (� 4' 1' 1' C O E Q O O U. F Q m N W LL LL J z } 1 Q L J 2 LL LL LL LL J N ` z N m cc �..' Z LL ? U CC 0 U W VI N d E W W W W Q W F O VI W w r N z V a -1 10 O 1L U O .4 ¢ $ Q O o 0 l� cc ,,, U o t7 J z z `L g L u u J "' pQ N ~ F 3 3 's 3 z g a �n cr m o z ¢ W N o Q y X � W - x o a O 0 u LL 0 m I7 yj LL 6 M Q (J Q C O O Cc F ri 2 J J Y W x Q V1 W W W W O W \ S Q x Q Q O W 2 w 0- M W W O U Ln F > CO W W W W W LL cc O {{1n O Q S > O O = I �I tU� � a3 LL XLL LL LL W � CN J W 1 LL N D Q J J m g W J W w W W Z Z W Q W a O 7 O z u' S J J J Z Z u y m w Q F F F f a m > F- z n W 0 0 0 0 0 2 V1 Z x x S O w 0 O g g J ui O O o in J in Z Z x Z i`n w j O O O CY w j W J Q ed V V1 VI VI to V Q U a m O 6 W W W W Z W O Z ~ O CO O m O W W W W C W H = J > > > > W O W 0 eQo[ o ' cmC >o o 'o o 2 o W �C z z z z s = Q lt) Q O G W J J J J W > Q . :.: X 2 > m m W l7 0 0 0 L9 x w 4 f ham- 3 Q m Z Z Z Z > a H N v}i H � (►- J J J J J J J J J J J J J Z O O O O O O O O O O O O O Z Z z z Z z Z Z Z Z Z z z z z F F I.- r h I.- � � ��.. M � � 0 0 0 0 0 0 0 0 0 0 o o F 0 0 o z z z z z z z z z z Q Q Q Q Q Q 0 0 0 0 0 0 0 0 0 0 0 0 0 Q m w m �+ u u v u u u u u u u u u u f- F- ~ � R � y W S M M z z z z z z z z x z z z z z z z z z z z z z z z z z W O O O O O O O O Q O 0 0 0 w o 0 o G G G G G G G G G G 6 G G r W W W W W W W W W W W W W O O O O O a O O O O O O O C LL LL z LL I.L. LL LL LL LL LL LL LL LL Q Q Q Q Q Q Q Q Q ¢ Q Q a z z z_ _z z_ _z _z Z z_ z_ z_ z_ > > > > > > > > > > > > > > ry M a N m n m Q+ O N N M Q to l0 n 00 Of p .-� ry M an •-1 rf .+ e-1 N N.-a N N N N N N N N M M M M M M M M m .till ri -1 r-1 .i r1 N �-1 ei r1 t1 �-/ rl N 'i �-1 •i A rl � ''1 ei e� -1 ) O O -O -LL samdx -IUOWPUOWV PUB I a s Is - 'IBOIPa anal p r o :ju9 g3ejj Cl) g go ri � ��^3• r^,r A r^.. is r'"., .^d r^.. ��r^py. �'i r e � •^ r^. .^i r^, e�� � e^• .^s• I: �np !'.��tij r^, �^,, yjy� (+" 'aI L"r' � s ; Z 9 D1 a a 6 !4 /`1 f1 A T w I'1 M a A . .•1 IT M � Uf W � '^ �b d A O !• m '!� � W �0 O; •h y r M d aQ t/� t/� QQ QQ QQ QQ V� m m O] m LLi U l7 W W m i x W W m W m W W W m W W W W W W W W Ucc O inO •n O O O O O s! O O In N N O O O 7Wn QQ N N O In N Q Q a0 m w w O '+cr - N to 1l N N m m Q N W p� � P• P• P• P• P� P• P• `T.. P• P� P• P• P• P• P� P• P� P• P• P� P� P� P• P, P• P� P• P• P• P• a"i 1 d � s a ` W W 0 � J Q u a � v Q m > �>F 7 Qj N W > W r ro O r a a 0 a O x x a x x a Q 3 0 o c r G p m \ F W N Z Z Z In Z M m > _ J \ In O N INZ N M m O Q 14 a4 It It Z 21 N m X x x x \ .y 0 O CL WU' 0 0 0 U � , am � U a OC O 1 K W Y Q CJC F"' \ • C J G u a G E rW- g W z Z cc tD _9 A W 2 Q _V -1 N N edM J 1v/�� D7 aO V?i Q LL } z �..1 O O V W W W W W U VI W \ W W r v Z Q S a N� N {!- LL uj LL LL LL Q ly "'1 uj z U• Q z W G' W z 4 W '-� LL J a U Z a vri V Y °° \ n J J a y w� • W W W W Q .Q-1 Z Q y CC 0. LL Z Z U W M J N Q g g S 3 Q 'ccJ cJ N CJ J O Q } Q (7 J Q O UJca c� J pq pG C Y G 61 Q J J O_ H O S Z in- N m Q } O Z �j q \ J N V1 N In .y .y 1A Q Q w p J Z .n J U N l7 J O Q O O O O '^ a• m m vt •n .pr p q ,n -+ ZRAI Z Z Z j In O O O a N N Q �2 �-1 W 2r a 7 Q Q d' ccN 2 � O Long 2 Z CC 10 Z O O to O W r r r 0 0 0 p p O z 2 0 .� = o g W W a O N Z Z Z Z _ oc z Y u v u oc oc O I\' ¢ a W i W u W Td f z ¢ Z O O a U W N Z W J r ►- o W r Q 2 Z Z 2 f O Q N W s x Z `� 0o l? w S S 2 S aL >_ > > .2• 2 O_ G aQ U W Q = Q W W FQ.. oc Q r rG r¢Q FQQ- O O O q W W m vaVt� s J U V U U H h N Q Q Q Q Q Q Q Q O O O O O W w I. LL 2 Z OJ 2 K -W K W Z Z Z Z Z Z z Z Z Z z Z Z Z Z Z Z 2 Z Z z z Z Z z W W W W Z 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 �' w w rii �ai a H F F aFa FQQ aFa QF QF FQ FQ QF F FQ FQ t4- QF QF FQ- QF QF hQ aF QF ra QF (•� r r r r � J J J U V V V l.7 lJ (.1 lJ U C.1 l.J lS 4 CJ ll C� V CJ lJ U U V IY' Q Q s 0 o 0 0 p 0 O 0 0 0 q q q D O 0 0 D O 0 0 0 0 0 0 F U tJ W W W W W W W W W W W W W W W W W w W W W W 1D r a0 an O .-• N M Q of %D n 00 an o " N m , .n .O n cc In O H N M Q to R! .Q-1 •Q-1 eQ-1 e�-1 eN-• N N .W-1 .N-1 •�-1 .�-1 e�-1 .N-/ rWi M .W-1 .W-1 .�-1 eW/ M .W-1 .W-1 .�-1 en-{ .n-1 .n1 :. ) O O -O -LL saa' x -IUOWPUOWV PUB I a s Is - 'IBOIPa anal puno a} aLu o ll v a gi a ♦`j Qy {J 1+My�� Ct{ V, �"� Cvg4! �4 �`I �"� 1�+�{. `�rA+� V Y'� � mY M V7 Yam► M Vl 01f G�7 Vl �''1 �9 VI 01 k � a ug m m z W W u3 u� w uQl w ul ui m w a U U U 2 coo O O Ln to O O N N co l0 in F� H n m N V n It eq m N "I tt IY C V6 Q W O M ZA � a _ u Y N U •- O Q 3 m aZA o W LIA O W l7 O In '2 z tq m d J z Z F D m = C Q N Y n ar Q O tz m W C N N m K Z C Z cc Z o O V1 W Ln W J J C C7 K LL Q Q +. 0. C LLJ Q O Q ¢� u ¢ Z N G W a a O w W 0 Z Cf. 0 r 0 o W z o ° g ?' c p a to g p, x o J x H F Q a O 3 = > x W J O H W U LA o a z u r x z u; uo6 N J In3 Y M rr > x x O Q z m Z J \ J U In 471 Qm` Q q Q 0 lL > ryOH m p�Q w W Z W 1f1 _ = O J O Q N JcC W CJ 1I1 J = J C O LL O 0 U c m H 0 Z r J I a {-. Ln r Q Q W C LL W J _Z Q Q Q l0 W N K > > J H J cJc O m O O C; J 3 J J Q N Q C J 5y�f W O Q 6 0 J Q N J w w lcC7 OCC O M W Lnw J J O C Q Q G C ` Q' O J Z V` Z N Z Z LA O J a Cz g W N Ln o o o N W G Q z14 Ln Z0 j am¢c aQ O 00 Z N be N W W u v Fes- p 0 0 OC Z O Z_ Z � O z c c W ] Z V W a O = x U C7 Z =Z V i C ui 0 O J W W W O a ~ ~ Z 0 0 0 0 'Q W O W X X Z Z Z O a CY Lni I n of > !- Z O O w K w w W W W W Ln Ln &n to Ln w Ln Ln %n %n Ln of Ln Ln > > > Z Z Z Z Z Z Z Z Z Z Z Z z Z J J J y O O O O O O O o 0 0 0 0 0 0 w W w w F F .F F ►= F F �= F F r F 2 o n. z o 3 8 5 S 3 5 z Z Z Z 0 0 0 0 0 0 0 0 o c o 0 0 0 } W W ' W W W W W W W W W W W W W o o O gu. l0 n m O1 �n tD n n n n m m m m m oD m m m m m m m C.9.b Attachment B SUBMISSION PROPOSAL RESPONSE FORM U SET PRICING FOR MEDICAL SUPPLIES AND PHARMACEUTICALS Proposer's Name and Mailing Address: Bound Tree Medical, LLC 5000 Tuttle Crossing Blvd x Dublin, OH 43016 0 Telephone and Fax Numbers: Crj 2 t have included: CL CL • ProposaUrabbed Sections • Medical Supply Discount Off List and Pricing Worksheet (Attachment A) _ • Submission Proposal Response Form (Attachment B) 1/ • Non-Collusion Affidavit (Attachment C) co • Lobbying and Conflict of Interest Clause Form (Attachment D) CL • Drug Free Workplace Form (Attachment E) • Public Entity Crime Statement (Attachment F) • Local Preference Form (Attachment G) y! • Scope of Services Response Form (Attachment H) • Insurance Requirements,Indeninification/Hold Harmless, / and Request for Waiver of Insurance Requirements (Attachment I) ►/ (Check mark items above, as a reminder that they are included). I state that I am authorized to submit this proposal. STATE OF Ohio J ignature of Proposers) COUNTYOF Franklin Vice President Date 9/06/2016 PERSONALLY APPEARED BEFORE ME,the undersigned authority, ,-A, L19llcn a i e, who,after first being sworn by me,(name of individual signing}affix wit nature in the space provided above on this 6th day of 20 i6 0 Da�•� 'd 72do II My commission e= NOTARY PUBLI � � U Packet Pg. 315 C.9.b Attachment C 2 0 U t— NON-COLLUSION AFFIDAVIT 0 1, Rhiannon Greene according to law,on my oath,and under penalty of perjury,depose and say that: a) 1. I am Vice President ,ofthe firm of Bound Tree Medical, LLC 0 the bidder/responder making the proposal for the project described in the Notice of Request for Competitive Solicitations for: > 0 CL Medical Supplies and Pharmaceuticals CL 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 S for the purpose of restricting competition,as to any matter relating to such prices with any other bidder/responder or with any 04 competitor. 04 r 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 bidden'responder prior to the opening of the responses, directly or indirectly,to any other bidder/responder or to any competitor. 4. No attempt has been made or will be made by the bidden'responder to induce any other person,partnership or corporation to CL submit,or not to submit,a proposal for the purpose of restricting competition. UJ r 5. Th ents contained in this affidavit are true and correct,and made with full knowledge that Monroe County relies upon e truth of aAstatements contained in this affidavit in awarding contracts for said project. 09/06/2016 (Signature ofBidder/Responder) (Date) Rhiannon Greene, Vice President Print Name/Title r_ Q) STATE OF: Ohio r COUNTY OF: Franklin f � PERSONALLY APPEARED BEFORE ME,the undersigned authority, KV►a.N Yl o V1 ��4. Ai- CrJ (name of individual signing Affidavit),who,after first being sworn by me,affixed his/her signature in the space provided above U on this 6th day of September 20 16 F- 1111t11 Mycommissiq� NOTARY IC 0 David Mello II BONALOdA20 Packet Pg. 316 C.9.b Attachment D O U O LOBBYING AND CONFLICT OF INTEREST FORM x SWORN STATEMENT UNDER ORDINANCE NO, 10-1990 jt jONROE COUNTY.FLORIDA � ETHICS CLAUSE 2 CL CL 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 Ordnance AV 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, co 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. CL x Uj (Signature) Date: 9/06/2016 Crj STATE OF: Ohio COUNTY OF: Franklin PERSONALLY APPEARED BEFORE ME,the undersigned authority, c yVi 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 6tn day of September 20 16 . U My Commission Expires: ,,11A11 I'������i,-- NOT Y PUBLIC - David Bello II P„�, daro L .= Oatnt 1mgA1'2 a 01„ Packet Pg. 317 C.9.b Attachment E 0 U DRUG-FREE WORKPLACE FORM 0 x a) The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: 0 0 Bound Tree Medical LLC C CL (Name of Business) CL 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 M 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 r 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). CL Uj 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 polo contenders to,any violation of Chapter 893(Florida Statutes)or of any controlled substance la%v of the United States or any state,for a violation occurring in the workplace no later than five(5)days after such conviction. 5. Imposes a sanction on,or requires the satisfactory participation in,a drug abuse assistance or rehabilitation program if such is available in the employee's community,for any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. Cn As the person authorized to sign the statement,I certify that this firm complies fully with the above requirements. J J U Bidder's Signature Rhiannon Greene, Vice President 9/06/2016 Date F- David Ziteiio II 0 �* * nol.rPl,�,sl�aahn Caaaiatott efiW AURAI&M Packet Pg. 318 C.9.b Attachment F L r- 0 U 0 in PUBLIC ENTITY CRIME STATEMENT x "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 CL 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." in I have read the above and state that neither sound Tree Medical , LtX (Proposer's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. Q r r (Signature) CL Rhiannon Greene, Vice President uj r Date: 9/06/2016 STATE OF: Ohio COUNTY OF: Franklin Subscribed and sworn to(or affirmed)before me on the 6th day of September ,20 16 , by 4�,!L}6 61'�� t f1^�,�11�s (name of individual signing Affidavit). He/She is personallown to ur me or has produced r J (type of identification)as identification. CU U My Commission Expires: V IAL NOTARY BLIC David MOO II o = *'= p�ic,9tl�ddib C qn 6ipirt N�psaR 18,�20 Packet Pg. 319 C.9.b Attachment G 2 "Not Applicable 0 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? 0 List Address: CL CL 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? M If yes,please provide: r 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: CL 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 far the purposes therein contained. My commission expires: as Notary Public (Seal) Print Name 0 * This Form is only required if Local Preference is applicable pursuant to See.2-349,Monroe County Code. U Packet Pg. 320 C.9.b Attachment H - Scope of Services Response Form 12016 ..�.�_ The Proposer will be evaluated on compliance with the below service requirements. By submitting a proposal,the Proposer agrees that these provisions will be part of the agreement between the parties. 0 03 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) 0 QUALITY ASSURANCE PROVISIONS 2 Ordered Supplies/Receiving: CL 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 03 supplier's invoice shall be reported immediately by the x Monroe County Logistics Specialist to the Supplier and shall be corrected within a two(2)business day time co frame when the County has made that report within normal working hours of 8 am to 5 pm Monday through Friday. CL 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. CU 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 CU 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 U Packet Pg. 321 C.9.b U Attachment H - Scope of Services Response Form 2016 0 YES NO YES SERVICE REQUIREMENT can cannot Can comply, cam I cam I but with specified deviations � P y p y (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 0 overexposure. 4. The emergency procedure for spills,fires,disposal x CL and first aid. CL 1, 5. A description,in lay terms,of the known specific 1 x potential health risks posed by the toxic substance intended to alert any person reading this information. 04 04 6. The year and month,if available,that the co information was compiled and the name, x address,and emergency telephone number of the manufacturer responsible for preparing the CL information. I X LU .__............. Supply Time: Proposers must be able to supply contracted requested supplies within a three(3)business day time frame of ' normal request of supplies when the County has made x that request within normal working hours of 8 am to 5 I pm Monday through Friday. CU Natural or Man-Made Emergencies: I CUDuring emergency(natural or man-made emergencies) situations,Proposers must be able to supply requested I x supplies on a next day basis,twenty-four(24)hours a Cn day seven(7)days a week. PROPOSER'S'LIABIUTY Warranty: Crj It shall be the Proposer's responsibility to submit at the time of shipment the original manufacturer's warranty x °S for the materials supplied. 0 U Packet Pg. 322 C.9.b U Attachment H - Scope of Services Response Form 12016 ._ YES NO YES Can comply, SERVICE REQUIREMENT can cannot but with specified deviations comply comply (please detail deviations below) Defects: Upon un-packaging and discovering defects to materials shipped by Supplier,any medical supplies and/or a) pharmaceuticals requiring replacement shall be 0 finalized within five(5)working days of reporting the defect. C CL CL (See also information required behind Tab 2 regarding warranties and replacements.) Guarantee: The material(s)supplied shall be guaranteed to be free N from defect of composition,conception and workmanship for a minimum period of 120 days from co 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 CL Proposer at the Proposer's expense for immediate replacement. r Quality: The materials to be furnished shall be currently in production and shall be of the manufacturer's standard 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 J to purchase any minimum or maximum quantities during the term of any award resulting from this U 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. 0 U Packet Pg. 323 C.9.b Attachment H - Scope of Services Response Form 12016 2 YES NO YES I F SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations � (please detail deviations below) Packaging: OnlyMaterials 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 L_ CL at the receiving location.Any attempts by the CL Proposers to furnish the County with other than first quality materials shall constitute default as outlined in this specification. j i I Refrigeration: i i Maintaining a specific temperature range throughout the shipping process is essential to the quality of co healthcare products. Proposer has the ability to ship I x products in a proper tem peratu re-control led u� environment. Only materials which have been properly CL shipped in a temperature-controlled environment shall be accepted by the COUNTY. I uj 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. I CONDITIONS Authorization: Proposer has the ability to handle orders placed by the electronic ordering software Operative IQ. (All orders shall be placed via Monroe County by individual X ur Purchase Orders generated by the County's electronic ordering software,Operative IQ,or as"Open"Purchase orders.) Furnishing Proposal Items: I T Contract items are to be furnished on an"as needed, I °S when needed basis"during the life of the contract. i x 0 U Packet Pg. 324 C.9.b U Attachment H - Scope of Services Response Form 12016 YES YES NO SERVICE REQUIREMENT can cannot Can comply, com I com I but with specified deviations � ply ply (please detail deviations below) Delivery: Materials ordered shall be delivered within three(3) business days after receipt of order.Failure to do same x a) shall be considered breach of contract or default,and �° the County shall utilize its options as stated within the contract. L CL CL 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. r Penalties: co r The County reserves the right to increase or decrease quantities shown without penalty. CL x Samples(Medical Supplies only): LU 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 r within ten days following receipt of the sample. J J Substitution: No items will be substituted without the prior written approval of the County. Any violation of such es procedure may result in a possible cancellation of the x contract. All approved substitutes shall be annotated E2 as such on the Proposer's shipping document(s). 0 U Packet Pg. 325 C.9.b Attachment H - Scope of Services Response Form 2016 2 YES NO YES T SERVICE REQUIREMENT can cannot Can comply, but with specified deviations comply comply (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 L- CL outlined in this specification. CL Shipping Costs: Prices quoted in the Proposal and Proposal Response M 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. co " Taxes: All taxes of any kind and character payable on account of the word done and materials furnished under the CL award shall be paid by the Proposer and shall be xuj deemed to have been included in the proposal. The County is exempt from all state and federal sales,use, transportation,and excise taxes. Infringement: Proposal prices must include all royalties and costs arising from patents,trademarks,and copyrights in any way involved in the work. Whenever the Proposer is required or desires to use any design,device,material or process covered by letters of patent or copyright,the Proposer shall indemnify and save harmless the County, its officers,agents,and employees from any and all x claims of infringement by reason of the use of any such patented design,toll,material,equipment or process, to be performed under the contract,and shall indemnify the said County,its officers,agents and U 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. 0 U Packet Pg. 326 C.9.b U Attachment H - Scope of Services Response Form 12016 YES YES NO SERVICE REQUIREMENT can cannot Can comply, com I com I but with specified deviations � p y p y (please detail deviations below) Award Changes: No changes,over the contract period,shall be permitted unless prior written approval is given by the 0 County and,where applicable,confirmed by the x Monroe County Board of Commissioners. > 2 CL CL 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. CD CD Price Escalation: CD co The County will allow a price escalation provision with this award. The original proposal prices quoted on Medical Supply Discount Off List and Pricing WorksheetCL (Attachment A)shall be firm for a one;1)year minimum period. A price escalation/de-escalation will uj r 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 CU 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 Crj right to place the Proposer in default,cancel the U contract,and remove the Proposer from the County's c, proposer list for a period of time deemed suitable to the County. i"- 0 U Packet Pg. 327 C.9.b U Attachment H - Scope of Services Response Form 2016 0 YES YES NO SERVICE REQUIREMENT can cannot Can comply, com I com I but with specified deviations � PY PY (please detail deviations below) Invoicing: The Proposer shall furnish the County complete itemized invoices for the goods received. Invoices are 0 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 C x CL also to reflect the provisional price discount in the form CL 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 co r • Company name • Purchase order number CL x uj • Location and dates of delivery , • Cost of items as stated on Proposal Response and extended price to reflect total cost for number of items received. Prompt Payment Act: The Proposer agrees to accept payment per the terms of the Florida Local Government Prompt Payment Act. Normal processing time is approximately 30 days from x presentation of the invoice. Ordering: Proposers will provide web-based online ordering website designed specifically for service. x J Disaster Recovery: 9 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 F- situations.These numbers will be updated immediately if the contact number changes. 0 Q) U Packet Pg. 328 C.9.b U Attachment H - Scope of Services Response Form 12016 0 YES YES NO F Can comply, SERVICE REQUIREMENT can cannot comply comply but with specified deviations 0 (please detail deviations below) Indemnification and Insurance Requirements: The Proposer can comply with the insurance requirements outlined in Attachment I to the RFP,or 0 has submitted a Request for Waiver(also found in x Attachment 1). Also,the Proposer can comply with the > 2 indemnification and hold harmless requirements(also CL CL found in Attachment 1). r co r Cn UJI CL CU Cn J J U 0 U Packet Pg. 329 C.9.b A CERTIFICATE OF LIABILITY INSURANCE DATE(MM 01/1312017 YY) 2017 i 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 O BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED O REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.If F SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Z O NAME: M Aon Risk Services Northeast, Inc. POE (866) 283-7122 FAX (800) 363-0105 Columbus OH office (A/C.No.Ext): AlC.No.: — 445 Hutchinson Avenue E-MAIL Suite 900 ADDRESS: 3 Columbus OH 43235 USA x INSURER(S)AFFORDING COVERAGE NAIC M O INSURED INSURER A: Hartford Fire insurance Co. 19682 Sarnova, Inc., Bound Tree Medical, LLC INSURERB: Hartford Casualty insurance Co 29424 5000 Tuttle Crossing Blvd. Dublin off 43016 USA INSURERC: Sentinel insurance Company, Ltd 11000 0- INSURER D: Medmarc Casualty Ins Co 22241 CL CL 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 MMIOD MMIOD LIMITS X COMMERCIAL GENERAL LIABILITY UUNVG EACH OCCURRENCE $1,000,000 CLAIMS-MADE X❑OCCUR $300,000 PREMISES Ea occurrence e✓ e✓ MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY S1,000,000 y GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE S2,000,000 a POLICY ❑X JEa LOC PRODUCTS-COMPIOPAGG Excluded u UJ OTHER: c e r +s C AUTOMOBILE LIABILITY Y 33 UUN VG3435 12/01/201612/01/2017 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) 1 i OWNED SCHEDULED BODILY INJURY(Per accident) - AUTOS ONLY AUTOS I HIRED AUTOS NON-OWNED PROPERTYDAMAGE r ONLY AUTOS ONLY Per aeeidenl ti i B X UMBRELLA LIAB X OCCUR 33RHUVG1892 12 01 201612/01/2017 EACH OCCURRENCE' S101000,000 L EXCESS cri LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION 510,000 WORKERS COMPENSATION AND PER STATUTE OTH- EMPLOYERS'LWBILITY YIN ER ANY PROPRIETOR I PARTNER I EXECUTIVE ❑ E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N I A (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT _ e✓ D Products Liab 160H380015 12/01/2016 12/01/2017 Aggregate Limit $10,000,000 r claims Made SIR Aggregate $150,000 SIR applies per policy ter ins & condi ions Per Occ Limit $10,000,000 J DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) cri Re: Account No. 104754. Monroe County BOCC is included as Additional insured in accordance with the policy provisions of the ac General Liability and Auto Liability policies. I AF'� GEMENT�/ �4t a WDE AIV R N/AEG YES— -7 CERTIFICATE HOLDER CANCELLATION 1 O 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 t i �cJlN�atedc/1011 ✓saaCU ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD Packet Pg. 330 C.9.b AGENCY CUSTOMER ID: 570000037575 LOC#: A�o ADDITIONAL REMARKS SCHEDULE Page _ of _ L AGENCY NAMEDINSURED Aon Risk Services Northeast, Inc. Sarnova, Inc., Bound Tree Medical, LLC 0 POLICY NUMBER See Certificate Number: 570065283042 CARRIER NAIC CODE See Certificate Number: 570065283042 EFFECTIVE DATE: ADDITIONAL REMARKS C THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance x INSURERS)AFFORDING COVERAGE NAIC# a) 2 INSURER INSURER 2 CL CL INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD 04 certificate form for policy limits. , INSR ADDL SUBR POLICY NUMBER POLICY POLICY LIMITS LTR TYPE OF INSURANCE INSD WVD EFFECTIVE EXPIRATION DATE DATE (MMIDDNYYY) (MM/DD/YYYY) OTHER CL x Uj D Products Liab 160H380015 12/01/2016 12/01/2017 SIR Per $50,000 , Claims Made Occurrence SIR applies per policy to ms & conditions Crj J J U 0) 01 i F- C U ACORD 101(2008101) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD Packet Pg. 331 C.9.b AGENCY CUSTOMER ID:SARNINC-01 BDICKSOKI LOC#: q`�pR ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY NAMED INSURED 0 Thompson Flanagan Executive Liability Group Sarnova,Inc.Bound Tree Medical,LLC 9 Y P 5000 Tuttle Crossing Blvd. POLICY NUMBER P.O.BOX 8023 y Dublin,OH 43016 F- EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 ISEE P 1 EFFECTIVE DATE:SEEPAGE1 O ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance O Named Insureds 1.Sarnova,Inc. FEIN:262386055 2 CL CL 2.Bound Tree Medical Products,Inc. FEIN:731646550 3.Tri-Anim Health Services, Inc. FEIN:952959155 4.Bound Tree Medical,LLC FEIN:311739487 M 5.Sarnova HC LLC FEIN:262549813 r 6.Emergency Medical Products Inc. FEIN:391164909co 7.Cardiovascular Concepts,Inc. FEIN:751835412 CL r r J J U F- O U ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Packet Pg. 332 C.9.c CONTRACT BETWEEN THE BOARD OF COUNTY COI4 MISSIONERS 0 AND THE BOARD GOVERNOR FIRE AND AMBULANCE DISTRICT I a OF MONROE COUNTY,FLORIDA AND > 2 BOTIND TREE MEDICAL, LLC CL FOR THE PURCHASE OF MEDICAL SUPPLIES AND PHARMACEUTICALS THIS CONTRACT", hereinafter "CONTRACT" or "AGREEMENT", is made and entered into this I" day of December, 2016 by and between. the Monroe County Board of County Cornmissioners and Board of Governors Fire and Ambulance District 1 of Monroe County, Florida, hereinafter referred to as COUNTY", and Bound Tree Medical, LLC", hereinafter referred to as "CONTRACTOR". co W ITN ESSETH: 0 WHEREAS, the COUNTY advertised a notice of request for proposals for medical supplies and pharmaceuticals. CL WHEREAS.the successful Proposer was Bound Tree Medical, LLC,and; r WHEREAS, this CONTRACTOR represents that it is capable and prepared to provide such U seservices, R'Y Aie�:.J, and, U M WHEREAS, the COUNTY intends to enter into an agreement to furnish medical supplies and E CU pharmaceuticals at set pricing and; EL WHEREAS,this contract is an "Agreement" between both parties, NOW. THEREFORE, in consideration of"the promises contained herein, the parties agree CL CL as follows: U) CU 1.. CONTRACT DOCUMI NTS — This contract consists of the Agreement, the U CONTRACTOR'S response to the Request for- Proposals (RFP), and the documents °S referred to in the Agreement as a part of this Agreement. In the event of any conflict between any of the contract documents, the one imposing the greater burden on the CONTRACTOR will control. CU U . CONTRACT PERIOD AND RENEWAL - The effective date of this Agreement shall be December 1, 2016 through November :its, 2019, with two one-year options for renewal, subject to the approval of the Monroe County Board of County Commissioners and the Board of Governors of fire and Ambulance District 1.. CONTRACT TERM[NATION - This Agreement may b terminated for anyreason by o either party on 0-play 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 Packet Pg.333 C.9.c 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 0 the County, become property of the County. The County shall pay the CCyNTRAC'FOR fair and equitable: compensation for expenses incurred prier to termination of the agreement, less any amount or damages caused by the C.C)N`I"RACTOR'S breach. If the a) damages are more than compensation payable, the CONTRACTOR will remain liable after termination and the County shall pursue collection for damages. L CL CL . SUBJECT MATTER OF CONTRACT T - This Agreement is to furnish medical supplies and pharmaceuticals at set pricing to Monroe County lire Rescue. . PRICING is set forth in the Medie l 5'uj)p v Discount Qft'Lisf and Pricing Worksheet (Attachment A), This will be inserted in the contract, which outlines both a discount in the form of a percentage off list, and pricing on specified numbered items. 04 6. QUALITY INSURANCE PROVISIONS A. Quality and Quality Control. A systern of test inspections shall be used to insure receipt of the quality and quantity of material(s)lservice(s) purchased. I' aterial(s),/Service(s) will be promptly inspected any discrepancies from the purchase order and/or the supplier's invoice shall be reported immediately by the CL x Monroe County Logistics Specialist, r I . Material Safety Data Sheet (MSI S). Any items delivered must be accompanied U by a M"SDS. The MSDS must be rnaontained by the user agency and trust include the fallowing information: CU CU 1) The Chemical name and the common Marne of the toxic substance. CL 2) The hazards or other risks in the use of the toxic substance, including. a) The potential for fire, explosion,corrosively and reactivity; CL CL b) The known acute and chronic health effects of risk from exposure, U), including the medical conditions which are generally recognized as g being aggravated by exposure to the toxic substance; and r c) The primary routes of entry and symptoms of overexposure. J ) The proper precautions, handling practices, necessary personnel CU 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. 0 :5) A description, in lay terms, ofthe known specific potential health risks posed by the toxic substance intended to alert any person reading this infon-nation. U 2 Packet Pg.334 C.9.c ) The yearand month, if available, that the information was compiled and 0 the name, address, and emergency telephone number of the manufacturer responsible for preparing the information. a) 0 C. CONTRACTOR must be able to supple contracted requested supplies within a three (3) business day time frame of normal request of supplies when the County has made that request within normal working hours of 8 am to 5 pm Monday CL C CL 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(2 ) hours a day seven (7)days a week.. 7. CONTRACTOR'S I...11ABILITY 04 A. Warranty. It shall be the CONTRACTOR'S responsibility to submit at the time of. co shipment the original manufacturer's warranty for the materials supplied. CONTI` ACTOR. shall follow procedure(s) to accomplish supplying a replacement product. if warranted. Replacements shall be finalized within five working days of reporting the defect. 13. Guarantee. The material(s) supplied shall be guaranteed to be free from defect of CL composition, conception and workmanship for a minimum period of '120 days r from the date of acceptance by the County. Any parts or portions found not in yr accordance with this specification will be rejected by the County and returned to U the CONTRACTOR at the CONTRACTORS expense for immediate replacement. Crj E Crj . SPECIFICATIONS: EL 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 riot equal to the product specified as a standard shall CL CL 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 manufacturers standard or better quality. °S r C. Quantities. The quantities listed on the 1'Ir edical }`uj)j)ly Discount Off List and Pricing W rksheel (Attachment A) are estimated quantities for one (I) year. The Crj COUNTY shall not be required to purchase any minimum or maximum quantities Y daring the term of any award resulting from this specification. The COUNTY as 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 darnagged packages shall be accepted at the receiving location, nor shall after-i-narket materials be accepted at the receiving location. U Packet Pg.335 C.9.c 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 0 have been properly shipped in a temperature-controlled environment shall be accepted by the COUNTY. > 0 L- CL CL F. Expiration Dates. All merchandise shall have a minimum expiration date of l months from date of shipment, and date must be displayed on the package.. 9. CONDITIONS:: A. Authorization. All orders shall be placed via Monroe County by individual 0" Purchase Orders generated by the: County's electronic ordering software. co Operative IQ, or as "Open" purchase orders, at the Countv's election. I . Furnishing Items. Contract iterns 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- CL receipt of order. Failure to der same shall be considered breach of contract or , default, and the COUNTY shall utilize its options as stated within the proposal specification. U D. Backorders. In the event an itern is not immediately available at the time of an order, or is not able to be delivered within three (3) days, the County shall have the option ofpurchasing the item from another vendor. CL E. Penalties. The COUNTY reserves the right to increase or decrease quantities shown without penalty. CL F. Addition/Deletion. The COUNTY reserves the right to add or delete any item 3 Cn from this proposal or resulting contract when deemed to be in the interest of the Crj 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 COUN'l"Y. 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). 0 1. Contract Prices. Contract prices From Wedical &rj)j)1y Discount ()Jf List' and Pricing Wor°ksl eel (Attachment A) shall be firm and shall not be amended after the contract is executed. Any atten-rpt by the CONTRACTOR to amend said prices unilaterally shall constitute default as outlined in the contrast,. U CU Packet Pg.336 C.9.c Prices quoted shall include all shipping costs, shipped T.O.B Marathon, Florida or to the facility location specified by the requestor or the purchase order. x All taxes of av kind and character payable on account of the work clone and 0 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. CL C CL Contract prices shall include all royalties and casts 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 co design, tall, 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. .1. Contract Provisional Prices off Dist Price. Contract pricing for items not CL included on A4ecticcal Siaa pa y Discount Off List and Pricing Pforks eet r (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 U contrast is executed. Any attempt by the CONTRACTOR R to amend said prices shall constitute default as outlined in the contract. CU COUNTY will verify items by a printout from the CONTRACTOR's online CL catalog showing both the. "list price" and "your price", the latter being the: COUNTY'S price. CU Cn K. Contract Changes.. No changes, over the contract period, shall be permitted CL CL unless prior written approval is given by the Monroe County Board of � Commissioners and the Board of Governors of Tire and Ambulance District 1. No CONTRACTOR shall assign the contract or any rights or obligations there Lander to a subcontractor without the prior written approval of the Monroe County °S Board of Commissioners and the board of Governors of Fire and Ambulance ' District 1. L. Price Escalation. The County will allow a price escalation provision for items on U the - ecliccal Suj)ply Discount (WJ'L iast and Pricing fforksheet (Attachment A) with this award. The original CONTRACTOR prices on plcdiccal ASuj)lalV List Pricing PVorksheet (Attachment A) shall be firm for a one (1) year minimum period. A 2 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 ( 0) days prior to those changes taking effect. This request must be accompanied by a certified letter from the CONTRACTOR'S supplier showing U CU Packet Pg.337 s C.9.c 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. 0 If' at the point of` exercising the price escalation provision market media indicators show that the prices have decreased, and that the CONTRACTOR TOR has a) not passed the decrease on to the COLJN'I"Y, the COUNTY reserves the right to place the CONTRACTOR in default, cancel the comet, and remove the CONTRACTOR from the COOT NTY's CO TRAcroR list for a period of time CL C CL deemed suitable to the COUNTY. M. Invoicing. The CONTRACTOR shall furnish the COUNTY complete itemized invoices for the goods received. Invoices are to reflect the prices stipulated on the purchase order, and as outlined on the )We ical Discs uni Q/' List erred Pricing Jforksheet (Attachment. A). Invoices are also to reflect the provisional price discount in the form of a percentage at which the CONTRACTOR will sell co Hasse iterns 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 fallowing information;. CL o Invoice number " o Company name • Purchase order-number U • 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. E N. Payment. Full payment will be made by t1le COtsNTY after receipt and acceptance of s aterialslservices and proper invoices in accordance with the CU Florida Local Government Prompt Payment Act, Section 218.70 et al. CL CL 0. Ordering. CONTRACTOR will provide web-based online ordering website : designed specifically for service. P. Disaster Recovery. CONTRACTOR must have a proven Disaster Support °S Prograrn in place and shall provide the COUNTY with emergency numbers for ' these situations. 'These numbers will be updated immediately if the contact number-changes. CU 10.. INDEMNIFICATION ` CONTRACTOR shall indemnify and hold the COUNTY and Monroe County and Monroe County Fire and Ambulance District I harmless for any negligence on its part or faulty or improper workmanship, for all work performed under this contract, including all costs of collection, reasonable attorney fees, claim costs, and as per "Attachment I". All property or equipment being directly maintained or repaired by CONTRACTOR shall be considered in its care, custody, and control while such work is in progress and until physical control of`such property or equipment is restored to the COUNTY. U Crj Packet Pg.338 C.9.c IL INSURANCE The Proposer will comply with the insurance requirements listed in Attachment I to the RFP. 12. ADDITIONAL REQUIRED STATEMENTS ./ VERIFICATIONS r� AFFIDAVITS. Attached hereto in Attachments 0 Attachment A Medical Supply Discount Off List and Pricing Worksheet Attachment B-- Submission Proposal Response Fong CL C CL 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 I1 — Scope of Services Response Form Attachment I—Request for Waiver of Insurance Requirements (if applicable) co 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. o 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. - r "SS 'THEREOF, each party hereto has caused this contract to be executed by its duly or resentative. BOARD OF COUNTY COMMISSIONERS MADOK OF MONROE COUNTY,FLORIDA CL Iym�- Crj Clerk of Court Mayor — Q) r BOUND TREE MEDICAL, LLC; BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT I OF MONROE COUNTY, FL a� .0 0**0"L.'U �A7ejee j By ...... 11r,t�_ . � :. - By: . Print Name and Title "Mayor/Chairperson Date:—_W.1.21_t s'., U ,, , Packet Pg.339 SECTION FOUR: ATTACHMENTS AND FORMS 0 Attachment A Medical Supply Discount Off List and Pricing Worksheet Attachment B Submission Proposal Response Farm 0 Attachment C Nan-Collusion Affidavit 2 CL CL Attachment D Lobbying and Conflict of Interest Attachment E Drug Free Workplace Attachment F Public Entity Crime Statement Attachment G Focal Preferenceco Attachment H Scope of Services Response Farm 0 Attachment I Insurance Requirements, Indemnification/Hold Harmless, and Request for Cn Waiver of Insurance Requirements CL uj Crj U U M EL Cn CL CL U) U r J J 0 U Packet Pg.340 C.9.c 5 m CO xa m Cz Ca m m w to m esa m m.... Car w w w m u5 w 0 ra +-a ry rat ry ry -_ ,-s ,_n ,�-+ tea. CL a a+'r ,,,,y. „w o_-_0 a a QC. i CL ae 04 CO Q w r_a' 0 0 u Q 0 to Cn CL t5s � i r� r4 t ui u w *' z Z .. Q Z z w Q UP Car 0 +� w w t C7 C7 L7 +. 47 Q � .w cw m et u w w 5� w ur as u to Q M X ac x st ar m n m m m w es w w w wCL q fl'a'a" m c5 Z ` can 4n a✓p w•o sera C7 an an C`3 >n t5 xca Ct w Cae w Caa w 2 V! vi Ln W ram. ra: M M a,. 3sE w 4 . Cu o 0 0 U} ii va C�'ar �i w i— may` E"l y"� u ... Q Q Q Q OCn Cr, +x. arr Ca. w w V Lt s s t.t U rar F^ Y f» s/f vA ®1 �7 �.7 Q 2 .®t Y Y a C3 CY QS 1!7 Cfl a'S7 w d37 f6 UT a97 RS7 w €b » Cd cA ....3 0 i a < sL � < 8 2 T T 2 _ w5r u7 tp F YJ 4J 4.r 6t S,F 4.3 A} V < i.F < 4r 4.Y w w 4. 4 4 ad a>C d Cr Q w w 4. L"7 {"� " C'. 'Lg u Cr r3� � � e.� , Car tl— fl Q QQ 4Q 4 Q 0 0 0 Q £o &� w w �1lzll_ aat w W sa.i w U` i A Y Y Y Y Y 'Y Y Y Y Y Y Y Y 's- w �^ 4Y ez e� � cC � aC aC tC: � eC 15C cC d`L cx: Q +s Packet Pg.341 C.9.c t :2 :2 2 rh 2 M TIM Ti.mi F1 CL Cr � in I N CL BCo 0 Co x — ilCL v9 ¢ uj C w w w w 'Q csa z. z t+r w w us w rdr a. Ta (4 m 4 CL x x x x x x x x x x -7 u n a ft � w. mm. m lm l!� u Q 1 0 aer w w w Cri iF C z z a i.,.9 z z z z z y z zCri w W w LU w tar UJ W u w w trs w w d„e w arm ax. 3a. u. w xx. t� w c CL � kw- � CL vi trb #.±'r v5 4A M H r. ry a^+I N P+i'. N t^d C+'Q g CL c+s teM vs va - V L,b W V tit V +.F L.7 t.T l.,k z In z a. W w w w w w W w W w tar `t 4 d SC Z r Cn w w w w w cc cca�1a rr v~i ca. ax, tk ax. a a .. tX u. L, 2 a7 w x x x x x x x x x x Q aCL t.3 Li C3 S..F m ua uy ua z�a.... w a eu w w w w w w w w w { t-- t-- - Br- a F- F- Q z 2 2 w z d t- to w 0 w w w a Q w tsar w w E a a d Q Q m f/i ss. ak. aa. :s 2 z 2 z 2 2 2 2 2 G{ da W- 2 toad u a. 0: w. a; � � a; ai � � ra. � 3- 5�- � �- �- 3- �- 3- � a: a r w C� — O rn O v_a ztn a c>r: 4 Q Q ¢ 6 Q 4 4 C w " a. #3 w a7 mCwo CW0 W ui tad w ett 1m 1w^ Fw a. 0.. 'o §1 1 u u u a d.3 t t S°J t7 �7 L� t 67 C to L 20 0 0 � � � G"Y z' z z z z z z 2 z � : � 2 2 u u ua u z 3 9 €J 0 0 [3 ar-� vs an d Q d d Q Q Q Q Q Q � cc � w w w z z Cri z z 2 z z €� Q 0 l'� a. a. m a. m a,. a. a. �. €� � ¢ t ei' �¢ o o — a cc cc x4 0 0 0 0 C7 0 0 0 �c� d d d � Q a Qcc z z z z z z z z 2 z z z z z z z 0 0 0 0 0 � n Q Q < a w w w w w '25 Le 5 F1 5G Packet Pg.342 C.9.c _1TY aY'! UTJ 1d°� r i^1 Y"! r'R ri a s R 2 N'& T fPi h W4 #r d #r �ii q%d vl +af a k 4+6 ai rrf +i f er'S e go 0 g�adq S 1�y4 9^^ w,.s ke ere r.✓ �I w +.G7 r r F t- +a ret w w w w w w co CD w # °# F 57' b' va ,y C5 4 ,. M1 4LF Q £3 C ati€ O r*e rV G€ N i7 tD i� '» sLe eC CL CL JO E CD 04 M 0 CL -0 z F F F uj H I. d xra in D w Z Uld u ' tn u u eu ae mhe u tL I a tz CC IX U w F _ d zcu w w uw au C] Ca t-- ' x ca ca L'1' Gi GY w m .-a 'n tm7 x ' tw 4eu [a €a ca vy i cg x x U} caz F b rr X CL cc d �-` Fes- V :z .a,..to z n' 6 N z ! 8 � rm z x C6 eC3 w y — 01 ctw r w — x Z a ^ar N F U) E.3 a a e"3 Ci ate.+ z t'J x X x d eTr w 1%. Y:. Y T Crj ...a 9 0 °�` sa.7 twca W- — — — u". -7 9 Let ta u Cy a �. F r Cri x z d a ci7 OF ce cc- V 4.s 4# sad v e� "s7 s.. Q u; s: X 'Z d '2. saC ei tea. rti w EC cWWC CW[ t _ uss g n' Fw. sir aFrs ^•' CA QS z � d w *� � aC d d C� e p ID z0 Vs z 0 0 0w uu".a z z z zer t t t� a r vs n t o rs 0 a� 0 0 C3 � � � e� *� s t7 �] �S da sra Ct 4 +n w ue uT n ¢ ¢ ¢ CZF a vs an u'e sra ve rs°s cn e17 eaa ci e'k7 w at t&s tss rG aes c0 aq 5.i t.7 'k7 4 8 ev cn In en 0 us to Lq Ln xn v5 In sn �A va v'a to srti z z z z z z z z z z z z z z z z z z zIn 'A F— w w w w w w w w w w w w w w w w ems, cc w cK - a •Zn -. err an e+'a N9 sett v3 w°t. L+! aPy Uti c+Y sie s� as +� u'f s.�4 rn w w w w w eae w w w w w w w ccr w w w ct ar sc vc z Im a' ac a cc z z z I < <e m t, , N > Packet Pg.343 C.9.c in on WIN 96 a a Nd xx mac'' LW w w w 40 Qo co m C. m W W w w w w > XI.� .� CL C CL .. , - ' - are a =... 2�- co m � w z i D sr+ � Q 2 J. w ,Q+. a u O r� d U} via w z Q sp io w _ CL 4 €c ., -s "r'. uj m e a as LU r a to crj CY a > w w w x Iz . L u m r ' n aECL 0 � z col � 6 ® � +wn ;Ao Z mCC Cx m 'a Ln inw cs c z a _, m x w 'S z a 0 0 a Q 0 cra CY 7' a ats 'w t# _ < K ti co J z r° v v a z _ va w3 a, z z z w a� w 3-• C} C] W w w w car w w w' dx m d - a �* CL yr wed 2 z ' ,''.r J z }"" y.... CX Cu C3. a. Q ei W wi R, �. Z h- 3= t" eS sC d v7 ua ct Ce. C7 W, ur 5J d dd ...t 7 7 a Q h 4- 0 C3 C7 43. °7' m j La cJ w :0 Q or. a- r& 4J 'S.7 i7 ci z z C Ca ! C& r� u.. +ad yd c. �# w vs t- 1p Qy � L 9 � s=x w > -� � � �, Xw.. �.- � m c� m 4J � � m a€a m m m d3 CT w w 4'� z z 2 td 4J 4? V 'iJ tJ a.} €� fJ l..k L1 tY L3 4.J t.k V *� Ci e..r Z 2 2 , W Fes-• tom- $- 1a k�- h Z z z z z z 0 0 0 0 0 .. z z i'3 47 E'? 49 4 E' S7 t,.. ¢ a d a � n a ca ru m �r n a n +s Packet Pg.344 C.9.c t a `a war v n to b y %;" ito on � A I D ri M a x x a ¢ a x x x � x x x x x a tr w w M a m m m Q w w w m Q U m w m m m m i CL r4 wi .-a i rat.. r uT ,. st r•7'.. In N Q 14 Ln L 4n hl co i 6v 2{7 ty '� a ..a � kan w "J U} `� ski. wwa ]e 47 y 2 Cy. CL uj Qj VA kA 0 0 4 x 03 m' p t� L 0 '(a m e`a u m a s Ct +s t+ �a < w 7ca ( Vf #J} sr9 a/kcc w is w be ,�-� Y to 0 ra€ } CL tt h t- t vs Q w w " z rya " CL 2 ° ... 2 :?. w. w Fes-' gam-. K.7 ac awn cir ii cc w u W aI, a crj u u u +� Z cc cn a s C5 ea sn Y,7 F- w s i ++� s_i w w h sue. ,,, ,,. . W i s z z �c w x W CL CL w w ga.—wi vaa aka t..1 v'" vt + w �* w y� ffi p ne s w w w u C7 C : J 0 x Pn crj tv w w w saws Q. IA C3 uwi r,p ra t- r +.y &7 uN w u cs cs 6 ,, a r ca w S w ' a u , a w se5 w w w w , w dL u F m w v- a yr � +s +a� y a= cs ai i sa a m u m u9 Cxys Cl m u rn � S '' ` ' cm Sn to t s '� 5= W ? .. T C3 vi c� C7 CS C9 sn .� +n Z irp w 3 0 0 zo � tc�ra.' crj w — r" c`a +n rr tti cra Q 0 0 m w � apt w tmp c7 t7 V7 �" u w1 CO m €a p Yee ,urea wu �"a 6 , v w g � 7 > 7 ur m ut z aaC 0 0 W '" tom% S. 1- Fes,- Yam- b_= $ aC Y S rxs w w 4 C'3 4'7 C'3 S.° S tic an t- taw CL wa kA 00Z 2 z z %- C r- ' w w xss ua ap.€ w pAP w 4Gp t- =0m N �G § p 7 0 Q a 0 0 0 O 0 0 0 @ m n-_zFa tri '7 .-t tv rn 7 u, u r•. s tes .r ra. tre cn ut r- t�s + -, ry m '.. Al c +s Packet Pg.345 C.9.c 2 F"s m _9 PIR 2 RT k`"5% g t +•'S i'�M !'9. Z7 r 2 2 A4 crj 0 L:a �Cd say C'3 gA � Gd cm C3 Q s Q �a r�i5 W tft C] Cs 11 m — #< P, P• P+ PB ' P+ *, P+ p, p,F.F P + CD y 04 M i w, 0 ucc x i e` CL C a > > a u 0 0 p x x ca � x y en eaa sn. cta X ❑ L3. us u, w Ica x *t z °—,� Q x cr ra 4S Q cC y w 1 w usi >. F "w > t7 escc CS p ca Ca ry c? x E o-- 2 € "L3 w w ua w sra caa p'a xn T — m w eaa CL w ua �. s,t.a � �' +,rr C'S Lu .0 caa 4 r, r.t wCL Lu x X ?c e� le > r eegg �g saJ €� � can =� zz 7 a r+a 9 crj ca Im > w Z vs rkDCa ss o x a a ,� a c� a MF� u, F- w w xZ Z i z z z z z z z z z z z z z z' zZ r cP n co sat 0ua. s# n co m � «r n zn � u`r tD - tact - - �-s - - - - v �a an ar's sra ws an to to to ua =r, cds sty ua sta'.. u3 sA 14 %0 +o r. C4' a<- — cu s Packet Pg.346 C.9.c 4 m t � 2: q E-j C Kz ,� 41 G A 12 � co a a a e 0 v mLn CL v , CL IL >0 � � � � �• LA CD L- W E 0 ba c "' LA " m uj CL n c 0tZ Cc, 4. cc `� w < u ui 0 t V cr z crj i * . I z us flc CL a cr v, v an rs r z , v} j x pp , w u CL 0, j ,. rM c3COCs o N4 7 An 2fw he cc C? O a w u & x t z + m z x sD vzl i w w g r J m as ccc cc w yr yr to z z z z z z z z z ees ut . 2 z z w t z w z rr z .. a al 25 a a Z5 a 7. a 6 a ud ur tag ua eu w w w ur w w. a�a su _ 0. 0 rl co Ch Packet Pg.347 t C.9.c Attachment B 0 SUBMISSION PROPOSAL RESPONSE FORM SET PRICING FOR MEDICAL SUPPLIES AND PHARMACEUTICALS Proposer's?lame and Mailing Address: Bound Tree 14edi cal, L..,C 0 L_ 5000 Tuttle Crossing Blvd CL CL Dublin,in, OH 43016 Telephone and Fax Numbers: I have included: • Proposal('I`abbed Sections co • Medical Supply Discount Off List and Pricing Worksheet (Attachment A) a) • Submission Proposal Response F'orin (Attachinettl l ) • Non-Collusion Affidavit (Attachment CL • Lobbying and Conflict of Interest Clause Form (Attachment D) x r • Drug Free'Workplace Form (Attachment E) Crj • Public Entity Crime Statement (Attachment l') U M • Local Preference Form (Attachment ) • Scope of Services Response Form (Attachmment I-I) fEL • Insurance Requirements, Indemnification/Hold Harmless, and Request for Waiver of Insurance Requirements (Attachment I) CL CL (Check mark items above, as a ren inner that they are included). U I slate that I ant authorized to submit this prcposat. � STATE OF Ch i.o inature of Proposers) COUNTY Franklin Vice President Elate 9I061`2C16 U PERSONALLY APPEARED EEFORF ME,the undersigned authority, , 1"�ot1 & who,after first being sworn by me,(name of individual signing)affi ature in the space provided above on this 6th day of. ,2tt p My commission e.. � NOTARY PUBLI �Illist CU Packet Pg.348 C.9.c Attachment C 0 x NON-COLLUSION AFFIDAVIT 0 2 CL CL l,, ®Yunnan Greene according to law,on my oath,and under penalty ofperlury,depose arid say that: 1. ]am Vice President ofthefirmof Bound 'Tree Medical., LLC the bidderfresponder making the proposal for the project described in the Notice of Request for Competitive Solicitations fear:. Medical Supplies and Pharmaceuticals and 1 executed the said proposal with full authority to do so. 4) The prices in this proposal have been arrived at independently vAthout 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. 0 3. Unless otherwise required by lase, the prices which have been quoted in this proposal have not been knowingly disclosed by the bidder'responder and will not knowingly be disclosed by the bidder:responder prior to the opening of the responses, CL directly or indirectly,to any other bidder/responder or to any competitor. UJ 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- . , nts contained in this affidavit are true and correct,and mane with full knowledge that Monroe County relies upon Q e truth oft statements contained in this affidavit in awarding contracts for said project.. CL 09/06/2016 (Signature ofBidderiResponder) (Date) pMannon Greene, Vice President Print Nanic/Title CL CL U) CrJ STATE OF: Ohio £°ClUN'f`tr or: Fran k1i.rz PERSONALLY APPEARED BEFORE W the undersigned authority, a (name of individual signing Affidavit),who,after first being sworn by me,affixed his/her signature in the space provided above on this September 6 t h day of20 16 U W Ad41;kl4ttw� My Comrnissic " NOTARY rBLIC * ! 0 14 811110 CrJ Packet Pg.349 i C.9.c Attachment,, 0 x a 0 2 LOBBYING AND CONFLICT OF INTEREST FORM CL CL MQM.a1AUhff,MJNJ2ERQRDj,NAN!CE NQ. ID-12 MONEDECOLMY,I+LORiII}A. ETHICS CLAUSE Rhiannon rreeTi; , Vice r wider* _ warrants that he/it has not employed, retained or co otherwise had act on his/its behalf any former County officer or employee in violation of"Section 2 of Or-rlinairce No, 10- 1990 or any County officer or employee in violation of Section 3 of Orclinance Ao, 10-1990. For breach or violation of y 0 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, CL Uj or consideration paid to the former County officer or employee. va U M -- (Signature) CL Date: 9 01)J201 tr STATE OF: Ohio CL CL C lU TY F. Franklin Crj �r PERSONALLY APPEARED BEFORE ME,the undersigned authority,. 4 " v��0 rt (natxte of individual signing Affidavit), who, after first being sworn by me, affixed his/her signature in the space °S provided above on this 6r h day of 5 C ptembe r 20 16 ' J J My Commission Expires: ' a �� ° Crj_ + ' DWd� MM NOT P.�a'l�l.JI3LiC .� ,. � 1 0 �rttet �t ''► U Packet Pg.350 C.9.c Attachment 0 m 0 DRUG-FREE WORKPLACE FORM 0 L_ CL CL The undersigned vendor in accordance with Florida Statute 287.087 herebycertifses chat: Bound Tree Medical LLC (Name of Business) 04 C 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. a 0 2 Informs employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free � workplace, any available drag counseling, rehabilitation, and employee assistance programs, and the penalties that may be � imposed upon employees for drug abuse violations. CL x Uj 1 Gives each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection(1). Crj 4. In the statement specified in subsection(1`, notifies the employees that, as a condition of working on the commodities or :3 contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of U any conviction of or plea of guilty or polo 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 ssorkplace no later than five(5)days after such Crj conviction, CL 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. � Es. Makes a goad faith effort to continue to maintain a drug-frec workplace through intplenmentation of this section, CL CL U) U As the person authorized to sign the statement,I certify that this firm complies fully with the above requirements. a; r J J bidder`s Signature Ahiannon Greene, Vince Presidents U 9/06/2016 Qy Date David ell 0 ,. +11iw1 1'ttts�w�r� U CU Packet Pg.351 C.9.c Attachment 0 x a 0 2 PUBLIC ENTITY CRIME STATEMIENT CL CL "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 can 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 C) business with any public entity in excess of the threshold amount provided in Section 27. 17, Florida Statutes, co for CATEGORY TWO for a period of36 months from the date of being placed on the convicted vendor list." 1 have read the above and state that neither ,... r°' ,c ( roposer's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. 0 DIM CL .. r (Signature) fzp3 ...76''<sx *�: Vi Fret 3 at U Iat . 3 r7 i 6 U M E CL STATE OF: Crj COUNTY OF: FranYIin Cn CL Subscribed and sworn to(car affirmed)before me on the r.c} day of '�`���',-r�r ,20 16 by CL U) Yea i lit n k _(name of individual signing Affidavit). He/She is personally known to me or has produced (type of identification)as identification, J J °g My Commission Expires: r 'g;l#e to TT 1�1C)TAP Y lE1LlC r AIVA I U Packet Pg.352 C.9.c 0 Not Applicable LOCAL,PREFERENCE POEM a) A. Vendors claiming a local preference according to Ordinance02'3-2009 must complete this form. 0 Name of Bidderaesponder _ _r.. Date: > 0 CL I„ Does the vendor have a valid receipt for the business tax paid to the Monroe County'rax Collector dated at CL least one year prior to the notice or request for bid or proposal? (Please fiu'nish 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: 04 Telephone Number: C0 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, 0 l 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. CL � X 2. Subcontractor Address within Monroe County from which the subcontractor operates: r Telephone Number, U Address U _..®....�.._ Address CL Print Nate: Signature and Title of Authorized Signatory for Bidder/Responder CL CL STATE OF U COUNTY OF � — U On this _ _ . .___day of 20 before me, the undersigned notary public, as personally appeared _.� known to me to be the person whose name is subscribed above or who produced as identification, and acknowledged that helshe is the person Who executed the above l..ocal Preference Form for the purposes therein contained. J My commission expires- Notary Public _ (Sea]) wm PrintNarne This Form is ouly required if Local Preference is applicable pursuant to See. _349,Monroe County Cade. 0 Q) U CU Packet Pg.353 C.9.c i Attachment H - Scope of Services Response Form 20�16 0 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. 0 C 0 YES CL YES NO C Can comply, SERVICE REQUIREMENT can cannot but with specified deviations comply comply (please detail deviations below) Q UAUTY ASSURANCE PROVISIONS Ordered Supplies/Receiving: system of test inspections shall be used to assure quality and quantity of materials received by County. co Materials will be promptly inspected and any discrepancies from the purchase order and/or the supplier's invoice shall be reported immediately by the a) o Monroe County Logistics Specialist to the Supplier and 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 uj Friday.. , Material Safety Data Sheet(MSDS): U Any items delivered must be accompanied by a MSD5. The M5t1S will be maintained by the County and must include the following information; Crj 1. The Chemical name and the common name of the CL toxic substance. 2, The hazards or other risks in the use of the toxic x substance,including. CL CL a) The potential for fire,explosion,corrosively x and reactivity; b) The known acute and chronic health effects r of risk from exposure,including the medical x conditions which are generally recognized as being aggravated by exposure to the toxic substance;and U cj The primary routes of entry and symptoms of x overexposure. . The proper precautions,handling practices, necessary personnel protective equipment,and Xo U Packet Pg.354 Attachment H Swope of e c Response Form 2 YES NO YES SERVICE REQUIREMENT i Sarre comply, 0 Icomnl complyt but with specified deviations p Y (please detail deviations below) > �. 0 CL other safety precautions in the use of,or CL exposure to,the toxic substances,including I appropriate emergency treatment in the case of overexposure. I 4. The emergency procedure for spills,fires,:disposal � x I and first aid. 04 5° A description,in lay terms,of the known specific s potential health risks posed by the toxic substance intended to alert any person reading i 9 this information. 0 6. The year and month,if available,that the information was compiled and the name, i lCL address,and emergency telephone number of I the manufacturer responsible for preparing the I ' information. I U Supply rime: Proposers must be able to supply contracted requested i M supplies within a three(3)business day time frame of normal request of supplies when the County has mane (' Crj that request within normal working hours of 8 am to 5 CL pm Monday through Friday. Crj I �' 1 lUatural or Man-glade Emergencies: During emergency(natural or man-,made emergencies) CL CL situations,proposers must be able to supply requested supplies on a next day basis,twenty-four(24)hours a Crj day seven(7)days a week. {g f U PRO POSER'S LIABILITY Warranty: J It shall be the Proposer's responsibility to submit at the Crj time of shipment the original,manufacturer's warranty U for the materials supplied. 0 U Packet Pg.355 C.9.c i Attachment H - Scope of Services e pron e Form1 0 ES YES NO Y SERVICE REQUIREMENT cars cannot Can comply, 0 comply complybrat with specified deviations (Please dermal deviations below) 0 - --- CL Defects: CL Upon un-packaging and discovering defects to materials shipped by Supplier,any medical supplies and/or pharmaceuticals requiring replacement shall be finalized within five(5)working days of reporting the defect. (See also information required behind Tab 2 regarding C 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 CL portions found not in accordance with this specification uJ will be rejected by the County and returned to the ' Proposer at the Proposer's expense for immediate CrJ replacement Quality- U M The materials to be furnished shall be currently in E production and shall be of the manufacturer's standard CrJ or better quality. CL Quantities, The quantities listed on the Medical Supply Discount Off CL Cast and pricing Waarksheet(Attachment A)are CL 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. 0 U C Packet Pg.356 C.9.c Attachment -- Scope of Services Response Form 12016 0 YES Nt7 YES SERVICE REQUIREMENT 1 can cannot� Can comply, � comply comply P but with specified deviations tpleose detail deviations below) > 0 CL_.... _ Packaging; CL 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 i 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 co quality materials shall constitute default as outlined in this specification. Refrigeration: _ Maintaining a specific temperature range throughout the shipping process is essential to the duality of healthcare products. Proposer has the ability to ship ? ! CL x products in a proper temperature-control led UJI environment. Only materials which have been properly shipped in a temperature-controlled environment shall be accepted by the COUNTY. U Expiration Elates. + Where applicable,all merchandise shall have a � � E minimum expiration date of 18 months from date of jCrj shipment and date must be displayed on the package. # jCL CONDITIONS Authorization. CL CL Proposer has the ability to handle orders placed by the electronic ordering software Operative ICE. (All orders shall be placed via Monroe County by Individual _ Purchase Girders generated by the County's electronic ordering software,Operative ILA,or as"Open"Purchase orders.) I " Furnishing Proposal Items. Contract Items are to be furnished on an"as needed, I CU I r: when needed basis"during the life of the contract. F- 0 U Packet Pg.357 { k I t Attachment H - Scope of Services Response Form] 201 06 X YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations(please detail deviations below) 22 CL Delivery: CL 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 0 M the County shall utilize its options as stated within the contract. Q Backorders: In the event an item is not immediately available at the co time of an order,and able to be delivered within three (3)days,the County shall have the option of purchasing E a) the item from another vendor. > 0 Z The County reserves the right to increase or decrease X quantities shown without penalty. uj Samples(Medical Supplies only): Crj U From time to time,either at the stage of the Proposal :3 or subsequently while the contract is in force,the a) U Proposer may wish to recommend an alternative to an M E item listed on Medicol Supply Discount Off List and L- Crj Pricing Worksheet(Attachment A). In those situations, CL the County may require the Proposer or the Proposer may elect to submit a sample for inspection,to ensure 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 CL :3 vendor can determine whether the sample should be U) returned or destroyed. Samples not destroyed will be returned upon request at the Proposer's expense within ten days following receipt of the sample. W Substitution: No items will be substituted without the prior written Crj 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 Proposer's shipping document(s). 0 W E U CU Packet Pg. 358 C.9.c Attachment H - Scope o ServicesResponse F� � 1 201 YES NO YE SERVICE REQUIREMENT can cannot Can comply, � comply comply but with specified deviations (please detoil deviations below) > 0 CL Proposal Prices: CL 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 the proposal opening. Any attempt by the Proposer to amend said proposal prices shall constitute default as outlined in this specification. co Shipping Costs: Prices quoted in the Proposal and Proposal Response form shall include all shipping casts,shipped F.0..13 x a Marathon,Florida or to the facility location specified by 0 the requester or the purchase order. —faxes: CL _ x All taxes of any kind and character payable on account UJI r of the word done and materials furnished under the � award shall be paid by the Proposer and shall be U deemed to have been included in the proposal. The County is exempt from all state and federal sales,use, a) transportation,and excise taxes. Infringement: CL 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 C CL or process covered by letters of patent or copyright,the U) Proposer shall indemnify and save harmless the County, its officers,agents,and employees from any and all g claims of infringement by reason of the use of any such as patented design,troll,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 CU may be incurred by reason of any infringement at any g time during the prosecution or after the completion of ao the work. 0 U i i Packet Pg.359 C.9.c Attachment Scope of Services Response Form 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, 0 comply comply but with specified deviations ru (please detail deviations below) .. L- CL Award Changes: CL No changes,over the contract period,shall be permitted unless prior written approval is given by the County and,where applicable,confirmed by the Monroe County Board of Commissioners. Assignment No Proposer shall assign the contract or any rights orco obligations thereunder to a subcontractor without the written consent of the County and approval of the Monroe County Board of Commissioners. a) 0 Price Escalation; The County will allow a price escalation provisions with CL this award. The original proposal prices quoted on Medical Supply Discount Off List and Pricing Worksheet r (Attachment A)shall be firm for a ane;1)year minimum period, A price escatation/de escalation will g be allowed one(1)year after the beginning of the s) award period and at one(1)year intervals thereafter, U provided the Proposer notifies the County,in uniting of any requested price changes at least sixty(60)days prior to those changes taking effect. This request must CL be acco pained by a certified letter from the CU 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 CL stated in this letter. ua If,at the point of exercising the price escalation g provision,market media indicators show that the prices as 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 g the County. F- 0 U Packet Pg.360 C.9.c Attachment H - Scope of Servicesp n +e Forr 2016 0 YES NO YES SERVICE REQUIREMENT can cannot Can comply, � comply comply but with specified deviations r (Please detail deviations below) 0- CL Invoicing. CL The Proposer shall furnish the County complete itemized invoices for the goads received. Invoices are to reflect the prices stipulated on the purchase order and as outlined on the hrledicolSuppily Discount Off List and Pricing War s eet(Attachment A). Invoices are also to reflect the provisional price discount in the fours c� 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: 0 Cn • invoice number CL • Company name r • Purchase order number us • g Location and elates of delivery Cost of Items as stated on Proposal Response U CU and extended price to reflect total cost for number of items received CU . EL Prompt Payment Act: . The Proposer agrees to accept payment per the terms of the Florida Local Government Prompt Payment Act. Normal processing time is approximately 30 days from CL CL presentation of the invoice. U) Ordering- Proposers will provide web-based online ordering website designed specifically for service. r J Disaster Recovery: Proposers have a provers Disaster Support Program in place and can demonstrate previous experience in — disaster recovery supply chain management and shall provide the County with emergency numbers for these situations.These numbers will be updated immediately if the contact number changes. 0 U C Packet Pg.361 i C.9.c Attachment H _ Scope of Services Response Form [LO16 YES NO YES SERVICE REQUIREMENT can cannot Can comply, 0 comply comply but with specified deviations ru (please detoil deviations belowv L CL Indemnification and Insurance Requirements; CL 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 x Attachment I). Also,the Proposer can comply with the indemnification and held harmless requirements(also CD found in Attachment I). 04 _. 0 uj CL Crj U U M CL CL U J J 0 U CU Packet Pg.362 i ,��f�+ DATE(t�dMODMYYYI CERTIFICATE F LIABILITY INSURANCE tDIII3F2Od7 O 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 INSUR€R(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy{les)must have ADDITIONAL INSURED provisions or be endorsed, I) SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement,A statement on this O +s certificate dears not confer rights to the certificate holder in Ilea of such endorseddTerlt(s). PRODUCER CONTACT Aon Risk services Northeast, Inc.. NAME Columbus OH office PHONE No.Extl° (866) 281-71,2 R1C.No Csc(a) 363 {HITS ID CL 445 Hutchinson Avenue EMAIL CL '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, L.LC INSURER8: Hartford Casualty insurance crr... 2942.4 5000 Tuttle Crossing Blvd. Dublin OR 43016 USA INSURERC: Sentinel Insurance Company, Ltd 11,000 INSURER0: Medmarc casualty Ins cc 22241 CD 04 INSURER E. I'NS'URER F: ...m_�.�.�.�.�.�.a....W...�_,.�.. CD - COVERAGE 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 O EXP LTR.. 'TYPE OF INSURANCE IN WV POLICY NUMBER MMR,7DdYY`i'"Y MMIDDFYYY I LIMITS A X COMMERCIAL GENERAL LIABIUTY Y 33UUNVG3435EACH OCCURRENCE. S1,000,.11F CLAIMS-MADE X�OCCUR I�"RERT a 130b,000 � RRE..FNISES Ea ocvurrence` CL — MED EXP(Any erne person) S10,000 LU PERSONAL&ADV INJURY S1,000,00o I e GENLAGGRE�GA.TE.LIMIT APPLIES PLR: GENERAL AGGREGATE $2,000,000 m in Y1 ,x, IPR{7- 1C?G PRODUCTS CLONPAOY AC,�G... Excluded � t� L�1 JECT OTHER cis C AUTOMOBILE LIABILITY Y 33 UUN VG3435 12'./01/201.61210112017 COMBINED SINGLE LIMIT S1,OOO,OtI{D. � Q) .Ma amdent .. X ANYALITO. BODILY INJURY(Per per wn) O z OwtN...E0 SCHEDULED BODILY INJURY(Per asrldent) Aycri AUTOS ONLY. AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE. ONLY AUTOS ONLY Per accslent � €a B X UMBRELLAUAB.... X OCCUR 33RHuv 1892 12101 2017 EACH OCCURRENCE 11t7,[It}(l,t#CD4I E.XCESSLIAB CLAIMS-MADE AGGREGATE.. SIO) 000,.000 I) DEO I X RETENTION 110,004 CL WORKERS COMPENSATION AND pER STATUTE EMPLOYERS'LIABILITY Y 1 N ER"""�I ANY PROPR ETOR.f PARTNER t EXECUTIVE r E,L EACH ACCIDENT LJ OF FICEPUMEMBER EXC.LUDEDa NIA _, .. .. (Mandatory in NH) E L DISEASE-EA EMPLOYEE IP yyes describe under °U DESCRIPTION OF OPERATIONS bola. E,L,DISEASE POLICY LIMIT _— D- products Liab IGoH380015 12/01/20161210112017 Aggregate Limit S10,000,AIlII I) Claims trade SIR Aggregate $ISO,l00 SIR applies per policy ter s & Conditions Per OC: Limit S10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(ACORD 101,Additional Remarks Schedule,may be anached If mom space Is required) -- Re: Account No. 104754. Monroe county SOCC is included as Additional insured in accordance with the policy provisions of the General Liability and Auto Liability policies. AP 6EI EI Tq °� SSA ..,_ Qd WA R N/A S—.. CERTIFICATE HOLDER CANCELLATION F- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T31E .. EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE -� POLICY PROVISIONS, O Monroe County BOCC AUTHORIZED REPRESENTATIVE 1111 12th St. suite 409 +s I Ivey west FL 33040 USAILS -- - - U CU 01988®2815 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Packet Pg.363 C.9.c AGENCY CUSTOMER ID- 570000037575 Lc : ADDITIONAL REMARKS D L Page of AGFNCY NAMEDINSURED 0 Aon Risk Services Northeast, Inc. Sarnova, Inc., Bound Tree Medical, LLC POLICY NUMBER see Certificate Number. 570065283042 CARMEr NAIC Cb JE See Certificate Number. 570065283042' EFFECTIVE DATE 0 ADDITIONAL REMARK THIS ADDITIONAL REMARKS FORM I5 A SCHEDULE TO ACORDFORM, FORM NUMBER: ACORD 25 FORMTITLE. Certificate of Liability Insurance CL CL INSURER(S)AFFORDING COVERAGE NAIL INSURE INSURFR IN5LIRE co INSURER i ADDITIONAL,AI.s POLICIES IFS If a policy'below does not include lintil information,ref6r to the corresponding policy on the r"#t_ORI7 a) certificate Form for policy limits. 0 POLICY POLICY U} IN'sR ADDL SURR POLICY NVNItREtt L14t1'CS LTR t'YPE OF INSURANCE INSID Wi"ID... EI�fiEC`GBY'F. 'F.7.PIRNTdtD�t DATE DATE C OTHER Uj Crj D Products Liab 16OH380015 12/01/2016 1210112017 SIR Per S5€,06-0 � claims made occurrence sett applies per policy to ms conditions _ U CL CL CL Crj I U Q) r J J Crj Q) i F— 0 U ACORD 101(2008101) 9�2008 ACORD CORPORATION.All rights reserved. The ACORD name and logs are registered marks of ACORD Packet Pg.364 SARNINC-01 BIDICKSON AGENCY CUSTOMER ID. LOC ACCORLY Illw� ADDITIONAL REMARKS SCHEDULE Page 1 a 1 :3 0 AGENCY NAMED INSURED h OMPSO Sarnova,Inc.Bound Tree Medical,LLC on Tana an Executive Liability Group 5000 Tuttle Crossing Blvd. a) UMSER .......................-P.O.Box 13023 X EEPAGE Dublin,OH 43016 a) 1 0 CARRIER NA1C CME iSEE PAGE 1 SEE P I EFFECTIVE DAM SEE PAGE 1 > —--- ---- - ------ -------- ------------ ------------ 0 ADDITIONAL REMARKS CL CL THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: _AqqRP,?_k FORM TITLE: certificate of Liability Insurance ........................................................................ 0 Named Insureds 1.Sarnova,Inc. FEIN: 262386055 Q 2.Bound Tree Medical Products,Inc. FEIN:73,1646550 04 co 3.Tri-Anirn Health Services, Inc. FEIN:952959155 4.Bound Tree Medical,LLC FEIN: 311739487 E 5.Sarnova HC LLC FEIN:262549813 0 z 6.Emergency Medical Products Inc. FEIN:391164909 (n CL 7.Cardiovascular Concepts,Inc. FEIN:751835412 X U.1 U U E_ CL CL CL U) Q) 0 E U ----------------- ACORD 101 (2008/01) t 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Packet Pg. 365 DATE(MM/DD/YYYY) _ CERTIFICATE OF LIABILITY INSURANCE 12/19/2019 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 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 NAME: AOn Risk services Northeast, Inc. PHONE FAX Columbus OH Office (A/C.No.Ext): (866) 283-7122 (A/C.No.): (800) 363-0105 445 Hutchinson Avenue E-MAIL Suite 900 ADDRESS: 0 Columbus OH 43235 USA U INSURER(S)AFFORDING COVERAGE NAIC# L INSURED INSURER A: Medmarc Casualty Ins CO 22241 F— 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 M INSURER E: INSURER F: QJ �a COVERAGES CERTIFICATE NUMBER: 570079659291 REVISION NUMBER: Q) THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 0 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 requested INSR ADDL SUBR POLICY EFF POLICYEXP y LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MIWDD/YYYY) (MIWDD/YYYY) LIMITS CL B X COMMERCIAL GENERAL LIABILITY Y 33UUNVG3435 12 01 2019 12 01 2020 EACH OCCURRENCE $1,000,000 CL CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 m GENT AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY "PRO ❑LOC PRODUCTS-COMP/OPAGG Excluded JECT CD OTHER: CD C AUTOMOBILE LIABILITY Y 33 UUN VG3435 12/01/2019 12/01/2020 COMBINED SINGLE LIMIT $1000 e , ,000 (Ea accident) 04 X ANYAUTO BODILY INJURY(Per person) L OWNED SCHEDULED BODILY INJURY(Per accident) � AUTOS ONLY AUTOS ,r,a HIREDAUTOS NON-OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Per accident) 1 D CD X UMBRELLA LIAB X OCCUR 33RHUVG1892 12/01/2019 12/01/2020 EACH OCCURRENCE $10,000,000 04 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 Q) DED I X RETENTION $10,000 WORKERS AND PER STATUTE OTH- EMPLOY U EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/ E.L.EACH ACCIDENT EXECUTIVE OFFICER/MEMBER N/AUJI (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE e If yes,describe under DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT A Products Liab 1190H380015 12/Ol/2019 12/01/2020 Aggregate Limit $10,000,000 Claims Made Agg Deductible $150,000 Per Occ Limit $10,000,000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if 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 Automobile Liability policies. CERTIFICATE HOLDER CANCELLATION U SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION �a DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. s. y� i Monroe County BOCC AUTHORIZED REPRESENTATIVE 1111 12th St., Suite 408 Key West FL 33040 USA ©1988-2015 ACORD CORPORATION.All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACID Packet Pg. 366 AGENCY CUSTOMER ID: 570000037575 LOC#: � Page _ _ADDITIONAL REMARKS SCHEDULE of AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. Sarnova, Inc. , Bound Tree Medical , LLC POLICYNUMBER 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 0 O INSURER(S)AFFORDING COVERAGE NAIC# F— INSURER INSURER 0 INSURER INSURER 0 ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. 0 CL POLICY POLICY CL INSR ADDL SUBR POLICY NUMBER TYPE OF INSURANCE LIMITS EFFECTIVE EXPIRATION DATE LTR INSD WVD DATE (MM/DD/YYYY) OTHER CD A Products Liab 190H380015 12/01/2019 12/01/2020 Per Occ $50,000 claims Made Deductible CD e hl CD e e hl V- Q) O m- 55 Q) i F— 0 Q) O ACORD 101(2008101) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD Packet Pg. 367