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3rd Extension 11/17/2021
cVR COU(�Q el.: 4 Kevin Madok, _CPA ;b" ta •......:. 'c Clerk of the Circuit Court&Comptroller—Monroe County, Florida 4. DATE: January 19, 2022 TO: Chief Steve Hudson Fire Rescue/EMS Cheri Tamborski Executive Administrator FROM: Pamela G. Hanco• 'HI.C. SUBJECT: November 17th BOCC Meeting Attached is an electronic copy of the following item for your handling: J1/U5 Contract with Bound Tree Medical LLC for one-year, effective December 1, 2021, through November 30, 2022,while reviewing piggyback arrangements with Board Tree Medical, LLC to obtain the best terms and pricing. Should you have any questions please feel free to contact me at(305) 292-3550. cc: County Attorney Finance File 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 330: 305-294-4641 305-289-6027 305-852-7145 305-852-7145 EXTENSION AGREEMENT BETWEEN THE OF COUNTY COMMISSIONERS,AN THE BOARD OF GOVERNORS FIRE AND AMBULANCE DISTRICT I OF MONROE COUNTY,FLORIDA, N BOUNDE AL,LLC FOR THE PURCHASE OF MEDICAL SUPPLIES AND PHARMACEUTICALS THIS EXTENSION (hereinafter "EXTENSION") to the contract for the purchase of Medical supplies and pharmaceuticals is made and entered into this 3rd day of November 2021 by and between the Monroe County Bayard 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 LL , hereinafter referred to as"CONTRACTOR". ITNESSET WHEREAS, on December I, 2016, the parties entered into an Agreement (hereinafter "Original Agreement")whereby the Contractor is to provide medical supplies and pharmaceuticals to the County; and WHEREAS, the Original agreement had an initial three-year term beginning December 1,2016 through November 30,2019 with two one-year options for renewal subject to the approval of the County,and WHEREAS, on .November 20, 2019 the COUNTY entered into the 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 WHEREAS,S, on October 21, 2020, the COUNTY TY entered into the 2" Renewal and Amendment Agreement and also amended the Original agreement in order to update and incorporate certain COUNTY and FEMA/FDEM previsions,and WHEREAS, the COUNTY desires to extend the Original Agreement as amended one additional year while the COUNTY T procures a new contract medical supplies and pharmaceuticals under the COUNTY purchasing policies and procedures, NOW THEREFORE, in consideration of the mutual promises and covenants contained in this EXTENSION,the parties agree: Page I of SECTION 1. The parties' December 1, 2016 agreement, a copy of which is attached and incorporated into this renewal as Exhibit A, is hereby extended for a one-year term beginning December 1, 2021 and terminating November 30, 2022. SECTION 2. Paragraph 5 of the original agreement is amended to read; 5. PRICING is set forth in the Medical Supply Discount Off List and Pricing Workshect (Attachment A — Oct. 2020). 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. SECTION 3. In all other respects, the parties' December 1,2016 original agreement as amended in the November 20, 2019 l' Renewal and Amendment Agreement and the October 21, 2020 2"d Renewal Agreement not inconsistent herewith remain in full force and effect. SECTION 12. ADDITIONAL VERIFICATIONS, The contractor verifies the following is true and it is in compliance with the following: 12.1 Prohibition on certain telecommunications and video surveillance sq[yj�ges or egtsiprnent as set forth in 2 CF 200.216. Recipients and subreciplents and their contractors and subcontractors may not obligate or expend any federal funds to(1)Procure or obtain; (2) Extend or renew a contract to procure or obtain; or(3)Enter into a contract(or extend or renew a contract)to procure or obtain equipment, services,or systems that uses covered telecommunications equipment or services as a substantial or essential component of any system,or as critical technology as part of any system. As described in Public Law 115-232,section 889, covered telecommunications equipment is telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities). (I)For the purpose of public safety,security of government facilities, physical security surveillance of critical infrastructure,and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Flangzhou Hikvision Digital Technology Company, or Dahua Technology Company(or any subsidiary or affiliate of such entities). (ii) Telecommunications or video surveillance services provided by such entities or using such equipment. (iii)Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense,in consultation with the Director of the National Intelligence or the Director of the Federal Bureau of Investigation,reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country. Page 2 of 4 12.2 of preference for orocurements,as set forth in 2 CFR '200,322 The COUNTY and CONTRACTOR should,to the great extent practicable, provide a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). These requirements of this section must be included in all subawards including contracts and purchase orders for work or products under federal award. For pUrPOSCS Ofthk SWi0n: (1)"Produced in the United States" means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States. (2) "Manufactured products" means items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polyrner-based products such as polyvinyl chloride pipe; aggregates such as concrete;glass, including optical fiber; and lumber. THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK. Page 3 of 4 S WHEREOF, each party hereto has causedthis )Cte lo to be executed its BOARD } IN MADOK,CLERK COMMISSIONERS OF MONROE ' FLORIDA s eaty ClerkBY: '401('W BOARDMayor V AND AMBULANCE DISTRICT I OF MONROE COUNTY,FLORIDA : Mayor/Chairperson MEDICAL,BOUND TREE �.....� By: MONROE 4 ( i t re) P Name and Mde Ole, C�re�Case/Seer Vice President�f arketi ASSISTANT ATTOPNEY 1 I II STATE COUNTY F: t notarization,Subscribed and sworn to(or affinned)before me,by means ofXfphysical presence or 0 online �i (date)by (name affient). He/She Is personallyn to me or has produced of ° ati )as, ntiE H T. OT Wwy 4 of " - g o SWwnberO7,2025 Page 4 of r O' Le - i EXHIBIT A CONTRACT BETWEEN THE BOARD OF COUNTY COMMISSIONERS AND THE BOARD GOVERNORS FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY,FLORIDA AND BOUND TREE MEDICAL,LLC FOR THE PURCHASE OF MEDICAL SUPPLIES AND PHARMACEUTICALS THIS CONTRACT, hereinafter "CONTRACT" or "AGREEMENT", is made and entered into this 1st day of December, 2016 by and between the Monroe County Board of County Commissioners and Board of Governors Fire and Ambulance District 1 of Monroe County, Florida, hereinafter referred to as "COUNTY", and Bound Tree Medical, LLC, hereinafter referred to as "CONTRACTOR". WITNESSETH: WHEREAS, the COUNTY advertised a notice of request for proposals for medical supplies and pharmaceuticals. WHEREAS,the successful Proposer was Bound Tree Medical, LLC, and; WHEREAS, this CONTRACTOR represents that it is capable and prepared to provide such services, and; WHEREAS, the COUNTY intends to enter into an agreement to furnish medical supplies and pharmaceuticals at set pricing and; WHEREAS,this contract is an"Agreement" between both parties, NOW, THEREFORE, in consideration of the promises contained herein, the parties agree as follows: 1. CONTRACT DOCUMENTS — This contract consists of the Agreement, the CONTRACTOR'S response to the Request for Proposals (RFP), and the documents referred to in the Agreement as a part of this Agreement. In the event of any conflict between any of the contract documents, the one imposing the greater burden on the CONTRACTOR will control. 2. CONTRACT PERIOD AND RENEWAL - The effective date of this Agreement shall be December 1, 2016 through November 30, 2019, with two one-year options for renewal, subject to the approval of the Monroe County Board of County Commissioners and the Board of Governors of Fire and Ambulance District 1. 3. CONTRACT TERMINATION - This Agreement may be terminated for any reason by either party on 30-day written notice without cause. If the CONTRACTOR fails to fulfill the terms of this Agreement, or attachments, properly or on time, or otherwise violates the provisions of the agreement or of applicable laws or regulations governing the use of funds, the County may terminate the contract immediately by written notice. The notice shall specify cause. All finished or unfinished supplies or services shall, at the option of the County, become property of the County. The County shall pay the CONTRACTOR fair and equitable compensation for expenses incurred prior to termination of the agreement, less any amount or damages caused by the CONTRACTOR'S breach. If the damages are more than compensation payable, the CONTRACTOR will remain liable after termination and the County shall pursue collection for damages. 4. SUBJECT MATTER OF CONTRACT - This Agreement is to furnish medical supplies and pharmaceuticals at set pricing to Monroe County Fire Rescue. 5. PRICING — is set forth in the Medical Supply Discount Off List and Pricing Worksheet (Attachment A). This will be inserted in the contract, which outlines both a discount in the form of a percentage off list, and pricing on specified numbered items. 6. QUALITY INSURANCE PROVISIONS A. Quality and Quality Control. A system of test inspections shall be used to insure receipt of the quality and quantity of material(s)/service(s) purchased. Material(s)/Service(s) will be promptly inspected any discrepancies from the purchase order and/or the supplier's invoice shall be reported immediately by the Monroe County Logistics Specialist. B. Material Safety Data Sheet (MSDS). Any items delivered must be accompanied by a MSDS. The MSDS must be mantained by the user agency and must include the following information: 1) The Chemical name and the common name of the toxic substance. 2) The hazards or other risks in the use of the toxic substance, including: a) The potential for fire, explosion, corrosively and reactivity; b) The known acute and chronic health effects of risk from exposure, including the medical conditions which are generally recognized as being aggravated by exposure to the toxic substance; and c) The primary routes of entry and symptoms of overexposure. 3) The proper precautions, handling practices,necessary personnel protective equipment, and other safety precautions in the use of, or exposure to, the toxic substances, including appropriate emergency treatment in the case of overexposure. 4) The emergency procedure for spills, fires, disposal and first aid. 5) A description, in lay terms, of the known specific potential health risks posed by the toxic substance intended to alert any person reading this information. 6) The year and month, if available, that the information was compiled and the name, address, and emergency telephone number of the manufacturer responsible for preparing the information. C. CONTRACTOR must be able to supply contracted requested supplies within a three (3) business day time frame of normal request of supplies when the County has made that request within normal working hours of 8 am to 5 pm Monday through Friday. During emergency (natural or man-made emergencies) situations CONTRACTOR must be able to supply requested supplies on a next day basis, twenty-four(24) hours a day seven (7) days a week. 7. CONTRACTOR'S LIABILITY A. Warranty. It shall be the CONTRACTOR'S responsibility to submit at the time of shipment the original manufacturer's warranty for the materials supplied. CONTRACTORS shall follow procedure(s) to accomplish supplying a replacement product, if warranted. Replacements shall be finalized within five working days of reporting the defect. B. Guarantee. The material(s) supplied shall be guaranteed to be free from defect of composition, conception and workmanship for a minimum period of 120 days from the date of acceptance by the County. Any parts or portions found not in accordance with this specification will be rejected by the County and returned to the CONTRACTOR at the CONTRACTORS expense for immediate replacement. 8. SPECIFICATIONS: A. Substitutions. Items supplied shall be as ordered and specified. When substitutions are recommended or necessary, the determination as to whether any proposed substitution is or is not equal to the product specified as a standard shall be made by the COUNTY, and such determination shall be final and binding. B. Quality. The materials to be furnished shall be currently in production and shall be of the manufacturer's standard or better quality. C. Quantities. The quantities listed on the Medical Supply Discount Off List and Pricing Worksheet (Attachment A) are estimated quantities for one (1) year. The COUNTY shall not be required to purchase any minimum or maximum quantities during the term of any award resulting from this specification. The COUNTY may purchase as little as zero percent (0%) or exceed as much as one hundred percent(100%) of the forecasted or estimated quantities. D. Packaging. Only materials that are packaged in the original factory fresh packaging shall be accepted. No materials that have been re-packaged or that are in the adulterated or damaged packages shall be accepted at the receiving location, nor shall after-market materials be accepted at the receiving location. i Any attempts by the CONTRACTOR to furnish the COUNTY with other than first quality materials shall constitute default as outlined in this specification. E. Refrigeration. Maintaining a specific temperature range throughout the shipping process is essential to the quality of healthcare products. Only materials which have been properly shipped in a temperature-controlled environment shall be accepted by the COUNTY. F. Expiration Dates. All merchandise shall have a minimum expiration date of 18 months from date of shipment, and date must be displayed on the package. 9. CONDITIONS: A. Authorization. All orders shall be placed via Monroe County by individual Purchase Orders generated by the County's electronic ordering software, Operative IQ, or as "Open" Purchase orders, at the County's election. B. Furnishing Items. Contract items are to be furnished on an "as needed, when needed basis" during the life of the contract. C. Delivery. Materials ordered shall be delivered within three (3) business days after receipt of order. Failure to do same shall be considered breach of contract or default, and the COUNTY shall utilize its options as stated within the proposal specification. D. Backorders. In the event an item is not immediately available at the time of an order, or is not able to be delivered within three (3) days, the County shall have the option of purchasing the item from another vendor. E. Penalties. The COUNTY reserves the right to increase or decrease quantities shown without penalty. F. Addition/Deletion. The COUNTY reserves the right to add or delete any item from this proposal or resulting contract when deemed to be in the interest of the COUNTY. G. Samples. When required, samples shall be labeled with the CONTRACTORS' name and item number and shall be furnished free of charge. Samples not destroyed will be returned upon request at the CONTRACTOR'S expense. H. Substitution. The CONTRACTOR shall not substitute items for like items without the approval of the COUNTY. Any violation of such procedure may result in a possible cancellation of the contract. All approved substitutes shall be annotated as such on the CONTRACTOR'S shipping document(s). I. Contract Prices. Contract prices from Medical Supply Discount Off List and Pricing Worksheet (Attachment A) shall be firm and shall not be amended after the contract is executed. Any attempt by the CONTRACTOR to amend said prices unilaterally shall constitute default as outlined in the contract. Prices quoted shall include all shipping costs, shipped F.O.B Marathon, Florida or to the facility location specified by the requestor or the purchase order. All taxes of any kind and character payable on account of the work done and materials furnished under the award shall be paid by the CONTRACTOR and shall be deemed to have been included in the price. The COUNTY is exempt from all state and federal sales, use, transportation, and excise taxes. Contract prices shall include all royalties and costs arising from patents, trademarks, and copyrights in any way involved in the work. Whenever the CONTRACTOR is required or desires to use any design, device, material or process covered by letters of patent or copyright, the CONTRACTOR shall indemnify and save harmless the COUNTY, its officers, agents, and employees from any and all claims of infringement by reason of the use of any such patented design, toll, material, equipment or process, to be performed under the contract, and shall indemnify the said COUNTY, its officers, agents and employees for any costs, expenses and damage which may be incurred by reason of any infringement at any time during the prosecution or after the completion of the work. J. Contract Provisional Prices off List Price. Contract pricing for items not included on Medical Supply Discount Off List and Pricing Worksheet (Attachment A) and sold to the County at a discounted percentage rate off the list price issued by CONTRACTOR shall be firm and shall not be amended after the contract is executed. Any attempt by the CONTRACTOR to amend said prices shall constitute default as outlined in the contract. COUNTY will verify items by a printout from the CONTRACTOR's online catalog showing both the "list price" and "your price", the latter being the COUNTY'S price. K. Contract Changes. No changes, over the contract period, shall be permitted unless prior written approval is given by the Monroe County Board of Commissioners and the Board of Governors of Fire and Ambulance District 1. No CONTRACTOR shall assign the contract or any rights or obligations there under to a subcontractor without the prior written approval of the Monroe County Board of Commissioners and the Board of Governors of Fire and Ambulance District 1. L. Price Escalation. The County will allow a price escalation provision for items on the Medical Supply Discount Off List and Pricing Worksheet(Attachment A) with this award. The original CONTRACTOR prices on Medical Supply List Pricing Worksheet (Attachment A) shall be firm for a one (1) year minimum period. A price escalation/de-escalation will be allowed one (1) year after the beginning of the award period and at one (1) year intervals thereafter, provided the CONTRACTOR notifies the COUNTY, in writing of any requested price changes at least sixty (60) days prior to those changes taking effect. This request must be accompanied by a certified letter from the CONTRACTOR'S supplier showing the price increase to the contractor. The price increase to the County shall be limited to the percentage increase to the CONTRACTOR as stated in this letter. If, at the point of exercising the price escalation provision, market media indicators show that the prices have decreased, and that the CONTRACTOR has not passed the decrease on to the COUNTY, the COUNTY reserves the right to place the CONTRACTOR in default, cancel the contract, and remove the CONTRACTOR from the COUNTY's CONTRACTOR list for a period of time deemed suitable to the COUNTY. M. Invoicing. The CONTRACTOR shall furnish the COUNTY complete itemized invoices for the goods received. Invoices are to reflect the prices stipulated on the purchase order, and as outlined on the Medical Supply Discount Off List and Pricing Worksheet (Attachment A). Invoices are also to reflect the provisional price discount in the form of a percentage at which the CONTRACTOR will sell these items off its list price. The COUNTY will not accept an aggregate invoice. As part of the award process, the COUNTY may request a sample invoice. Invoices shall contain, but not limited to the following information: o Invoice number o Company name o Purchase order number o Location and dates of delivery o Cost.of items as stated on the contract and extended price to reflect total cost for number of items received. N. Payment. Full payment will be made by the COUNTY after receipt and acceptance of materials/services and proper invoices in accordance with the Florida Local Government Prompt Payment Act, Section 218.70 et al. O. Ordering. CONTRACTOR will provide web-based online ordering website designed specifically for service. P. Disaster Recovery. CONTRACTOR must have a proven Disaster Support Program in place and shall provide the COUNTY with emergency numbers for these situations. These numbers will be updated immediately if the contact number changes. 10. INDEMNIFICATION — CONTRACTOR shall indemnify and hold the COUNTY and Monroe County and Monroe County Fire and Ambulance District 1 harmless for any negligence on its part or faulty or improper workmanship, for all work performed under this contract, including all costs of collection, reasonable attorney fees, claim costs, and as per "Attachment 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. i 11. INSURANCE — The Proposer will comply with the insurance requirements listed in Attachment I to the RFP. 12. ADDITIONAL REQUIRED STATEMENTS/VERIFICATIONS / AFFIDAVITS. Attached hereto in Attachments Attachment A—Medical Supply Discount Off List and Pricing Worksheet Attachment B—Submission Proposal Response Form Attachment C—Non-Collusion Affidavit Attachment D—Lobbying and Conflict of Interest Attachment E—Drug Free Workplace Attachment F—Public Entity Crime Statement Attachment G—Local Preference (if applicable) Attachment H— Scope of Services Response Form Attachment I—Request for Waiver of Insurance Requirements (if applicable) 13. Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners of Monroe County, Florida. 14. Venue for any litigation arising under this contract must be in a court of competent jurisdiction in Monroe County, Florida. This Agreement is not subject to arbitration. SS WHEREOF, each party hereto has caused this contract to be executed by its duly oqw resentative. l� 23 BOARD OF COUNTY COMMISSIONERS r MADOK OF MONROE COUNTY,FLORIDA 40 91, By: J Clerk of Court Mayor BOUND TREE MEDICAL,LLC: BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY,FL By: �- By. Print Name and Title Mayor/Chairperson Date: 11 �l Io�D]Co Pr .� V r_i f. { SECTION FOUR: ATTACHMENTS AND FORMS Attachment A Medical Supply Discount Off List and Pricing Worksheet Attachment B Submission Proposal Response Form Attachment C Non-Collusion Affidavit Attachment D Lobbying and Conflict of Interest Attachment E Drug Free Workplace Attachment F Public Entity Crime Statement Attachment G Local Preference Attachment H Scope of Services Response Form Attachment I Insurance Requirements, Indemnification/Hold Harmless, and Request for Waiver of Insurance Requirements u p pQ p o p W 'V '4 y tJ R? i Q 4 O 40 g! $ r.�o p m n ci ed� ci c! �v�i 9rr n �n F� �s rV as Ft ��y' oMf M �i 3 G �•.� M N 6R V� l�Z Mp Sa L'� M MQ MQ MQ MQ ✓! � Np7 M Np M® Orps� !ma�yy C* " �Y "'Z f"! N W �'1 �'! ^� r"! 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O W� W t r` W Z 3 m p W W U of o cc LL z a 14 I Z "' 3 m co z J \ J U Q\ ¢ Q Q Q p ^mom > ry6 m W Z W Ln Q C z p > V 00 N G W O j O j N O J W W O O F j r O> Z Z W \ N O C N z z N W G p 0 gLA > � �n J a .� O O O .4 �n o � Q ¢ U _ o z z C or cc po •` z g 'I a p + N W w z $ 6 5 z C � Z �' � a J q W W U U F z N m m o z p m z O _7 Z Z In O z c cW Z V W 0 p S U� C� Z d . c2 cL z z Z O a (y O O O a > z O O W W W W 0 to In VI Vf Vf Ln VI to to tN to z z z Z z Z z Z z Z z Z Z Z W W y 0 0 0 0 0 0 0 0 0 0 0 0 0 0 F F F F F F F F F r= F F F F o 0 0 0 W W W W W W W W W W W W W W 21 O1 ,01 0161 �. 10 fn 00 O1 0 N m �n t0 n 0o Ci O fV m n n n r4 oo ao 1-4 0o a0 `tm m 00 ao ao co m m m CAm i Attachment B SUBMISSION PROPOSAL RESPONSE FORM SET PRICING FOR MEDICAL SUPPLIES AND PHARMACEUTICALS Proposer's Name and Mailing Address: Bound Tree Medical, LLC 5000 Tuttle Crossing Blvd Dublin, OH 43016 Telephone and Fax Numbers: I have included: f • Proposal/Tabbed Sections Y • Medical Supply Discount Off List and Pricing Worksheet (Attachment A) • Submission Proposal Response Form (Attachment B) V • Non-Collusion Affidavit (Attachment C) J • Lobbying and Conflict of Interest Clause Form (Attachment D) • Drug Free Workplace Form (Attachment E) • Public Entity Crime Statement (Attachment F) • Local Preference Form (Attachment G) ! • Scope of Services Response Form (Attachment H) • Insurance Requirements,Indemnification/Hold Harmless, f and Request for Waiver of Insurance Requirements (Attachment 1) V (Check mark items above, as a reminder that they are included). I state that I am authorized to submit this proposal. STATE OF Ohio ignature of Proposers) COUNTYOF Franklin Vice President Date 9/06/2016 PERSONALLY APPEARED BEFORE ME,the undersigned authority, kh f tr}non who,after first being sworn by me,(name of individual signing}affi ature in the space provided above on this 6 t n day of♦ ��i ,20 i 6 i DWd DO II My commission e= lyl14�INd� NOTARY PUBLI � � Attachment C NON-COLLUSION AFFIDAVIT 1, Rhiannon Greene ,according to law,on my oath,and under penalty of perjury,depose and say that: I. lam Vice President ofthe firmof Bound Tree Medical, LLC the bidder/responder making the proposal for the project described in the Notice of Request for Competitive Solicitations for: Medical Supplies and Pharmaceuticals and I executed the said proposal with full authority to do so. 2. The prices in this proposal have been arrived at independently without collusion,consultation,communication or agreement for the purpose of restricting competition,as to any matter relating to such prices with any other bidder/responder or with any competitor. 3. Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the bidder/responder and will not knowingly be disclosed by the biddedresponder prior to the opening of the responses, directly or indirectly,to any other bidder/responder or to any competitor. 4. No attempt has been made or will be made by the bidder/responder to induce any other person,partnership or corporation to submit,or not to submit,a proposal for the purpose of restricting competition. 5. Th ents contained in this affidavit are true and correct,and made with full knowledge that Monroe County relies upon e truth of statements contained in this affidavit in awarding contracts for said project. AW 09/06/2016 (Signature ofBidder/Responder) (Date) Rhiannon Greene, Vice President Print Name/Title STATE OF: Ohio COUNTY OF: Franklin PERSONALLY APPEARED BEFORE ME,the undersigned authority, K it,#,h n o y\ It f Q A R (name of individual signing Affidavit),who,after first being sworn by me,affixed his/her signature in the space provided above on this 6th day of September 20 16 MyCommissio� N i ` David Mello II NOTARY IC L *� 1to�ryPu6it;8mrdONO Z � C�am�on 6q>tw�upult tb� Ui11111N� j Attachment D LOBBYING AND CONFLICT OF INTEREST FORM SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 jtiMONROE COUNTY.FLORIDA ETHICS CLAUSE Rhianron Greene, Vice President warrants that he/it has not employed, retained or otherwise had act on his/its behalf any former County officer or employee in violation of Section 2 of Ordinance No. 10- 1990 or any County officer or employee in violation of Section 3 of Ordinance No, 10-1990. For breach or violation of this provision, the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price,or otherwise recover,the full amount of any fee,commission, percentage,gift, or consideration paid to the former County officer or employee. (Signature) Date: 9/06/201 E STATE OF: Ohio COUNTY OF: Franklin PERSONALLY APPEARED BEFORE ME,the undersigned authority, (name of individual signing Affidavit), who, after first being sworn by me, affixed his/her signature in the space provided above on this sth day of September 20 16 . My Commission Expires: ! a AL & NOTILRYPUBLIC David bdello II Q. WwAVA%20 f Attachment E DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: Sound Tree Medical LLC (Name of Business) i. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free Workplace,any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection(1). 4, In the statement specified in subsection(1), notifies the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of,or plea of guilty or nolo contendere to,any violation of Chapter 893(Florida Statutes)or of any controlled substance law of the United States or any state,for a violation occurring in the workplace no later than five(5)days after such Conviction. i 5. Imposes a sanction on,or requires the satisfactory participation in,a drug abuse assistance or rehabilitation program if such is available in the employee's community,for any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. i As the person authorized to sign the statement,I certify that this firm complies fully with the above requirements. Di t Bidder's Signature Rhiannon Greene, Vice President 9/06/2016 Date '= David Mello H '`colntawtolt��tlpu�ttasc�o �N/III{{lN� f r Attachment F PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work,may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." I have read the above and state that neither Pound Tree Medical, uLc (Proposer's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (Signature) Rhiannon Greene, Vice President Date: 9/0U2016 STATE OF: Ohio COUNTY OF: Franklin Subscribed and sworn to(or affirmed)before me on the Etta day of September ,20 16 by k;T, 'A br (name of individual signing Affidavit). He/She is personallyown to me or has produced (type of identification)as identification. My Commission Expires: ' NOTARY TBLTC David Zdello II *: �ry Pubic,9�1r ddio WuAodit i Attachment G "Not Applicable LOCAL PREFERENCE FORM ** A. Vendors claiming a local preference according to Ordinance 023-2009 must complete this form. Name of Bidder/Responder Date: 1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at least one year prior to the notice or request for bid or proposal? (Please furnish copy.) 2. Does the vendor have a physical business address located within Monroe County from which the vendor operates or performs business on a day to day basis that is a substantial component of the goods or services being offered to Monroe County? List Address: Telephone Number: B. Does the vendor/prime contractor intend to subcontract 50%or more of the goods,services or construction to local businesses meeting the criteria above as to licensing and location? If yes,please provide: 1 Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subcontractor dated at least one year prior to the notice or request for bid or proposal. 2. Subcontractor Address within Monroe County from which the subcontractor operates: Telephone Number Address Address Print Name: Signature and Title of Authorized Signatory for Bidder/Responder STATE OF COUNTY OF } On this day of 20 before me, the undersigned notary public, personally appeared known to me to be the person whose name is subscribed above or who produced as identification, and acknowledged that he/she is the person who executed the above Local Preference Form for the purposes therein contained. My commission expires. Notary Public (Seal) Print Name **This Form is only required if Local Preference is applicable pursuant to Sec.2-349,Monroe County Code. 4 i Attachment H - Scope of Services Response Form 2016 The Proposer will be evaluated on compliance with the below service requirements. By submitting a proposal,the Proposer agrees that these provisions will be part of the agreement between the parties. YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) QUALITY ASSURANCE PROVISIONS Ordered Supplies/Receiving: A system of test inspections shall be used to assure quality and quantity of materials received by County. Materials will be promptly inspected and any discrepancies from the purchase order and/or the supplier's invoice shall be reported immediately by the Monroe County Logistics Specialist to the Supplier and x shall be corrected within a two(2)business day time frame when the County has made that report within normal working hours of 8 am to 5 pm Monday through Friday. Material Safety Data Sheet(MSDS): Any items delivered must be accompanied by a MSDS. The MSDS will be maintained by the County and must include the following information: 1. The Chemical name and the common name of the x toxic substance. 2. The hazards or other risks in the use of the toxic x substance,including: a) The potential for fire,explosion,corrosively x and reactivity; b) The known acute and chronic health effects of risk from exposure,including the medical x conditions which are generally recognized as being aggravated by exposure to the toxic substance;and c) The primary routes of entry and symptoms of x overexposure. 3. The proper precautions,handling practices, necessary personnel protective equipment,and x i Attachment H - Scope of Services Response Form 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) other safety precautions in the use of,or exposure to,the toxic substances,including appropriate emergency treatment in the case of overexposure. 4. The emergency procedure for spills,fires,disposal x and first aid. 5. A description,in lay terms,of the known specific J potential health risks posed by the toxic x substance intended to alert any person reading this information. 5. The year and month,if available,that the information was compiled and the name, x address,and emergency telephone number of I the manufacturer responsible for preparing the information. I Supply rime: I Proposers must be able to supply contracted requested supplies within a three(3)business day time frame of normal request of supplies when the County has made x I i that request within normal working hours of 8 am to 5 pm Monday through Friday. I Natural or Man-Made Emergencies: During emergency(natural or man-made emergencies) situations,Proposers must be able to supply requested supplies on a next day basis,twenty-four(24)hours a x day seven(7)days a week. PROPOSERS LIABILITY Warranty: It shall be the Proposer's responsibility to submit at the time of shipment the original manufacturer's warranty x for the materials supplied. 6 t S i 1 Attachment H - Scope of Services Response Form 2016 f E YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Defects: Upon un-packaging and discovering defects to materials shipped by Supplier,any medical supplies and/or x pharmaceuticals requiring replacement shall be finalized within five(5)working days of reporting the defect. (See also information required behind Tab 2 regarding warranties and replacements.) Guarantee: The material(s)supplied shall be guaranteed to be free from defect of composition,conception and workmanship for a minimum period of 120 days from the date of acceptance by the County.Any parts or portions found not in accordance with this specification will be rejected by the County and returned to the Proposer at the Proposer's expense for immediate replacement. Quality: --- ----- --- ---------_— The materials to be furnished shall be currently in production and shall be of the manufacturer's standard r. or better quality. Quantities: The quantities listed on the Medical Supply Discount Off List and Pricing Worksheet(Attachment A)are estimated quantities for one(1)year and are for cost comparison only. Any reference to forecasted or estimated quantities within the proposal documents is intended to inform the proposers of approximate x annual requirements.The County shall not be required to purchase any minimum or maximum quantities during the term of any award resulting from this specification.The County may purchase as little as zero percent(0%)or exceed as much as one hundred percent(100%)of the forecasted or estimated quantities. i 3 Attachment H - Scope of Services Response Form 2016 i YES YES NO SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Packaging: Only-materials that are packaged in the original factory fresh packaging shall be accepted.No materials that have been re-packaged or that are in the adulterated or damaged packages shall be accepted at the receiving location,nor shall after-market materials be accepted at the receiving location.Any attempts by the Proposers to furnish the County with other than first quality materials shall constitute default as outlined in this specification. j i Refrigeration: f Maintaining a specific temperature range throughout the shipping process is essential to the quality of healthcare products. Proposer has the ability to ship x I i products in a proper tem peratu re-control led environment. Only materials which have been properly j shipped in a temperature-controlled environment shall be accepted by the COUNTY. _ } Expiration Dates: Where applicable,all merchandise shall have a minimum expiration date of 18 months from date of shipment,and date must be displayed on the package. CONDITIONS Authorization: z Proposer has the ability to handle orders placed by the electronic ordering software Operative IQ. (All orders shall be placed via Monroe County by individual Purchase Orders generated by the County's electronic ordering software,Operative IQ,or as"Open"Purchase orders.) Furnishing Proposal Items: Contract items are to be furnished on an"as needed, when needed basis"during the life of the contract. ?' E t i Attachment H - Scope of Services Response Form [ 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Delivery: Materials ordered shall be delivered within three(3) business days after receipt of order.Failure to do same x shall be considered breach of contract or default,and the County shall utilize its options as stated within the contract. Backorders: In the event an item is not immediately available at the time of an order,and able to be delivered within three (3)days,the County shall have the option of purchasing x the item from another vendor. Penalties: The County reserves the right to increase or decrease quantities shown without penalty. x Samples(Medical Supplies only): From time to time,either at the stage of the Proposal or subsequently while the contract is in force,the Proposer may wish to recommend an alternative to an item listed on Medical Supply Discount Off List and Pricing Worksheet(Attachment A). in those situations, the County may require the Proposer or the Proposer may elect to submit a sample for inspection,to ensure x that the alternative is of similar quality. Such samples shall be labeled with the Proposer's name and item number and shall be furnished free of charge. The vendor can determine whether the sample should be returned or destroyed. Samples not destroyed will be returned upon request at the Proposer's expense within ten days following receipt of the sample. Substitution: No items will be substituted without the prior written approval of the County. Any violation of such procedure may result in a possible cancellation of the x contract. All approved substitutes shall be annotated as such on the Proposer's shipping document(s). i Attachment H - Scope of Services Response Form 2016 �.ss�e■ ma�soaea YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Proposal Prices: Proposal prices quoted on Medical Supply Discount Off List and Pricing Worksheet(Attachment A)shall be firm and shall not be amended after the dates and time of x the proposal opening. Any attempt by the Proposer to amend said proposal prices shall constitute default as outlined in this specification. Shipping Costs: Prices quoted in the Proposal and Proposal Response form shall include all shipping costs,shipped F.O.B x Marathon,Florida or to the facility location specified by the requestor or the purchase order. Taxes: All taxes of any kind and character payable on account of the word done and materials furnished under the award shall be paid by the Proposer and shall be x deemed to have been included in the proposal. The County is exempt from all state and federal sales,use, transportation,and excise taxes. Infringement: Proposal prices must include all royalties and costs arising from patents,trademarks,and copyrights in any way involved in the work. Whenever the Proposer is required or desires to use any design,device,material or process covered by letters of patent or copyright,the Proposer shall indemnify and save harmless the County, I its officers,agents,and employees from any and all x claims of infringement by reason of the use of any such patented design,toll, material,equipment or process, to be performed under the contract,and shall indemnify the said County,its officers,agents and employees for any costs,expenses and damage which may be incurred by reason of any infringement at any time during the prosecution or after the completion of the work. `s I 3 a i i 4 Attachment H - Scope of Services Response Form 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Award Changes: No changes,over the contract period,shall be permitted unless prior written approval is given by the County and,where applicable,confirmed by the x Monroe County Board of Commissioners. Assignment: No Proposer shall assign the contract or any rights or obligations thereunder to a subcontractor without the X written consent of the County and approval of the Monroe County Board of Commissioners. Price Escalation: The County will allow a price escalation provision with this award. The original proposal prices quoted on Medical Supply Discount Off List and Pricing Worksheet (Attachment A)shall be firm for a one,1)year minimum period. A price escalation/de-escalation will be allowed one(1)year after the beginning of the award period and at one(1)year intervals thereafter, provided the Proposer notifies the County,in writing of any requested price changes at least sixty(60)days prior to those changes taking effect. This request must be accompanied by a certified letter from the Proposer's supplier showing the price increase to the contractor.The price increase to the County shall be limited to the percentage increase to the Proposer as stated in this letter. If,at the point of exercising the price escalation provision,market media indicators show that the prices have decreased,and that the Proposer has not passed the decrease on to the County,the County reserves the right to place the Proposer in default,cancel the contract,and remove the Proposer from the County's proposer list for a period of time deemed suitable to the County. Attachment H - Scope of Services Response Form 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Invoicing: The Proposer shall furnish the County complete itemized invoices for the goods received. Invoices are to reflect the prices stipulated on the purchase order and as outlined on the Medical Supply Discount Off List and Pricing Worksheet(Attachment A). Invoices are x also to reflect the provisional price discount in the form of a percentage at which the Proposer will sell these items off its list price. The County will not accept an aggregate invoice. As part of the award process,the County may request a sample invoice. Invoices shall contain, but not limited to the following information: • Invoice number • Company name • Purchase order number • location and dates of delivery • Cost of items as stated on Proposal Response and extended price to reflect total cost for number of items received. Prompt Payment Act: The Proposer agrees to accept payment per the terms of the Florida Local Government Prompt Payment Act. x Normal processing time is approximately 30 days from presentation of the invoice. Ordering: Proposers will provide web-based online ordering website designed specifically for service. '� Disaster Recovery: Proposers have a proven Disaster Support Program in place and can demonstrate previous experience in disaster recovery supply chain management and shall x provide the County with emergency numbers for these situations.These numbers will be updated immediately if the contact number changes. Attachment H - Scope of Services Response Form 2016 YES NO YES SERVICE REQUIREMENT can cannot Can comply, comply comply but with specified deviations (please detail deviations below) Indemnification and Insurance Requirements: The Proposer can comply with the insurance requirements outlined in Attachment I to the RFP,or has submitted a Request for Waiver(also found in " Attachment 1). Also,the Proposer can comply with the indemnification and hold harmless requirements(also found in Attachment 1). DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/13/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this L certificate does not confer rights to the certificate holder in lieu of such endorsement(s). tv PRODUCER CONTACTNAME: AOn Risk services Northeast, Inc. PHONE FAX Columbus OH Office (A/C.No.EM): (866) 283-7122 AlC.No.; (800) 363-0105 445 Hutchinson Avenue E-MAIL 6 Suite 900 ADDRESS: _ Columbus OH 43235 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Fire insurance Co. 19682 Sarnova, Inc., Bound Tree Medical, LLC INSURER B: Hartford Casualty Insurance Co 29424 5000 Tuttle Crossing Blvd. Dublin OH 43016 USA INSURERC: sentinel Insurance Company, Ltd 11000 INSURER D: Medmarc casualty Ins Co 22241 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570065283042 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYW MMIDD LIMITS A X COMMERCIALGENERALLIABILITY UUNVG3435 1ZIOlIZO17 EACH OCCURRENCE $1,000,000 CLAIMS-MADE —1OCCUR DAMAGE TO nR= $300,000 PREMISES Ea occurrence MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 ro POLICY ❑X PRO- JECT O LOC PRODUCTS-COMP/OPAGG Excluded ui OTHER: o n C Y 33 UUN VG3435 12/01/2016 12/01/2017 COMBINED SINGLE LIMIT `O AUTOMOBILE LIABILITY S1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) O 2 OWNED SCHEDULED BODILY INJURY(Per accident) N AUTOS HIRED AUOTOSY NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident d B X UMBRELLALIAB TOCCIMUR 33RHUVG1892 12/01/2016 12/01/2017 EACH OCCURRENCE $10,000,000 L) EXCESS LIAB MADE AGGREGATE $10,000,000 DED I X RETENTION$10,000 WORKERS COMPENSATION AND PER STATUTE OTH- EMPLOYERS'LIABILITY YIN ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? ❑NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT _ D Products Liab 160H380015 12/01/2016 12/01/2017 Aggregate Limit $10,000,000 claims Made SIR Aggregate $150,000 SIR applies per policy ter s & conditions Per Occ Limit $10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached ff more space is required) Re: Account No. 104754. Monroe County BOCC is included as Additional insured in accordance with the policy provisions of the General Liability and Auto Liability policies. kk GEMENTtI DATE WAIVER N/A YES„ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe county BOCC AUTHORIZED REPRESENTATIVE - 1111 12th St. Suite 408 Key west FL 33040 USA e�Gxon i �Gw7V6 c//fe.�edc.//o �lnelci46✓>� ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000037575 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk services Northeast, Inc. Sarnova, Inc., Bound Tree Medical, LLC POLICY NUMBER See Certificate Number: 570065283042 CARRIER NAIC CODE See Certificate Number: 570065283042 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. INSR POLICY POLICY ADDL SUBR POLICY NUMBER LIMITS LTR TYPE OF INSURANCE INSD WVD EFFECTIVE EXPIRATION DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) OTHER D Products Liab 160H380015 12/01/2016 12/01/2017 SIR Per S50,000 claims Made Occurrence SIR applies per policy to ms & conditions ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID.SARNINC-01 BDICKSON LOC#: A O' ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Thompson Flanagan Executive Liability Group Sarnova,Inc.Bound Tree Medical,LLC g y p 5000 Tuttle Crossing Blvd. POLICY NUMBER P.O.Box 8023 EE PAGE 1 Dublin,OH 43016 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: EE PA E 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Named Insureds 1.Sarnova,Inc. FEIN:262386055 2.Bound Tree Medical Products,Inc. FEIN:731646550 3.Tri-Anim Health Services, Inc. FEIN:952959155 4.Bound Tree Medical, LLC FEIN: 311739487 5.Sarnova HC LLC FEIN:262549813 6.Emergency Medical Products Inc. FEIN:391164909 7.Cardiovascular Concepts,Inc. FEIN:751835412 E i t ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/30/2021 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 (866) 283-7122 FAX (800) 363-0105 Columbus OH Office (A/C.No.Ext): A/C.No.): 445 Hutchinson Avenue E-MAIL p Suite 900 ADDRESS: _ Columbus OH 43235 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Fire Insurance Co. 19682 Sarnova, Inc., Bound Tree Medical, LLC INSURERB: Hartford Casualty Insurance Co 29424 5000 Tuttle Crossing Blvd. Dublin OH 43016 USA INSURERC: Noetic Specialty Insurance Co 17400 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570090448076 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 I POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY UUNVG EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑OCCUR $300,000 ppr ved Risk Management with attac hments PREMISES Ea occurrence f i MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ) GENERAL AGGREGATE $2,000,000 POLICY x PRO JECT ❑LOC 12-19-2021 PRODUCTS-COMP/OPAGG Excluded H0 OTHER: ^o A Y 33 UEN FH4745 12/01/2021 12/01/2022 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) 0 AUTOS ONLY AUTOS R HIRED AUTOS NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident B X UMBRELLA LIAB X OCCUR 33RHUVG1892 12101120211210112022 EACH OCCURRENCE $10,000,000 V EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED I X RETENTION$10,000 WORKERS COMPENSATION AND PER STATUTE OTH- EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER,EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT —_ C Products Liab N21OH380025 12/01/2021 12/01/2022 Aggregate Limit $10,000,000— Claims Made Agg Deductible $150000 Per Occ Limit $10,000:000 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. see Attach Addendum for Named Insured Includes. III CERTIFICATE HOLDER CANCELLATION V SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. r 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 ACORD AGENCY CUSTOMER ID: 570000037575 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk services Northeast, Inc. Sarnova, Inc. , Bound Tree Medical , LLC POLICY NUMBER see Certificate Number: 570090448076 CARRIER NAIC CODE see Certificate Number: 570090448076 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. INSR ADDL SUBR POLICY NUMBER POLICY POLICY LIMITS w LTR TYPE OF INSURANCE INSD VD EFFECTIVE EXPIRATION DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) OTHER C Products Liab N21OH380025 12/01/2021 12/01/2022 Per occ $50,000 claims Made Deductible ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000037575 LOC#: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk services Northeast, Inc. Sarnova, Inc. , Bound Tree Medical , LLC POLICY NUMBER see Certificate Number: 570090448076 CARRIER NAIC CODE see Certificate Number: 570090448076 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Named Insured Includes 1. sarnova, Inc. FEIN: 262386055 2. Bound Tree Medical Products, Inc. FEIN: 731646550 3. Tri-Anim Health services, Inc. FEIN: 952959155 4. Bound Tree Medical , LLC FEIN: 311739487 5. sarnova HC LLC FEIN: 262549813 6. Emergency Medical Products Inc. FEIN: 391164909 7. Cardlovascular Concepts, Inc. FEIN: 751835412 ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD