Item C35 BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: July 17, 2013 Division: Emergency Services
Bulk Item: Yes X No Department: Fire Rescue
Staff Contact Person: Deputy Chief Gary Boswell 289-6011
AGENDA ITEM WORDING: Request to issue a request for proposal (RFP)for Purchasing Medical Supplies and
Pharmaceuticals.
ITEM BACKGROUND: The Agreement between the Monroe County Fire Rescue and Bound Tree Medical,
LLC provided for a three (3) year term from December 1, 2010 through November 30, 2013 with no renewal
options.
PREVIOUS RELEVANT BOCC ACTION: On November 17, 2010, the Board approved a Contract with
Bound Tree Medical, LLC for the purpose of purchasing medical supplies and pharmaceuticals at set pricing;
attachment H of the Contract. On March 16, 2011 the Board approved an amendment to the Contract with
Bound Tree Medical, LLC to add verbiage to allow for the purchase of items not included in the pricing list at a
specific discounted pricing. Staff has now incorporated both pricing structures into attached RFP as part of the
requirements.
CONTRACT/AGREEMENT CHANGES: N/A
STAFF RECOMMENDATIONS: N/A
TOTAL COST: $900 advertising fees BUDGETED: Yes X No
COST TO COUNTY: _ $900 advertising fees SOURCE OF FUNDS: 11001-530340
REVENUE PRODUCING: Yes No .,,,X AMOUNT PER MONTH Year _
APPROVED BY: County Atty OMB/Purc sing Risk Managemen&
t/
DOCUMENTATION: Included X Not Required
DISPOSITION: AGENDA ITEM#
f
Y , . .
REQUEST FOR PROPOSALS
MEDICAL SUPPLIES AND PHARMACEUTICALS
MONROE COUNTY EMERGENCY SERVICES
1
,.T
1
J
Of
BOARD OF COUNTY COMMISSIONERS
BOCC MEMBERS:
Mayor George Neugent, District 2
Commissioner Danny L. Kolhage, District 1
Commissioner Heather Carruthers, District 3
Commissioner David Rice, District 4,
Commissioner Sylvia Murphy, District 5
AND
THE BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1
OF MONROE COUNTY
BOG MEMBERS:
Monroe County Mayor George Neugent, District 2
Commissioner Danny L. Kolhage, District 1
County Commissioner David Rice, District 4
Layton Mayor, Norm Anderson
Layton Councilman, Clark Snow
COUNTY ADMINISTRATOR CLERK OF THE CIRCUIT COURT
Roman Gastesi Amy Heavilin
MONROE COUNTY FIRE CHIEF
James Callahan
July 2013
Prepared by Monroe County Emergency Services
1
NOTICE OF REQUEST FOR COMPETITIVE SOLICITATIONS
NOTICE IS HEREBY GIVEN that on September 17, 2013 at 3:00 P.M. the
Monroe County Purchasing Office will receive and open sealed responses for the following:
MEDICAL SUPPLIES AND PHARMACEUTICALS
MONROE COUNTY, FLORIDA
Requirements for submission and the selection criteria may be requested from DemandStar
by Onvia at www.demandstar.com OR www.monroecoun m or call toll-free at 1-
800-711-1712. The Public Record is available at the Monroe County Purchasing Office
located at The Gato Building, 1100 Simonton Street, Room 2-213, Key West, Florida. All
Responses must be sealed and must be submitted to the Monroe County Purchasing Office.
Publication dates:
Reporter (Fr) 7/26/13
Keynoter (Sa) 7/27/13
Citizen (Fr) 7/26/13
2
TABLE OF CONTENTS
NOTICE OF REQUEST FOR PROPOSALS
SECTION ONE
Instruction to Proposer
SECTION TWO
Definitions
SECTION THREE
Draft Agreement
SECTION FOUR
Attachments and Forms
3
SECTION ONE: INSTRUCTION TO PROPOSER
1.01 DESCRIPTION
The Proposer awarded a contract shall provide set pricing on medical supplies and
pharmaceuticals for Monroe County Fire Rescue. This contract shall be for a three-year period,
subject to approval of the Monroe County Fire Chief, the Office of Management and Budget, the
Monroe County Board of County Commissioners and the Board of Governors of Fire and
Ambulance District 1 of Monroe County, Florida.
All submissions must remain valid for a period of ninety (90) days from the date of the deadline
for submission stated above. The Board will automatically reject the response of any person or
affiliate who appears on the convicted vendor list prepared by the Department of Management
Services, State of Florida, under Sec. 287.133(3)(d), Florida Statutes.
Once completed, the proposal package will be presented to the Monroe County Board of County
Commissioners and the Board of Governors of Fire and Ambulance District 1 for review and
approval and shall ultimately become a part of the contract.
1.02 COPIES OF REQUEST FOR PROPOSAL (RFP) DOCUMENTS
A. Only complete sets of RFP documents will be issued and shall be used in preparing
responses. The County does not assume any responsibility for errors or misinterpretations
resulting from the use of incomplete sets.
B. Complete sets of RFP documents may be obtained in the manner and at the locations
stated in the Notice of Request for Proposals.
1.03 STATEMENT OF PROPOSAL REQUIREMENTS
(See Notice of Request for Proposals)
1.04 DISQUALIFICATION OF PROPOSERS (Section Four contains these forms)
A. NON-COLLUSION AFFIDAVIT: Any person submitting a proposal in response to this
invitation must execute the enclosed NON-COLLUSION AFFIDAVIT. If it is
discovered that collusion exists among the Proposers, the proposals of all participants in
such collusion shall be rejected, and no participants in such collusion will be considered
in future proposals for the same work.
B. PUBLIC ENTITY CRIME: A person or affiliate who has been placed on the convicted
vendor list following a conviction for a public entity crime may not submit a proposal on
a contract to provide any goods or services to a public entity, may not submit a proposal
on a contract with a public entity for the construction or repair of a public building or
public work, may not submit Proposals on leases or perform work as a Proposers,
supplier, or subcontractor 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. Category Two: $25,000.00
4
C. DRUG-FREE WORKPLACE FORM: Any person submitting a proposal in response to
this invitation must execute the enclosed DRUG-FREE WORKPLACE FORM and
submit it with his proposal. Failure to complete this form in every detail and submit it
with the proposal may result in immediate disqualification of the proposal.
D. LOBBYING AND CONFLICT OF INTEREST ETHICS CLAUSE: Any person
submitting a proposal in response to this invitation must execute the enclosed
LOBBYING AND CONFLICT OF INTEREST CLAUSE and submit it with his
proposal. Failure to complete this form in every detail and submit it with the proposal
may result in immediate disqualification of the proposal.
1.05 EXAMINATION OF RFP DOCUMENTS
A. Each Proposer shall carefully examine the RFP and other contract documents, and inform
himself thoroughly regarding any and all conditions and requirements that may in any
manner affect cost, progress, or performance of the work to be performed under the
contract. Ignorance on the part of the Proposers shall in no way relieve him of the
obligations and responsibilities assumed under the contract.
B. Should a Proposer find discrepancies or ambiguities in, or omissions from, the
specifications, or should he be in doubt as to their meaning, he shall at once notify the
County.
C. Examination of Specification. Each Proposer is required before submitting a proposal, to
be thoroughly familiar with the specifications contained herein. No additional allowances
will be made because of lack of knowledge of the conditions. It is the responsibility of
the successful Proposers to ascertain if any components of the specification are unsafe or
contrary to current applicable regulations. If any unsafe or unlawful criteria are contained
herein, they shall be thoroughly explained to the purchaser in the proposal.
1.06 INTERPRETATIONS, CLARIFICATIONS,AND ADDENDA
No oral interpretations will be made to any Proposers as to the meaning of the contract
documents. Any inquiry or request for interpretation received seven (7) or more days prior to the
date fixed for opening of responses will be given consideration. All such answers, changes or
interpretation will be made in writing in the form of an addendum and, if issued, will be
furnished to all known prospective Proposers prior to the established Proposal opening date.
Each Proposer shall acknowledge receipt of such addenda in his Proposal. In case any Proposers
fails to acknowledge receipt of such addenda or addendum, his response will nevertheless be
construed as though it had been received and acknowledged and the submission of his response
will constitute acknowledgment of the receipt of same. All addenda are a part of the contract
documents and each Proposer will be bound by such addenda, whether or not received by him. It
is the responsibility of each Proposer to verify that he has received all addenda issued before
responses are opened.
1.07 GOVERNING LAWS AND REGULATIONS
5
The Proposers is required to be familiar with and shall be responsible for complying with all
federal, state, and local laws, ordinances, rules, and regulations that in any manner affect the
work. Knowledge of business tax requirements and obtaining such licenses for Monroe County
and municipalities within Monroe County are the responsibility of the Proposer. Monroe County
is exempt from all local, state, and federal sales and use taxes.
1.08 PREPARATION OF RESPONSES
Signature of the Proposer: The Proposer must sign the response forms in the space provided for
the signature. If the Proposer is an individual, the words "doing business as ", or
"Sole Owner" must appear beneath such signature. In the case of a partnership, the signature of
at least one of the partners must follow the firm name and the words "Member of the Firm"
should be written beneath such signature. If the Proposer is a corporation, the title of the officer
signing the Response on behalf of the corporation must be stated along with the Corporation Seal
Stamp and evidence of his authority to sign the Response must be submitted. The Proposer shall
state in the response the name and address of each person having an interest in the submitting
entity.
1.09 SUBMISSION OF RESPONSES
Interested firms or individuals shall submit two (2) signed originals and one (1) complete copy
(total=3) of the proposal in a sealed envelope clearly marked on the outside with the Proposer's
name and "Proposal—Medical Supplies and Pharmaceuticals". If sent by mail or by courier,
the above-mentioned envelope shall be enclosed in another envelope addressed to Monroe
County Purchasing Department, 1100 Simonton Street, Room 1-213, Key West, FL 33040,
which shall be received on or before 3:00 P.M. local time on September 17, 2013. Faxed or e-
mailed Proposals shall be automatically rejected.
1.10 CONTENT OF SUBMISSION
The proposal submitted in response to this Request for Proposals (RFP) shall be printed on 8-
1/2" x 11" white paper and bound; shall be clear and concise and provide the information
requested herein. Statements submitted without the required information will not be considered.
Responses shall be organized as indicated below. The Proposer should not withhold any
information from the written response in anticipation of presenting the information orally or in a
demonstration, since oral presentations or demonstrations may not be solicited. Each Proposer
must submit adequate documentation to certify the Proposer's compliance with the County's
requirements. Proposers should focus specifically on the information requested.
The following information, at a minimum, shall be included in the Submittal:
A. Cover Page
A cover page that states "Proposal — Medical Supplies and Pharmaceuticals". The cover
page should contain Proposer's name, address, telephone number, and the name of the
Proposer's contact person.
B. Tabbed Sections
This Proposal is written around specific needs of this department. The contract shall be
6
awarded to the Proposer whose Proposal comes closest to meeting these specifications at the
most competitive price.
Tab 1. Qualifications
A. Please provide the following documents in your proposal:
1. The number of years the Proposer has operated under its present name and any prior
names.
2. The number of years the Proposer has been operating and, if different, the number of
years it has been providing the services, goods, or construction services called for in
this Request.
3. Customer References —A minimum of ten (10) customer references for product
and/or services of similar scope dating within past 3 years (with at least three (3)
references preferably being a Florida government entity).
B. Performance. The Proposer may be required to furnish evidence in writing that he or
she maintains a permanent place of business and has adequate equipment, finances,
personnel, and inventory to furnish the items offered satisfactorily and expeditiously, and
can provide necessary services.
C. Proof of Distributorship. When requested, it shall be the responsibility of the Proposer
to furnish with their proposal a letter stating that said Proposer is a factory authorized
distributor for the items for which said Proposer has submitted their proposal.
D. Inspection. The County reserves the right to inspect the Proposer's place of business
prior to awarding the contract to determine the responsibility of said Proposer to perform
or provide the requirements of the proposal request.
Tab 2. Quality Assurance 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 and any discrepancies from the
purchase order and/or the supplier's invoice shall be reported immediately from the
Monroe County Logistics Specialist.
B. Material Safety Data Sheet(MSDS). Any items delivered must be accompanied by a
MSDS. The MSDS must be maintained by the user agency and must include the
following information:
1. The Chemical name and the common name of the toxic substance.
2. The hazards or other risks in the use of the toxic substance, including:
a. The potential for fire, explosion, corrosively and reactivity;
b. The known acute and chronic health effects of risk from exposure, including
the medical conditions which are generally recognized as being aggravated by
exposure to the toxic substance; and
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. 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 that
request within normal working hours of 8 am to 5 pm Monday through Friday. 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 day seven (7)
days a week.
Tab 3. Proposer's Liability
A. Warranty. It shall be the Proposer's responsibility to submit at the time of shipment the
original manufacturer's warranty for the materials supplied. Proposers shall submit, in
writing, a detailed explanation of the procedure(s) that they will follow to accomplish the
replacement, with their proposal. Replacement 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 Proposer at the Proposer's
expense for immediate replacement.
Tab 4. Specifications
A. Additions and Substitutions. Proposers shall, as to each item, submit only one proposal
for the specified product or recommended substitution which Proposer believes equal to
item specified. 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 upon all Proposers.
8
B. Quality. The materials to be furnished shall be currently in production and shall be of the
manufacturer's standard or better quality.
C. Quantities. The quantities listed on the Medical Supply List Pricing Worksheet
(Attachment A) are estimated quantities for one (1) year and is for cost comparison only.
Any reference to forecasted or estimated quantities within the proposal documents is
intended to inform the proposers of approximate 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.
D. Brand Indication. Where brand and item type is as specified, proposers shall clearly
indicate with a "Y" in the space provided on the Medical Supplies and Equipment
Worksheet. Where brand and item type is not as specified, proposers shall clearly
indicate with an "N" in the space provided. Proposers shall attach a list of any proposed
substitutions, referencing the original item number, and providing a full description of
each.
E. 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.
F. 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.
G. 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.
Tab 5. Conditions
A. Authorization. All orders shall be placed via Monroe County by individual Purchase
Orders, or as "Open"Purchase orders.
B. Furnishing Proposal 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 this specification.
D. Backorders. In the event an item is not immediately available at the time of an order, and
able to be delivered within three (3) days, the County shall have the option of purchasing
the item from another vendor.
9
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 Proposer's name and item
number and shall be furnished free of charge. Samples not destroyed will be returned
upon request at the Proposer's expense within ten days following the opening of
proposals. Samples of brand(s) being proposal may be requested after the proposal
opening date and time, in order to allow the County to make a fair evaluation of brand(s)
being proposal.
H. Substitution. The Proposer 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 Proposer's
shipping document(s).
I. Proposal Prices. Proposal prices quoted on Medical Supply List 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.
Prices quoted in the Proposal and Proposal Response form 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 word done and materials
furnished under the award shall be paid by the Proposer and shall be deemed to have been
included in the proposal. The County is exempt from all state and federal sales, use,
transportation, and excise taxes.
Proposer 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 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. Provisional Proposal Prices off List Price. In light of the fact that it impossible for the
County to envision all of the medical supplies and pharmaceuticals, the County may need
to order from time to time as operational changes occur and needs change, items not
included on the Medical Supply List Pricing Worksheet(Attachment A). For these items,
in its Proposal, Proposer shall propose a discount in the form of a percentage, at which
the Proposer will sell these items off its list price, and shall provide a link to its price list
10
or shall provide a copy of the price list in its Proposal. This catch-all provisional pricing
will allow for the purchase of items not included on the Medical Supply List Pricing
Worksheet(Attachment A). Proposer will sell these items to County at discounted
percentage rate off the list price issued by Proposer.
K. 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 Monroe
County Board of Commissioners.
No Proposer shall assign the contract or any rights or obligations there under to a
subcontractor without the written consent of the County and approval of the Monroe
County Board of Commissioners.
L. Price Escalation. The County will allow a price escalation provision with this award.
The original proposal prices quoted 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 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.
M. 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 List Pricing Worksheet(Attachment A). Invoices are 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.
N. Payment. Full payment will be made by the County after receipt and acceptance of
materials/services, proper invoices submitted in accordance with the Florida Local
Government Prompt Payment Act. Normal processing time is approximately 30 days in
11
total. The County does not pay service charges on late payments however the County is
subject to the Florida's Local Government Prompt Payment Act.
O. Ordering. Proposers will provide web-based online ordering website designed
specifically for service.
P. Disaster Recovery. Proposers must have a proven 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.
Tab 6. Litigation
Proposers must supply answers to the following questions regarding claims and suits:
A. Has the Proposer ever failed to complete work or provide the goods for which it has
contracted? (If yes,provide details.)
B. Are there any judgments, claims, arbitration proceeding or suits pending or outstanding
against the Proposer, or its officers, managing members, or general partners? (If yes,
provide details.)
C. Has the Proposer, within the last five (5) years, been a party to any lawsuit or arbitration
with regard to a contract for services, goods or construction services similar to those
requested in the RFP? (If yes, the Proposer shall provide a history of any past or pending
claims and litigation in which the Proposer is involved as a result of the provision of the
same or similar services which are requested or described herein.)
D. Has the Proposer ever initiated litigation against the County or been sued by the County
in connection with any contract to provide services, goods or construction services? (If
yes,provide details.)
E. Whether, within the last five (5) years, an officer, general partner, controlling shareholder
or major creditor or Proposer was an officer, general partner, controlling shareholder or
major creditor of any other entity that failed to perform services or furnish goods similar
to those sought in the request for proposals.
Tab 7. Other Information
Provide any additional information which will present evaluators with insight about the
knowledge, skills and products of the Proposer.
Tab 8. County Forms and Licenses
Proposer shall complete and execute the forms specified below and located in Section Four in
this RFP, as well as copies of all professional licenses and receipts of business tax and shall
include them in appropriate tabbed section.
Forms
12
Medical Supply List Pricing Worksheet
Submission Response Form (including acknowledgement of addenda if applicable)
Non-Collusion Affidavit
Public Entity Crime Statement
Drug Free Workplace Form
Lobbying and Conflict of Interest Clause
Indemnification and Hold Harmless
Local Preference Form
1.11 MODIFICATION OF RESPONSES
Written modification will be accepted from Proposers if addressed to the entity and address
indicated in the Notice of Request for Proposals and received prior to Proposal due date and
time. Modifications must be submitted in a sealed envelope clearly marked on the outside, with
the Proposer's name and "Modification to Proposal — Medical Supplies and
Pharmaceuticals". If sent by mail or by courier, the above-mentioned envelope shall be
enclosed in another envelope addressed to the entity and address stated in the Notice of Request
for Proposal. Faxed or e-mailed modifications and modifications received after the proposal
opening date shall be automatically rejected.
1.12 RESPONSIBILITY FOR RESPONSE
The Proposer is solely responsible for all costs of preparing and submitting the response,
regardless of whether a contract award is made by the County.
1.13 RECEIPT AND OPENING OF RESPONSES
Responses will be received until the designated time and will be publicly opened. Proposers
names shall be read aloud at the appointed time and place stated in the Notice of Request for
Proposals. Monroe County's representative authorized to open the responses will decide when
the specified time has arrived and no responses received thereafter will be considered. No
responsibility will be attached to anyone for the premature opening of a response not properly
addressed and identified. Proposers or their authorized agents are invited to be present.
1.14 DETERMINATION OF SUCCESSFUL PROPOSERS
The following describes the general guidelines to be used for analyzing and evaluating the
various proposals. To decide the best qualified Proposers, Monroe County Fire Rescue reserves
the right to eliminate all factors it deems inappropriate, whether or not such factors have been
stated in this section. If a joint venture is proposed then each firm must include all of the
information required and the submittal shall be combined into a single document. This contract
shall be awarded on the following criteria:
• Pricing (40 points)
- Quoted price per item (Attachment A)
- Discount in the form of a percentage off list price
- Prices quoted will also be used to establish the extent of a Proposer's product
lines and services
13
• Ability to Provide and Perform the Required Services for the Contract(30 points)
- Ability to accept and process orders for pharmaceuticals, including Schedule 11
and IV drugs
- The qualification and financial stability of the Proposers
- Service turnaround time for delivery of supplies
- Location of nearest full time local representative, and nearest personnel on call
- Location of distribution center(s)
- Proposer's logistical and service support
• Technology for Supporting the Program (20 points)
- Electronic online catalog; online ordering and tracking; ease of order entry
- Quality of Proposer's online resources
- Online product and/or service specifications and features offered by Proposers
• References (10 points)
- A minimum of ten (10) customer references for product and/or services of similar
scope dating within past 3 years (with at least three (3)references preferably
being a Florida government entity)
NOTE: In performing the evaluation, only information contained within the Proposer's written
proposal will be considered.
Monroe County reserves the right to accept or reject any or all proposals. Monroe County also
reserves the right to (1) waive any non-substantive irregularities and technicalities; (2)reject the
proposal of any Proposer who has previously failed in the proper performance of a contract of a
similar nature, who has been suspended or debarred by another government entity, or who is not
in a position to perform under this award; and(3) inspect all facilities of Proposers in order to
make a determination as to its ability to perform.
Monroe County reserves the rights to reject any offer or proposal if the prices for any line items
or sub line items are materially unbalanced. An offer is materially unbalanced if it is
mathematically unbalanced, and if there is reason to believe that the offer would not result in the
lowest overall cost to the County, even though it is the lowest evaluated offer. An offer is
mathematically unbalanced if it is based on prices which are significantly less than fair market
price for some proposal line item and significantly greater than fair market price for other
proposal line items. Fair market price shall be determined based on industry standards,
comparable proposals or offers, existing contracts, or other means of establishing a range of
current prices for which the line items may be obtained in the market place. The Purchasing
Director, citing the basis for the determination, shall make the determination of whether a
particular offer or proposal is materially unbalanced in writing.
The County shall be the final authority in the award of this proposal.
1.15 AWARD OF CONTRACT
A. The County reserves the right to reject any and all proposals, or any part of any
proposals; to award separate contracts for the services based on geographic area or other,
and to waive any informality in any response, or to re-advertise for all or part of the work
contemplated.
14
B. The County also reserves the right to reject the response of a Proposer who has
previously failed to perform properly or to complete contracts of a similar nature on time.
C. The recommendation of staff shall be presented to the Monroe County Board of County
Commissioners and the Board of Governors of Fire and Ambulance District 1 of Monroe
County, Florida, for final selection and award of contract. If proposal is found to be
acceptable to the County, written notice will be given to the selected Proposer of the
acceptance of the Proposer's proposal and the award of the contract to Proposer.
1.16 EXECUTION OF CONTRACT AND TERM
The Proposer with whom a contract is negotiated shall be required to return to the County four
(4) executed counterpart originals of the prescribed Agreement.
The contract period shall be for a three-year period from the effective date of the award.
1.18 INDEMNIFICATION
The Proposer to whom a contract is awarded shall defend, indemnify and hold harmless the
County as outlined below.
The Proposer covenants and agrees to indemnify, hold harmless and defend Monroe County, its
commissioners, officers, employees, agents and servants from any and all claims for bodily
injury, including death, personal injury, and property damage, including damage to property
owned by Monroe County, and any other losses, damages, and expenses of any kind, including
attorney's fees, court costs and expenses, which arise out of, in connection with, or by reason of
services provided by the Proposer or any of its Sub-proposers in any tier, occasioned by the
negligence, errors, or other wrongful act or omission of the Proposer, its Sub-proposers in any
tier, their officers, employees, servants or agents.
In the event that the service is delayed or suspended as a result of the Proposer's failure to
purchase or maintain the required insurance, the Proposer shall indemnify the County from any
and all increased expenses resulting from such delay.
The first ten dollars ($10.00) of remuneration paid to the Proposer is consideration for the
indemnification provided for above. The extent of liability is in no way limited to, reduced, or
lessened by the insurance requirements contained elsewhere within this agreement.
This indemnification shall survive the expiration or earlier termination of the contract.
15
SECTION TWO: DEFINITIONS
2.01 Definitions
Wherever used in these General Conditions or in the other contract documents the terms below
have the meanings indicated which are applicable to both the singular and the plural thereof. The
use of the terms "he", "him", "himself' or "his" shall refer to male and female persons alike and
should not be construed as derogatory or discriminatory to female persons.
Purchaser —The end user of the equipment specified or the applicable purchasing agent for
Monroe County Fire Rescue and the Board of Governors of Fire and Ambulance District 1 of
Monroe County through the Board of County Commissioners of Monroe County, Florida.
Proposers —The individual, firm,partnership, manufacturer or corporation to whom the contract
is awarded by the County and who is subject to the terms thereof. For purposes the terms,
Proposers, and Proposers, and vendor are synonymous.
Equal—Shall be taken in it is general sense and shall not mean identical. These specifications
are for the sole purpose of establishing minimum requirements for the level of quality, standards
of performance and design and is in no way intended to prohibit the proposal of any
manufacturer's item of equal material.
Note: Monroe County Fire Rescue shall be the sole judge of equality and this decision shall be
final.
16
SECTION THREE: DRAFT AGREEMENT
17
CONTRACT BETWEEN
THE BOARD OF COUNTY COMMISSIONERS
AND
THE BOARD GOVERNORS
FIRE AND AMBULANCE DISTRICT 1
OF MONROE COUNTY, FLORIDA
AND
FOR THE PURCHASE OF MEDICAL SUPPLIES AND PHARMACEUTICALS
THIS CONTRACT, hereinafter "CONTRACT" or "AGREEMENT", is made and entered into
this I" day of December, 2013 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 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 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), the documents referred
to in the Agreement as a part of this Agreement and . 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, 2013 through November 30, 2016.
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
18
the County, become property of the County. The County shall pay the CONTRACTOR
fair and equitable compensation for expenses incurred prior to termination of the
agreement, less any amount or damages caused by the CONTRACTOR'S breach. If the
damages are more than compensation payable, the CONTRACTOR will remain liable
after termination and the County shall pursue collection for damages.
4. SUBJECT MATTER OF CONTRACT - This Agreement is to furnish medical supplies
and pharmaceuticals at set pricing to Monroe County Fire Rescue.
5. PRICING — is set forth in Attachment A. This will be inserted in the contract from the
Proposal Response.
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 from
the Monroe County Logistics Specialist.
B. Material Safety Data Sheet (MSDS). Any items delivered must be accompanied
by a MSDS. The MSDS must be maintained by the user agency and must include
the following information:
1) The Chemical name and the common name of the toxic substance.
2) The hazards or other risks in the use of the toxic substance, including:
a) The potential for fire, explosion, corrosively and reactivity;
b) The known acute and chronic health effects of risk from exposure,
including the medical conditions which are generally recognized as
being aggravated by exposure to the toxic substance; and
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
19
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 List Pricing Worksheet
(Attachment A) are estimated quantities for one (1) year. The COUNTY shall not
be required to purchase any minimum or maximum quantities during the term of
any award resulting from this specification. The COUNTY may purchase as little
as zero percent (0%) or exceed as much as one hundred percent (100%) of the
forecasted or estimated quantities.
D. Packaging. Only materials that are packaged in the original factory fresh
packaging shall be accepted. No materials that have been re-packaged or that are
in the adulterated or damaged packages shall be accepted at the receiving
location, nor shall after-market materials be accepted at the receiving location.
Any attempts by the CONTRACTOR to furnish the COUNTY with other than
first quality materials shall constitute default as outlined in this specification.
20
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, or as "Open"Purchase orders.
B. Furnishing Items. Contract items are to be furnished on an "as needed, when
needed basis" during the life of the contract.
C. Delivery. Materials ordered shall be delivered within three (3) business days after
receipt of order. Failure to do same shall be considered breach of contract or
default, and the COUNTY shall utilize its options as stated within the proposal
specification.
D. Backorders. In the event an item is not immediately available at the time of an
order, and able to be delivered within three (3) days, the County shall have the
option of purchasing the item from another vendor.
E. Penalties. The COUNTY reserves the right to increase or decrease quantities
shown without penalty.
F. Addition/Deletion. The COUNTY reserves the right to add or delete any item
from this proposal or resulting contract when deemed to be in the interest of the
COUNTY.
G. Samples. When required, samples shall be labeled with the CONTRACTORS'
name and item number and shall be furnished free of charge. Samples not
destroyed will be returned upon request at the CONTRACTOR'S expense.
H. Substitution. The CONTRACTOR shall not substitute items for like items
without the approval of the COUNTY. Any violation of such procedure may
result in a possible cancellation of the contract. All approved substitutes shall be
annotated as such on the CONTRACTOR'S shipping document(s).
L Contract Prices. Contract prices from Medical Supply List Pricing Worksheet
(Attachment A) shall be firm and shall not be amended after the contract is
executed. Any attempt by the CONTRACTOR to amend said prices shall
constitute default as outlined in the contract.
Prices quoted include all shipping costs, shipped F.O.B Marathon, Florida or to
the facility location specified by the requestor or the purchase order.
21
All taxes of any kind and character payable on account of the word done and
materials furnished under the award shall be paid by the CONTRACTOR and
shall be deemed to have been included in the price. The COUNTY is exempt
from all state and federal sales, use, transportation, and excise taxes.
Contract prices shall include all royalties and costs arising from patents,
trademarks, and copyrights in any way involved in the work. Whenever the
CONTRACTOR is required or desires to use any design, device, material or
process covered by letters of patent or copyright, the CONTRACTOR shall
indemnify and save harmless the COUNTY, its officers, agents, and employees
from any and all claims of infringement by reason of the use of any such patented
design, toll, material, equipment or process, to be performed under the contract,
and shall indemnify the said COUNTY, its officers, agents and employees for any
costs, expenses and damage which may be incurred by reason of any infringement
at any time during the prosecution or after the completion of the work.
J. Contract Provisional Prices off List Price. Contract pricing not included on
Medical Supply List Pricing Worksheet(Attachment A), and sold to the County at
a discounted percentage rate off the list price issued by CONTRACTOR shall be
firm and shall not be amended after the contract is executed. Any attempt by the
CONTRACTOR to amend said prices shall constitute default as outlined in the
contract.
COUNTY will verify items by a printout from the CONTRACTOR's online
catalog showing both the "list price" and "your price", the latter being the
COUNTY'S price.
K. Contract Changes. No changes, over the contract period, shall be permitted
unless prior written approval is given by the Monroe County Board of
Commissioners and the Board of Governors of Fire and Ambulance District 1.
No CONTRACTOR shall assign the contract or any rights or obligations there
under to a subcontractor without the written consent of the COUNTY and
approval of the Monroe County Board of Commissioners.
L. Price Escalation. The County will allow a price escalation provision with this
award. The original CONTRACTOR prices on Medical Supply List Pricing
Worksheet (Attachment A) shall be firm for a one (1) year minimum period. A
price escalation/de-escalation will be allowed one (1) year after the beginning of
the award period and at one (1) year intervals thereafter, provided the
CONTRACTOR notifies the COUNTY, in writing of any requested price changes
at least sixty (60) days prior to those changes taking effect. This request must be
accompanied by a certified letter from the CONTRACTOR'S supplier showing
the price increase to the contractor. The price increase to the County shall be
limited to the percentage increase to the CONTRACTOR as stated in this letter.
If, at the point of exercising the price escalation provision, market media
indicators show that the prices have decreased, and that the CONTRACTOR has
not passed the decrease on to the COUNTY, the COUNTY reserves the right to
place the CONTRACTOR in default, cancel the contract, and remove the
22
CONTRACTOR from the COUNTY's CONTRACTOR list for a period of time
deemed suitable to the COUNTY.
M. Invoicing. The CONTRACTOR shall furnish the COUNTY complete itemized
invoices for the goods received. Invoices are to reflect the prices stipulated on the
purchase order, and as outlined on the Medical Supply List Pricing Worksheet
(Attachment A). Invoices are also to reflect the provisional price discount in the
form of a percentage at which the CONTRACTOR will sell these items off its list
price.
The COUNTY will not accept an aggregate invoice. As part of the award
process, the COUNTY may request a sample invoice. Invoices shall contain, but
not limited to the following information:
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. Normal processing time is
approximately 30 days in total. The COUNTY does not pay service charges on
late payments; however the COUNTY is subject to the Florida's Local
Government Prompt Payment Act.
O. Ordering. CONTRACTOR will provide web-based online ordering website
designed specifically for service.
P. Disaster Recovery. CONTRACTOR must have a proven Disaster Support
Program in place and shall provide the COUNTY with emergency numbers for
these situations. These numbers will be updated immediately if the contact
number changes.
10. INDEMNIFICATION — CONTRACTOR shall indemnify and hold the COUNTY and
Monroe County and Monroe County Fire and Ambulance District 1 harmless for any
negligence on its part or faulty or improper workmanship, for all work performed under
this contract, including all costs of collection, reasonable attorney fees, claim costs, and
as per "Attachment G". All property or equipment being directly maintained or repaired
by CONTRACTOR shall be considered in its care, custody, and control while such work
is in progress and until physical control of such property or equipment is restored to the
COUNTY.
11. INSURANCE—No insurance is required for this contract.
12. ADDITIONAL REQUIRED STATEMENTS /VERIFICATIONS /
AFFIDAVITS. Attached hereto in Attachments A, B, C, D, E, F and G are Scope of
23
Work Supply List with Pricing, Submission Response Form, Non-Collusion Affidavit,
Public Entity Crime Statement, Drug-Free Workplace Form, Lobbying & Conflict of
Interest Clause, Indemnification & Hold Harmless, and the Local Preference Form (if
applicable).
13. Monroe County's performance and obligation to pay under this contract is contingent
upon an annual appropriation by the Board of County Commissioners of Monroe County,
Florida.
14. Venue for any litigation arising under this contract must be in a court of competent
jurisdiction in Monroe County, Florida. This Agreement is not subject to arbitration.
IN WITNESS WHEREOF, each party hereto has caused this contract to be executed by its duly
authorized representative.
(SEAL) BOARD OF COUNTY COMMISSIONERS
ATTEST: AMY HEAVILIN, OF MONROE COUNTY, FLORIDA
COUNTY CLERK
By: By:
Deputy Clerk Mayor, George Nugent
RESPONDENT: BOARD OF GOVERNORS OF FIRE AND
AMBULANCE DISTRICT 1 OF MONROE
COUNTY, FL
By: By:
Print Name and Title Mayor/Chairman
Date:
24
SECTION FOUR: ATTACHMENTS AND FORMS
Attachment A Medical Supply List Pricing Worksheet
Attachment B Submission Response Form
Attachment C Non-Collusion Affidavit
Attachment D Public Entity Crime Statement
Attachment E Drug Free Workplace Form
Attachment F Lobbying & Conflict of Interest Clause (Ethics Clause)
Attachment G Indemnification and Hold Harmless
Attachment H Local Preference Form
25
Attachment A
MEDICAL SUPPLY LIST PRICING WORKSHEET
26
"a
a
C
U
L
° a
x
w
d
U
�L
CL
Y
c
H
•4� X X X X X X X X Q X X X X X Q Q Q Q X X Q Q Q Q Q Q Q Q Q Q X Q Q Q Q Q Q X X X X X X X
L m m m m m m m m W m m m m m W W W W m m W W W W W W W W W W m W W W W W W m m m m m m m
N N N N N N N N O cy cy cy cy cy O O O O cy cy O O O O O O O O O N m N N N N N N N N N N N N N
W n
GJ
U
W Z
C
t
C
f0
L
m
Y
m Y
\ m
w Q
O w0
J c-I
d' Q
W �
U Q
N U
N
� p w_
U
J U W
H
F Q
� — m
p C2 Q
Q Q co
Q N \
W Q d
H w Z Z Z Z Z = Y
r W W W W J J J J J m U N
r Z Z Z
2! J J J z W W W W W d U U U U U U U
wK K K K K Q Z Ln Ln Ln Ln Ln Ln
Q U U U W C7 C7 C7 C7 C7 J
w w w w w S C7 C7 C7 : = O `� N m d Gc w m m m m m m m
w w w w w w w w U > > > m O O O O O O O
in in in in in in in in X X X X X p Ln Ln Ln
U U U U
X X X X X X X X W W W W W W W W d Q Q Q Q J J J J J =U O UW UW UW UW UW UW U
r r r G G G G G G G G G
m U Z Z Z J J J J J J J J W W Z LL >- >- >- Qw W W W W W W W W
r
O O O O O � W W W W W W W W W J rWQ
W W W W W W W
Q yyyyc L,L L L L Ln Ln Ln Ln � Z d l O N d
N N N4O O O O O O O O 7Z 7Z 7Z Q N u u u u U U UN M M d d V1 _ _ _ ZZ Q o o o o o o o o o
Z w w w w w w w w w U J > > > > > > >
Q Q J J J J J J J J JF- d d d d d d d
r = Z_ Z_ Z_ Z_ Z Z Z Z Z d W W W W W W W
w w w w w w w w in w w w w w H 0 0 0 U N w w w w w w w w
J J J J J J J J O Q Q N N N N N N N N N X X X X X X X
O N N N N N C) C) C Q Q U U U U U U U U U m Y W W W W W W W
O O O J J CL CL CL CL CL CL CL CL CL W Q Z Z Z Z Z Z Q Q Q Q Q Q Q
In In In In In In In In r r r r r r Q J J J m m d d d d d d d d d
N W W W W W O O O O O O O O O z > > > > > J J J J J J J
H H H H H H H H } } } d d K K K K K K K K K J W W W W W W
Q Q Q Q Q Q W p p W W W W W W W W W p J J J J J J Q Q Q Q Q Q Q
U U m m m m m m m m m z W = _ _ _ _ = a a a a a a a
W W W W W J W W W {n Ln
W W W W W W W W W N N N N Ln LnZ Z Z Z Z Z Z
Q Q Q Q Q Q Q Q W W W W W W m N N N W GG
W W W W W W W W J U U U U U W r r r Z Z N N N N N N N N N Q Q Q Q Q Q Q
u u u u u u u u O Z Z Z Z Z u J J J } } Q Q Q Q Q Q Q Q Q W W W W W W W
U U U U U U U U = Q Q Q Q Q Q Q Q Q K K W W W W W W W W W J W O N d' to W
Z W W W W W W W W W W W W W W Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q n 0
m m m m m m m m m m m m m m Q Q Q J J Z N Q Q Q Q Q Q Q
_O O Q Q Q Q Q Q Q Q Q W W W W W W
D D D D D D D D D D D D D D = Y Y Y O O J J J J J J J J J Q } m m m m m m J J J J J J J
H H H H H H H H H H H H H H H Q Q Q W W CO CO CO CO CO CO CO m m = J Q Q Q Q Q Q Q Q Q Q Q Q Q
d J J J J J J J J J J J J J J Z d d d Q Q W W W W W W W W W W W r r r r r r W W W W W W W
Q Q Q Q Q Q Q Q Q Q Q Q Q Q — In In In d d d d d d d d d d
V w w w w w w w w w w w w w w > > U U U U U U Z Z Z Z Z Z Z
O O O O O O O O O O C7
Ln Ln Ln Ln z z U U U U U U U U U U } } } } } } }
� U U U U U U U U U U U U U U w w w p p Ln Ln Ln �n �n �n �n U �n Vn Z H H H H H H � � � =
Lu Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q 0 0 0 0 0 0 0 0 0 0 Q Q Q Q Q Q Q
0 F- F- F- F- F- F- F- F- F- F- F- F- F- F W N N N L 0 0 0 0 0 0 0 0 C7 C7 U C7 C7 C7 C7 C7 C7 a a a a a a a
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 > > z z z z z z z z z z 0 0 0 0 0 0 0 0 0 0 0 0 0
LLI Q Q Q Q Q Q Q Q Q Q Q Q Q Q w w w z z K m Ln in in in in in in in in in in in in
Z Z Z Z Z Z Z Z Z Z Z Z Z Z H Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q
W W W W W W W W W W W W W W W — �21— Y Y J J J J J J J J J J J Z Z Z Z Z Z Z Z Z Z Z Z Z
LLI Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q
c� a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a
"a
a
C
U
L
° a
x
w
d
U
�L
CL
Y
c
H
•4� x x x ¢ ¢ ¢ ¢ ¢ ¢ ¢ In ¢ ¢ ¢ ¢ ¢ ¢ ¢ In ¢ ¢ ¢ x x X In ¢ ¢ ¢ ¢ ¢ ¢ In X X ¢ x x ¢ x ¢
m m m W W W W W W W U W W W W W W W U W W W m m m U W W W W W W U m m m m m W m m W m W
N N N 0 0 0 0 0 0 I" N d' d' d' d' d' d' m cy O O W ^ m 0 0 0 N O N N O N dt lD O lD lD lD N d
LJJ Ln N N m m Ln N N N N N N N I" cy N m a-I N N N c-I a-I a-I a-I d' m N m d' m m m m N
GJ
U
GJ Z
C
f0
L
m
W
Q
m
W
N
N
J
Z
N
U_ w
C7 m
w � r
H H H H
O
Z Z Q 0co
H H H H ¢ ¢ U C ¢ w 00
in in in vj H H Q t > N
w Ln Lnw ,,J jj x W o x ¢ w
U U U w w w Z 'o o U
to to to Y Y Y Y d w O C Y O Z
\ Z Z Z Z Y Y ¢ H d r w
K K K W Z Z K Z C Ln C7
X X X Y Y Y Y Y Y O N N ¢ }
\ \ \ U LL LL LL LL U O C X U Y } O
O O O p U U U U W W H m d J _
W J () t J
c-I a-I a-I o ¢ ¢ ¢ ¢ U U J p rj W m N
L¢L L¢L Q r c-I Ln J W
z z z Z N N N N H ¢ ¢ m Z N �' J o d
K K K W Q Q Q Q N N N Q Q O\ to J cN-I w J r X _
_ O m w m
lD W O In In In In F- F W Q r W m X � J X C7 N N Q dt
N N m C7 O O O O vj vj > J J N Z Ln
p m m Q ti-i `n
U U U z = = = = 0 0 O J J 0 } Q
> > > W W W W d' d' J Z O r M p d } z N O
d d d m W W - w ¢ m p m O F- U Ln N N N `~ m O r
W W W U � Q Q Q Q Q Q r CJ Q x `~ X `"j V1 Q Z Z Z c-I d' } N ¢
K K K O r H H H H W W Z } W In Z_ X N d p — X X H m ~
W W W Z O W ¢ ¢ ¢ ¢ O X r Z Q cy Z ¢ X N z Z \ X
W Q Q Q Q ¢ ¢ U N O ¢ a-I Ln — X K W X N m W W In
W W W Z ¢ Q Q Q Q _ \ to m N } to aN-I F- W jn N z Z X `~ V) to
H H H ¢ = Z O ,M ¢ ¢ ¢ ¢ Q Q m 0 Ln m Z m J U L!1 J to to O W
¢ ¢ ¢ c Z Z Z ¢ H d' d' d' d' ¢ ¢ Ln J H m z Z Z — ¢ W N Z Q
J J J G W ¢ ¢ GG = C7 0 0 0 = d Z d W J �. _
m ¢ G Q U H _ w X Z H H
¢ ¢ ¢ w w w ¢ C7 C7 " "' Y z 0 vj X X X Y Q Z w d r ¢ ¢ Z Z
a a a m vj w w m w w w w H lD Z jn Z — W cc N } } ti ¢
J W Z Z Z ¢ U Z p ~ N G = N O O ^ = W
m W 0 0 0 0 m ~ ¢ n ti O U O ti ti Y Z
d r QY m W J Z O LL W W = Q N d' W m W to X Z Q J Z C H
} } } O U H �yzj O N U U U U O O m Q m r ¢ J J J J J W c-I X X Q W W
¢ ¢ ¢ D = ¢ = " J p t O ¢ X GG x z m a O Z Z J Q
a = J K W d = W W W W K K K c H U Q W X G K K K K K Z_ V W W N c N m
Z G r CO C7 } N H N d D W W W W } r = J W ¢ W W W W W = J n U m Z Z
G G G G G G a-I a-I a-I a-I lD W J Z w W ¢ Q O Ln U ¢ 0 W = = In O
O ¢ ¢ ¢ G G G G GG Q = Z OG ¢ Z W ¢ J ¢ ¢ ¢ ¢ ¢ ~ z Z In Z Q r r O W
J J J o C d' W W W W W W Y O C O > _ F7 LLi Z W G O ¢ G 0 0 ¢ Z
d W W W o o o o o o W W H H H H H H z lCn Z In �' O Q ¢ F- C Z m C O D U W U Y
W p ~ ~ W W W W W W W Z J C7 C7 C7 C7 C7 J {n O = F-
r, N
C7 C7 C7 j^ j^ _ _ _ _ _ _ } Zp N _ `n ¢ = Z Z Z Z Z m In Q O w W w vj O ¢
Z Z z } } } } } } Z Z H H H H H H m O W ¢ c — — — Z U` m W > > ✓j cc
V — d m G
} } } ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ d Q W U In Q J F- G In In In In In r — Z ¢ Z Z Z In In
W ¢ ¢ ¢ U U U U U U U U H H J w ¢ W vj vj vj vj vj w Y O O Z w w H w
w w w LLi w w w w w w U C7 a a O w = = W Z >
o = _ _ �_ �_ �_ �_ �_ Q ¢Q z Q Q Q Q Q v d U Q
Z Z Z Z Z Z Z Z Z Z U' = ¢ � Z to to U' Q Q ¢ ¢
c a a a ¢ ¢ ¢ ¢ ¢ ¢ 0 0 0 0 0 0 0 0 0 0 W o 0 o p Z Z z Z Z Z Q 0 N N N 0 ¢ ¢ >
C O O O J J J J J J r
W N N N ¢ ¢ ¢ ¢ ¢ ¢ tj tj tj tj tj tj tj tj � ¢ Q r Z Z Z Z J Z W Q Q Q Q d d ¢ d U'
¢ ¢ ¢ _ _ _ _ _ _ _ _ _ _ ¢ z ¢ ¢ ¢ ¢ > > > > > > O O ¢ ¢ ¢ } ¢ ¢ ¢
Z Z Z O O O CIO O vj vj vj vj vj vj vj vj vj Ln m w W m m m m m m m m m m U U Q 0 0 0 = H H H H m
n Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln
n Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln
w w w w w w w w w w w w w w w w w w w w w
Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln
Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q
Z
0 w w w w w w w w w w w w w w w w w w w w w Z
uj ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢
z z z z z z z z z z z z z z z z z z z z z w
C! ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ m m m m m m m m m m m m m m m m m m m m Co.m
"a
W
C
U
L
° a
x
w
d
U
�L
CL
Y
c
H
Q Q Q Q Q Q Q Q Q Q Q Q Q N X X X X Y X X X Q Q Q Q Q Q m X X X X N Q N Q Q X
w w w w w w w w w w w w w U CO CO CO CO d CO m m w w w w w w dTnill,
w d r m m m m U LL U w w m)
W d '0 0 0 0 0 O O O O O NW d M W ddM O t O O O O O O m -- O O O O - O O
11, dNNOc OlDlDlD L L d N m d I, O m OmO O O O OO dO mL L
LJ N N N Ln m N m
d'
W
U
C Z
C
f0
L
m
z
Z
U >
Q Z
d
z w
Z J
w �
co
co U w
w G U
C J Q HLn
Q K U
ro� W j Ln v cW c Z_
N
Q C7 Z O a c� p W W ti
a Z O W o N O W O
W Q In Q �- `� W U W K W
Q \ W W W X
J X
w Z d J m
\ Q w
p a o z d J U W O m X O X N
X Q Q in n w cl S J Ln \ m m
> Z K K N in Q Y O O O .--i
ti r X GG m W Q Q Z O O d W W X \ X G
Ln Q a w w Z Z Ln
QZ 0 � in = 0 0 w Y X (D Q W M in p O 0 Z
Q .� O O Q Z H Ln N U Q Ln Ln `n Q
Y w w r O H Y Y LL d Y Q d U XLn p Q W �_ J J =
Q Q J m Z ~ Z Q Q N Q W O Q J Q Z `� p Q CL W
>_ a Q p O z O a a J 0 O w — Z = w w
p U > G C LL LL o x p = r �n o= N w Q N
Z = m d ~ C Y J J U O m W ~ W Q Q) W W W W U
O w �yzj Q Y Q = W Q N d C7 Ln W Q X J J J J J Z
N = d r d a w H H Z w - Q w Ln Z z K K K K Q Y
W JL
Z H J LL Y Z w — H H H H N U
W
Q a o v a W J � � o z X ° � u U z a � z z z z u o
Z d' N SW W W \ J
JL~L = J = N N U O Z �n W d z Q y/ m W W W W d' \
Y } J lD H = H m U J J > N N W J U (D m N
d U N = O ~ K K GG O m J C Q Y Q N Q J = U U U U O m w
In K Q r U J W O O G mc Q W O U Q U z U N m Q = Q Q Q Q In
Y K H m W w O G C7 Q O W Q (D H w w w w p U
�n Q O �n Q � p r H U O C7 a 2 W J a Z 0 O p p p p w \
Q a p r p Q J J Y U p m w > � O Q � U Z Z Z Z Ln m v =
gi p \ = O O o o Q Y = CO X Z Z OJ y' _ a H H H H m `° v "' Ln
r Q Q r�Y N m O Gc Q G� N J w U a Q W � a Q w w w w J m w
Q U \ m J Q Z W J v U \ L!1 G J G Y L~L J W N \ N W W W W O \ Q X
p (D \ \ `1 GG J Y Z w w 0 J O = O m Z_ CO
J Q Q } G U J J J W W W W W W W
Q a \ w _ ,� J X d �. Q w r U m m J Q J _ `^ O N E Q o 0
G In J z Q m O W C7 = ~ Y Q O Q Q WCL m N J W W W W U W L!1 O
C U H Q U — J In Q N �"� Q O r In U m z } J N f0 Z a-I
p r w Q .--� J X ti Y X m H H Q Q w
Q W L.L Y J d d d d d Q W Y J m W a m Q O } In In W In Q J W W W W Q N r O In W
p in p w a C7 in in in in in Q a X a \ N \ \ Q � J w m > > U O O Q Q Q Q C7 W U
W d U in Z 0 0 0 0 0 Ln in m Q o �0 O w O C7
Q K = Q \ O ✓1 v1 L, w m m > Q N Q Z_ Q d in K K
Z J U Q N W W W W W Q Q O U N n J Q Q m J
Q ,n U "' Z o Z Q Q W p ~ O O O O p H a
\ H a = V X m O Q Q } C7 w a a a a L
0 0 2 r = _ _ _ = a m a a O_ w p } r W z Q C7 U Q in
Z Q U U U U U CJ Ur �. Q J �n r O a N a a a J Y W ~ m W W W W K O In Q Q
Y Y U Q W W W W W U U N d J J J O U In (n > W W Q
d In In = W d' d' �' �' �' �' �' W W N Q d' N O Q = Z J In d LL LL LL LL 0' O
Ln w a = a w 0 0 0 0 = Q U �n N J C7 a
GQG G QG Q U U p p p p p 0 m a H 0 a in Q z m K U U U Q in Z 3: in w w Z m a
V G G W W Z Z In N N N N Z_ Z N N v� z J Q a W p ~ Z Z Z Z Y J Q W W W W z Z W Q W
Vf w w H O O w w w w w w w W — ri W Q O `n a Q °� r r r r > r Z
uw m = = U U p Q r W n N W r r 0 0 0 Q U n W o Q Q Q Q w 0 0 n
> > Z r r W d = O J J J J J
0 J J ,n W Q Q a a a a a a a 0 0 Ln `^ _ �n O Z Z Q Q Q w J Q Q vi t� Ln Ln Ln Ln u Q U a m O
O > J J Q Q Q Q Q \ \ = = O w C7 � = Q�:�E U U U M Q m C7 w w w w = w
> > a Q 0 0 0 0 0 °� °� U U U U w Z O = U H H E E E Q p p = } m > > > > Q d w Z - O
w Q Q a w w w 0 0 0 0 0 w w J J - Q Q w Q 2 Z w w X X X Q w Q Qp w 0 0 0 0 Q w a Q
m m U = > > m m m m m p p W W J d d = r r K K W W W = _ > m m W 0 0 (D � = K N H 51 Q
J J J J J J J J J J J J J O O O O O O O O O O O O O z
Z Z Z Z Z Z Z Z = = = = = = = = = = = = = O
H H H H H H H H H H H H H
O O O O O O O O Z z z z z z z z z z z z z Q
r r r r r r r r 0 0 0 0 0 0 0 0 0 0 0 0 0
U U U U U U U U U U U U U U U U Q Q Q Q Q Q Q Q U U U U U U U U U U U U U H
0 C7 C7 C7 C7 C7 C7 N N N N N N N N
Z_ Z_ Z_ Z_ Z_ _ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Z Z Z Z Z Z Z Z Z Z Z Z Z
O Z N N N N N N N N N N N N N N N N J J J J J J J J_ Z
O O O O O O O O O O O O O O O O m m m m m m m m 0 0 0 0 0 0 0 0 0 0 0 0 0
H F- F- F- F- F- F- z z z z z z z z z z z z z z z z 0 0 0 0 0 0 0 0 U U U U U U U U U U U U U
U U U U U U U U U U U U U p
w w w w w w
Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q z W W W W W W W W W W W W Q
C! m m m m m m Q o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 z z z z z z z z z z z z z >
"a
W
� U
C
L
° a
x
w
W
U
�L
CL
Y
c
H
•4� X N N X N N a X X X X Ln X X X X a Ln Ln Lna a X a a X a a a a X a a a a a a a a N X a
m u u m u u W m m m m U m m m m m W U U U W W m W W m W m W W W m W W W W W W W W U m W
d' ON Ln 2d' d' 2d' N Ln N O N O O O N N ON `~ d' N d' W d' �m W lD d' N to r, 0 m Om � /V 0
W
W
U
C Z
C
m
CL
m
}
W
a
W
W
Ln
Q
J
Ln Ln W O
N
O O
Q
Ln Ln a W
Z Q
W W O
O O p H z > > ? > F O
Z a F- F- U > H Z
w
O O C7 U Q m r r H U r J
w w Z °� u a Q 0 0 = 0
> > w a \ w w U a a a O a Qw
> > kj rn Q m m m m a m Q r
z > w O o o o x 0 Z w
n Ln Ln Ln
Lmn � W Z m Z Z Z o Z J o > d
N N x Ln ~ _ Z \ m m Ln Ln � Q
} } m } In N O N N N z N m m Q a
•--� •--� o N Z m Y in X Ln ti ti ti ti ti ON X C7 \ a Z U
w w 2 2 0 U Z � p X X X X X \ CO— o W C) J
F- p 0 Y M w w w w w w Y c�c a ti r C7 z U
W W J U = J U N J C7 C7 C7 C7 C7 U G W W
\W C7 J aU U
O O QaN
Q
\NC <
K a a a a a O Ln Gc
> OC
O LL 77777 wa Z Z
Z K lO W O N cd o a xT K UU �
Z Z U d N NLn m 5- K a O X0)U m W U N Ln Z a -t
mLn Ln a Z
Ln
N J W > J =
\ d W Q O Q W X W W W
O Z Z Ln Z W W O \ ~ c-I X X X X X d' Z W �. Z > OJ LL a J N U Y > J N d J G Ln X
O O O Z r Zvut WW rnONJW OcYwpJ-I OYwpJ cXwHJW-I W>wdz' W
aerQ z OWcc �J CZ7
Z UJC W OGGd
UCa OCO>>7
aaw O d O N O W a _ O U co
N W Z a a a Ln J '6 J * W = J J aJU
ZZ U U — J J J J J J J O J p< U U K � cc O
O In U o o W > > > > > > X Q m OLnw o Q -J�7
\C¢
O a> OO OO OO NQ N \ J a z ULn Ln z7/5 cc zUw LnJ < UN >
Z Z � wa W Ln Ln a O zLn
" Ln Ln Lno 0 o J Jm1 = ¢ >
= o ` U U U z
Z aW ~ OOO 0 0 0 0 0ofofof 'n O U O
O JJ
Z Z Z Z Z O O O
Z a a Z a w \ 0 0 O
O a O Z Z> > > > OO m
CO a a a a a a m Ln m \ O - �
N a im O WU 0 ¢ Ln an an an an O O O w OQ .
Q Q Q QZ J >-- J O O W W OJ_LJn7
J
Y = _ = W W J LLJ Q N = .� U Ln Ln p W Z Z U z C U < 0
w in Z Z Z Z V) w J 0 0 0 U U U O \ a w w w } O p
0 a w w w w Z W w w w w w w w w U a s W < U Ln < w = Z } w J a O
> > > > W F- F- O U U „ a z Z z a = = < 0 CL
U a a a a H N W C7 C7 C7 Z W W W W W U Q Q Q 0 0 H a Q H Z d Q W Q W C W W a a o U N d
LLIw x z z z z x x x x x a z z p Q O_ U O c� a r ¢ a 0
0 0 Q Q m Z H a w a J p a a w J Z C
m - a an an an an H U U U U U an an an an a a a a a a a
Z Z Z Z Z Z Z Z Z Z Z Z
O O O O O O O O O O O O
Ln Ln Ln Ln Ln Z Ln Ln Ln Ln Ln Ln Ln Ln Lr)a a a a a a a a a a a a
Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln Ln
� � � � � � � � � � � � � � � � � I z z z z z z z z zLr) zLr) zLr) zLr) z z z z z z z z z z z z z
d' �n- �n- �n- �n- �n- �n- �n- �n- �n- �n- �n �n w w w w w Z 0 0 0 0 0 0 0 0 0 Z Z Z 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F- F- F- F- O
Z Z Z Z Z Z Z Z Z w w w w w a F- F- H H H H H H H H H H H H H H H H H H H H H H H
W F- F- F- F- F- J J u u u u u u u u u u u u u u u u u u u u u u u
Q Q Q Q Q Q Q Q Q Q Q Q Q ¢ a a a a 0 0 0 0 p p p p p p p p p p p p p p p p p p p p p p o
a a a a a a a a a a a a U U U U U U an an in w w w w w w w w w w w w w w w w w w w w w w w
V > > > > > > > > > > > > > > > > > > > > >
"a
W
� U
C
L
° a
x
w
d
U
�L
CL
Y
c
H
X X Q Q Q Q Q Q Q Q Q X Q Y to to to
m m w w w w w w w w w m w d U U U
0 0 0 0 0 0 0 0 m m O O N N W lD
LLJJ Cf
W
U
W Z
C
f0
L
m
U
Q
w
O
V1
d
J
U
w N
O
x V) Z w
Q Q Ln
O
00 OL Z
ti (D C7 m
J Z Z
m = ~
H �
a r Q W
p Y r w
Q \ ^ m w
H U = (7
V) m Z
F- z X OZ d
N Z W J J
U W
d - Q Q
\
O F- U = Q
ti
w >- W w
Q Q Z
a a p
V) W Q = z
V) p O Q
O p z Q W
x O " ¢ O
O lD �_ Z \ LL z W
\ } = w J ^ w W
w U O U
2 Z U
J N Z J Z z N F- O }
g O x r U r
GJG \ J UG Q Q p Q p C7
G r m C Q w W J W \ O W = Z
N CO 0 W U, Z W LnJ W �. = O
J J O Ln = O W p p U
N - 2 w Q m . 0 Z r H
} w W _
m ON > > O J cJ O < m p
U d J J J o o G p J W Z Q
* J w In 2 2 Q N a N N Q J*
p Q > d W O r w p
p N J \ N O cJ W W cC7 p c-I W J
Z W J J C7 C7 \ G r r G c Oc \ O J Z
cG Z Z G 0
d >0 Ln O 0 O O ,- In O O J p Q
C7 z z z m m O w a a J
* 0
O O p O Q Q O p z Ln V) Ln
VVf < w w U U � Z U U H p Z Q
Lu a Z Z } } w 0 m m o z z 0 w z
N 2 C7 C7 Z U U C7 w w
LLI o O - °' °' p Z W p p J z U m m } }
z z z O a cJ O O Ln O lan > H Z O O
W W W W
Ln Ln Ln Ln Ln �n �n �n �n �n Ln Ln Ln > > > >
Z Z Z Z Z Z Z Z Z Z Z Z Z J J J J
O O O O O O O O O O O O O W W W W
0 H H H H H H H H H H H H H p p p p
(9 a a a a a a a a a a a a a Z Z Z Z
LV U_ U_ U_ U_ U_ U_ U_ U_ U_ U_ U_ U_ U w w w w
F- p p p p p p p p p p p p p C7 C7 C7 C7
Q w w w w w w w w w w w w w X X X X
(! 2,0 01010
Attachment B
SUBMISSION PROPOSAL RESPONSE FORM
SET PRICING FOR MEDICAL SUPPLIES AND PHARMACEUTICALS
Proposer's Name and Mailing Address:
Telephone and Fax Numbers:
All amounts must be written clearly.
I have included:
o Proposal/Tabbed Sections
o Medical Supply List Pricing Worksheet
o Discount in the form of a percentage off list price
o Submission Response Form
o Non Collusion Affidavit
o Public Entity Crime Statement
o Drug Free Workplace Form
o Lobbying and Conflict of Interest Clause Form
o Indemnification and Hold Harmless
o Local Preference Form (AttachmentH ifapplicable)
(Check mark items above, as a reminder that they are included).
I state that I am authorized to submit this proposal.
STATE OF
(Signature of Proposers)
COUNTY OF
Date
PERSONALLY APPEARED BEFORE ME, the undersigned
authority, who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above on this
day of , 20
My commission expires:
NOTARY PUBLIC
32
Attachment C
NON- COLLUSION AFFIDAVIT
I, of the city of
according to law on my oath, and under
penalty of perjury, depose and say that;
1) I am the respondent making the
Solicitation for the project described as follows:
2) The prices in this solicitation have been arrived at independently without collusion,
consultation, communication or agreement for the purpose of restricting competition, as to any
matter relating to such prices with any other respondent or with any competitor;
3) Unless otherwise required by law, the prices which have been quoted in this
solicitation have not been knowingly disclosed by the respondent and will not knowingly be
disclosed by the respondent prior to solicitation opening, directly or indirectly, to any other
respondent or to any competitor; and
4) No attempt has been made or will be made by the respondent to induce any other
person,partnership or corporation to submit, or not to submit, a solicitation for the purpose of
restricting competition; and
5) The statements contained in this affidavit are true and correct, and made with full
knowledge that Monroe County relies upon the truth of the statements contained in this affidavit
in awarding contracts for said project.
STATE OF
(Signature of Respondent)
COUNTY OF
Date
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above on this
day of , 20
My commission expires:
NOTARY PUBLIC
OMB-MCP FORM#1
33
Attachment D
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list following a conviction
for public entity crime may not submit a solicitation on a contract to provide any goods or
services to a public entity, may not submit a solicitation on a contract with a public entity for the
construction or repair of a public building or public work, may not submit solicitations on leases
of real property to public entity, may not be awarded or perform work as a proposers, supplier,
subproposers, RESPONDENT or subRespondents under a contract with any public entity, and
may not transact business with any public entity in excess of the threshold amount provided in
Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months from the
date of being placed on the convicted vendor list."
By executing this form, I acknowledge that Fray company is in compliance with the above.
STATE OF
(Signature of Respondent)
COUNTY OF
Date
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above on this
day of , 20
My commission expires:
NOTARY PUBLIC
34
Attachment E
DRUG-FREE WORKPLACE FORM
The undersigned Respondent in accordance with Florida Statute 287.087 hereby certifies that:
(Name of Business)
1. Publishes a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the workplace and
specifying the actions that will be taken against employees for violations of such prohibition.
2. Informs employees about the dangers of drug abuse in the workplace, the business's policy of
maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee
assistance programs, and the penalties that may be imposed upon employees for drug abuse
violations.
3. Gives each employee engaged in providing the commodities or contractual services that are
under solicitation a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notifies the employees that, as a condition of
working on the commodities or contractual services that are under solicitation, the employee will
aproposale by the terms of the statement and will notify the employer of any conviction of, or
plea of guilty or nolo contendre to, any violation of Chapter 893 (Florida Statutes) or of any
controlled substance law of the United States or any state, for a violation occurring in the
workplace no later than five (5) days after such conviction.
5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or
rehabilitation program if such is available in the employee's community, or any employee who is
so convicted.
6. Makes a good faith effort to continue to maintain a drug-free workplace through
implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with the
above requirements.
Respondent's Signature
Date
OMB-MCP FORM 45
35
Attachment F
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
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:
STATE OF
COUNTY OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
who, after first being sworn by me, affixed his/her
signature (name of individual signing) in the space provided above on this day of
, 20
NOTARY PUBLIC
My commission expires:
OMB-MCP FORM#4
36
Attachment G
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION
MANUAL
Indemnification and Hold Harmless
for
Other Respondents and subRespondents
The Responder covenants and agrees to indemnify and hold harmless Monroe County Board of
County Commissioners AND Board of Governors for District I, its servants, agents and
employees from any and all claims for bodily injury (including death),personal injury, and
property damage (including property owned by Monroe County) and any other losses, damages,
and expenses (including consultant's fees)which arise out of, in connection with, or by reason of
services provided by the Proposers or any of its subRespondents (s) in any tier, occasioned by
the negligence, errors, or other wrongful act or omission of The Responder or its sub-Responder
in any tier, their employees, or agents.
In the event the completion of the project(to include the work of others) is delayed or suspended
as a result of the Responder's failure to purchase or maintain the required insurance, the
Respondent shall indemnify the County from any and all increased expenses resulting from such
delay.
The first ten dollars ($10.00) of remuneration paid to the Respondent is for the indemnification
provided for above.
The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements
contained elsewhere within this agreement.
Respondent's Signature
Date
37
Attachment H
LOCAL PREFERENCE FORM
Vendors claiming a local preference according to Ordinance 023-2009 must complete this form.
Name of Proposers/Responder Date:
1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at least
one year prior to the notice or request for proposal or solicitation? (Please furnish copy.)
2. Does the vendor have a physical business address located within Monroe County from which the vendor operates
or performs business on a day to day basis that is a substantial component of the goods or services being offered to
Monroe County?
List Address:
Telephone Number:
B.Does the vendor/prime Respondent intend to subcontract 50%or more of the goods,services or construction to
local businesses meeting the criteria above as to licensing and location?
If yes,please provide:
1. Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subRespondent dated at least
one year prior to the notice or request for proposal or solicitation.
2. SubRespondent Address within Monroe County from which the subRespondent operates:
Tel.Number
Print Name:
Signature and Title of Authorized Signatory for
Proposers/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.
Notary Public
Print Name
My commission expires: Seal
38